senate Bill S2225D

2013-2014 Legislative Session

Enhances the assisted outpatient treatment program and eliminates the expiration and repeal of Kendra's Law

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  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor

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Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Jun 16, 2014 referred to mental health
delivered to assembly
passed senate
Jun 09, 2014 ordered to third reading cal.1201
committee discharged and committed to rules
Jun 06, 2014 print number 2225d
amend and recommit to mental health and developmental disabilities
Jan 30, 2014 print number 2225c
amend and recommit to mental health and developmental disabilities
Jan 08, 2014 referred to mental health and developmental disabilities
May 30, 2013 print number 2225b
amend and recommit to mental health and developmental disabilities
Feb 14, 2013 print number 2225a
amend and recommit to mental health and developmental disabilities
Jan 14, 2013 referred to mental health and developmental disabilities

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S2225 - Bill Details

Current Committee:
Law Section:
Mental Hygiene Law
Laws Affected:
Amd §§7.17, 9.47, 9.48, 9.60 & 29.15, Ment Hyg L; amd §404, Cor L; amd §18, Chap 408 of 1999
Versions Introduced in 2011-2012 Legislative Session:
S4881A

S2225 - Bill Texts

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Enhances the assisted outpatient treatment program; eliminates the expiration and repeal of Kendra's Law.

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BILL NUMBER:S2225

TITLE OF BILL: An act to amend the mental hygiene law and the
correction law, in relation to enhancing the assisted outpatient
treatment program; and to amend Kendra's Law, in relation to making
the provisions thereof permanent

PURPOSE OR GENERAL IDEA OF BILL: To improve care for people with
serious mental illness, and protect the safety of patients and the
public by streamlining and improving New York's Assisted Outpatient
Treatment (AOT) program (Kendra's Law).

SUMMARY OF SPECIFIC PROVISIONS:

Section 1 amends Mental Hygiene Law (MHL) S 7.17(f) to require that
AOT program coordinators monitor local programs to ensure that
expiring ACT orders are adequately reviewed to consider the need for
renewal of the order; to ensure appropriate assignment of a director
for each outpatient; and to monitor local needs for training of judges
and court personnel in order for the office of mental health to
adequately provide such training.

Section 2 provides that the Commissioner of Mental Health shall
develop an educational pamphlet on the process of petitioning for AOT
to be made available to persons wishing to submit reports of
individuals who may be in need of AOT, as well as disseminated to
family members and other individuals eligible to petition for AOT.

Section 3 amends 5 9.47 of the MHL to clarify that directors of
community services shall be responsible for ensuring that reports of
persons who may be in need of continued AOT orders are subject to a
timely investigation. It also provides that directors of community
services shall notify program coordinators when AOT patients cannot be
located or are believed to have taken residence outside of the local
governmental unit served.

Section 4 amends MHL § 9.48 to require that ACT program directors'
quarterly reports to program coordinators include information on any
expired AOT court orders, including the determination made as to
whether to petition for renewal of the AOT, the basis for such
determination, and the court's disposition of the renewal petition, if
any.

Section 5 amends MHL § 9.60 to clarify that assisted outpatient
treatment services provided may include: medication education or
symptom management education; appointment of a representative payee;
and that tests for alcohol or drugs may be random. This section also
provides that the parties to the treatment order may stipulate, upon
mutual consent, that an examining physician need not testify in court.
The bill also provides that the appointed physician shall make a
reasonable effort to gather relevant information for the development
of a treatment plan from a member or members of the patient's family
or significant other.

This section also clarifies that directors of hospitals or
superintendents of correctional facilities may initiate a petition.


This section also requires the Commissioner to establish by regulation
a procedure to ensure that reports of persons who may be in need of
AOT that are made by family and community members of such person axe,
if warranted, investigated in a timely manner, and that ACT petitions
are filed, where appropriate.

This section also provides that the Commissioner shall promulgate
regulations to require that prior to a assisted outpatient relocating
to a location within the state of New York which is not served by his
or her current director of community services, that patient or other
appropriate party must notify the program coordinator. The program
coordinator shall then redetermine who the appropriate director shall
be, and cause a copy of the court order and treatment plan to be
transmitted to the new director.

This section also provides that a director shall review whether the
assisted outpatient continues to meet ACT criteria within 30 days
before the expiration of an order for AOT. If the director determines
that such assisted outpatient no longer meets the criteria, such
director is required to give notice to the program coordinator that a
petition for continued AOT is unnecessary. However, if such assisted
outpatient continues to meet the criteria, as determined by the
director, such director shall file a petition for continued treatment.

This provision clarifies procedures any other person authorized to
petition for continued AOT may use to bring such petition in the event
that the appropriate director or current petitioner does not petition
for continued AOT prior to the expiration of the court order.

