HB 6022

HOUSE BILL NO. 6022
A bill to amend 1974 PA 258, entitled
"Mental health code,"
by amending sections 100a, 400, 409, 410, 439, 464,
475, 482, 498e, 498f, 498h, 498l,
498p, and 972 (MCL 330.1100a, 330.1400, 330.1409, 330.1410, 330.1439, 330.1464,
330.1475, 330.1482, 330.1498e, 330.1498f, 330.1498h, 330.1498l, 330.1498p, and
330.1972), section 100a as amended by 2023 PA 118, section 400 as amended by
2018 PA 595, section 409 as amended by 2022 PA 214, sections 410, 475, and 482
as amended by 2018 PA 593, section 439 as amended and section 972 as added by
2020 PA 402, sections 464, 498f, 498l,
and 498p as amended by 1995 PA 290, and sections 498e and 498h as amended by
2012 PA 540.
the people of the state of michigan enact:
Sec. 100a. (1) "Abilities" means
the qualities, skills, and competencies of an individual that reflect the
individual's talents and acquired proficiencies.
(2)
"Abuse" means nonaccidental physical or emotional harm to a
recipient, or sexual contact with or sexual penetration of a recipient as those
terms are defined in section 520a of the Michigan penal code, 1931 PA 328, MCL
750.520a, that is committed by an employee or volunteer of the department, a
community mental health services program, or a licensed hospital or by an
employee or volunteer of a service provider under contract with the department,
community mental health services program, or licensed hospital.
(3) "Adaptive
skills" means skills in 1 or more of the following areas:
(a) Communication.
(b) Self-care.
(c) Home living.
(d) Social skills.
(e) Community use.
(f) Self-direction.
(g) Health and
safety.
(h) Functional
academics.
(i) Leisure.
(j) Work.
(4) "Adult
foster care facility" means an adult foster care facility licensed under
the adult foster care facility licensing act, 1979 PA 218, MCL 400.701 to
400.737.
(5) "Alcohol
and drug abuse counseling" means the act of counseling, modification of
substance use disorder related behavior, and prevention techniques for
individuals with substance use disorder, their the individuals' significant others, and individuals
who could potentially develop a substance use disorder.
(6)
"Applicant" means an individual or his or
her the individual's legal
representative who makes a request for mental health services.
(7) "Approved
service program" means a substance use disorder services program licensed
under part 62 of the public health code, 1978 PA 368, MCL 333.6230 to 333.6251,
to provide substance use disorder treatment and rehabilitation services by the
department-designated community mental health entity and approved by the
federal government to deliver a service or combination of services for the
treatment of incapacitated individuals.
(8) "Assisted
outpatient treatment" or "AOT" means the categories of
outpatient services ordered by the court under section 468 or 469a. Assisted
outpatient treatment may include a case management plan and case management
services to provide care coordination under the supervision of a psychiatrist
and developed in accordance with person-centered planning under section 712.
Assisted outpatient treatment may also include 1 or more of the following
categories of services: medication; periodic blood tests or urinalysis to
determine compliance with prescribed medications; individual or group therapy;
day or partial day programming activities; vocational, educational, or
self-help training or activities; assertive community treatment team services;
alcohol or substance use disorder treatment and counseling and periodic tests
for the presence of alcohol or illegal drugs for an individual with a history
of alcohol abuse or substance use disorder; supervision of living arrangements;
and any other services within a local or unified services plan developed under
this act that are prescribed to treat the individual's mental illness and to
assist the individual in living and functioning in the community or to attempt
to prevent a relapse or deterioration that may reasonably be predicted to
result in suicide, the need for hospitalization, or serious violent behavior.
The medical review and direction included in an assisted outpatient treatment
plan shall must be
provided under the supervision of a psychiatrist.
(9)
"Board" means the governing body of a community mental health
services program.
(10) "Board of
commissioners" means a county board of commissioners.
(11)
"Center" means a facility operated by the department to admit
individuals with developmental disabilities and provide habilitation and
treatment services.
(12)
"Certification" means formal approval of a program by the department
in accordance with standards developed or approved by the department.
(13) "Child
abuse" and "child neglect" mean those terms as defined in
section 2 of the child protection law, 1975 PA 238, MCL 722.622.
(14) "Child
and adolescent psychiatrist" means 1 or more of the following:
(a) A physician who
has completed a residency program in child and adolescent psychiatry approved
by the Accreditation Council for Graduate Medical Education or the American
Osteopathic Association, or who has completed 12 months of child and adolescent
psychiatric rotation and is enrolled in an approved residency program as
described in this subsection.
(b) A psychiatrist
employed by or under contract as a child and adolescent psychiatrist with the
department or a community mental health services program on March 28, 1996, who
has education and clinical experience in the evaluation and treatment of children
or adolescents with serious emotional disturbance.
(c) A psychiatrist
who has education and clinical experience in the evaluation and treatment of
children or adolescents with serious emotional disturbance who is approved by
the director.
(15)
"Children's diagnostic and treatment service" means a program
operated by or under contract with a community mental health services program,
that provides examination, evaluation, and referrals for minors, including
emergency referrals, that provides or facilitates treatment for minors, and
that has been certified by the department.
(16)
"Community mental health authority" means a separate legal public
governmental entity created under section 205 to operate as a community mental
health services program.
(17)
"Community mental health organization" means a community mental
health services program that is organized under the urban cooperation act of
1967, 1967 (Ex Sess) PA 7, MCL 124.501 to 124.512.
