1Amending the act of July 9, 1976 (P.L.817, No.143), entitled "An 
2act relating to mental health procedures; providing for the 
3treatment and rights of mentally disabled persons, for 
4voluntary and involuntary examination and treatment and for 
5determinations affecting those charged with crime or under 
6sentence," providing for assisted outpatient treatment 
7programs.

8The General Assembly of the Commonwealth of Pennsylvania
9hereby enacts as follows:

10Section 1. The act of July 9, 1976 (P.L.817, No.143), known 
11as the Mental Health Procedures Act, is amended by adding an 
12article to read:

13ARTICLE III-A

14Assisted Outpatient Treatment

15Section 301-A. Definitions.

16The following words and phrases when used in this article
17shall have the meanings given to them in this section unless the
18context clearly indicates otherwise:

19"Assisted outpatient" or "patient." A person under a court 
20order to receive assisted outpatient treatment.

1"Assisted outpatient treatment." Any of the following 
2categories of outpatient services which have been ordered by the 
3court pursuant to section 305-A:

4(1) Case management services or assertive community
5treatment team services to provide care coordination.

6(2) Medication.

7(3) Periodic blood tests or urinalysis to determine
8compliance with prescribed medications.

9(4) Individual or group therapy.

10(5) Day or partial programming activities.

11(6) Educational and vocational training or activities.

12(7) Alcohol or substance abuse treatment and counseling
13and periodic tests for the presence of alcohol or illegal
14drugs for persons with a history of alcohol or substance
15abuse.

16(8) Supervision of living arrangements.

17(9) Any other services within an individualized
18treatment plan developed pursuant to Article I prescribed to
19treat the person's mental illness and to assist the person in
20living and functioning in the community, or to attempt to
21prevent a relapse or deterioration that may reasonably be
22predicted to result in suicide or the need for
23hospitalization.

24"Assisted outpatient treatment program" or "program." A 
25system to arrange for and coordinate the provision of assisted 
26outpatient treatment, to monitor treatment compliance by 
27assisted outpatients, to evaluate the condition or needs of 
28assisted outpatients, to take appropriate steps to address the 
29needs of assisted outpatients and to ensure compliance with 
30court orders.

1"Director." The director of a hospital licensed or operated 
2by the Department of Public Welfare which operates, directs and 
3supervises an assisted outpatient treatment program, or the 
4county administrator which operates, directs and supervises an 
5assisted outpatient treatment program.

6"Program coordinator." An individual appointed under section 
7302-A(a) who is responsible for the oversight and monitoring of 
8assisted outpatient treatment programs.

9"Secretary." The Secretary of Public Welfare of the
10Commonwealth.

11"Subject of the petition" or "subject." A person who is 
12alleged in a petition, filed pursuant to the provisions of 
13section 305-A, to meet the criteria for assisted outpatient 
14treatment.

15Section 302-A. Program coordinators to be appointed.

16(a) Duty of secretary.--The secretary shall appoint program
17coordinators of assisted outpatient treatment, who shall be
18responsible for the oversight and monitoring of assisted
19outpatient treatment programs established pursuant to section
20305-A. County administrators shall work in conjunction with the
21program coordinators to coordinate the implementation of
22assisted outpatient treatment programs.

23(b) Oversight and monitoring duties.--The oversight and
24monitoring role of the program coordinator of the assisted
25outpatient treatment program shall include each of the
26following:

27(1) That each assisted outpatient receives the treatment
28provided for in the court order issued pursuant to section
29305-A.

30(2) That existing services located in the assisted

1outpatient's community are utilized whenever practicable.

2(3) That a case manager or assertive community treatment
3team is designated for each assisted outpatient.

4(4) That a mechanism exists for a case manager or
5assertive community treatment team to regularly report the
6assisted outpatient's compliance, or lack of compliance, with
7treatment to the director of the assisted outpatient
8treatment program.

9(5) That assisted outpatient treatment services are
10delivered in a timely manner.