This section also provides that counties shall notify the department
when an assisted outpatient is missing and thereby unavailable for an
evaluation as to whether he or she continues to meet AOT criteria. It
also provides that when a patient is missing upon the expiration date
of the order, the order shall be extended until sixty days after such
patient is found.

Section 6 amends MHL § 29.15 to provide that if the director of the
hospital does not petition for AOT upon the discharge of an
involuntarily committed inpatient or upon the expiration of a period
of conditional release for such inpatient, such director shall report
the discharge in writing to the director of community services of the
local government unit where the inpatient is expected to reside.

Section 7 amends subdivision 1 of section 404 of the correction law to
require that, prior to discharging an inmate who is still mentally
ill, the director shall, where appropriate, either apply for a
person's admission to a hospital for care and treatment, or initiate a
petition for an order authorizing assisted outpatient treatment, or
the commissioner may apply for the person's admission to a secure
treatment facility.

Section 8 would repeal the current sunset date of June 30, 2015 to
make the provisions of Kendra's Law permanent.

Section 9 Severability.

Section 10 states that this act shall take effect immediately.


JUSTIFICATION: In 1999, the legislature enacted "Kendra's Law,"
establishing a statewide court-ordered assisted outpatient treatment
(AOT) program to improve outcomes for persons with severe mental
illness who, in view of their treatment history and present
circumstances, are likely to have difficulty living safely in the
community. At the approach of the law's original 2005 expiration date,
the legislature took note of Office of Mental Health (OMH) research
documenting declines in rates of homelessness, hospitalization,
substance abuse, alcoholism, violence, arrest and incarceration, and
documented increases in treatment compliance, service engagement and
positive consumer perceptions. In 2005 and 2010, the legislature opted
to extend Kendra's Law for an additional five years to further
evaluate the program.

On June 30, 2009, a team of independent researchers released the
report of their long term study of AOT throughout New York State and
in October, 2010 Psychiatric Services published six peer reviewed
studies on the AOT program. These reports confirm the earlier OMH
data. These studies found patients given mandatory outpatient
treatment who were more violent to begin with - were nevertheless four
times less likely than members of the control group to perpetrate
serious violence after undergoing assisted outpatient treatment and
found less frequent psychiatric hospitalizations, shorter length of
hospitalizations, reduction in the likelihood of arrest, higher social
functioning, slightly less stigma and no increase in perceived
coercion. AOT stimulates service providers efforts to prioritize care
for AOT recipients; judges hearing AOT cases could benefit from
additional AOT training; counties favored increasing the availability
of stipulations to reduce the court burden, costs, and transportation
burdens; recipients are far more likely than other patients to
consistently receive psychotropic medications appropriate to their
psychiatric condition; that those who receive AOT for periods of at
least one year are more likely than those who receive AOT for shorter
periods to sustain gains after leaving the program; that the law has
been applied in a non-discriminatory manner; and that the court order
itself, in addition to high quality services, is a significant factor
in the program's success.

The experience of thousands of patients, treatment providers and
families who have utilized Kendra's Law since 1999, point to several
areas where the law should be improved to achieve costs savings,
promote smoother functioning of the AOT program and easier access to
those who stand to benefit from it. The amendments included in this
act are intended to reflect these findings and maximize the unique
potential of this legislation to simultaneously serve the goals of
compassionate care, fiscal responsibility, and public safety.

PRIOR LEGISLATIVE HISTORY: 2011-12: S.4881-B - referred to Mental
Health/Developmental Disabilities

FISCAL IMPLICATIONS: To be determined. Cost-savings for the state and
local governments are anticipated following implementation, due to
reduced instances of hospitalizations and incarcerations that would
result.

EFFECTIVE DATE:This act shall take effect immediately.


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                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  2225

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                            January 14, 2013
                               ___________

Introduced by Sens. YOUNG, ADAMS, ADDABBO, AVELLA, BALL, BONACIC, BOYLE,
  DeFRANCISCO,   FARLEY,  GALLIVAN,  GOLDEN,  GRIFFO,  HASSELL-THOMPSON,
  LANZA,  LARKIN,  LIBOUS,  LITTLE,  MARCELLINO,   MARCHIONE,   MARTINS,
  MAZIARZ,  NOZZOLIO, RITCHIE, SEWARD, VALESKY -- read twice and ordered
  printed, and when printed to be committed to the Committee  on  Mental
  Health and Developmental Disabilities

AN  ACT  to  amend  the  mental  hygiene  law and the correction law, in
  relation to enhancing the assisted outpatient treatment  program;  and
  to  amend  Kendra's  Law, in relation to making the provisions thereof
  permanent

