PRINTER'S NO. 2365
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
1630
Session of
2015
INTRODUCED BY DAVIDSON, KINSEY, ROZZI, MURT, COHEN, THOMAS,
YOUNGBLOOD, DEAN, DAVIS, BISHOP, V. BROWN, BULLOCK AND
DRISCOLL, OCTOBER 15, 2015
REFERRED TO COMMITTEE ON HEALTH, OCTOBER 15, 2015
AN ACT
Amending the act of July 9, 1976 (P.L.817, No.143), entitled "An
act relating to mental health procedures; providing for the
treatment and rights of mentally disabled persons, for
voluntary and involuntary examination and treatment and for
determinations affecting those charged with crime or under
sentence," establishing an Assertive Community Treatment
Program in the Department of Human Services.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. The act of July 9, 1976 (P.L.817, No.143), known
as the Mental Health Procedures Act, is amended by adding
articles to read:
ARTICLE III-A
( RESERVED )
ARTICLE III-B
ASSERTIVE COMMUNITY TREATMENT
Section 301-B. Declaration of policy.
The General Assembly finds and declares as follows:
(1) ACT services are targeted to individuals with
serious mental illnesses that cause symptoms and impairments
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in basic mental and behavioral processes.
(2) Patients are not excluded from ACT services because
of severity of illness, disruptiveness in the community or
hospital or failure to participate in or respond to
traditional mental health services.
(3) ACT services are individually tailored for each
patient through relationship building, individualized
assessment and planning and active involvement with a patient
to enable each patient:
(i) to find and live in his own residence;
(ii) to find and maintain work in the community;
(iii) to better manage symptoms;
(iv) to achieve individual goals; and
(v) to maintain optimism and recover.
(4) The ACT team shall advocate for patients' self-
determination and independence in day-to-day activities.
Section 302-B. Definitions.
The following words and phrases when used in this article
shall have the meanings given to them in this section unless the
context clearly indicates otherwise:
"ACT services." Assertive community treatment services
provided in accordance with this article.
"ACT team." A group of multidisciplinary mental health staff
who work as a team to deliver ACT services.
"Assertive community treatment" or "ACT." A service delivery
model for providing comprehensive community-based treatment to
individuals with serious mental illness that is a self-contained
mental health program made up of a multidisciplinary mental
health staff, including a peer specialist, who work as a team to
provide the majority of treatment, rehabilitation and support
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services that patients need to achieve their goals.
"Comprehensive assessment." The organized process of
gathering and analyzing current and past information with each
patient and the patient's family, support system and other
significant people to evaluate:
(1) Mental and functional status.
(2) Effectiveness of past treatment.
(3) Current treatment, rehabilitation and support needs
to achieve individual goals and support recovery.
"DACTS." The Dartmouth Assertive Community Treatment Scale,
a research-based instrument developed to assess the degree to
which an ACT provider achieves the ACT model and to quantify the
requirements related to a provider's organization, structure and
provision of direct services. The department shall identify the
version of DACTS for use as an assessment tool.
"Department." The Department of Human Services of the
Commonwealth.
"DSM." The Diagnostic and Statistical Manual of Mental
Disorders or any successor.
"Homeless." When an individual lives outdoors or the primary
residence of an individual during the night is in a supervised
public or private facility that provides temporary living
accommodations.
"Imminent risk of being homeless." A situation in which an
individual meets at least one of the following criteria:
(1) Doubled-up living arrangement where the individual's
name is not on the lease.
(2) Living in a condemned building without a place in
which to move.
(3) Having arrears in rent and utility payments with no
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ability to pay.
(4) Having received an eviction notice without a place
in which to move.
(5) Living in temporary or transitional housing that
carries time limits or being discharged from a health care or
correctional facility without a place to live.
"Individual treatment team." A group or combination of a
minimum of three to five team members who together have a range
of clinical and rehabilitation skills and expertise who are
assigned to a particular patient.
"Individual supportive therapy." Verbal therapies, including
psychotherapy, that help individuals make changes in their
feelings, thoughts and behavior in order to move toward
recovery, clarify goals and address self-esteem issues.
Supportive therapy helps patients identify and achieve personal
goals, understand and identify symptoms in order to find
strategies to lessen distress and symptomatology, improve role
functioning and evaluate treatment and rehabilitative services.
Psychotherapy approaches include cognitive behavioral therapy,
personal therapy and psychoeducational therapy.
"Initial assessment." An initial evaluation of a patient to
determine the following:
(1) The patient's mental and functional status.
(2) The effectiveness of past treatment.
(3) The current treatment, rehabilitation and support
service needs.
"Mental health advance directive." A written document that
describes a patient's advance directive and preference for
treatment in the event that the patient's mental illness renders
the patient unable to make decisions.
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"Office of Mental Health and Substance Abuse Services." The
Office of Mental Health and Substance Abuse Services in the
Department of Human Services.
"Patient." An individual who has agreed to receive services
and is receiving patient-centered treatment, rehabilitation and
support services from an ACT team.
"Patient-centered community support plan." The culmination
of a collaborative process involving a patient, the patient's
family with the patient's consent, the patient's identified
support network and the ACT team, which sets forth in writing a
plan that individualizes service activity and intensity to meet
patient-specific treatment, rehabilitation and support needs.