(18)
"Community mental health services program" means a program operated
under chapter 2 as a county community mental health agency, a community mental
health authority, or a community mental health organization.
(19)
"Consent" means a written agreement executed by a recipient, a minor
recipient's parent, a recipient's legal representative with authority to
execute a consent, or a full or limited guardian authorized under the estates
and protected individuals code, 1998 PA 386, MCL 700.1101 to 700.8206, with the
authority to consent, or a verbal agreement of a recipient that is witnessed
and documented by an individual other than the individual providing treatment.
(20) "Contracted health plan" means that term as defined in
section 106 of the social welfare act, 1939 PA 280, MCL 400.106.
(21) (20) "Conversion
therapy" means any practice or treatment by a mental health professional
that seeks to change an individual's sexual orientation or gender identity,
including, but not limited to, efforts to change behavior or gender expression
or to reduce or eliminate sexual or romantic attractions or feelings toward an
individual of the same gender. Conversion therapy does not include counseling
that provides assistance to an individual undergoing a gender transition,
counseling that provides acceptance, support, or understanding of an individual
or facilitates an individual's coping, social support, or identity exploration
and development, including sexual orientation-neutral intervention to prevent
or address unlawful conduct or unsafe sexual practices, as long as the
counseling does not seek to change an individual's sexual orientation or gender
identity. As used in this subsection:
(a) "Gender
identity" means "gender identity or expression" as that term is
defined in section 103 of the Elliott-Larsen civil rights act, 1976 PA 453, MCL
37.2103.
(b) "Sexual
orientation" means that term as defined in section 103 of the
Elliot-Larsen civil rights act, 1976 PA 453, MCL 37.2103.
(22) (21) "County
community mental health agency" means an official county or multicounty
agency created under section 210 that operates as a community mental health
services program and that has not elected to become a community mental health
authority or a community mental health organization.
(23) (22) "Crisis
stabilization unit" means a prescreening unit established under section
409 or a facility certified under chapter 9A that provides unscheduled clinical
services designed to prevent or ameliorate a behavioral health crisis or reduce
acute symptoms on an immediate, intensive, and time-limited basis in response
to a crisis situation.
(24) (23) "Department"
means the department of health and human services.
(25) (24) "Department-designated
community mental health entity" means the community mental health
authority, community mental health organization, community mental health
services program, county community mental health agency, or community mental
health regional entity designated by the department to represent a region of
community mental health authorities, community mental health organizations,
community mental health services programs, or county community mental health
agencies.
(26) (25) "Dependent
living setting" means all of the following:
(a) An adult foster
care facility.
(b) A nursing home
licensed under part 217 of the public health code, 1978 PA 368, MCL 333.21701
to 333.21799e.
(c) A home for the
aged licensed under part 213 of the public health code, 1978 PA 368, MCL
333.21301 to 333.21335.
(27) (26) "Designated
representative" means any of the following:
(a) A registered
nurse or licensed practical nurse licensed or otherwise authorized under part
172 of the public health code, 1978 PA 368, MCL 333.17201 to 333.17242.
(b) A paramedic
licensed or otherwise authorized under part 209 of the public health code, 1978
PA 368, MCL 333.20901 to 333.20979.
(c) A physician's
assistant licensed or otherwise authorized under part 170 or 175 of the public
health code, 1978 PA 368, MCL 333.17001 to 333.17097 and 333.17501 to
333.17556.
(d) An individual
qualified by education, training, and experience who performs acts, tasks, or
functions under the supervision of a physician.
(28) (27) "Developmental
disability" means either of the following:
(a) If applied to
an individual older than 5 years of age, a severe, chronic condition that meets
all of the following requirements:
(i) Is attributable to a mental or physical
impairment or a combination of mental and physical impairments.
(ii) Is manifested before the individual is
22 years old.
(iii) Is likely to continue indefinitely.
(iv) Results in substantial functional
limitations in 3 or more of the following areas of major life activity:
(A) Self-care.
(B) Receptive and
expressive language.
(C) Learning.
(D) Mobility.
(E) Self-direction.
(F) Capacity for
independent living.
(G) Economic
self-sufficiency.
(v) Reflects the individual's need for a
combination and sequence of special, interdisciplinary, or generic care,
treatment, or other services that are of lifelong or extended duration and are
individually planned and coordinated.
(b) If applied to a
minor from birth to 5 years of age, a substantial developmental delay or a
specific congenital or acquired condition with a high probability of resulting
in developmental disability as defined in subdivision (a) if services are not
provided.
(29) (28) "Director"
means the director of the department or his or her the director's designee.
(30) (29) "Discharge"
means an absolute, unconditional release of an individual from a facility by
action of the facility or a court.
(31) (30) "Eligible
minor" means an individual less than 18 years of age who is recommended in
the written report of a multidisciplinary team under rules promulgated by the
department of education to be classified as 1 of the following:
(a) Severely
mentally impaired.
(b) Severely
multiply impaired.
(c) Autistic impaired Impaired
by autism spectrum disorder and receiving special education services in
a program designed for the autistic impaired students with autism spectrum disorder under R
340.1758 of the Michigan Administrative Code or in a program designed for the
severely mentally impaired or severely multiply impaired.
(32) (31) "Emergency
situation" means a situation in which an individual is experiencing a
serious mental illness or a developmental disability, or a minor is
experiencing a serious emotional disturbance, and 1 of the following applies:
(a) The individual
can reasonably be expected within the near future to physically injure himself, herself, the
individual's self or another individual, either intentionally or
unintentionally.