11(c) Standards to be developed.--The secretary shall develop
12standards designed to ensure that case managers or assertive
13community treatment teams have appropriate training and have
14clinically manageable caseloads designed to provide effective
15case management or other care coordination services for persons
16subject to a court order under section

17305-A.

18(d) Corrective action to be taken.--Upon review or receiving
19notice that services are not being delivered in a timely manner,
20the program coordinator shall require the director of the
21assisted outpatient treatment program to immediately commence
22corrective action and inform the program coordinator of the
23corrective action taken. Failure of a director to take
24corrective action shall be reported by the program coordinator
25to the secretary as well as to the court which ordered the
26assisted outpatient treatment.

27Section 303-A. Duties of county administrators.

28Each county administrator shall be responsible for the filing
29of petitions for assisted outpatient treatment pursuant to
30section 305-A, for the receipt and investigation of reports of

1persons who are alleged to be in need of that treatment and for
2coordinating the delivery of court-ordered services with program
3coordinators, appointed by the secretary pursuant to section
4302-A(a). In discharge of the duties imposed by section 305-A,
5directors of community services may provide services directly,
6or may coordinate services with the offices of the secretary or
7may contract with any public or private provider to provide
8services for assisted outpatient treatment programs as may be
9necessary to carry out the duties imposed pursuant to this
10article.

11Section 304-A. Directors of assisted outpatient treatment
12programs.

13(a) General duties.--

14(1) Directors of assisted outpatient treatment programs
15established pursuant to section 305-A shall provide a written
16report to the program coordinators, appointed by the
17secretary pursuant to section 302-A(a), within three days of
18the issuance of a court order. The report shall demonstrate
19that mechanisms are in place to ensure the delivery of
20services and medications as required by the court order and
21shall include, but not be limited to, the following:

22(i) A copy of the court order.

23(ii) A copy of the written treatment plan.

24(iii) The identity of the case manager or assertive
25community treatment team, including the name and contact
26data of the organization which the case manager or
27assertive community treatment team member represents.

28(iv) The identity of providers of services.

29(v) The date on which services have commenced or
30will commence.

1(2) The directors of assisted outpatient treatment
2programs shall ensure the timely delivery of services
3described in section 305-A pursuant to any court order issued
4thereunder. Directors of assisted outpatient treatment
5programs shall immediately commence corrective action upon
6receiving notice from program coordinators that services are
7not being provided in a timely manner, and the directors
8shall inform the program coordinator of the corrective action
9taken.

10(b) Quarterly reports to program coordinators.--Directors of
11assisted outpatient treatment programs shall submit quarterly
12reports to the program coordinators regarding the assisted
13outpatient treatment program operated or administered by them.
14The report shall include the following information:

15(1) The names of individuals served by the program.

16(2) The percentage of petitions for assisted outpatient
17treatment that are granted by the court.

18(3) Any change in status of assisted outpatients,
19including, but not limited to, the number of individuals who
20have failed to comply with court-ordered assisted outpatient
21treatment.

22(4) A description of material changes in written
23treatment plans of assisted outpatients.

24(5) Any change in case managers.

25(6) A description of the categories of services which
26have been ordered by the court.

27(7) Living arrangements of individuals served by the
28program including the number, if any, who are homeless.

29(8) Any other information as required by the secretary.

30(9) Any recommendations to improve the program Statewide

1or locally.

2Section 305-A. Assisted outpatient treatment program.

3(a) Director to obtain approval from secretary.--A director
4may operate, direct and supervise an assisted outpatient
5treatment program as provided in this section, upon approval by
6the secretary. The county administrator shall operate, direct
7and supervise an assisted outpatient treatment program as
8provided in this section, upon approval by the secretary. County
9administrators shall be permitted to satisfy the provisions of
10this article through the operation of joint assisted outpatient
11treatment programs. Nothing in this article shall be construed
12to preclude the combination or coordination of efforts between
13and among counties and hospitals in providing and coordinating
14assisted outpatient treatment.

15(b) Criteria for assisted outpatient treatment.--A patient
16may be ordered to obtain assisted outpatient treatment if the
17court finds all of the following:

18(1) The patient is 18 years of age or older.