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1.  Paragraph  2  of  subdivision  (f) of section 7.17 of the
mental hygiene law, as amended by chapter 158 of the laws  of  2005,  is
amended to read as follows:
  (2)  The  oversight  and monitoring role of the program coordinator of
the assisted outpatient treatment program  shall  include  each  of  the
following:
  (i)  that each assisted outpatient receives the treatment provided for
in the court order issued pursuant to section  9.60  of  this  [chapter]
TITLE;
  (ii)  that  existing  services  located  in  the assisted outpatient's
community are utilized whenever practicable;
  (iii) that a case manager or assertive  community  treatment  team  is
designated for each assisted outpatient;
  (iv)  that  a  mechanism  exists  for  such case manager, or assertive
community treatment team, to regularly report the assisted  outpatient's
compliance, or lack of compliance with treatment, to the director of the
assisted outpatient treatment program;
  (v)  that directors of community services establish procedures [which]
THAT provide that reports of persons who may  be  in  need  of  assisted

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD02670-01-3

S. 2225                             2

outpatient  treatment are appropriately investigated in a timely manner;
[and]
  (vi)  that  assisted  outpatient treatment services are delivered in a
timely manner[.];
  (VII) THAT, PRIOR TO THE EXPIRATION OF ASSISTED  OUTPATIENT  TREATMENT
ORDERS,  THE  CLINICAL  NEEDS  OF  ASSISTED  OUTPATIENTS  ARE ADEQUATELY
REVIEWED IN DETERMINING THE NEED  TO  PETITION  FOR  CONTINUED  ASSISTED
OUTPATIENT TREATMENT PURSUANT TO SUBDIVISION (M) OF SECTION 9.60 OF THIS
TITLE;
  (VIII)  THAT  THE APPROPRIATE DIRECTOR IS DETERMINED FOR EACH ASSISTED
OUTPATIENT, PURSUANT TO SUBDIVISIONS (K) AND (L) OF SECTION 9.60 OF THIS
TITLE; AND
  (IX) THAT THE OFFICE FULFILLS ITS DUTIES PURSUANT TO  SUBDIVISION  (T)
OF SECTION 9.60 OF THIS TITLE TO MEET LOCAL NEEDS FOR TRAINING OF JUDGES
AND COURT PERSONNEL.
  S  2.  Subdivision  (f)  of  section 7.17 of the mental hygiene law is
amended by adding a new paragraph 5 to read as follows:
  (5) THE COMMISSIONER SHALL DEVELOP  AN  EDUCATIONAL  PAMPHLET  ON  THE
PROCESS  OF  PETITIONING  FOR  ASSISTED OUTPATIENT TREATMENT FOR DISSEM-
INATION TO INDIVIDUALS SEEKING TO SUBMIT REPORTS OF PERSONS WHO  MAY  BE
IN  NEED  OF  ASSISTED  OUTPATIENT TREATMENT, AND INDIVIDUALS SEEKING TO
FILE A PETITION PURSUANT TO SUBPARAGRAPH (I) OR (II) OF PARAGRAPH ONE OF
SUBDIVISION (F) OF SECTION 9.60 OF THIS TITLE. SUCH PAMPHLET  SHALL  SET
FORTH,  IN  PLAIN  LANGUAGE: THE CRITERIA FOR ASSISTED OUTPATIENT TREAT-
MENT, RESOURCES AVAILABLE TO SUCH INDIVIDUALS, THE  RESPONSIBILITIES  OF
PROGRAM  COORDINATORS  AND DIRECTORS OF COMMUNITY SERVICES, A SUMMARY OF
CURRENT LAW, THE PROCESS FOR PETITIONING FOR CONTINUED  ASSISTED  OUTPA-
TIENT  TREATMENT, AND OTHER SUCH INFORMATION THE COMMISSIONER DETERMINES
TO BE PERTINENT.
  S 3.  Subdivision (b) of section 9.47 of the mental  hygiene  law,  as
amended  by  chapter  158  of  the  laws  of 2005, is amended to read as
follows:
  (b) All directors of community services shall be responsible for:
  (1) receiving reports of persons who may be in need of assisted outpa-
tient treatment PURSUANT TO SECTION 9.60 OF THIS ARTICLE and documenting
the receipt date of such reports;
  (2) conducting timely investigations of such reports RECEIVED PURSUANT
TO PARAGRAPH ONE OF THIS SUBDIVISION and providing written  notice  upon
the  completion of investigations to reporting persons and program coor-
dinators, appointed by the commissioner [of mental health]  pursuant  to
subdivision  (f)  of  section  7.17  of  this title, and documenting the
initiation and completion dates of such investigations and the  disposi-
tions;
  (3)  filing of petitions for assisted outpatient treatment pursuant to
[paragraph] SUBPARAGRAPH (vii) of PARAGRAPH ONE OF subdivision [(e)] (F)
of section 9.60 of this article, and  documenting  the  petition  filing
[date] DATES and the [date] DATES of the court [order] ORDERS;
  (4)  coordinating  the  timely delivery of court ordered services with
program coordinators and documenting the date assisted outpatients begin
to receive the services mandated in the court order; [and]
  (5) NOTIFYING PROGRAM COORDINATORS WHEN ASSISTED OUTPATIENTS CANNOT BE
LOCATED AFTER REASONABLE EFFORTS OR ARE BELIEVED TO HAVE TAKEN RESIDENCE
OUTSIDE OF THE LOCAL GOVERNMENTAL UNIT SERVED; AND
  (6) reporting on a quarterly basis to program coordinators the  infor-
mation collected pursuant to this subdivision.