(b) The individual
is unable to provide himself or herself the individual's self with food, clothing, or shelter
or to attend to basic physical activities such as eating, toileting, bathing,
grooming, dressing, or ambulating, and this inability may lead in the near
future to harm to the individual or to another individual.
(c) The individual
has mental illness that has impaired his or her the individual's judgment so that the individual is
unable to understand his or her the individual's need for treatment and presents a
risk of harm.
(33) (32) "Executive
director" means an individual appointed under section 226 to direct a
community mental health services program or his or
her the executive director's designee.
Sec. 400. As used in this chapter, unless
the context requires otherwise:
(a) "Clinical
certificate" means the written conclusion and statements of a physician or
a licensed psychologist that an individual is a person requiring treatment,
together with the information and opinions, in reasonable detail, that underlie
the conclusion, on the form prescribed by the department or on a substantially
similar form.
(b) "Competent
clinical opinion" means the clinical judgment of a physician,
psychiatrist, or licensed psychologist.
(c)
"Court" means the probate court or the court with responsibility with regard to responsible for mental health services for the county
of residence of the subject of a petition, or for the county in which the
subject of a petition was found.
(d) "Formal
voluntary hospitalization" means hospitalization of an individual based on
both of the following:
(i) The execution of an application for
voluntary hospitalization by the individual or by a patient advocate designated
under the estates and protected individuals code, 1998 PA 386, MCL 700.1101 to
700.8206, to make mental health treatment decisions for the individual.
(ii) The hospital director's determination
that the individual is clinically suitable for voluntary hospitalization.
(e) "Informal
voluntary hospitalization" means hospitalization of an individual based on
all of the following:
(i) The individual's request for
hospitalization.
(ii) The hospital director's determination
that the individual is clinically suitable for voluntary hospitalization.
(iii) The individual's agreement to accept
treatment.
(f)
"Involuntary mental health treatment" means court-ordered
hospitalization, assisted outpatient treatment, or combined hospitalization and
assisted outpatient treatment as described in section 468. For the purpose of
this chapter, involuntary mental health treatment does not include a full or
limited guardian authorized under the estates and protected individuals code,
1998 PA 386, MCL 700.1101 to 700.8206, with the authority to consent to mental
health treatment for an individual found to be a legally incapacitated
individual under the estates and protected individuals code, 1998 PA 386, MCL
700.1101 to 700.8206.
(g) "Mental
illness" means a substantial disorder of thought or mood that
significantly impairs judgment, behavior, capacity to recognize reality, or
ability to cope with the ordinary demands of life.
(h)
"Preadmission screening unit" means a any of the following:
(i) A service component of a community mental health services
program established under section 409.
(ii) A contracted health plan or a contracted
health plan's delegate.
(i)
"Private-pay patient" means a patient whose services and care are
paid for from funding sources other than the community mental health services
program, the department, or other state or county funding.
(j)
"Release" means the transfer of an individual who is subject to an
order of for combined
hospitalization and assisted outpatient treatment from 1 treatment program to
another in accordance with his or her individual the individual's plan of services.
(k) "Subject
of a petition" means an individual regarding whom a petition has been
filed with the court asserting that the individual is or is not a person
requiring treatment or for whom an objection to involuntary mental health
treatment has been made under section 484.
Sec. 409. (1) Each community mental health
services program must
and contracted health plan shall establish
1 or more preadmission screening units with 24-hour availability to provide
assessment and screening services for individuals being considered for
admission into hospitals, assisted outpatient treatment programs, or crisis
services on a voluntary basis. The preadmission
screening unit of a contracted health plan is solely responsible for assessment
and screening services if the contracted health plan is or could be responsible
for a covered service. A community mental health services program is
responsible for all other admission services. The community mental
health services program or contracted health plan shall
employ mental health professionals or licensed bachelor's social workers
licensed under part 185 of the public health code, 1978 PA 368, MCL 333.18501
to 333.18518, to provide the preadmission screening services or contract with
another agency that meets the requirements of this section. Preadmission Except as
otherwise provided in subsection (6), preadmission screening unit staff shall must be
supervised by a registered professional nurse or other mental health
professional possessing at least a master's degree.
(2) Each community
mental health services program and contracted health
plan shall provide the address and telephone number of its preadmission
screening unit or units to law enforcement agencies, the department, the court,
hospital emergency rooms, and private security companies under contract with a
county under section 170.
(3) A Not later than 3 hours
after receiving notice from a hospital, or from a hospital as that term is
defined in section 20106 of the public health code, 1978 PA 368, MCL 333.20106,
of the need to assess an individual being considered for admission into a hospital
operated by the department or under contract with the community mental health
services program, a preadmission screening unit shall assess an the individual. being considered for
admission into a hospital operated by the department or under contract with the
community mental health services program. If the individual is
clinically suitable for hospitalization according to
the preadmission screening unit's criteria, the preadmission screening unit shall
authorize the individual's voluntary admission
to the hospital.
(4) If a preadmission screening unit of a contracted health plan denies
hospitalization, the individual or the person making the application may
request a second opinion from the contracted health plan. The contracted health
plan shall arrange for an additional evaluation by a psychiatrist, other
physician, or licensed psychologist to be performed not later than 3 days,
excluding Sundays and legal holidays, after the contracted health plan receives
the request. If the conclusion of the second opinion is different from the
conclusion of the preadmission screening unit, the contracted health plan, in
conjunction with the medical director of the contracted health plan, shall make
a decision based on all clinical information available. The contracted health
plan's decision must be confirmed in writing to the individual who requested
the second opinion, and the confirming document must include the signature of
the medical director of the contracted health plan or verification that the
decision was made in conjunction with the medical director of the contracted
health plan.