The plan documents a patient's self-determined goals and the
services necessary to help the patient achieve them. The plan
also delineates the roles and responsibilities of team members
who will carry out the services.
"Patient-centered individualized treatment plan." A patient-
centered community support plan.
"Peer support." Supportive intervention provided by a
certified peer specialist who has experience as a recipient of
mental health services for serious mental illness. The term
includes drawing on common experiences as well as using and
sharing practical experiences and knowledge gained as a
recipient of mental health services, which may validate
patients' experiences and provide guidance and encouragement to
patients to take responsibility and actively participate in
their own recovery.
"Program." The Assertive Community Treatment Program
established in section 303-B.
"Provider." A provider of ACT services licensed by the
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department under section 304-B.
"Recovery." A self-determined and holistic journey that
people undertake to heal and grow. Recovery is facilitated by
relationships and environments that provide hope, empowerment,
choices and opportunities that promote people reaching their
full potential as individuals and community members.
"Service coordination." A process of organization and
coordination within a multidisciplinary team to carry out the
range of treatment, rehabilitation and support services each
patient expects to receive in accordance with the patient's
treatment plan.
"Team member." An ACT team member.
"Treatment plan." A patient-centered community support plan
or patient-centered individualized treatment plan.
"Wellness Recovery Action Plan" or "WRAP." A tool designed
for self-management of illness and wellness that is facilitated
only by those who have completed department-approved training.
Section 303-B. Program.
(a) Establishment.--The department shall establish in its
Office of Mental Health and Substance Abuse Services the
Assertive Community Treatment Program to deliver ACT services in
each county of this Commonwealth.
(b) Organization.--An ACT team shall be organized or
identified as a separate service within the organization of the
provider. Teams operating in urban and rural settings shall be
designated as full-size teams and modified teams, respectively,
as determined by the department.
Section 304-B. Eligibility.
(a) Provider participation.--ACT providers shall be licensed
and approved by the department. A prospective provider shall
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complete an enrollment application and list each service
location that will be performing ACT.
(b) Patient eligibility.--An individual who is 18 years of
age or older and has serious and persistent mental illness shall
be eligible for ACT services. An individual shall be considered
to have a serious and persistent mental illness when all of the
following criteria are met:
(1) Primary diagnosis of schizophrenia or other
psychotic disorders, such as schizoaffective disorder or
bipolar disorder as defined in the DSM. Individuals with a
primary diagnosis of a substance use disorder, intellectual
disability or brain injury are not eligible patients.
(2) Global Assessment of Functioning Scale, as specified
in DSM, ratings of 40 or below.
(3) Patients who meet at least two of the following
criteria:
(i) At least two psychiatric hospitalizations in the
past 12 months or lengths of stay totaling over 30 days
in the past 12 months that may include admissions to
psychiatric emergency services.
(ii) Intractable severe major symptoms.
(iii) Co-occurring mental illness and substance use
disorders of more than six months' duration at the time
of contact.
(iv) High-risk or recent history of criminal justice
system involvement, which may include frequent contact
with law enforcement personnel, incarcerations, parole or
probation.
(v) Homeless, at imminent risk of being homeless or
residing in unsafe housing.
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(vi) Residing in an inpatient or supervised
community residence, but clinically assessed to be able
to live in a more independent living situation if
intensive services are provided, or requiring a
residential or institutional placement if more intensive
services are not available.
(4) Difficulty effectively utilizing traditional case
management or office-based outpatient services or evidence
that a more assertive and frequent non-office-based service
is required to meet clinical needs.
(c) Exception.--An individual who does not meet the
requirements identified in subsection (b) may be eligible for
ACT services upon written prior approval by the behavioral
health managed care organization or the county mental health and
intellectual disability office, as applicable. In order to meet
the DACTS standard related to admission criteria, at least 90%
of the patients admitted to the program shall meet the
eligibility criteria under this article.
Section 305-B. Discharge.
(a) General rule.--The program shall not have an arbitrary
time limit for patients to receive ACT services. An ACT team
shall remain a point of contact for patients as needed. The
provider shall have a no-drop-out policy and work to retain
patients at a mutually satisfactory level. In order to meet
DACTS standards for patient retention, at least 95% of a
provider's caseload must be retained over a 12-month period. A
discharge from ACT services may occur when a patient:
(1) Has successfully reached individually established
goals for discharge and when the patient and program staff
mutually agree to the termination of services.
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(2) Has successfully demonstrated an ability to function
in all major functional areas, including work, social and
self-care, without ongoing assistance from the program,
without significant relapse when services are withdrawn and
when the patient requests termination of services. When a
patient is discharged to a lower level of care, based on a
careful assessment of readiness and upon mutual agreement,
the process shall involve a transition period, including at
least 30 days of overlap of responsibility for monitoring the
patient's status and progress. The patient shall also have
the option to reenroll with the provider. After the
transition period has ended, the ACT team shall periodically
monitor the patient's engagement with a new agency until the
patient is assessed to have fully and successfully engaged
with the new agency.
