ENGROSSED SENATE
BILL NO. 1499	By:	David of the Senate

			and

		Echols of the House

[ mental health - Department of Mental Health and Substance Abuse Services - outpatient treatment - codification - effective date ]

BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1.     AMENDATORY     43A O.S. 2011, Section 1-103, as last amended by Section 1, Chapter 213, O.S.L. 2013 (43A O.S. Supp. 2013, Section 1-103), is amended to read as follows:
Section 1-103.  When used in this title, unless otherwise expressly stated, or unless the context or subject matter otherwise requires:
1.  "Department" means the Department of Mental Health and Substance Abuse Services;
2.  "Chair" means the chair of the Board of Mental Health and Substance Abuse Services;
3.  "Mental illness" means a substantial disorder of thought, mood, perception, psychological orientation or memory that significantly impairs judgment, behavior, capacity to recognize reality or ability to meet the ordinary demands of life;
4.  "Board" means the "Board of Mental Health and Substance Abuse Services" as established by the Mental Health Law;
5.  "Commissioner" means the individual selected and appointed by the Board to serve as Commissioner of Mental Health and Substance Abuse Services;
6.  "Indigent person" means a person who has not sufficient assets or resources to support the person and to support members of the family of the person lawfully dependent on the person for support;
7.  "Facility" means any hospital, school, building, house or retreat, authorized by law to have the care, treatment or custody of an individual with mental illness, or drug or alcohol dependency, gambling addiction, eating disorders, an opioid substitution treatment program, including, but not limited to, public or private hospitals, community mental health centers, clinics, satellites or facilities; provided that facility shall not mean a child guidance center operated by the State Department of Health;
8.  "Consumer" means a person under care or treatment in a facility pursuant to the Mental Health Law, or in an outpatient status;
9.  "Care and treatment" means medical care and behavioral health services, as well as food, clothing and maintenance, furnished to a person;
10.  Whenever in this law or in any other law, or in any rule or order made or promulgated pursuant to this law or to any other law, or in the printed forms prepared for the admission of consumers or for statistical reports, the words "insane", "insanity", "lunacy", "mentally sick", "mental disease" or "mental disorder" are used, such terms shall have equal significance to the words "mental illness";
11.  "Licensed mental health professional" means:
a.	a psychiatrist who is a diplomate of the American Board of Psychiatry and Neurology,
b.	a physician licensed pursuant to the Oklahoma Allopathic Medical and Surgical Licensure and Supervision Act or the Oklahoma Osteopathic Medicine Act,
c.	a clinical psychologist who is duly licensed to practice by the State Board of Examiners of Psychologists,
d.	a professional counselor licensed pursuant to the Licensed Professional Counselors Act,
e.	a person licensed as a clinical social worker pursuant to the provisions of the Social Worker's Licensing Act,
f.	a licensed marital and family therapist as defined in the Marital and Family Therapist Licensure Act,
g.	a licensed behavioral practitioner as defined in the Licensed Behavioral Practitioner Act,
h.	an advanced practice nurse as defined in the Oklahoma Nursing Practice Act specializing in mental health,
i.	a physician's assistant who is licensed in good standing in this state and has received specific training for and is experienced in performing mental health therapeutic, diagnostic, or counseling functions, or
j.	a licensed drug and alcohol counselor/mental health ("LADC/MH") as defined in the Licensed Alcohol and Drug Counselors Act;
12.  "Mentally incompetent person" means any person who has been adjudicated mentally or legally incompetent by an appropriate district court;
13.	a.	"Person requiring treatment" means a person who because of his or her mental illness or drug or alcohol dependency:
(1)	poses a substantial risk of immediate physical harm to self as manifested by evidence or serious threats of or attempts at suicide or other significant self-inflicted bodily harm,
(2)	poses a substantial risk of immediate physical harm to another person or persons as manifested by evidence of violent behavior directed toward another person or persons,
(3)	has placed another person or persons in a reasonable fear of violent behavior directed towards such person or persons or serious physical harm to them as manifested by serious and immediate threats,
(4)	is in a condition of severe deterioration such that, without immediate intervention, there exists a substantial risk that severe impairment or injury will result to the person, or
(5)	poses a substantial risk of immediate serious physical injury to self or death as manifested by evidence that the person is unable to provide for and is not providing for his or her basic physical needs.
b.	"Assisted outpatient" means a person who:
(1)	is eighteen (18) years of age or older, and
(2)	is suffering from a mental illness, and
(3)	is unlikely to survive safely in the community without supervision, based on a clinical determination, and
(4)	has a history of lack of compliance with treatment for mental illness that has:
