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"Subject of the petition" or "subject." A person who is 
10alleged in a petition, filed pursuant to the provisions of 
11section 305-A, to meet the criteria for assisted outpatient 
12treatment.

13Section 302-A. Program coordinators to be appointed.

14(a) Duty of secretary.--The Secretary of Public Welfare
15shall appoint program coordinators of assisted outpatient
16treatment, who shall be responsible for the oversight and
17monitoring of assisted outpatient treatment programs established
18pursuant to section 305-A. County administrators shall work in
19conjunction with the program coordinators to coordinate the
20implementation of assisted outpatient treatment programs.

21(b) Oversight and monitoring duties.--The oversight and
22monitoring role of the program coordinator of the assisted
23outpatient treatment program shall include each of the
24following:

25(1) That each assisted outpatient receive the treatment
26provided for in the court order issued pursuant to section
27305-A.

28(2) That existing services located in the assisted
29outpatient's community be utilized whenever practicable.

30(3) That a case manager or assertive community treatment

1team is designated for each assisted outpatient.

2(4) That a mechanism exist for a case manager, or
3assertive community treatment team, to regularly report the
4assisted outpatient's compliance, or lack of compliance, with
5treatment to the director of the assisted outpatient
6treatment program.

7(5) That assisted outpatient treatment services be
8delivered in a timely manner.

9(c) Standards to be developed.--The Secretary of Public
10Welfare shall develop standards designed to ensure that case
11managers or assertive community treatment teams have appropriate
12training and have clinically manageable caseloads designed to
13provide effective case management or other care coordination
14services for persons subject to a court order under section

15305-A.

16(d) Corrective action to be taken.--Upon review or receiving
17notice that services are not being delivered in a timely manner,
18the program coordinator shall require the director of the
19assisted outpatient treatment program to immediately commence
20corrective action and inform the program coordinator of the
21corrective action taken. Failure of a director to take
22corrective action shall be reported by the program coordinator
23to the Secretary of Public Welfare as well as to the court which
24ordered the assisted outpatient treatment.

25Section 303-A. Duties of county administrators.

26Each county administrator shall be responsible for the filing
27of petitions for assisted outpatient treatment pursuant to
28section 305-A, for the receipt and investigation of reports of
29persons who are alleged to be in need of that treatment and for
30coordinating the delivery of court-ordered services with program

1coordinators, appointed by the Secretary of Public Welfare
2pursuant to section 302-A(a). In discharge of the duties imposed
3by section 305-A, directors of community services may provide
4services directly, or may coordinate services with the offices
5of the Secretary of Public Welfare or may contract with any
6public or private provider to provide services for assisted
7outpatient treatment programs as may be necessary to carry out
8the duties imposed pursuant to this article.

9Section 304-A. Directors of assisted outpatient treatment
10programs.

11(a) General duties.--

12(1) Directors of assisted outpatient treatment programs
13established pursuant to section 305-A shall provide a written
14report to the program coordinators, appointed by the
15Secretary of Public Welfare pursuant to section 302-A(a),
16within three days of the issuance of a court order. The
17report shall demonstrate that mechanisms are in place to
18ensure the delivery of services and medications as required
19by the court order and shall include, but not be limited to,
20the following:

21(i) A copy of the court order.

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

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

27(iv) The identity of providers of services.

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

30(2) The directors of assisted outpatient treatment

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

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

14(1) The names of individuals served by the program.

15(2) The percentage of petitions for assisted outpatient
16treatment that are granted by the court.

17(3) Any change in status of assisted outpatients,
18including, but not limited to, the number of individuals who
19have failed to comply with court-ordered assisted outpatient
20treatment.

21(4) A description of material changes in written
22treatment plans of assisted outpatients.

23(5) Any change in case managers.

24(6) A description of the categories of services which
25have been ordered by the court.

26(7) Living arrangements of individuals served by the
27program including the number, if any, who are homeless.

28(8) Any other information as required by the Secretary
29of Public Welfare.

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 of Public Welfare. The county administrator shall
7operate, direct and supervise an assisted outpatient treatment
8program as provided in this section upon approval by the
9Secretary of Public Welfare. County administrators shall be
10permitted to satisfy the provisions of this article through the
11operation of joint assisted outpatient treatment programs.
12Nothing in this article shall be construed to preclude the
13combination or coordination of efforts between and among
14counties and hospitals in providing and coordinating assisted
15outpatient treatment.