(5) (4) If the a preadmission screening unit of the a community mental
health services program denies hospitalization of an
individual, the individual or the person making the application may
request a second opinion from the executive director. The executive director
shall arrange for an additional evaluation of the
individual by a psychiatrist, other physician, or licensed psychologist
to be performed within not later than 3 days, excluding Sundays and legal
holidays, after the executive director receives the request. If the conclusion
of the second opinion is different from the conclusion of the preadmission
screening unit, the executive director, in conjunction with the medical
director, shall make a decision based on all clinical information available.
The executive director's decision shall must be confirmed in writing to the individual who
requested the second opinion, and the confirming document shall must include
the signatures of the executive director and medical director or verification
that the decision was made in conjunction with the medical director. If an individual is assessed and found not to be
clinically suitable for hospitalization, the preadmission screening unit shall
provide appropriate referral services.
(6) If a preadmission screening unit is unable to assess an individual
not later than 3 hours after the notice described in subsection (3), a
clinically qualified individual may assess the individual for the hospital,
hospital as that term is defined in section 20106 of the public health code,
1978 PA 368, MCL 333.20106, community mental health services program, crisis
stabilization unit, contracted health plan, or other entity under contract to
perform the assessment and screening services under this act. The preadmission
screening unit is responsible for the costs of performing an assessment under
this subsection.
(7) Telehealth service, as that term is defined in section 16283 of the
public health code, 1978 PA 368, MCL 333.16283, may be used to assess an
individual described in this section.
(8) (5) If
an individual is assessed and found not to be clinically suitable for
hospitalization according to a preadmission screening
unit's criteria, the preadmission screening unit shall provide
information regarding alternative services and the availability of those
services, provide appropriate referral services, and
make appropriate referrals.
(9) (6) A
preadmission screening unit shall assess and examine, or refer to a hospital
for examination, an individual who is brought to the
preadmission screening unit a facility by
a peace officer or security transport officer or ordered by a court to be
examined. If the individual meets the requirements for hospitalization, the
preadmission screening unit shall designate the hospital to which the
individual shall must
be admitted. The preadmission screening unit shall consult with the
individual and, if the individual agrees, the preadmission screening unit must shall consult
with the individual's family member of choice, if available, as to the
preferred hospital for the individual's admission. of the individual.Nothing prohibits a contracted health plan from directing
care to a participating health facility. As used in this subsection,
"participating health facility" means that term as it is defined in
section 24504 of the public health code, 1978 PA 368, MCL 333.24504.
(10) (7) A
preadmission screening unit may operate a crisis stabilization unit under
chapter 9A. A preadmission screening unit may provide crisis services to an
individual , who, by through assessment and screening, is found to be a
person requiring treatment. Crisis services at a crisis stabilization unit must
entail an initial psychosocial assessment by a master's level mental health
professional and a psychiatric evaluation within 24 hours to stabilize the
individual. In this event, crisis services may be provided for a period of up
to 72 hours, after which the individual must be provided with the clinically
appropriate level of care, resulting in 1 of the following:
(a) The A decision that the individual
is no longer a person requiring treatment.
(b) A referral to
outpatient services for aftercare treatment.
(c) A referral to a
partial hospitalization program.
(d) A referral to a
residential treatment center, including crisis residential services.
(e) A referral to
an inpatient bed.
(f) An order for
involuntary treatment of the individual has been issued
under section 281b, 281c, former 433, or 434, or former section 433.
(11) (8) A
preadmission screening unit operating a crisis stabilization unit under chapter
9A may also offer crisis services to an individual who is not a person
requiring treatment, but who is seeking crisis services on a voluntary basis.
(12) (9) If
the an individual
chooses a hospital not under contract with a community mental health services
program, and the hospital agrees to the individual's admission,
the preadmission screening unit shall refer the individual to the hospital that
is requested by the individual requests. Any financial obligation for the services
provided by the hospital shall must be satisfied from funding sources other than the
community mental health services program, the department, or other state or county funding, or a contracted health plan.
(13) The preadmission screening unit of a contracted health plan may
engage in assessment and screening services before discharge, at the point of
discharge, or post-discharge. Assessment and screening services include, but
are not limited to, an evaluation of all of the following:
(a) Clinical risk factors.
(b) Medication adherence.
(c) Care transitions.
(d) Access to outpatient and community-based behavioral health services.
(e) Social determinants of health.
(f) Prior utilization of health care services.
(14) The preadmission screening unit of a contracted health plan may use
the results of an assessment or screening services conducted under this section
to authorize, arrange, or coordinate medically necessary post-discharge
services, including, but not limited to, all of the following:
(a) Care management.
(b) Case management.
(c) Outpatient behavioral health services.
(d) Crisis services.
(e) Peer support.
(f) Medication management.
(g) Other covered services designed to reduce the likelihood of
avoidable psychiatric readmission.
Sec. 410. Except as otherwise provided in
section 402a, an individual who requests, applies for, or assents to either
informal or formal voluntary admission to a hospital or outpatient treatment
program operated by the department or a hospital or outpatient treatment
program under contract with a community mental health services program may be
considered for admission by the hospital or outpatient treatment program only
after authorization by a community mental health
services the applicable preadmission screening
unit.