(3) Moves outside the geographic area of the ACT team's
responsibility. In such cases, the ACT team shall arrange for
transfer of mental health service responsibility to a
provider or other entity within the patient's new geographic
location. The ACT team shall maintain contact with the
patient until the service transfer is implemented.
(b) Treatment refusal.--If an individual declines or refuses
services and requests discharge despite an ACT team's attempts
to engage the individual in treatment, discharge or transfer to
a lower level of care shall not occur until a thorough review of
the circumstances, clinical situation, risk factors and
strategies to reengage the individual is conducted and
documented.
Section 306-B. Responsibilities of county administrators.
County mental health administrators in partnership with
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managed care organizations, as appropriate, shall be responsible
for identifying the need for ACT services, providing for
implementation of the program in the county and developing a
fiscal plan to address program costs. County administrators
shall ensure that the latest version of DACTS is completed
annually for each ACT team either by the managed care
organization or a consultant familiar with DACTS. The results of
the most recent DACTS shall be made available to the department.
The Office of Mental Health and Substance Abuse Services' field
office staff shall monitor the compliance of ACT providers under
their jurisdiction with the provisions of this article. The
county administrators and managed care organizations shall be
responsible for providing fiscal and program outcome reports as
requested by the department.
Section 307-B. Responsibilities of providers.
Providers shall adhere to the requirements set forth in this
article and submit reports as required by the department and the
county administrator. The ACT team shall maintain written
admission and discharge policies and procedures. The provider
shall develop policies and procedures for each of the areas
identified in the standards. Providers shall maintain the
organizational and services structure that supports the program
and is useful in orienting and training new staff. The following
apply:
(1) Providers shall utilize a system to collect and
analyze data pertaining to the program that includes data
required to complete annually the latest version of the
DACTS. The system shall be capable of measuring outcomes, and
the data analysis results from the system shall be used to
improve services and processes.
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(2) Providers shall establish the minimum number of
staff persons required to cover shifts, set the frequency of
staff services contacts with patients and require gradual
admission of patients to the ACT team.
(3) An ACT team shall systematically identify any need
for assertive engagement strategies, use motivational
interventions and employ therapeutic limit setting
interventions only when needed.
Section 308-B. Department requirements.
(a) General rule.--
(1) The department shall establish minimum staff
requirements for full-size and modified ACT teams.
(2) The department shall provide standards for use by
providers in coordinating with health insurers for coverage
of ACT services , including specific time frames for
reevaluation of patients to determine their continuing
eligibility for ACT services .
Section 309-B. Personnel duties for providers.
A provider shall:
(1) Maintain written personnel policies and procedures
for hiring.
(2) Establish core staff competencies, orientation and
training.
(3) Maintain personnel files for each team member
containing the job application, copies of credentials or
licenses, position description, annual performance appraisals
and individual orientation and training plan.
Section 310-B. Patient-centered assessment and individualized
treatment planning.
(a) Assessment and treatment planning.--A patient and an
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individual treatment team shall work together to formulate a
patient-centered individualized treatment plan. The individual
treatment team members are assigned to work with a patient by
the team leader and psychiatrist prior to the first treatment
planning meeting or 30 days after admission, whichever occurs
first. The core members are the service coordinator,
psychiatrist and one clinical or rehabilitation staff person who
backs up and shares case coordination tasks and substitutes for
the service coordinator when the service coordinator is
unavailable. The individual treatment team has the
responsibility to:
(1) Be knowledgeable about the patient's life,
circumstances, goals and desires.
(2) Collaborate with the patient to develop and write
the treatment plan.
(3) Offer options and choices in the treatment plan.
(4) Ensure that immediate changes are made as a
patient's needs change.
(5) Advocate for the patient's wishes, rights and
preferences and support the patient in articulating goals and
plans.
(6) Provide the majority of the patient's treatment,
rehabilitation and support services. Individual treatment
team members are assigned to take separate service roles with
the patient as specified by the patient and the individual
treatment team in the treatment plan.
(b) Initial assessment.--An initial assessment shall be
completed the day of the patient's admission by the team leader
or the psychiatrist, with participation by designated team
members. The initial assessment shall be based upon all
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available information, including self-reports, reports of family
members and other significant parties and written summaries from
other agencies, including law enforcement, courts and outpatient
and inpatient facilities, where applicable. The assessment shall
include a review of all aspects of an individual's life,
including physical health, and shall not be limited to mental
health information only. The results of the information
gathering and analysis are used to establish the initial
treatment plan to support recovery and help the patient achieve
individual goals. The patient's initial assessment and treatment
plan guide team services until the comprehensive assessment and
treatment plan are completed. At a minimum, the initial
assessment shall contain the following patient information, with
patient strengths listed for each appropriate item:
(1) Name and date of birth.
(2) Telephone number.
(3) Next of kin.
(4) Emergency contact.
(5) Date of admission to the program.
(6) Social Security number.
(7) Presenting problem.
(8) Self-assessment of problem.
(9) Reason for treatment.
(10) Availability of social supports and resources.
(11) History of psychiatric illness and previous
services.
(12) Developmental and social history.
(13) Current functioning.
(14) Mental health diagnosis per the DSM.
(15) Primary care physician information.
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(16) Physical health diagnosis.
(17) Current medication list.
(18) Justification for admission.