16(b) Criteria for assisted outpatient treatment.--A patient
17may be ordered to obtain assisted outpatient treatment if the
18court finds all of the following:

19(1) The patient is 18 years of age or older.

20(2) The patient is suffering from a mental illness.

21(3) The patient is unlikely to survive safely in the
22community without supervision, based on a clinical
23determination.

24(4) The patient has a history of lack of compliance with
25treatment for mental illness that has:

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

1hospitalized or imprisoned immediately preceding the
2filing of the petition; or

3(ii) resulted in one or more acts of serious violent
4behavior toward self or others or threats of, or attempts
5at, serious physical harm to self or others within the
6preceding 48 months, not including any period in which
7the person was hospitalized or imprisoned immediately
8preceding the filing of the petition.

9(5) The patient is, as a result of the patient's mental
10illness, unlikely to voluntarily participate in the
11recommended treatment pursuant to the treatment plan.

12(6) In view of the patient's treatment history and
13current behavior, the patient is in need of assisted
14outpatient treatment in order to prevent a relapse or
15deterioration which would be likely to pose a clear and
16present danger of harm to others or to himself as determined
17under section 301.

18(7) It is likely that the patient will benefit from
19assisted outpatient treatment.

20(c) Petition to the court.--

21(1) A petition for an order authorizing assisted
22outpatient treatment may be filed in the court of common
23pleas of the county in which the subject of the petition is
24present or reasonably believed to be present. A petition to
25obtain an order authorizing assisted outpatient treatment may
26be initiated only by the following persons:

27(i) a person 18 years of age or older with whom the
28subject of the petition resides;

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

1the petition;

2(iii) the director of the facility in which the
3subject of the petition is hospitalized;

4(iv) the director of any public or charitable
5organization, agency or home providing mental health
6services to the subject of the petition in whose
7institution the subject of the petition resides;

8(v) a qualified psychiatrist who is either
9supervising the treatment of or treating the subject of
10the petition for a mental illness;

11(vi) the county administrator or his designee; or

12(vii) a parole officer or probation officer assigned
13to supervise the subject of the petition.

14(2) The petition shall state:

15(i) Each of the criteria for assisted outpatient
16treatment as set forth in subsection (b).

17(ii) The facts which support the petitioner's belief
18that the person who is the subject of the petition meets
19each criterion, provided that the hearing on the petition
20need not be limited to the stated facts.

21(iii) That the subject of the petition is present,
22or is reasonably believed to be present, within the
23county where the petition is filed.

24(3) The petition shall be accompanied by an affirmation
25or affidavit of a physician, who shall not be the petitioner,
26and shall state that either:

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

1petition and is willing and able to testify at the
2hearing on the petition.

3(ii) Not more than ten days prior to the filing of
4the petition, the physician or his designee has made
5appropriate attempts to elicit the cooperation of the
6subject of the petition but has not been successful in
7persuading the subject to submit to an examination, that
8the physician has reason to suspect that the subject of
9the petition meets the criteria for assisted outpatient
10treatment and that the physician is willing and able to
11examine the subject of the petition and testify at the
12hearing on the petition.

13(d) Right to counsel.--The subject of the petition shall
14have the right to be represented by counsel at all stages of a
15proceeding commenced under this section. The subject of the
16petition shall be represented either by counsel of his selection
17or if unrepresented and unable to afford counsel as determined
18by the court, by court-appointed counsel.

19(e) Hearing.--

20(1) Upon receipt by the court of the petition submitted
21pursuant to subsection (c), the court shall fix the date for
22a hearing at a time not later than three days from the date
23the petition is received by the court, excluding Saturdays,
24Sundays and holidays. Adjournments shall be permitted only
25for good cause shown. In granting adjournments, the court
26shall consider the need for further examination by a
27physician or the potential need to provide assisted
28outpatient treatment expeditiously.

29(2) The court shall cause the subject of the petition,
30the petitioner, the physician whose affirmation or affidavit

1accompanied the petition, the appropriate director and such
2other persons as the court may determine to be advised. The
3subject of the petition shall have the opportunity to provide 
4in writing names and parties to be notified of the hearing 
5which shall be considered by the court.

6(3) Upon the date for the hearing, or upon such other
7date to which the proceeding may be adjourned, the court
8shall hear testimony and if it be deemed advisable and the
9subject of the petition is available, examine the subject
10alleged to be in need of assisted outpatient treatment in or
11out of court.