19(2) The patient is suffering from a mental illness.

20(3) The patient is unlikely to survive safely in the
21community without supervision, based on a clinical
22determination.

23(4) The patient has a history of lack of compliance with
24treatment for mental illness that has:

25(i) at least twice within the preceding 36 months
26been a significant factor in necessitating
27hospitalization, or receipt of services in a forensic or
28other mental health unit of a correctional facility, not
29including any period during which the person was
30hospitalized or imprisoned immediately preceding the

1filing of the petition; or

2(ii) resulted in one or more acts of serious violent
3behavior toward self or others or threats of, or attempts
4at, serious physical harm to self or others within the
5preceding 48 months, not including any period in which
6the person was hospitalized or imprisoned immediately
7preceding the filing of the petition.

8(5) The patient is, as a result of the patient's mental
9illness, unlikely to voluntarily participate in the
10recommended treatment pursuant to the treatment plan.

11(6) In view of the patient's treatment history and
12current behavior, the patient is in need of assisted
13outpatient treatment in order to prevent a relapse or
14deterioration which would be likely to pose a clear and
15present danger of harm to self or others as determined under
16section 301.

17(7) It is likely that the patient will benefit from
18assisted outpatient treatment.

19(c) Petition to the court.--

20(1) A petition for an order authorizing assisted
21outpatient treatment may be filed in the court of common
22pleas of the county in which the subject of the petition is
23present or reasonably believed to be present. A petition to
24obtain an order authorizing assisted outpatient treatment may
25be initiated only by the following persons:

26(i) a person 18 years of age or older with whom the
27subject of the petition resides;

28(ii) the parent, spouse, sibling 18 years of age or
29older, or child 18 years of age or older of the subject
30of the petition;

1(iii) the director of the facility in which the
2subject of the petition is hospitalized;

3(iv) the director of any public or charitable
4organization, agency or home providing mental health
5services to the subject of the petition in whose
6institution the subject of the petition resides;

7(v) a qualified psychiatrist who is either
8supervising the treatment of or treating the subject of
9the petition for a mental illness;

10(vi) the county administrator, or his designee; or

11(vii) a parole officer or probation officer assigned
12to supervise the subject of the petition.

13(2) The petition shall state:

14(i) Each of the criteria for assisted outpatient
15treatment as set forth in subsection (b).

16(ii) The facts which support the petitioner's belief
17that the person who is the subject of the petition meets
18each criterion, provided that the hearing on the petition
19need not be limited to the stated facts.

20(iii) That the subject of the petition is present,
21or is reasonably believed to be present, within the
22county where the petition is filed.

23(3) The petition shall be accompanied by an affirmation
24or affidavit of a physician, who shall not be the petitioner,
25and shall state either that:

26(i) The physician has personally examined the person
27who is the subject of the petition not more than ten days
28prior to the submission of the petition, recommends
29assisted outpatient treatment for the subject of the
30petition and is willing and able to testify at the

1hearing on the petition.

2(ii) Not more than ten days prior to the filing of
3the petition, the physician or his designee has made
4appropriate attempts to elicit the cooperation of the
5subject of the petition but has not been successful in
6persuading the subject to submit to an examination, that
7the physician has reason to suspect that the subject of
8the petition meets the criteria for assisted outpatient
9treatment, and that the physician is willing and able to
10examine the subject of the petition and testify at the
11hearing on the petition.

12(d) Right to counsel.--The subject of the petition shall
13have the right to be represented by counsel at all stages of a
14proceeding commenced under this section. The subject of the
15petition shall be represented either by counsel of his selection
16or, if unrepresented and unable to afford counsel as determined
17by the court, by court-appointed counsel.

18(e) Hearing.--

19(1) Upon receipt by the court of the petition submitted
20pursuant to subsection (c), the court shall fix the date for
21a hearing at a time not later than three days from the date
22the petition is received by the court, excluding Saturdays,
23Sundays and holidays. Adjournments shall be permitted only
24for good cause shown. In granting adjournments, the court
25shall consider the need for further examination by a
26physician or the potential need to provide assisted
27outpatient treatment expeditiously.