S. 2225                             3

  S 4.  Paragraphs (viii) and (ix) of subdivision (b) of section 9.48 of
the  mental hygiene law are renumbered paragraphs (ix) and (x) and a new
paragraph (viii) is added to read as follows:
  (VIII)  AN  ACCOUNT  OF  ANY COURT ORDER EXPIRATION, INCLUDING BUT NOT
LIMITED TO THE DIRECTOR'S DETERMINATION AS TO WHETHER  TO  PETITION  FOR
CONTINUED  ASSISTED  OUTPATIENT  TREATMENT,  PURSUANT TO SECTION 9.60 OF
THIS ARTICLE, THE BASIS FOR SUCH DETERMINATION, AND THE  DISPOSITION  OF
ANY SUCH PETITION;
  S 5. Section 9.60 of the mental hygiene law, as amended by chapter 158
of  the  laws  of  2005,  paragraph  1  of subdivision (a) as amended by
section 1 of part E of chapter 111 of the laws of 2010, paragraph  5  of
subdivision  (c)  as  amended  by  chapter  137  of the laws of 2005, is
amended to read as follows:
S 9.60 Assisted outpatient treatment.
  (a) Definitions. For purposes of this  section,  the  following  defi-
nitions shall apply:
  (1)  "assisted  outpatient  treatment" shall mean categories of outpa-
tient services [which] THAT have been ordered by the court  pursuant  to
this  section.  Such treatment shall include case management services or
assertive community treatment team  services  to  provide  care  coordi-
nation,  and  may  also  include  any  of  the  following  categories of
services: medication SUPPORT; MEDICATION EDUCATION OR SYMPTOM MANAGEMENT
EDUCATION; periodic blood tests or urinalysis  to  determine  compliance
with prescribed medications; individual or group therapy; day or partial
day  programming  activities;  educational  and  vocational  training or
activities; APPOINTMENT OF A REPRESENTATIVE  PAYEE  OR  OTHER  FINANCIAL
MANAGEMENT  SERVICES,  SUBJECT  TO FINAL APPROVAL OF THE SOCIAL SECURITY
ADMINISTRATION, WHERE APPLICABLE; alcohol or substance  abuse  treatment
and  counseling and periodic OR RANDOM tests for the presence of alcohol
or illegal drugs for persons with a  history  of  alcohol  or  substance
abuse; supervision of living arrangements; and any other services within
a  local  services  plan developed pursuant to article forty-one of this
chapter, CLINICAL OR NON-CLINICAL,  prescribed  to  treat  the  person's
mental illness and to assist the person in living and functioning in the
community,  or to attempt to prevent a relapse or deterioration that may
reasonably be predicted to result in [suicide] SERIOUS PHYSICAL HARM  TO
ANY PERSON or the need for hospitalization.
  (2)  "director"  shall  mean  the  director of community services of a
local governmental unit, or the director of a hospital licensed or oper-
ated by the office of mental health which operates, directs  and  super-
vises an assisted outpatient treatment program.
  (3)  "director  of  community  services" and "local governmental unit"
shall have the same meanings as provided in article  forty-one  of  this
chapter.
  (4)  "assisted  outpatient  treatment  program" shall mean a system to
arrange for and coordinate the provision of assisted  outpatient  treat-
ment, to monitor treatment compliance by assisted outpatients, to evalu-
ate  the condition or needs of assisted outpatients, to take appropriate
steps to address the needs of such individuals, and to ensure compliance
with court orders.
  (5) "assisted outpatient" shall mean the person under a court order to
receive assisted outpatient treatment.
  (6) "subject of the petition" or "subject" shall mean the  person  who
is  alleged  in  a  petition,  filed  pursuant to the provisions of this
section, to meet the criteria for assisted outpatient treatment.