(19) Name of the primary case manager.
(c) Initial treatment plan.--A patient's initial treatment
plan shall be completed on the day of admission and shall guide
ACT team services until the comprehensive assessment and
comprehensive treatment plan are completed. Interventions from
the initial treatment plan shall be reported on the patient's
weekly schedule. The service coordinator and individual
treatment team members shall be assigned by the team leader in
collaboration with the psychiatrist at the initial treatment
planning meeting. The time frame to assign the service
coordinator and individual treatment team members shall not
exceed six weeks from the date of admission. At a minimum, the
initial treatment plan shall contain the following information:
(1) Patient name.
(2) Date.
(3) Short-term goals.
(4) Problems to be addressed.
(5) Objectives.
(6) Patient or guardian participation.
(7) Patient's signature.
(8) Team leader's signature.
(d) Comprehensive assessment.--Each part of the assessment
shall be completed by a team member with skill and knowledge in
the area being assessed. The assessment is based upon all
available information, including information obtained from
patient interview, family members of the patient and other
significant parties and written summaries from other agencies,
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including law enforcement, courts and outpatient and inpatient
facilities, where applicable. The results of the information
gathering and analysis are used to establish immediate and long-
term service needs, to set goals and to develop the initial
treatment plan with each patient. A comprehensive assessment
shall be initiated and completed within six weeks after a
patient's admission according to the following requirements:
(1) In collaboration with the patient, the individual
treatment team shall complete a psychiatric and social
functioning history timeline to chronologically organize
information about significant events in a patient's life, the
patient's experience with mental illness and treatment
history. The individual treatment team shall analyze and
evaluate the information systematically to formulate
hypotheses for treatment and to determine appropriate
treatment and rehabilitation approaches and interventions
with the patient.
(2) In collaboration with the patient, the comprehensive
assessment shall include an evaluation in the following
areas:
(i) Psychiatric history, mental status and
diagnosis. The psychiatrist shall be responsible for
completing the psychiatric history, mental status and
diagnosis assessment. A psychiatrist or a clinical or
counseling psychologist shall make an accurate diagnosis.
The psychiatrist shall present the assessment findings at
the initial treatment planning meeting. The psychiatric
history, mental status and diagnosis assessment shall
include information from the patient, the patient's
family and past treatment records regarding onset,
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precipitating events, course and effect of illness,
including past treatment and treatment responses, risk
behaviors and current mental status. The psychiatric
history, mental status and diagnosis assessment shall be
used to effectively plan with the patient and the
patient's family the best treatment approach in order to
ensure accuracy of the diagnosis, to eliminate or reduce
symptomatology and to improve social, vocational and
avocational functioning.
(ii) Physical health. A registered nurse shall be
responsible for completing the physical health
assessment. The registered nurse shall present the
assessment findings at the initial treatment planning
meeting. The physical health assessment shall assess
health status and any medical conditions present to
ensure that appropriate treatment, follow-up and support
are provided to the patient. The first interview of a
patient for the purpose of assessment shall take place
within 72 hours of admission.
(iii) Use of drugs or alcohol. A team member with
experience and training in dual diagnosis substance abuse
assessment and treatment shall be responsible for
completing the use of drugs and alcohol assessment. The
substance abuse specialist shall present the assessment
findings at the initial treatment planning meeting.
(iv) Education and employment. A team member with
experience and training in vocational assessment and
services shall be responsible for completing the
education and employment assessment. The vocational
specialist shall present the assessment findings at the
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initial treatment planning meeting. A provider shall not
exclude a patient due to poor work history or ongoing
symptoms or impairments related to mental illness. The
education and employment assessment shall determine
current school or employment status, interests and
preferences regarding school and employment and how
symptomatology has affected previous and current school
and employment performance.
(v) Social development and functioning. A team
member who is interested and skillful in attainment and
restoration of social and interpersonal skills and
relationships and who is knowledgeable about human
development shall be responsible for completing the
social development and functioning assessment. The team
member who completes the assessment shall present the
assessment findings at the initial treatment planning
meeting. The social development and functional assessment
shall obtain information from the patient about the
patient's childhood, early attachments, role in family of
origin, adolescent and young adult development, culture,
religious beliefs, leisure activities, interests and
social skills. The ACT team shall evaluate how
symptomatology has interrupted or affected personal and
social development, collect information regarding the
patient's involvement with the criminal justice system
and identify social and interpersonal issues appropriate
for individual supportive therapy.
(vi) Activities of daily living (ADL) assessment.
Occupational therapists and nurses shall be responsible
to complete the ADL assessment. Other staff members with
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appropriate training and who have interest in and
compassion for patients in this area may complete the ADL
assessment. The team member who completes the assessment
shall present the assessment findings at the initial
treatment planning meeting. The ADL assessment shall
enable the ACT team to determine the level of assistance,
support and resources the patient needs to reestablish
and maintain ADL. The ADL assessment shall evaluate:
(A) The individual's current ability to meet
basic needs.
(B) The quality and safety of the patient's
current living situation.
(C) The adequacy of the patient's financial
resources.
(D) The effect that symptoms and impairments of
mental illness have had on self-care.
(E) The patient's ability to maintain an
independent living situation.