28(2) The court shall cause the subject of the petition,
29the petitioner, the physician whose affirmation or affidavit
30accompanied the petition, the appropriate director, and such

1other persons as the court may determine to be advised. The
2subject of the petition shall have the opportunity to 
3provide, in writing, names and parties to be notified of the 
4hearing which shall be considered by the court.

5(3) Upon the date for the hearing, or upon such other
6date to which the proceeding may be adjourned, the court
7shall hear testimony and, if it be deemed advisable and the
8subject of the petition is available, examine the subject
9alleged to be in need of assisted outpatient treatment in or
10out of court.

11(4) If the subject of the petition does not appear at
12the hearing and appropriate attempts to elicit the attendance
13of the subject have failed, the court may conduct the hearing
14in the subject's absence. If the hearing is conducted without
15the subject of the petition present, the court shall set
16forth the factual basis for conducting the hearing without
17the presence of the subject of the petition.

18(5) The court may not order assisted outpatient
19treatment unless an examining physician who has personally
20examined the subject of the petition within the time period
21commencing ten days before the filing of the petition
22testifies in person at the hearing.

23(6) If the subject of the petition has refused to be
24examined by a physician, the court may request the subject to
25consent to an examination by a physician appointed by the
26court. If the subject of the petition does not consent and
27the court finds reasonable cause to believe that the
28allegations in the petition are true, the court may order law
29enforcement officers or of a sheriff's department to take the
30subject of the petition into custody and transport him to a

1hospital for examination by a physician. Retention of the
2subject of the petition under the order shall not exceed 24
3hours.

4(7) The examination of the subject of the petition may
5be performed by the physician whose affirmation or affidavit
6accompanied the petition, if the physician is privileged by
7the hospital or otherwise authorized by the hospital to do
8so. If the examination is performed by another physician of
9the hospital, the examining physician shall be authorized to
10consult with the physician whose affirmation or affidavit
11accompanied the petition regarding the issues of whether the
12allegations in the petition are true and whether the subject
13meets the criteria for assisted outpatient treatment.

14(8) A physician who testifies pursuant to paragraph (5)
15shall state the facts which support the allegation that the
16subject meets each of the criteria for assisted outpatient
17treatment, and the treatment is the least restrictive
18alternative, the recommended assisted outpatient treatment
19and the rationale for the recommended assisted outpatient
20treatment. If the recommended assisted outpatient treatment
21includes medication, the physician's testimony shall describe
22the types or classes of medication which should be
23authorized, shall describe the beneficial and detrimental
24physical and mental effects of the medication and shall
25recommend whether the medication should be self-administered
26or administered by authorized personnel.

27(9) The subject of the petition shall be afforded an
28opportunity to present evidence, to call witnesses on behalf
29of the subject and to cross-examine adverse witnesses.

30(f) Written individualized treatment plan.--

1(1) (i) The court may not order assisted outpatient
2treatment unless an examining physician appointed by the
3appropriate director develops and provides to the court a
4proposed written individualized treatment plan. The
5written individualized treatment plan shall include case
6management services or assertive community treatment
7teams to provide care coordination, and all categories of
8services which the physician recommends that the subject
9of the petition should receive.

10(ii) If the written individualized treatment plan
11includes medication, it shall state whether the
12medication should be self-administered or administered by
13authorized personnel, and shall specify type and dosage
14range of medication most likely to provide maximum
15benefit for the subject.

16(iii) If the written individualized treatment plan
17includes alcohol or substance abuse counseling and
18treatment, the plan may include a provision requiring
19relevant testing for either alcohol or illegal
20substances, provided the physician's clinical basis for
21recommending the plan provides sufficient facts for the
22court to find:

23(A) That the person has a history of alcohol or
24substance abuse that is clinically related to the
25mental illness.

26(B) That the testing is necessary to prevent a
27relapse or deterioration which would be likely to
28result in serious harm to the person or others.