12(4) If the subject of the petition does not appear at
13the hearing and appropriate attempts to elicit the attendance
14of the subject have failed, the court may conduct the hearing
15in the subject's absence. If the hearing is conducted without
16the subject of the petition present, the court shall set
17forth the factual basis for conducting the hearing without
18the presence of the subject of the petition.

19(5) The court may not order assisted outpatient
20treatment unless an examining physician, who has personally
21examined the subject of the petition within the time period
22commencing ten days before the filing of the petition,
23testifies in person at the hearing.

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

1subject of the petition into custody and transport him to a
2hospital for examination by a physician. Retention of the
3subject of the petition under the order shall not exceed 24
4hours.

5(7) The examination of the subject of the petition may
6be performed by the physician whose affirmation or affidavit
7accompanied the petition, if the physician is privileged by
8the hospital or otherwise authorized by the hospital to do
9so. If the examination is performed by another physician of
10the hospital, the examining physician shall be authorized to
11consult with the physician whose affirmation or affidavit
12accompanied the petition regarding the issues of whether the
13allegations in the petition are true and whether the subject
14meets the criteria for assisted outpatient treatment.

15(8) A physician who testifies pursuant to paragraph (5)
16shall state the facts which support the allegation that the
17subject meets each of the criteria for assisted outpatient
18treatment, and the treatment is the least restrictive
19alternative, the recommended assisted outpatient treatment
20and the rationale for the recommended assisted outpatient
21treatment. If the recommended assisted outpatient treatment
22includes medication, the physician's testimony shall describe
23the types or classes of medication which should be
24authorized, shall describe the beneficial and detrimental
25physical and mental effects of the medication and shall
26recommend whether the medication should be self-administered
27or administered by authorized personnel.

28(9) The subject of the petition shall be afforded an
29opportunity to present evidence, to call witnesses on behalf
30of the subject and to cross-examine adverse witnesses.

1(f) Written individualized treatment plan.--

2(1) (i) The court may not order assisted outpatient
3treatment unless an examining physician appointed by the
4appropriate director develops and provides to the court a
5proposed written individualized treatment plan. The
6written individualized treatment plan shall include case
7management services or assertive community treatment
8teams to provide care coordination and all categories of
9services which the physician recommends that the subject
10of the petition should receive.

11(ii) If the written individualized treatment plan
12includes medication, it shall state whether the
13medication should be self-administered or administered by
14authorized personnel, and shall specify type and dosage
15range of medication most likely to provide maximum
16benefit for the subject.

17(iii) If the written individualized treatment plan
18includes alcohol or substance abuse counseling and
19treatment, the plan may include a provision requiring
20relevant testing for either alcohol or illegal substances
21provided the physician's clinical basis for recommending
22the plan provides sufficient facts for the court 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 be authorized to
5order the subject to receive assisted outpatient treatment
6for an initial period not to exceed six months. In fashioning
7the order, the court shall specifically make findings by
8clear and convincing evidence that the proposed treatment is
9the least restrictive treatment appropriate and feasible for
10the subject. The order shall state the categories of assisted
11outpatient treatment which the subject is to receive. The
12court may not order treatment that has not been recommended
13by the examining physician and included in the written
14treatment plan for assisted outpatient treatment as required
15by subsection (f).

16(3) If after hearing all relevant evidence the court
17finds by clear and convincing evidence that the subject of
18the petition meets the criteria for assisted outpatient
19treatment and the court has yet to be provided with a written
20individualized treatment plan and testimony pursuant to
21subsection (f), the court shall order the county
22administrator to provide the court with the plan and
23testimony no later than the third day, excluding Saturdays,
24Sundays and holidays, immediately following the date of the
25order. Upon receiving the plan and testimony, the court may
26order assisted outpatient treatment as provided in paragraph
27(2).

28(4) A court may order the patient to self-administer
29psychotropic drugs or accept the administration of the drugs
30by authorized personnel as part of an assisted outpatient

1treatment program. The order may specify the type and dosage
2range of psychotropic drugs, and the order shall be effective
3for the duration of the assisted outpatient treatment.

4(5) If the petitioner is the director of a hospital that
5operates an assisted outpatient treatment program, the court
6order shall direct the hospital director to provide or
7arrange for all categories of assisted outpatient treatment
8for the assisted outpatient throughout the period of the
9order. For all other persons, the order shall require the
10director of community services of the appropriate local
11governmental unit to provide or arrange for all categories of
12assisted outpatient treatment for the assisted outpatient
13throughout the period of the order.