(F) The patient's desires and individual
preferences.
(vii) Family structure and relationships. Members of
a patient's individual treatment team shall be
responsible for carrying out the family structure and
relationships assessment. The staff members working with
the family shall present the assessment findings at the
initial treatment planning meeting. The purpose of the
family structure and relationships assessment shall be to
obtain information from the patient's family and other
significant people about their perspective of the
patient's mental illness and to determine their level of
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understanding about mental illness as well as their
expectations of ACT services. This information shall
allow the ACT team to define the contact or relationship
between the patient and the patient's family in regard to
the patient's goals, treatment and rehabilitation. The
assessment shall begin at the time of admission.
(3) A patient's psychiatrist, service coordinator and
individual treatment team members shall assume responsibility
for preparing the written narrative of the results and
formulation of the psychiatric and social functioning history
timeline and the comprehensive assessment. The psychiatric
and social functioning history timeline and comprehensive
assessment shall be completed within six weeks of the
patient's admission to the program.
(e) Individualized community support planning.--The ACT team
shall use recovery planning tools, such as WRAP, and shall
incorporate the individual's recovery planning into all aspects
of treatment and service planning. The ACT team shall also
develop mental health advance directives with each patient,
unless the patient declines. Treatment plans shall be developed
within eight weeks of admission through the following treatment
planning process:
(1) A treatment plan shall be developed in collaboration
with the patient and the patient's family or guardian, if
any, when feasible and appropriate. The patient's
participation in the development of the treatment plan shall
be documented. The ACT team and the patient shall assess the
patient's needs, strengths and preferences and develop a
treatment plan. The treatment plan shall be guided primarily
by the patient's self-selected goals and it shall:
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(i) Identify individual strengths, issues and
problems.
(ii) Set specific measurable short-term and long-
term goals for each issue and problem.
(iii) Establish the specific approaches and
interventions necessary for the patient to meet the
stated goals, improve capacity to function as
independently as possible in the community and achieve
the maximum level of recovery possible.
(2) Team members shall meet at regularly scheduled times
for treatment planning meetings. At each meeting, the
following staff shall attend:
(i) Team leader.
(ii) Psychiatrist.
(iii) Service coordinator.
(iv) Individual treatment team members.
(v) Peer specialist.
(vi) Other team members involved in regular tasks
with the patient.
(3) Individual treatment team members shall be
responsible to ensure the patient is actively involved in the
development of recovery and service goals. With the
permission of the patient, team members shall also involve
pertinent agencies and members of the patient's social
network in the formulation of treatment plans.
(4) Each patient's treatment plan shall identify the
patient's issues and problems, strengths and weaknesses and
specific measurable short-term and long-term recovery goals.
The plan shall clearly specify the approaches and
interventions necessary for the patient to achieve the
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individual goals and identify who will carry out the
approaches and interventions. A treatment plan shall
incorporate two or more strengths and resources as identified
in the comprehensive assessment.
(5) The following key areas should be addressed in each
patient's treatment plan:
(i) Psychiatric illness or symptom reduction.
(ii) Housing.
(iii) Activities of daily living.
(iv) Daily structure and employment.
(v) Family and social relationships.
(vi) Trauma assessment.
(vii) Violence assessment.
(6) The service coordinator and the individual treatment
team, together with the patient, shall be responsible for
reviewing and rewriting the treatment goals and plan whenever
there is a major decision point in the patient's course of
treatment or at least every six months, whichever comes
first. The service coordinator shall prepare a summary which
thoroughly describes in writing the patient's and the
individual treatment team's evaluation of patient progress
and goal attainment, the effectiveness of the interventions
and the patient's satisfaction with services since the most
recent treatment plan. The plan and review shall be signed or
verbally approved by the patient, service coordinator,
individual treatment team members, team leader, psychiatrist
and team members.
(7) An ACT team shall maintain written assessment and
treatment planning policies and procedures incorporating the
requirements outlined in this section.
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Section 311-B. Required services.
(a) General rule.--An ACT team shall provide comprehensive
treatment, rehabilitation and support services as a self-
contained service unit. Services shall at a minimum include the
following:
(1) Service coordination. Each patient shall be assigned
a service coordinator who shall have the primary
responsibility for a patient. A service coordinator shall
lead and monitor the activities of the patient's individual
treatment team and is responsible for service coordination
for the patient. Service coordination shall include
coordination with community resources, including patient
self-help and advocacy organizations that promote recovery.
Members of the patient's individual treatment team shall
share service coordination duties with the service
coordinator and are responsible for performing the duties in
the absence of the service coordinator. In all cases, team
members work with each patient and shall be conversant with a
patient's strengths, background and treatment plan. A service
coordinator:
(i) Has primary responsibility for:
(A) Establishing and maintaining a therapeutic
relationship with the patient on a continuing basis.
(B) Collaborating with the patient to develop a
treatment plan.
(C) Providing individual supportive therapy.
(D) Offering options and choices in the
treatment plan.
(E) Ensuring that immediate changes are made as
the patient's needs change.
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(F) Advocating for the patient's wishes, rights
and preferences.
(ii) May be the first staff person called upon when
the patient is in crisis.
(iii) Provides primary support and education to the
patient's family and support system and to other
significant people in the patient's life.