29(iv) In developing the plan, the physician shall
30provide the following persons with an opportunity to

1actively participate in the development of the plan: the
2subject of the petition; the treating physician; and upon
3the request of the patient, an individual significant to
4the patient including any relative, close friend or
5individual otherwise concerned with the welfare of the
6patient. If the petitioner is a director, the plan shall
7be provided to the court no later than the date of the
8hearing on the petition.

9(2) The court shall not order assisted outpatient
10treatment unless a physician testifies to explain the written
11proposed treatment plan. The testimony shall state:

12(i) The categories of assisted outpatient treatment
13recommended.

14(ii) The rationale for each category.

15(iii) Facts which establish that the treatment is
16the least restrictive alternative.

17(iv) If the recommended assisted outpatient
18treatment includes medication, the types or classes of
19medication recommended, the beneficial and detrimental
20physical and mental effects of the medication and whether
21the medication should be self-administered or
22administered by an authorized professional.

23If the petitioner is a director, the testimony shall be given at
24the hearing on the petition.

25(g) Disposition.--

26(1) If after hearing all relevant evidence the court
27finds that the subject of the petition does not meet the
28criteria for assisted outpatient treatment, the court shall
29dismiss the petition.

30(2) If after hearing all relevant evidence the court

1finds by clear and convincing evidence that the subject of
2the petition meets the criteria for assisted outpatient
3treatment and there is no appropriate and feasible less
4restrictive alternative, the court shall order the subject to
5receive assisted outpatient treatment for an initial period
6not to exceed six months. In fashioning the order, the court
7shall specifically make findings by clear and convincing
8evidence that the proposed treatment is the least restrictive
9treatment appropriate and feasible for the subject. The order
10shall state the categories of assisted outpatient treatment
11which the subject is to receive. The court may not order
12treatment that has not been recommended by the examining
13physician and included in the written treatment plan for
14assisted outpatient treatment as required by subsection (f).

15(3) If after hearing all relevant evidence the court
16finds by clear and convincing evidence that the subject of
17the petition meets the criteria for assisted outpatient
18treatment, and the court has yet to be provided with a
19written individualized treatment plan and testimony pursuant
20to subsection (f), the court shall order the county
21administrator to provide the court with the plan and
22testimony no later than the third day, excluding Saturdays,
23Sundays and holidays, immediately following the date of the
24order. Upon receiving the plan and testimony, the court may
25order assisted outpatient treatment as provided in paragraph
26(2).

27(4) A court may order the patient to self-administer
28psychotropic drugs or accept the administration of the drugs
29by authorized personnel as part of an assisted outpatient
30treatment program. The order may specify the type and dosage

1range of psychotropic drugs and shall be effective for the
2duration of the assisted outpatient treatment.

3(5) If the petitioner is the director of a hospital that
4operates an assisted outpatient treatment program, the court
5order shall direct the hospital director to provide or
6arrange for all categories of assisted outpatient treatment
7for the assisted outpatient throughout the period of the
8order. For all other persons, the order shall require the
9director of community services of the appropriate local
10governmental unit to provide or arrange for all categories of
11assisted outpatient treatment for the assisted outpatient
12throughout the period of the order.

13(6) The director or his designee shall apply to the
14court for approval before instituting a proposed material
15change in the assisted outpatient treatment order unless the
16change is contemplated in the order. Nonmaterial changes may
17be instituted by the assisted outpatient treatment program
18without court approval. For the purposes of this paragraph, a
19material change shall mean an addition or deletion of a
20category of assisted outpatient treatment from the order of
21the court or any deviation without the patient's consent from
22the terms of an existing order relating to the administration
23of psychotropic drugs.