Sec. 439. (1) A cause of action is not
cognizable against a person who that in good faith files a petition under this
chapter alleging that an individual is a person requiring treatment, unless the
petition is filed as the result of an act or omission amounting to gross
negligence or willful and wanton misconduct.
(2) A cause of
action is not cognizable against a preadmission screening unit or its the preadmission
screening unit's employees or contractors,
or a crisis stabilization unit or its the crisis
stabilization unit's employees or contractors, or
a contracted health plan or the contracted health plan's employees or
contractors, who in good faith makes a determination as to whether an
individual is a person requiring treatment, or not, unless the determination is the result of
an act or omission amounting to gross negligence or willful and wanton
misconduct.
Sec. 464. Copies of court orders issued pursuant to under this
chapter shall must be
given to the all of
the following:
(a) The individual
who is the subject of the order. ; to the
(b) If a guardian has been appointed for the individual who is the
subject of the order, the individual's guardian. , if a guardian has been appointed; to the individual's
(c) The attorney of the individual who is the subject of the order. ; to the
(d) As applicable, either the executive director of the community mental health services
program or the contracted health plan responsible for
payment of the treatment of the individual who is
the subject of the order. ; and to the
(e) The hospital
director of any hospital in which the individual is or will be a patient.
Sec. 475. (1) During the period of an
order for assisted outpatient treatment or combined hospitalization and
assisted outpatient treatment, if the agency or mental health professional who
is supervising an individual's assisted outpatient treatment program determines
that the individual is not complying with the court order or that the assisted
outpatient treatment has not been or will not be sufficient to prevent harm
that the individual may inflict on himself or
herself or upon the individual's self or others,
then the supervising agency or mental health professional shall notify the
court immediately. If the individual believes that the assisted outpatient
treatment program is not appropriate, the individual may notify the court of
that fact.
(2) If it comes to
the attention of the court that an individual subject to an order of for assisted
outpatient treatment or combined hospitalization and assisted outpatient
treatment is not complying with the order, that the assisted outpatient
treatment has not been or will not be sufficient to prevent harm to the
individual or to others, or that the individual believes that the assisted
outpatient treatment program is not appropriate, the court may do either of the
following without a hearing and based upon on the record and other available information:
(a) Consider other
alternatives to hospitalization and modify the order to direct the individual
to undergo another program of assisted outpatient treatment for the duration of
the order.
(b) Modify the
order to direct the individual to undergo hospitalization or combined
hospitalization and assisted outpatient treatment. The duration of the
hospitalization, including the number of days the individual has already been
hospitalized if the order being modified is a combined order, shall must not
exceed 60 days for an initial order or 90 days for a second or continuing
order. The modified order may provide that if the individual refuses to comply
with the psychiatrist's order to return to the hospital, a peace officer shall
take the individual into protective custody and transport the individual to the
hospital selected.
(3) During the
period of an order for assisted outpatient treatment or a combination of
hospitalization and assisted outpatient treatment, if the agency or mental
health professional who is supervising an individual's assisted outpatient
treatment determines that the individual is not complying with the court order,
the supervising agency or mental health professional shall notify the court
immediately.
(4) If it comes to
the attention of the court that an individual subject to an order of for assisted
outpatient treatment or a combination of hospitalization and assisted
outpatient treatment is not complying with the order, the court may require 1
or more of the following, without a hearing:
(a) That the
individual be taken to the preadmission screening
unit established by the a community
mental health services program serving the community in which the individual
resides.
(b) That the
individual be hospitalized for a period of not more than 10 days.
(c) Upon On recommendation
by the community mental health services program serving the community in which
the individual resides, that the individual be hospitalized for a period of
more than 10 days, but not longer than the duration of the order for assisted
outpatient treatment or a combination of hospitalization and assisted
outpatient treatment, or not longer than 90 days, whichever is less.
(5) The court may
direct peace officers to transport the individual to a designated facility, or a preadmission
screening unit, as applicable, and the court may specify conditions
under which the individual may return to assisted outpatient treatment before
the order expires.
(6) An individual
hospitalized without a hearing as provided in subsection (4) may object to the
hospitalization according to the provisions of section 475a.
Sec. 482. Each individual subject to a
1-year order of involuntary mental health treatment has the right to adequate
and prompt review of his or her current the individual's status as a person requiring
treatment. Six months from the date of a 1-year order of involuntary mental
health treatment, the executive director of the community mental health
services program responsible for treatment, the
contracted health plan responsible for payment of treatment, or, if
private arrangements for the reimbursement of mental health treatment services
have been made, the hospital director or director of the assisted outpatient
treatment program shall assign a physician or licensed psychologist to review
the individual's clinical status as a person requiring treatment.
Sec. 498e. (1) Except as provided in
section 1074 2074 and
section 18s of chapter XIIA of the probate code of 1939, 1939 PA 288, MCL
712A.18s, a minor requesting hospitalization or for whom a request for
hospitalization was is made shall must be evaluated to determine the minor's suitability for hospitalization according to under this
section as soon as possible after the request is made.
(2) The Subject to subsection
(3), the executive director of the community mental health services
program that is responsible for providing services in the county of residence
of a minor requesting hospitalization or for whom a request for hospitalization
was is made
shall evaluate the minor to determine his or her the minor's suitability for hospitalization according
to this section. In making a determination of a minor's suitability for
hospitalization, the executive director shall utilize
use the community mental health services
program's children's diagnostic and treatment service. If a children's
diagnostic and treatment service does not exist in the community mental health
services program, the executive director shall, through written agreement,
arrange to have a determination made by the children's diagnostic and treatment
service of another community mental health services program, or by the
appropriate hospital.