S. 2225                             4

  (7) "correctional facility" and "local  correctional  facility"  shall
have the same meanings as provided in section two of the correction law.
  (8)  "health  care  proxy" and "health care agent" shall have the same
meanings as provided in article twenty-nine-C of the public health law.
  (9) "program coordinator" shall mean an individual  appointed  by  the
commissioner  [of mental health], pursuant to subdivision (f) of section
7.17 of this chapter, who is responsible for the oversight and  monitor-
ing of assisted outpatient treatment programs.
  (b) Programs. The director of community services of each local govern-
mental  unit  shall operate, direct and supervise an assisted outpatient
treatment program. The director of a hospital licensed  or  operated  by
the  office  [of  mental  health]  may  operate, direct and supervise an
assisted outpatient treatment program, upon approval by the  commission-
er.  Directors  of  community services shall be permitted to satisfy the
provisions of this subdivision through the operation of  joint  assisted
outpatient  treatment  programs.  Nothing  in  this subdivision shall be
interpreted to preclude  the  combination  or  coordination  of  efforts
between  and  among  local governmental units and hospitals in providing
and coordinating assisted outpatient treatment.
  (c) Criteria. A person may be ordered to receive  assisted  outpatient
treatment if the court finds that such person:
  (1) is eighteen years of age or older; and
  (2) is suffering from a mental illness; and
  (3)  is  unlikely  to  survive  safely in the community without super-
vision, based on a clinical determination; and
  (4) has a history of lack of  compliance  with  treatment  for  mental
illness that has:
  (i)  [prior  to the filing of the petition,] at least twice within the
[last] thirty-six months PRIOR TO THE FILING  OF  THE  PETITION  been  a
significant  factor  in  necessitating hospitalization in a hospital, or
receipt of services in a forensic or  other  mental  health  unit  of  a
correctional facility or a local correctional facility[, not including];
PROVIDED  THAT  SUCH  THIRTY-SIX  MONTH  PERIOD SHALL BE EXTENDED BY THE
LENGTH OF any current period[, or period ending] OF  HOSPITALIZATION  OR
INCARCERATION,  AND  ANY  SUCH  PERIOD  THAT  ENDED  within the last six
months[, during which the person was or is hospitalized  or  incarcerat-
ed]; or
  (ii)  WITHIN  FORTY-EIGHT  MONTHS prior to the filing of the petition,
resulted in one or more acts of serious violent behavior toward self  or
others  or  threats of, or attempts at, serious physical harm to self or
others [within the last forty-eight  months,  not  including];  PROVIDED
THAT  SUCH  FORTY-EIGHT  MONTH PERIOD SHALL BE EXTENDED BY THE LENGTH OF
any current period[, or period ending] OF HOSPITALIZATION OR  INCARCERA-
TION,  AND  ANY  SUCH  PERIOD THAT ENDED within the last six months[, in
which the person was or is hospitalized or incarcerated]; and
  (5) is, as a result of his or her mental illness, unlikely  to  volun-
tarily  participate in outpatient treatment that would enable him or her
to live safely in the community; and
  (6) in view of his or her treatment history and current  behavior,  is
in  need  of assisted outpatient treatment in order to prevent a relapse
or deterioration which would be likely to result in serious harm to  the
person or others as defined in section 9.01 of this article; and
  (7) is likely to benefit from assisted outpatient treatment.
  (d) Health care proxy. Nothing in this section shall preclude a person
with  a  health  care proxy from being subject to a petition pursuant to