(iv) Works with community resources, including the
county mental health and intellectual disability office
and patient-run services, to coordinate and integrate
these resources into the patient's treatment plan.
(2) Crisis assessment and intervention. Crisis
assessment and intervention that includes telephone and face-
to-face contact shall be provided 24 hours a day, seven days
a week.
(3) Symptom assessment and management, including, but
not limited to, the following:
(i) Ongoing comprehensive assessment of the
patient's mental illness symptoms, accurate diagnosis and
the patient's response to treatment.
(ii) Psychoeducation regarding mental illness and
the effects and side effects of prescribed medications.
(iii) Symptom management efforts directed to help
each patient identify and target the symptoms and
occurrence patterns of mental illness and develop methods
to help lessen the effects.
(iv) Individual supportive therapy.
(v) Psychotherapy.
(vi) Psychological support, on a planned and as-
needed basis, to help patients accomplish their personal
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goals, to cope with the stressors of day-to-day living
and to recover.
(4) Medication prescription, administration, monitoring
and documentation by psychiatrist. T he ACT team psychiatrist
shall:
(i) Establish an individual clinical relationship
with each patient.
(ii) Assess each patient's mental illness symptoms
and determine how these symptoms affect the patient's
ability to function productively and provide verbal and
written information about mental illness to the ACT team,
the patient and the patient's family or significant
others with the patient's consent.
(iii) Make an accurate diagnosis based on the
comprehensive assessment.
(iv) Provide education about medication, benefits
and risks and obtain informed consent.
(v) Assess and document the patient's mental illness
symptoms, behavior and social and community involvement
in response to medication and monitor and document
medication side effects.
(vi) Provide psychotherapy.
(5) Medication prescription, administration, monitoring
and documentation by team members. Team members shall assess
and document a patient's mental illness symptoms and behavior
in response to medication and shall monitor medication side
effects.
(6) Medication prescription, administration, monitoring
and documentation by program. The program shall establish
medication policies and procedures consistent with applicable
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Federal and State law to identify processes to:
(i) Record physician orders.
(ii) Order medication.
(iii) Arrange for patient medications to be
organized by the ACT team and integrated into patients'
weekly schedules and daily staff assignment schedules.
(iv) Provide security for medications and set aside
a private designated area for set up of medications by
the ACT team's nursing staff.
(v) Administer medications in accordance with State
law.
(7) Dual diagnosis substance abuse services as follows:
(i) Provision of a stage-based treatment model that:
(A) is nonconfrontational;
(B) considers interactions of mental illness and
substance abuse;
(C) follows cognitive-behavioral principles;
(D) does not expect complete abstinence and
supports harm reduction;
(E) understands and applies stages of change
readiness in treatment;
(F) incorporates skillful use of motivational
interviewing interventions; and
(G) has patient-determined goals.
(ii) A stage-based treatment model shall include,
but is not limited to, individual and group interventions
in:
(A) Engagement.
(B) Assessment, such as stage of readiness to
change and patient-determined problem identification.
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(C) Motivational enhancement, such as developing
discrepancies and psycho-education.
(D) Active treatment, such as cognitive skills
training and community reinforcement.
(E) Continuous relapse prevention, such as
trigger identification and building relapse
prevention action plans.
(8) Work-related services. Work-related services are
those services that help patients value, find and maintain
meaningful employment in community-based job sites. Work-
related services include, but are not limited to:
(i) Assessment of job-related interests and
abilities through a complete education and work history
assessment as well as on-the-job assessments in
community-based jobs.
(ii) Assessment of the effect of the patient's
mental illness on employment with identification of
specific behaviors that interfere with the patient's work
performance and development of interventions to reduce or
eliminate those behaviors and find effective job
accommodations.
(iii) Development of an ongoing employment
rehabilitation plan to help each patient establish the
skills necessary to find and maintain a job.
(iv) Individual supportive therapy to assist
patients to identify and cope with mental illness
symptoms that may interfere with their work performance.
(v) On-the-job or work-related crisis intervention.
(vi) Work-related supportive services, such as
assistance with grooming and personal hygiene, securing
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of appropriate clothing, wake-up calls and
transportation, if needed.
(vii) Maintaining ongoing relationships with
employers to facilitate the creation of work environments
that would be conducive to the hiring of patients seeking
employment.
(viii) Assisting patients in locating jobs that they
are interested in and making the initial contact with the
employer to arrange for any accommodations as necessary
or if requested by patients.
(9) Activities of daily living. Services to support
activities of daily living in community-based settings
include individualized assessment, problem solving,
sufficient assistance and support, skill training, ongoing
supervision and environmental adaptations to assist patients
to gain or use the skills required to:
(i) Find housing which is safe, of good quality and
affordable, and make living arrangements.
(ii) Perform household activities, including house
cleaning, cooking, grocery shopping and laundry, and
carry out personal hygiene and grooming tasks, as needed.
(iii) Develop or improve money management skills.
(iv) Use available transportation.
(v) Have and effectively use a personal physician
and dentist.