(3) If a minor is covered by a contracted health plan, the contracted
health plan shall evaluate the minor using the contracted health plan's
criteria to determine the minor's suitability for hospitalization under this
section.
(4) (3) In
evaluating a minor's suitability for hospitalization, the executive director or contracted health plan shall do all of the
following:
(a) Determine both
of the following:
(i) Whether the minor is a minor requiring
treatment.
(ii) Whether the minor requires
hospitalization and is expected to benefit from hospitalization.
(b) Determine
whether there is an appropriate, available alternative to hospitalization, and
if there is, refer the minor to that program.
(c) Consult with
the appropriate school, hospital, and other public or private agencies.
(d) If the minor is
determined to be suitable for hospitalization under subdivision (a), refer the
minor to the appropriate hospital.
(e) If the minor is
determined not to be suitable for hospitalization under subdivision (a),
determine if the minor needs mental health services. If it the minor is
determined that the minor needs to need mental health services, the executive
director or contracted health plan shall offer
an appropriate treatment program for the minor, if the program is available, or
refer the minor to any other appropriate agency for services.
(f) If a minor is
assessed and found not to be clinically suitable for hospitalization, the
executive director or contracted health plan shall
inform the individual or individuals requesting hospitalization of the minor of
appropriate available alternative services to which a referral should be made
and of the process for a request of requesting a second opinion under subsection (4).(5) or (6).
(5) (4) If
the children's diagnostic and treatment service of the community mental health
services program denies hospitalization, the parent or guardian of the minor
may request a second opinion from the executive director. The executive
director shall arrange for an additional evaluation by a psychiatrist, other
physician, or licensed psychologist to be performed within not later than 3
days, excluding Sundays and legal holidays, after the executive director
receives the request. If the conclusion of the second opinion is different from
the conclusion of the children's diagnostic and treatment service, the
executive director, in conjunction with the medical director, shall make a
decision based on all clinical information available. The executive director's
decision shall must
be confirmed in writing to the individual who requested the second
opinion, and the confirming document shall must include the signatures of the executive director
and medical director or verification that the decision was made in conjunction
with the medical director.
(6) If the contracted health plan denies hospitalization, the parent or
guardian of the minor may request a second opinion from the contracted health
plan. The contracted health plan shall arrange for an additional evaluation by
a psychiatrist, other physician, or licensed psychologist to be performed not
later than 3 days, excluding Sundays and legal holidays, after the contracted
health plan receives the request. If the conclusion of the second opinion is
different from the conclusion of the contracted health plan, the contracted
health plan, in conjunction with the medical director of the contracted health
plan, shall make a decision based on all clinical information available. The
contracted health plan's decision must be confirmed in writing to the
individual who requested the second opinion, and the confirming document must
include the signature of the medical director of the contracted health plan or
verification that the decision was made in conjunction with the medical
director of the contracted health plan.
(7) (5) If
a minor has been admitted to a hospital not operated by or under contract with
the department, or a
community mental health services program, or
contracted health plan, as applicable, and the hospital considers it
necessary to transfer the minor to a hospital under contract with a community
mental health services program, or contracted health
plan, as applicable, the hospital shall submit an application for
transfer to the appropriate community mental health services program, or contracted health plan, as applicable. The
executive director or contracted health plan shall
determine if there is an appropriate, available alternative to hospitalization
of the minor. If the executive director or contracted
health plan determines that there is an appropriate, available
alternative program, the minor shall must be referred to that program. If the executive
director or contracted health plan determines
that there is not an appropriate, alternative program, the minor shall must be
referred to a hospital under contract with the community mental health services
program or contracted health plan, as applicable.
(8) (6) Except
as provided in subsections (1), and (5), (3), (6), and
(7) this section only applies to hospitals operated under contract with
a community mental health services program.
Sec. 498f. If a minor is referred to a
hospital by an executive director pursuant to or contracted health plan under section 498e, the
hospital director may accept the referral and admit the minor, or the hospital
director may order an examination of the minor to confirm the minor's
suitability for hospitalization. The examination shall
must begin immediately. If the hospital
director confirms the minor's suitability for hospitalization, the minor shall must be
scheduled for admission to the hospital. If the minor cannot be admitted
immediately because of insufficient space in the hospital, the minor shall must be
placed on a waiting list and the executive director shall provide necessary
interim services, including periodic reassessment of the minor's suitability for hospitalization. The minor
may be referred to another hospital. If the hospital director does not confirm
the minor's suitability for hospitalization, the minor shall must be referred
to the executive director or contracted health plan,
who shall offer an appropriate treatment plan for the minor or refer the minor
to any other agency for services.
Sec. 498h. (1) Except as provided in
section 1074 2074 and
section 18s of chapter XIIA of the probate code of 1939, 1939 PA 288, MCL
712A.18s, a minor's parent, guardian, or person in loco parentis may request
emergency admission of the minor to a hospital, if the person making the
request has reason to believe that the minor is a minor requiring treatment and
that the minor presents a serious danger to the
minor's self or others.
(2) If a minor is covered by a contracted health plan, a request for
emergency admission to a hospital must be made to the contracted health plan's
preadmission screening unit. If the contracted health plan's preadmission
screening unit determines that emergency admission to a hospital is not
necessary, the person making the request may request hospitalization of the
minor under section 498d. If the preadmission screening unit determines that
emergency admission to a hospital is necessary, the minor must be hospitalized
or placed in an appropriate alternative program.