S. 2225                             5

this chapter and consistent with article  twenty-nine-C  of  the  public
health law.
  (e)  INVESTIGATION OF REPORTS. THE COMMISSIONER SHALL PROMULGATE REGU-
LATIONS ESTABLISHING A PROCEDURE TO ENSURE THAT REPORTS OF A PERSON  WHO
MAY  BE  IN  NEED  OF  ASSISTED  OUTPATIENT  TREATMENT,  INCLUDING THOSE
RECEIVED FROM FAMILY AND COMMUNITY MEMBERS OF SUCH PERSON, ARE  INVESTI-
GATED IN A TIMELY MANNER AND, WHERE APPROPRIATE, RESULT IN THE FILING OF
PETITIONS FOR ASSISTED OUTPATIENT TREATMENT.
  (F)  Petition  to  the  court. (1) A petition for an order authorizing
assisted outpatient treatment may be filed  in  the  supreme  or  county
court  in  the county in which the subject of the petition is present or
reasonably believed to be present. Such petition may be  initiated  only
by the following persons:
  (i) any person eighteen years of age or older with whom the subject of
the petition resides; or
  (ii)  the  parent,  spouse, sibling eighteen years of age or older, or
child eighteen years of age or older of the subject of the petition; or
  (iii) the director of a hospital in which the subject of the  petition
is hospitalized; or
  (iv)  the director of any public or charitable organization, agency or
home providing mental health services to the subject of the petition  or
in whose institution the subject of the petition resides; or
  (v)  a  qualified psychiatrist who is either supervising the treatment
of or treating the subject of the petition for a mental illness; or
  (vi) a psychologist, licensed pursuant to article one  hundred  fifty-
three  of  the  education  law, or a social worker, licensed pursuant to
article one hundred fifty-four of the education law, who is treating the
subject of the petition for a mental illness; or
  (vii) the director of community services, or his or her  designee,  or
the  social services official, as defined in the social services law, of
the city or county in which the subject of the petition  is  present  or
reasonably believed to be present; or
  (viii) a parole officer or probation officer assigned to supervise the
subject of the petition[.]; OR
  (IX)  THE  DIRECTOR OF THE HOSPITAL OR THE SUPERINTENDENT OF A CORREC-
TIONAL FACILITY IN WHICH THE SUBJECT  OF  THE  PETITION  IS  IMPRISONED,
PURSUANT TO SECTION FOUR HUNDRED FOUR OF THE CORRECTION LAW.
  (2)  THE  COMMISSIONER  SHALL PROMULGATE REGULATIONS PURSUANT TO WHICH
PERSONS INITIATING A PETITION, PURSUANT TO SUBPARAGRAPHS (I) AND (II) OF
PARAGRAPH ONE OF THIS SUBDIVISION, MAY RECEIVE ASSISTANCE IN FILING SUCH
PETITIONS, WHERE APPROPRIATE, AS DETERMINED PURSUANT TO SUBDIVISION  (E)
OF THIS SECTION.
  (3) The petition shall state:
  (i)  each  of  the  criteria  for assisted outpatient treatment as set
forth in subdivision (c) of this section;
  (ii) facts which support the petitioner's belief that the  subject  of
the  petition  meets  each  criterion,  provided that the hearing on the
petition need not be limited to the stated facts; and
  (iii) that the subject of the petition is present,  or  is  reasonably
believed to be present, within the county where such petition is filed.
  [(3)] (4) The petition shall be accompanied by an affirmation or affi-
davit of a physician, who shall not be the petitioner, stating THAT SUCH
PHYSICIAN  IS WILLING AND ABLE TO TESTIFY AT THE HEARING ON THE PETITION
AND THAT either [that]:
  (i) such physician has personally examined the subject of the petition
no more than ten days prior to the submission  of  the  petition[,]  AND

S. 2225                             6

recommends  assisted  outpatient  treatment for the subject of the peti-
tion[, and is willing and able to testify at the hearing  on  the  peti-
tion]; or
  (ii)  no  more than ten days prior to the filing of the petition, such
physician or his or her designee has made appropriate attempts  but  has
not  been  successful in eliciting the cooperation of the subject of the
petition to submit to an  examination,  such  physician  has  reason  to
suspect that the subject of the petition meets the criteria for assisted
outpatient  treatment, and such physician is willing and able to examine
the subject of the petition [and testify at the hearing on the petition]
PRIOR TO PROVIDING TESTIMONY.
  [(4)] (5) In counties with a  population  of  less  than  seventy-five
thousand,  the  affirmation  or  affidavit required by paragraph [three]
FOUR of this subdivision may be made by a physician who is  an  employee
of the office.  The office is authorized AND DIRECTED to make available,
at  no  cost  to  the  county,  a qualified physician for the purpose of
making such affirmation or affidavit consistent with the  provisions  of
such paragraph.
  [(f)]  (G)  Service.  The petitioner shall cause written notice of the
petition to be given to the subject of the petition and a  copy  thereof
to  be given personally or by mail to the persons listed in section 9.29
of this article, the mental hygiene legal service, the health care agent
if any such agent is known to the petitioner,  the  appropriate  program
coordinator, and the appropriate director of community services, if such
director is not the petitioner.
  [(g)] (H) Right to counsel. The subject of the petition shall have the
right to be represented by the mental hygiene legal service, or private-
ly  financed counsel, at all stages of a proceeding commenced under this
section.
  [(h)] (I) Hearing. (1) Upon receipt of the petition, the  court  shall
fix  the date for a hearing. Such date shall be no later than three days
from the date such petition is received by the court,  excluding  Satur-
days,  Sundays  and  holidays.  Adjournments shall be permitted only for
good cause shown. In granting adjournments, the court shall consider the
need for further examination by a physician or  the  potential  need  to
provide  assisted  outpatient  treatment  expeditiously. The court shall
cause the subject of the petition, any  other  person  receiving  notice
pursuant  to  subdivision [(f)] (G) of this section, the petitioner, the
physician whose affirmation or affidavit accompanied the  petition,  and
such  other  persons  as  the  court may determine to be advised of such
date. Upon such date, or upon such other date to  which  the  proceeding
may  be  adjourned,  the court shall hear testimony and, if it be deemed
advisable and the subject of the  petition  is  available,  examine  the
subject  of the petition in or out of court. If the subject of the peti-
tion does not appear at the hearing, and appropriate attempts to  elicit
the  attendance  of  the  subject have failed, the court may conduct the
hearing in the subject's absence. In such  case,  the  court  shall  set
forth  the factual basis for conducting the hearing without the presence
of the subject of the petition.
  (2) The court shall not order assisted outpatient treatment unless  an
examining  physician,  who  recommends assisted outpatient treatment and
has personally examined the subject of the petition  no  more  than  ten
days before the filing of the petition, testifies in person at the hear-
ing.  Such  physician  shall state the facts and clinical determinations
which support the allegation that the subject of the petition meets each
of the criteria for assisted outpatient  treatment;  PROVIDED  THAT  THE