24(h) Applications for additional periods of treatment.--If
25the director determines that the condition of the patient
26requires further assisted outpatient treatment, the director
27shall apply prior to the expiration of the period of assisted
28outpatient treatment ordered by the court for a second or
29subsequent order authorizing continued assisted outpatient
30treatment for a period not to exceed one year from the date of

1the order. The procedures for obtaining any order pursuant to
2this subsection shall be in accordance with this section,
3provided that the time period included in subsection (b)(4)(i)
4and (ii) shall not be applicable in determining the
5appropriateness of additional periods of assisted outpatient
6treatment. Any court order requiring periodic blood tests or
7urinalysis for the presence of alcohol or illegal drugs shall be
8subject to review after six months by the physician who
9developed the written individualized treatment plan or another
10physician designated by the director, and the physician shall be
11authorized to terminate the blood tests or urinalysis without
12further action by the court.

13(i) Application for order to stay, vacate or modify.--In
14addition to any other right or remedy available by law with
15respect to the order for assisted outpatient treatment, the
16patient, the patient's counsel or anyone acting on the patient's
17behalf may apply on notice to the appropriate director and the
18original petitioner to the court to stay, vacate or modify the
19order.

20(j) Appeals.--Review of an order issued pursuant to this
21section shall be conducted in the same manner as specified in
22section 303.

23(k) Failure to comply with the assisted outpatient
24treatment.--

25(1) (i) Where, in the clinical judgment of a physician,
26the assisted outpatient has failed or refused to comply
27with the assisted outpatient treatment and efforts were
28made to solicit compliance and such assisted outpatient
29may be in need of involuntary admission to a hospital or
30immediate observation, care and treatment pursuant to

1section 302 or 303, the physician may request the
2director of community services, the director's designee
3or any physician designated by the director of community
4services to take the assisted outpatient to an
5appropriate hospital for an examination to determine if
6the assisted outpatient has a mental illness for which
7hospitalization is necessary.

8(ii) If the assisted outpatient refuses to take
9medication as required by the court order or refuses to
10take or fails a blood test, urinalysis or alcohol or drug
11test as required by the court order, the physician may
12consider the refusal or failure when determining whether
13the assisted outpatient is in need of an examination to
14determine whether the assisted outpatient has a mental
15illness for which hospitalization is necessary.

16(2) Upon the request of the physician, the director or
17the director's designee may direct law enforcement officers
18or the sheriff's department to take into custody and
19transport the patient to the hospital operating the assisted
20outpatient treatment program or to any hospital authorized by
21the director of community services to receive such patients.
22The law enforcement officials shall carry out the directive.

23(3) (i) Upon the request of the physician, the director
24or the director's designee, the court may authorize the
25patient to be taken into custody and transported to the
26hospital operating the assisted outpatient treatment
27program or to any other hospital authorized by the county
28administrator to receive such patients in accordance with
29section 306.

30(ii) The patient may be retained for observation,

1care and treatment and further examination in the
2hospital for up to 72 hours to permit a physician to
3determine whether the patient has a mental illness and is
4in need of involuntary care and treatment in a hospital
5pursuant to this act.

6(iii) Any continued involuntary retention in the
7hospital beyond the initial 72-hour period shall be in
8accordance with this act relating to the involuntary
9admission and retention of a person.

10(iv) If at any time during the 72-hour period the
11person is determined not to meet the involuntary
12admission and retention provisions of this act and does
13not agree to stay in the hospital as a voluntary or
14informal patient, he shall be released.

15(v) Failure to comply with an order of assisted
16outpatient treatment shall not be grounds for involuntary
17civil commitment or a finding of contempt of court.

18(l) False petition.--A person making a false statement or 
19providing false information or false testimony in a petition or 
20hearing under this section is subject to criminal prosecution 
21pursuant to 18 Pa.C.S. § 4903 (relating to false swearing).

22(m) Construction.--Nothing in this section shall be
23construed to affect the ability of the director of a hospital to
24receive, admit or retain patients who otherwise meet the
25provisions of this act regarding receipt, retention or
26admission.

27(n) Educational materials.--The Department of Public
28Welfare, in consultation with the county administrator, shall
29prepare educational and training materials on the use of this
30section, which shall be made available to county providers of

1services, judges, court personnel, law enforcement officials and
2the general public.

3Section 2. This act shall take effect in 60 days.