(3) (2) If the For a request for emergency admission not
subject to subsection (2), if a hospital to which the request for emergency admission is made
is not under contract to the a community mental health services program, the
request for emergency hospitalization shall admission must be made directly to the hospital. If
the hospital director agrees that the minor needs requires emergency admission, the minor shall must be
hospitalized. If the hospital director does not agree, the person making the
request may request hospitalization of the minor under section 498d.
(4) (3) If the For a request for emergency admission not
subject to subsection (2), if a hospital to which the a request for emergency admission is made is under
contract to the community mental health services program, the request shall must be made
to the preadmission screening unit of the community mental health services
program serving in the county where the minor resides. If the community mental
health services program has a children's diagnostic and treatment service, the
preadmission screening unit shall refer the person making the request to that
service. In counties where there is no children's diagnostic and treatment
service, the preadmission screening unit shall refer the person making the
request to the appropriate hospital. If it is determined that emergency
admission is not necessary, the person may request hospitalization of the minor
under section 498d. If it is determined that emergency admission is necessary,
the minor shall must
be hospitalized or placed in an appropriate alternative program.
(5) (4) If
a preadmission screening unit assesses a minor is assessed by the preadmission screening unit and
found finds that
the minor is not to be clinically
suitable for hospitalization, the preadmission screening unit shall inform the
individual or individuals requesting hospitalization of the minor of
appropriate available alternative services to which a referral should be made
and of the process for a request of a second opinion under subsection (5).(6) or (7).
(6) If a preadmission screening unit of a contracted health plan denies
hospitalization, a minor's parent or guardian may request a second opinion from
the contracted health plan. The contracted health plan shall arrange for an
additional evaluation by a psychiatrist, other physician, or licensed
psychologist to be performed not later than 3 days, excluding Sundays and legal
holidays, after the contracted health plan receives the request. If the
conclusion of the second opinion is different from the conclusion of the
preadmission screening unit, the contracted health plan, in conjunction with
the medical director of the contracted health plan, shall make a decision based
on all clinical information available. The contracted health plan's decision must
be confirmed in writing to the individual who requested the second opinion, and
the confirming document must include the signatures of the contracted health
plan and medical director of the contracted health plan or verification that
the decision was made in conjunction with the medical director of the
contracted health plan.
(7) (5)
If the a preadmission
screening unit of the a community mental health services program denies
hospitalization, a minor's parent or guardian may request a second opinion from
the executive director. The executive director shall arrange for an additional
evaluation by a psychiatrist, other physician, or licensed psychologist to be
performed within not
later than 3 days, excluding Sundays and legal holidays, after the
executive director receives the request. If the conclusion of the second
opinion is different from the conclusion of the preadmission screening unit,
the executive director, in conjunction with the medical director, shall make a
decision based on all clinical information available. The executive director's
decision shall must
be confirmed in writing to the individual who requested the second
opinion, and the confirming document shall must include the signatures of the executive director
and medical director or verification that the decision was made in conjunction
with the medical director.
(8) (6) If
a person in loco parentis makes a request for emergency admission and the minor
is admitted to a hospital under this section, the hospital director or the
executive director of the community mental health services program immediately shall immediately
notify the minor's parent or parents or guardian.
(9) (7) If
a minor is hospitalized in a hospital that is operated under contract with a
community mental health services program, the hospital director shall notify
the appropriate executive director within not later than 24 hours after the hospitalization
occurs.
(10) (8) If
a peace officer, as a result of personal observation, has reasonable grounds to
believe that a minor is a minor requiring treatment and that the minor presents
a serious danger to the minor's self or others
and if after a reasonable effort to locate the minor's parent, guardian, or
person in loco parentis, the minor's parent, guardian, or person in loco
parentis cannot be located, the peace officer may take the minor into
protective custody and transport the minor to a
facility, to the appropriate community mental health preadmission
screening unit, if the community mental health services program has a
children's diagnostic and treatment service, or to a hospital if it the community mental
health services program does not have a children's diagnostic and
treatment service. After transporting the minor, the peace officer shall
execute a written request for emergency hospitalization of the minor stating
the reasons, based upon on personal
observation, that the peace officer believes that emergency hospitalization is
necessary. The written request shall must include a statement that a reasonable effort was
made by the peace officer to locate the minor's parent, guardian, or person in
loco parentis. If it is determined that emergency hospitalization of the minor
is not necessary, the minor shall must be returned to his
or her the minor's parent, guardian, or
person in loco parentis if an additional attempt to locate the parent, guardian,
or person in loco parentis is successful. If the minor's parent, guardian, or
person in loco parentis cannot be located, the minor shall must be
turned over to the protective services program of the family independence
agency. If it is determined that emergency admission of the minor is necessary,
the minor shall must
be admitted to the appropriate hospital or to an appropriate alternative
program. The executive director immediately shall
immediately notify the minor's parent,
guardian, or person in loco parentis. If the hospital is under contract with
the community mental health services program, the hospital director shall
notify the appropriate executive director within not later than 24 hours after the hospitalization
occurs.