(a)	prior to the filing of a petition, at least twice within the last thirty-six (36) months been a significant factor in necessitating hospitalization or treatment in a hospital or residential facility, or receipt of services in a forensic or other mental health unit of a correctional facility or local correctional facility, not including any current period, or period ending within the last six (6) months, during which the person was or is hospitalized or incarcerated, or
(b)	prior to the filing of the petition, resulted in one or more acts of serious violent behavior toward self or others or threats of, or attempts at, serious physical harm to self or others within the last eighteen (18) months, not including any current period, or period ending within the last six (6) months, in which the person was or is hospitalized or incarcerated, and
(5)	is, as a result of his or her mental illness, unlikely to voluntarily participate in outpatient treatment that would enable him or her to live safely in the community, and
(6)	in view of his or her treatment history and current behavior, is in need of assisted outpatient treatment in order to prevent a relapse or deterioration which would be likely to result in serious harm to the person or persons as defined by this section, and
(7)	is likely to benefit from assisted outpatient treatment.
c.	The mental health or substance abuse history of the person may be used as part of the evidence to determine whether the person is a person requiring treatment or an assisted outpatient.  The mental health or substance abuse history of the person shall not be the sole basis for this determination.
c.
d.	Unless a person also meets the criteria established in subparagraph a or b of this paragraph, person requiring treatment or an assisted outpatient shall not mean:
(1)	a person whose mental processes have been weakened or impaired by reason of advanced years, dementia, or Alzheimer's disease,
(2)	a mentally retarded or developmentally disabled person as defined in Title 10 of the Oklahoma Statutes,
(3)	a person with seizure disorder,
(4)	a person with a traumatic brain injury, or
(5)	a person who is homeless.
d.
e.	A person who meets the criteria established in this section, but who is medically unstable, or the facility holding the person is unable to treat the additional medical conditions of that person should be discharged and transported in accordance with Section 1-110 of this title;
14.  "Petitioner" means a person who files a petition alleging that an individual is a person requiring treatment or an assisted outpatient;
15.  "Executive director" means the person in charge of a facility as defined in this section;
16.  "Private hospital or facility" means any general hospital maintaining a neuro-psychiatric unit or ward, or any private hospital or facility for care and treatment of a person having a mental illness, which is not supported by the state or federal government.  The term "private hospital" or "facility" shall not include nursing homes or other facilities maintained primarily for the care of elderly and disabled persons;
17.  "Individualized treatment plan" means a proposal developed during the stay of an individual in a facility, under the provisions of this title, which is specifically tailored to the treatment needs of the individual.  Each plan shall clearly include the following:
a.	a statement of treatment goals or objectives, based upon and related to a clinical evaluation, which can be reasonably achieved within a designated time interval,
b.	treatment methods and procedures to be used to obtain these goals, which methods and procedures are related to each of these goals and which include specific prognosis for achieving each of these goals,
c.	identification of the types of professional personnel who will carry out the treatment procedures, including appropriate medical or other professional involvement by a physician or other health professional properly qualified to fulfill legal requirements mandated under state and federal law,
d.	documentation of involvement by the individual receiving treatment and, if applicable, the accordance of the individual with the treatment plan, and
e.	a statement attesting that the executive director of the facility or clinical director has made a reasonable effort to meet the plan's individualized treatment goals in the least restrictive environment possible closest to the home community of the individual;
18.  "Telemedicine" means the practice of health care delivery, diagnosis, consultation, evaluation, treatment, transfer of medical data, or exchange of medical education information by means of audio, video, or data communications.  Telemedicine uses audio and video multimedia telecommunication equipment which permits two-way real-time communication between a health care practitioner and a patient who are not in the same physical location.  Telemedicine shall not include consultation provided by telephone or facsimile machine; and
19.  "Recovery and recovery support" means nonclinical services that assist individuals and families to recover from alcohol or drug problems.  They include social support, linkage to and coordination among allied service providers, including but not limited to transportation to and from treatment or employment, employment services and job training, case management and individual services coordination, life skills education, relapse prevention, housing assistance, child care, and substance abuse education;
20.  "Assisted outpatient program" means a system to arrange for and coordinate the provision of assisted outpatient treatment, to monitor treatment compliance by assisted outpatients, to evaluate the condition or needs of assisted outpatients, to take appropriate steps to address the needs of such individuals and to ensure compliance with court orders; and