S. 2225                             7

PARTIES MAY STIPULATE, UPON MUTUAL CONSENT, THAT SUCH PHYSICIAN NEED NOT
TESTIFY.
  (3)  If  the  subject  of the petition has refused to be examined by a
physician, the court may request the subject to consent to  an  examina-
tion  by a physician appointed by the court. If the subject of the peti-
tion does not consent and the court finds reasonable  cause  to  believe
that the allegations in the petition are true, the court may order peace
officers,  acting  pursuant  to their special duties, or police officers
who are members of an authorized police department or  force,  or  of  a
sheriff's  department  to  take the subject of the petition into custody
and transport him or her to a hospital for examination by  a  physician.
Retention  of  the  subject  of  the petition under such order shall not
exceed twenty-four hours. The examination of the subject of the petition
may be performed by the physician whose affirmation or affidavit  accom-
panied the petition pursuant to paragraph three of subdivision [(e)] (F)
of  this  section,  if  such physician is privileged by such hospital or
otherwise authorized by such hospital to do so. If such  examination  is
performed by another physician, the examining physician may consult with
the physician whose affirmation or affidavit accompanied the petition as
to whether the subject meets the criteria for assisted outpatient treat-
ment.
  (4) A physician who testifies pursuant to paragraph two of this subdi-
vision  shall  state:  (i) the facts [which] AND CLINICAL DETERMINATIONS
THAT support the allegation that the subject meets each of the  criteria
for  assisted outpatient treatment, (ii) that the treatment is the least
restrictive  alternative,  (iii)  the  recommended  assisted  outpatient
treatment,  and  (iv)  the rationale for the recommended assisted outpa-
tient  treatment.  If  the  recommended  assisted  outpatient  treatment
includes medication, such physician's testimony shall describe the types
or  classes of medication which should be authorized, shall describe the
beneficial and detrimental physical and mental effects of  such  medica-
tion,  and shall recommend whether such medication should be self-admin-
istered or administered by authorized personnel.
  (5) The subject of the petition shall be afforded  an  opportunity  to
present  evidence, to call witnesses on his or her behalf, and to cross-
examine adverse witnesses.
  [(i)] (J) Written treatment  plan.  (1)  The  court  shall  not  order
assisted outpatient treatment unless a physician appointed by the appro-
priate  director,  in  consultation  with  such  director,  develops and
provides to the court a proposed written  treatment  plan.  The  written
treatment  plan  shall  include  case  management  services or assertive
community treatment team services  to  provide  care  coordination.  The
written treatment plan also shall include all categories of services, as
set  forth  in  paragraph  one of subdivision (a) of this section, which
such physician recommends that the subject of the petition receive.  All
service  providers  shall  be  notified regarding their inclusion in the
written treatment plan. If the written treatment plan  includes  medica-
tion, it shall state whether such medication should be self-administered
or  administered  by  authorized  personnel,  and shall specify type and
dosage range of medication most likely to provide  maximum  benefit  for
the subject. If the written treatment plan includes alcohol or substance
abuse  counseling  and  treatment,  such  plan  may  include a provision
requiring relevant testing for  either  alcohol  or  illegal  substances
provided  the  physician's  clinical  basis  for  recommending such plan
provides sufficient facts for the court to find (i) that such person has
a history of alcohol or substance abuse that is  clinically  related  to