(11) (9) An
evaluation of a minor admitted to a hospital under this section shall must begin
immediately after the minor is admitted. The evaluation shall must be
conducted in the same manner as provided in section 498e. If the minor is not
found to be suitable for hospitalization, the minor shall must be
released into the custody of his or her the minor's parent, guardian, or person in loco
parentis, and the minor shall must be referred to the executive director who shall
determine if the minor needs mental health services. If it is determined the
executive director determines that the minor needs mental health
services, the executive director shall offer an appropriate treatment program
for the minor, if the program is available, or refer the minor to another
agency for services.
(12) (10) A
hospital director shall proceed under either the estates and protected
individuals code, 1998 PA 386, MCL 700.1101 to 700.8206, or chapter XIIA of the
probate code of 1939, 1939 PA 288, MCL 712A.1 to 712A.32, as warranted by the
situation and the best interests of the minor, under any of the following
circumstances:
(a) The hospital
director cannot locate a parent, guardian, or person in loco parentis of a
minor admitted to a hospital under subsection (8).(10).
(b) The hospital
director cannot locate the parent or guardian of a minor admitted to a hospital
by a person in loco parentis under this section.
Sec. 498l. (1) Not more than 90 days after the
admission of a minor to a hospital pursuant to under this chapter, and at 60-day intervals after the
expiration of the 90-day period, the hospital director
of the hospital shall perform or arrange to
have performed a review of the minor's suitability for hospitalization. If the
minor is in a hospital under contract with a community mental health services
program, the executive director shall participate in the reviews. If a minor is covered by a contracted health plan, the
contracted health plan shall participate in the reviews.
(2) Subject to
section 114a, the reviews of the minor's suitability for continued
hospitalization shall must be conducted under rules promulgated by the
department. Results of the reviews shall must be transmitted promptly to all of the following:
(a) The minor, if
the minor is 14 years of age or older.
(b) The parent,
guardian, or person in loco parentis of the minor.
(c) The As applicable, the executive
director or the contracted health plan.
(d) The court, if
there was a court hearing on the admission of the minor.
Sec. 498p. (1) Upon On periodic
review of a hospitalized minor under section 498 l, 498l, or at any other time, if it is determined that the minor is
no longer suitable for hospitalization, the hospital director
of the hospital shall discharge the minor
from the hospital.
(2) If a minor
discharged under subsection (1) has been hospitalized under a court order, or
if court proceedings are pending, the court shall must be notified of the minor's discharge from the
hospital.
(3) The director of a hospital director
shall notify the appropriate executive director or contracted health plan of the pending discharge of
a minor not less than 7 days before the minor is discharged from the hospital.
(4) Before a minor
is discharged from a hospital under subsection (1), the executive director or contracted health plan, with the assistance of
the hospital, shall develop an individualized prerelease plan for the minor in
accordance with section 209a.
(5) If the parent
or guardian of a minor admitted to a hospital under this chapter refuses to
assume custody of the minor upon on discharge of the minor from the hospital, the
hospital director shall file or cause to be filed a petition in the juvenile
division of the probate court alleging that the minor is within the provisions of subject
to section 2(b) of chapter XIIA of Act No.
288 of the Public Acts of 1939, being section the
probate code of 1939, 1939 PA 288, MCL 712A.2,
of the Michigan Compiled Laws, to ensure
that the minor is provided with appropriate management, care, and residence.
Arrangements considered suitable by the hospital director and agreed to by the
parent or guardian for care of the minor outside the home of the parent or
guardian do not constitute a refusal to assume
custody of the minor.
Sec. 972. The department shall establish
minimum standards and requirements for certifying a crisis stabilization unit. Standards These standards
and requirements must include, but are
not limited to, all of the following:
(a) A standard
requiring the capacity to carry out emergency receiving and evaluating
functions but not to the extent that brings the crisis stabilization unit under
the provisions of section 1867 of the social
security act, 42 USC 1395dd.
(b) Standards
requiring the implementation of voluntary and
involuntary admission consistent with section 409.
(c) A prohibition
from holding itself the crisis stabilization unit out as a hospital or
from billing for hospital or inpatient services.
(d) Standards to
prevent inappropriate referral between entities of common ownership.
(e) Standards
regarding the maximum length of stay at a
crisis stabilization unit with discharge planning upon
on intake to a clinically appropriate
level of care consistent with section 409(7).409(10).
(f) Standards of
billing for services rendered at a crisis stabilization unit.
(g) Standards for
reimbursement of services for uninsured individuals, underinsured individuals,
or both, and Medicaid beneficiaries, including, but not limited to, formal
agreements with community mental health services programs or regional entities
for services provided to individuals utilizing public behavioral health funds,
outreach and enrollment for eligible health coverage, annual rate setting,
proper communication with payers, and methods for resolving billing disputes
between providers and payers.
(h) Physician
oversight requirements.
(i) Nursing
services.
(j) Staff to client
ratios.
(k) Standards
requiring a minimum amount of psychiatric supervision of an individual
receiving services in the crisis stabilization unit that are consistent with
the supervision requirements applicable in to a psychiatric hospital or psychiatric unit
setting.
(l) Standards requiring the implementation and posting of recipients' rights
under chapter 7.
(m) Safety and
emergency protocols.
(n) Pharmacy
services.
(o) Standards
addressing administration of medication.
(p) Standards for
reporting to the department.
(q) Standards
regarding a departmental complaint process and procedure affording patients the
right to file complaints for failure to provide services in accordance with
required certification standards. The complaint process and procedure must be
established and maintained by the department, must remain separate and distinct
from the providers delivering services under
this chapter, and must not be a function delegated to a community mental health
services program or an entity under contract with a community mental health
services program. The complaint process must provide for a system of appeals
and administrative finality.