21.  "Assisted outpatient treatment" means outpatient services which have been ordered by the court pursuant to a treatment plan approved by the court to treat an assisted outpatient's mental illness and to assist the person 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 or the need for hospitalization.
SECTION 2.     AMENDATORY     43A O.S. 2011, Section 5-416, is amended to read as follows:
Section 5-416.  A.  The court, in considering a commitment petition filed under Section 5-410 or Section 9-102 of this title, shall not order hospitalization without a thorough consideration of available treatment alternatives to hospitalization, or without addressing the competency of the consumer to consent to or refuse the treatment that is ordered including, but not limited to, the rights of the consumer:
1.  To be heard concerning the treatment of the consumer; and
2.  To refuse medications.
B.  1.  If the court, in considering a commitment petition filed under Section 5-410 or Section 9-102 of this title, finds that a program other than hospitalization, including an assisted outpatient treatment program, is adequate to meet the treatment needs of the individual and is sufficient to prevent injury to the individual or to others, the court may order the individual to receive whatever treatment other than hospitalization is appropriate for a period set by the court.  During this time the court:
a.	shall have continuing jurisdiction over the individual as a person requiring treatment or an assisted outpatient, and
b.	shall periodically, no less often than annually, review the treatment needs of the individual and determine whether or not to continue, discontinue, or modify the treatment.
2.  If at any time it comes to the attention of the court from a person competent to file or request the filing of a petition, pursuant to subsection A of Section 5-410 of this title, that the individual ordered to undergo a program of alternative treatment to hospitalization is not complying with the order or that the alternative treatment program has not been sufficient to prevent harm or injury which the individual may be inflicting upon himself or others, the court may order the person to show cause why the court should not:
a.	implement other alternatives to hospitalization, modify or rescind the original order or direct the individual to undergo another program of alternative treatment, if necessary and appropriate, based on written findings of the court, or
b.	enter an order of admission pursuant to the provisions of this title, directing that the person be committed to inpatient treatment and, if the individual refuses to comply with this order of inpatient treatment, the court may direct a peace officer to take the individual into protective custody and transport the person to a public or private facility designated by the court.
3.  The court shall give notice to the person ordered to show cause and hold the hearing within seventy-two (72) hours of the notice.  The person ordered to undergo a program of alternative treatment shall not be detained in emergency detention pending the show cause hearing unless, prior to the emergency detention, the person has undergone an initial examination and a determination is made that emergency detention is warranted.
4.  If an order of alternative treatment will expire without further review by the court and it is believed that the individual continues to require treatment, a person competent to file or request the filing of a petition, pursuant to subsection A of Section 5-410 of this title, may file or request the district attorney file either an application for an extension of the court's previous order or an entirely new petition for a determination that the individual is a person requiring treatment or an assisted outpatient.
5.  A hearing on the application or petition filed pursuant to paragraph 4 of this subsection shall be held within ten (10) days after the application or petition is filed, unless the court extends the time for good cause.  In setting the matter for hearing, the court shall consider whether or not the prior orders of the court will expire during the pendency of the hearing and shall make appropriate orders to protect the interests of the individual who is the subject of the hearing.
C.  Prior to ordering the inpatient treatment of an individual, the court shall inquire into the adequacy of treatment to be provided to the individual by the facility, and inpatient treatment shall not be ordered unless the facility in which the individual is to be treated can provide such person with treatment which is adequate and appropriate to such person's condition.
D.  Nothing in this section shall prohibit the Department of Mental Health and Substance Abuse Services or the facility or program providing the alternative treatment from discharging a person admitted pursuant to this section, at a time prior to the expiration of the period of alternative treatment, or any extension thereof.  The facility or program providing the alternative treatment shall file a report with the court outlining the disposition of each person admitted pursuant to this section within forty-eight (48) hours after discharge.
E.  Notice of any proceedings pursuant to this section shall be given to the person, the person's guardian, the person's attorney, and the person filing the petition or application.