(10) Social and interpersonal relationship and leisure
time skill training. Services to support social and
interpersonal relationships and leisure time skill training
include individual supportive therapy; social skills teaching
and assertiveness training; planning, structuring, and
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prompting of social and leisure time activities; support and
coaching; and organizing individual and group social and
recreational activities to structure patients' time, increase
their social experiences and provide them with opportunities
to practice social skills and receive feedback and support
required to:
(i) Improve communication skills, develop
assertiveness and increase self-esteem.
(ii) Develop social skills, increase social
experiences and develop meaningful personal
relationships.
(iii) Plan appropriate and productive use of leisure
time.
(iv) Relate to landlords, neighbors and others
effectively.
(v) Become familiar with available social and
recreational opportunities and increase use of such
opportunities.
(11) Peer support services. Peer support services
validate patients' experiences and guide and encourage
patients to take responsibility for and actively participate
in recovery. In addition, these services help patients
identify, understand and combat stigma and discrimination
against mental illness and develop strategies to enhance
self-esteem. Peer support services are multifaceted and
include, but are not limited to:
(i) Individual advocacy, crisis management support
and skills training.
(ii) Introduction and referral to patient self-help
programs and advocacy organizations that promote
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recovery.
(iii) Access and utilization of natural resources
within the community.
(iv) Cultivation of self-worth and a sense of
wellness.
(v) Modeling recovery-oriented attitudes and
behaviors.
(12) Support services. Support services or direct
assistance to ensure that patients obtain the basic
necessities of daily life, including, but not limited to:
(i) Medical and dental services.
(ii) Safe, clean, affordable housing. An ACT team
shall partner with patients in individual housing
assessment and planning. Patients may choose housing in
the most integrated setting possible.
(iii) Financial support and benefits counseling.
(iv) Social service.
(v) Transportation.
(vi) Legal advocacy and representation.
(13) Education and support of and consultation with
patients' families and other support services. Services
provided regularly under this category to patients' families
and other support services, with patient agreement or
consent, shall include:
(i) Individualized psychoeducation about the
patient's illness and the role of the family and other
significant people in the therapeutic process.
(ii) Intervention to restore contact, resolve
conflict and maintain relationships with family and other
significant people.
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(iii) Ongoing communication and collaboration, face-
to-face and by telephone, at least two times per month
for each patient, between the ACT team and the patient's
family and other significant people.
(iv) Introduction and referral to family self-help
programs and advocacy organizations that promote
recovery.
(v) Assistance to patients with children, including
individual supportive therapy, parenting training and
service coordination, including, but not limited to:
(A) Services to help patients throughout
pregnancy and the birth of a child.
(B) Services to help patients fulfill parenting
responsibilities and coordinate services for their
children.
(vi) Services to help patients restore relationships
with children who are not in the patient's custody.
(b) Duties of provider.--The provider shall maintain written
policies and procedures for all services outlined in this
section. If a patient requires services that an ACT team is not
mandated to provide, the team shall coordinate those services
with other providers or entities or consult with other providers
or entities to assist the team in meeting the comprehensive
needs of the individual.
Section 312-B. Recordkeeping.
Records shall be maintained in accordance with department
guidelines to verify compliance with the requirements of this
article and shall be retained for a minimum of seven years. Site
survey reports, employee schedules, payroll records, patient
case records, medication records, job descriptions, documents
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verifying employee qualifications and training, policies and
protocols, fees or charges, records of supervision and training,
letters of agreements with referral sources and service agencies
and a grievance and appeals process are records that shall be
kept to verify compliance with this article.
Section 313-B. Patient rights and grievance procedures.
(a) General rule.--Providers shall have and maintain
policies and procedures for patient rights and grievance
procedures that ensure compliance with Federal and State laws
and ensure that all team members fully understand, inform and
respect a patient's right to appropriate treatment in a setting
and under conditions that are the most supportive of each
individual's personal liberty and restrict such liberty only to
the extent necessary consistent with each patient's treatment
needs, applicable requirements of law and applicable judicial
orders.
(b) Confidentiality and treatment conditions.--Providers
shall be knowledgeable about and familiar with patient rights,
including the right to:
(1) Confidentiality.
(2) Informed consent to medication and treatment.
(3) Treatment with respect and dignity.
(4) Prompt, adequate and appropriate treatment.
(5) Treatment which is under the least restrictive
conditions.
(6) Nondiscrimination.
(7) Control own money.
(8) File grievances or complaints.
(9) Mental health advance directives.
(c) Grievance and complaint procedures.--Providers shall be
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knowledgeable about and familiar with the mechanisms to
implement and enforce patient rights with regard to:
(1) Grievance or complaint procedures under State law.
(2) Medicaid.
(3) The Americans with Disabilities Act of 1990 (Public
Law 101-336, 104 Stat. 327).
(4) Protection and advocacy for individuals with mental
illness.
(5) Mental health advance directives.
Section 314-B. Culturally and linguistically appropriate
services.
Providers shall:
(1) Ensure that patients receive effective,
understandable and respectful care that is provided in a
manner compatible with patients' cultural health beliefs and
practices and written and spoken language preferences,
including American Sign Language and Braille.
(2) Maintain written culturally and linguistically
appropriate services policies and procedures in accordance
with this section.
(3) Implement strategies to recruit, retain and promote
a diverse staff that are representative of the demographic
characteristics of the service area.