14(6) The director or his designee shall apply to the
15court for approval before instituting a proposed material
16change in the assisted outpatient treatment order unless the
17change is contemplated in the order. Nonmaterial changes may
18be instituted by the assisted outpatient treatment program
19without court approval. For the purposes of this paragraph, a
20material change shall mean an addition or deletion of a
21category of assisted outpatient treatment from the order of
22the court, or any deviation without the patient's consent
23from the terms of an existing order relating to the
24administration of psychotropic drugs.

25(h) Applications for additional periods of treatment.--If
26the director determines that the condition of the patient
27requires further assisted outpatient treatment, the director
28shall apply prior to the expiration of the period of assisted
29outpatient treatment ordered by the court for a second or
30subsequent order authorizing continued assisted outpatient

1treatment for a period not to exceed one year from the date of
2the order. The procedures for obtaining any order pursuant to
3this subsection shall be in accordance with this section,
4provided that the time period included in subsection (b)(4)(i)
5and (ii) shall not be applicable in determining the
6appropriateness of additional periods of assisted outpatient
7treatment. Any court order requiring periodic blood tests or
8urinalysis for the presence of alcohol or illegal drugs shall be
9subject to review after six months by the physician who
10developed the written individualized treatment plan or another
11physician designated by the director, and the physician shall be
12authorized to terminate the blood tests or urinalysis without
13further action by the court.

14(i) Application for order to stay, vacate or modify.--In
15addition to any other right or remedy available by law with
16respect to the order for assisted outpatient treatment, the
17patient, the patient's counsel or anyone acting on the patient's
18behalf may apply on notice to the appropriate director and the
19original petitioner to the court to stay, vacate or modify the
20order.

21(j) Appeals.--Review of an order issued pursuant to this
22section shall be conducted in like manner as specified in
23section 303.

24(k) Failure to comply with the assisted outpatient
25treatment.--

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

1immediate observation, care and treatment pursuant to
2section 302 or 303, the physician may request the
3director of community services, the director's designee
4or any physician designated by the director of community
5services to take the assisted outpatient to an
6appropriate hospital for an examination to determine if
7the assisted outpatient has a mental illness for which
8hospitalization is necessary.

9(ii) If the assisted outpatient refuses to take
10medication as required by the court order or refuses to
11take or fails a blood test, urinalysis or alcohol or drug
12test as required by the court order, the physician may
13consider the refusal or failure when determining whether
14the assisted outpatient is in need of an examination to
15determine whether the assisted outpatient has a mental
16illness for which hospitalization is necessary.

17(2) Upon the request of the physician, the director or
18the director's designee may direct law enforcement officers
19or the sheriff's department to take into custody and
20transport the patient to the hospital operating the assisted
21outpatient treatment program or to any hospital authorized by
22the director of community services to receive such patients.
23The law enforcement officials shall carry out the directive.

24(3) (i) Upon the request of the physician, the director
25or the director's designee, the court may authorize the
26patient to be taken into custody and transported to the
27hospital operating the assisted outpatient treatment
28program or to any other hospital authorized by the county
29administrator to receive such patients in accordance with
30section 306.

1(ii) The patient may be retained for observation,
2care and treatment and further examination in the
3hospital for up to 72 hours to permit a physician to
4determine whether the patient has a mental illness and is
5in need of involuntary care and treatment in a hospital
6pursuant to this act.

7(iii) Any continued involuntary retention in the
8hospital beyond the initial 72-hour period shall be in
9accordance with this act relating to the involuntary
10admission and retention of a person.

11(iv) If at any time during the 72-hour period the
12person is determined not to meet the involuntary
13admission and retention provisions of this act and does
14not agree to stay in the hospital as a voluntary or
15informal patient, he shall be released.

16(v) Failure to comply with an order of assisted
17outpatient treatment shall not be grounds for involuntary
18civil commitment or a finding of contempt of court.

19(l) False petition.--A person making a false statement or 
20providing false information or false testimony in a petition or 
21hearing under this section is subject to criminal prosecution 
22pursuant to 18 Pa.C.S. § 4903 (relating to false swearing).

23(m) Construction.--Nothing in this section shall be
24construed to affect the ability of the director of a hospital to
25receive, admit or retain patients who otherwise meet the
26provisions of this act regarding receipt, retention or
27admission.

28(n) Educational materials.--The Department of Public
29Welfare, in consultation with the county administrator, shall
30prepare educational and training materials on the use of this

1section, which shall be made available to county providers of
2services, judges, court personnel, law enforcement officials and
3the general public.

4Section 2. This act shall take effect in 60 days.