F.  If the petition alleges the person to be an assisted outpatient, the court upon hearing evidence shall determine if the person is an assisted outpatient.  The court shall not order assisted outpatient treatment unless a licensed mental health professional, in consultation with an assisted outpatient treatment program, develops and provides to the court a proposed written treatment plan.  A licensed mental health professional shall testify to explain the proposed written treatment plan unless the parties stipulate upon mutual consent that such licensed mental health professional need not testify.
G.  The court may order temporary assisted outpatient treatment pending receipt of the written treatment plan; provided, the court shall set a hearing to receive such treatment plan and testimony of a licensed mental health professional no later than the third day, excluding Saturdays, Sundays and holidays, immediately following the date of the temporary order.  The parties may stipulate upon mutual consent that such testimony need not be provided.  If no required written treatment plan and testimony is forthcoming, the temporary outpatient treatment order shall be terminated.
H.  A copy of any court order for assisted outpatient treatment shall be served personally, or by mail, facsimile or electronic means, upon the assisted outpatient, the assisted outpatient treatment program and all other parties to the action.
I.  The initial order for assisted outpatient treatment shall be for a period of one (1) year.  Within thirty (30) days prior to the expiration of the order, any person permitted to file a petition pursuant to the provisions of Section 5-410 of this title may petition to extend the order of outpatient treatment.  Notice shall be given in accordance with the provisions of Section 5-412 of this title.  The court shall hear the petition, review the treatment plan and determine if the assisted outpatient continues to meet the criteria for assisted outpatient treatment and if such treatment is the least restrictive alternative.  If the court finds the assisted outpatient treatment should continue, it shall make such an order extending the assisted treatment an additional year and order the treatment plan updated as necessary.  If the court's disposition of the motion does not occur prior to the expiration date of the current order, the current order shall remain in effect for up to thirty (30) additional days until such disposition.  Subsequent extensions of the order may be obtained in the same manner.
J.  In addition to any other right or remedy available by law with respect to the order for assisted outpatient treatment, the assisted outpatient or anyone acting on the assisted outpatient's behalf may petition the court on notice to the assisted outpatient treatment program, the original petitioner and all other parties to the action to stay, vacate or modify the order.
K.  The assisted outpatient treatment program shall petition the court for approval before instituting a proposed change in the assisted outpatient treatment plan, unless such change is authorized by the order of the court.  Such petition shall be filed on notice to all parties in the original action; provided that if the assisted outpatient informs the court that he or she agrees to the proposed material change, the court may approve such change without a hearing.
L.  Where, in the clinical judgment of a licensed mental health professional:
1.  The assisted outpatient has failed or refused to comply with the assisted outpatient treatment;
2.  Efforts were made to solicit compliance; and
3.  Such assisted outpatient appears to be a person requiring treatment,                                                        the licensed mental health professional may cause the assisted outpatient to be taken into protective custody pursuant to the provisions of Sections 5-206 through 5-209 of this title or may refer or initiate proceedings pursuant to Sections 5-410 through 5-415 of this title for involuntary commitment to a hospital or residential treatment facility.  Failure to comply with an order of assisted outpatient treatment shall not be grounds for involuntary civil commitment or a finding of contempt of court.
SECTION 3.     NEW LAW     A new section of law to be codified in the Oklahoma Statutes as Section 5-410.1 of Title 43A, unless there is created a duplication in numbering, reads as follows:
A.  Beginning July 1, 2015, the Board of Mental Health and Substance Abuse Services may certify outpatient treatment programs and enter into contracts with such programs to provide outpatient treatment.
B.  The venue, procedures, and legal rights and protections applicable to assisted outpatients shall be the same as those for persons requiring treatment as provided in Title 43A of the Oklahoma Statutes; provided that the procedures for emergency detention found in the provisions of Section 5-207 et seq. of Title 43A of the Oklahoma Statutes shall not apply to assisted outpatients.  Assisted outpatient treatment shall be ordered pursuant to the provisions of Section 5-416 of this title.  No court shall issue an order for assisted outpatient treatment, except a temporary order as provided in Section 5-416 of Title 43A of the Oklahoma Statutes, without a written treatment plan.
C.  The Board of Mental Health and Substance Abuse Services shall promulgate rules for certification of outpatient treatment programs.
SECTION 4.  This act shall become effective November 1, 2014.
Passed the Senate the 13th day of March, 2014.

	
	Presiding Officer of the Senate

Passed the House of Representatives the ____ day of __________, 2014.

	
	Presiding Officer of the House
	of Representatives