(4) Ensure that staff at all levels and across all
disciplines receive ongoing education and training in
culturally and linguistically appropriate service delivery.
(5) Offer and provide language assistance services,
including bilingual staff and interpreter services, at no
cost to each patient with limited English proficiency at all
points of contact, in a timely manner during hours of
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operation.
(6) Provide to patients, in their preferred language,
both verbal offers and written notices informing them of
their right to receive language assistance services.
(7) Assure the competence of language assistance
provided to limited English proficient patients by
interpreters and bilingual staff. Family and friends shall
not be used to provide interpretation services except when
requested by the patient.
(8) Make available easily understood patient-related
materials and post signage in the languages of the commonly
encountered groups and groups represented in the service
area.
(9) Develop, implement and promote a written strategic
plan that outlines clear goals, policies, operational plans
and management accountability and oversight mechanisms to
provide culturally and linguistically appropriate services.
(10) Conduct initial and ongoing organizational self-
assessments of culturally and linguistically appropriate
services and related activities and are encouraged to
integrate cultural and linguistic competence-related measures
into providers' internal audits, performance improvement
programs, patient satisfaction assessments and outcome-based
evaluations.
(11) Ensure that data on the individual patient's race,
ethnicity and spoken and written language are collected in
health records, integrated into the organization's management
information systems and periodically updated.
(12) Develop participatory and collaborative
partnerships with communities and utilize a variety of formal
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and informal mechanisms to facilitate community and patient
involvement in designing and implementing culturally and
linguistically appropriate services and related activities.
(13) Ensure that conflict and grievance resolution
processes are culturally and linguistically sensitive and
capable of identifying, preventing and resolving cross-
cultural conflicts or complaints by patients.
(14) Make available to the public information about
implementing the culturally and linguistically appropriate
services standards and provide public notice in the community
served of the availability of this information.
Section 315-B. Performance improvement and program evaluation.
(a) General rule.--Providers shall maintain performance
improvement and program evaluation policies and procedures. Each
provider shall evaluate the following:
(1) Patient outcome.
(2) Patient and family satisfaction with the services,
including independent patient family satisfaction team
reviews.
(3) The degree to which a provider conforms to the ACT
model using the latest version of DACTS. The DACTS shall be
completed annually for each provider either by the managed
care organization or a consultant familiar with DACTS. DACTS
scores shall be used to determine any corrective actions. The
department shall review the results of the DACTS scale along
with the program standards as part of the licensing and
approval process.
(b) Plan.--A provider shall have a performance improvement
and program evaluation plan, which shall include the following:
(1) A statement of the objectives relating directly to
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the program's patients or target population.
(2) Measurable criteria that shall be applied in
determining whether or not the stated objectives are
achieved.
(3) Methods for documenting achievements related to the
program's stated objectives.
(4) Methods for assessing the effective use of staff and
resources toward the attainment of the objectives.
(c) System.--A provider shall have a system for regular
review that is designed to evaluate the appropriateness of
admissions to the program, treatment or service plans, discharge
practices and other factors that may contribute to the effective
use of the program's resources.
Section 316-B. Rate setting and payment.
The department shall issue separate communications to address
rate setting and payments.
Section 317-B. ACT advisory committee.
(a) Policies and procedures.--A provider shall maintain
written advisory committee policies and procedures,
incorporating the requirements outlined in this section.
(b) Advisory committee.--Each provider shall establish an
advisory committee to support and enhance the ACT team through
assistance with start up, implementation and ongoing operations.
The committees shall support ACT teams as the providers deliver
each patient high quality, recovery-oriented services.
(c) Membership.--The committee membership shall be
representative of the populations served by the provider and
shall include representation from various stakeholder groups in
the community. At least 51% of the advisory committee shall be
comprised of recipients or former recipients of mental health
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services and family members. Other community stakeholders and
representatives from diverse community services, such as patient
support organizations, food pantries, homeless shelters, housing
authorities, landlords, educational institutions, the criminal
justice system, employers and the business community shall
constitute the remainder of the advisory committee. The
committee membership shall also represent the cultural diversity
of the local population.
(d) Meetings.--An advisory committee shall meet at least
quarterly, with regular attendance by a team leader or designee,
and shall:
(1) Promote the development and continuation of quality
ACT services.
(2) Review compliance with program audits and ACT
program standards.
(3) Inform and support the department's ongoing quality
improvement process.
(4) Promote and ensure the presence of patients'
empowerment and recovery values.
(5) Examine program outcome measures, including patient
and family satisfaction.
Section 318-B. Waiver of provisions.
(a) General rule.--Providers may request waivers of
requirements in program standards.
(b) Waiver conditions.--A provider may request from the
department a waiver of any required standard that would not
diminish the effectiveness of ACT services, violate the purposes
of the program or adversely affect patients' health and welfare.
A waiver shall not be granted if inconsistent with patient
rights or Federal, State or local law or regulation.
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(c) Admission decisions.--Requests for admission of
individuals who do not meet the eligibility criteria for ACT
services shall be directed to the behavioral health managed care
organization or the county mental health and intellectual
disability office, as applicable, for approval.
Section 2. This act shall take effect in 180 days.
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