S. 2225                             8

the mental illness; and (ii) that such testing is necessary to prevent a
relapse or deterioration which would be likely to result in serious harm
to  the  person  or others. If a director is the petitioner, the written
treatment  plan shall be provided to the court no later than the date of
the hearing on the petition. If a person other than a  director  is  the
petitioner,  such  plan shall be provided to the court no later than the
date set by the court pursuant to paragraph three of  subdivision  [(j)]
(K) of this section.
  (2)  The  physician  appointed  to  develop the written treatment plan
shall provide the following persons  with  an  opportunity  to  actively
participate  in  the  development of such plan: the subject of the peti-
tion; the treating physician, if  any;  and  upon  the  request  of  the
subject  of  the  petition,  an  individual  significant  to the subject
including any relative, close friend or individual  otherwise  concerned
with  the  welfare  of the subject. THE APPOINTED PHYSICIAN SHALL MAKE A
REASONABLE EFFORT TO GATHER RELEVANT INFORMATION FOR THE DEVELOPMENT  OF
THE  TREATMENT  PLAN FROM THE SUBJECT OF THE PETITION'S FAMILY MEMBER OR
MEMBERS, OR HIS OR HER SIGNIFICANT OTHER. If the subject of the petition
has executed a health care proxy, the appointed physician shall consider
any directions included in such proxy in developing the  written  treat-
ment plan.
  (3)  The  court shall not order assisted outpatient treatment unless a
physician appearing on behalf of a director  testifies  to  explain  the
written  proposed  treatment  plan; PROVIDED THAT THE PARTIES MAY STIPU-
LATE, UPON MUTUAL CONSENT, THAT SUCH PHYSICIAN NEED NOT TESTIFY.    Such
physician  shall  state  the categories of assisted outpatient treatment
recommended, the rationale for each such category, facts which establish
that such treatment is the least restrictive alternative,  and,  if  the
recommended assisted outpatient treatment plan includes medication, such
physician  shall  state  the types or classes of medication recommended,
the beneficial and detrimental physical and mental effects of such medi-
cation, and whether  such  medication  should  be  self-administered  or
administered  by an authorized professional. If the subject of the peti-
tion has executed a health care proxy, such physician  shall  state  the
consideration given to any directions included in such proxy in develop-
ing  the written treatment plan. If a director is the petitioner, testi-
mony pursuant to this paragraph shall be given at  the  hearing  on  the
petition.  If  a  person  other  than a director is the petitioner, such
testimony shall be given on the date set by the court pursuant to  para-
graph three of subdivision [(j)] (K) of this section.
  [(j)] (K) Disposition. (1) If after hearing all relevant evidence, the
court does not find by clear and convincing evidence that the subject of
the  petition  meets the criteria for assisted outpatient treatment, the
court shall dismiss the petition.
  (2) If after hearing all relevant evidence, the court finds  by  clear
and  convincing  evidence  that  the  subject  of the petition meets the
criteria for assisted outpatient treatment, and there is no  appropriate
and  feasible  less  restrictive  alternative,  the  court may order the
subject to receive assisted outpatient treatment for an  initial  period
not to exceed [six months] ONE YEAR.  In fashioning the order, the court
shall  specifically  make findings by clear and convincing evidence that
the proposed treatment is the least  restrictive  treatment  appropriate
and  feasible  for the subject. The order shall state an assisted outpa-
tient treatment plan, which shall include  all  categories  of  assisted
outpatient  treatment,  as set forth in paragraph one of subdivision (a)
of this section, which the assisted outpatient is to receive, but  shall

S. 2225                             9

not  include  any  such category that has not been recommended in [both]
the proposed written treatment plan and [the] IN ANY testimony  provided
to the court pursuant to subdivision [(i)] (J) of this section.
  (3)  If  after hearing all relevant evidence presented by a petitioner
who is not a director, the court finds by clear and convincing  evidence
that  the subject of the petition meets the criteria for assisted outpa-
tient treatment, and the court has yet to be  provided  with  a  written
proposed  treatment plan and testimony pursuant to subdivision [(i)] (J)
of this section, the court  shall  order  the  appropriate  director  to
provide  the  court with such plan and testimony no later than the third
day, excluding Saturdays, Sundays and  holidays,  immediately  following
the  date  of  such  order; PROVIDED THAT THE PARTIES MAY STIPULATE UPON
MUTUAL CONSENT THAT SUCH TESTIMONY NEED NOT BE PROVIDED.  Upon receiving
such plan and ANY REQUIRED  testimony,  the  court  may  order  assisted
outpatient treatment as provided in paragraph two of this subdivision.
  (4)  A  court  may  order  the patient to self-administer psychotropic
drugs or accept the administration of such drugs by authorized personnel
as part of an assisted outpatient  treatment  program.  Such  order  may
specify  the  type  and dosage range of such psychotropic drugs and such
order shall be effective for the duration of  such  assisted  outpatient
treatment.
  (5)  If  the petitioner is the director of a hospital that operates an
assisted outpatient treatment program, the court order shall direct  the
hospital  director  to provide or arrange for all categories of assisted
outpatient treatment for the assisted outpatient throughout  the  period
of  the order. For all other persons, the order shall require the direc-
tor of community services of the appropriate local governmental unit  to
provide  or  arrange for all categories of assisted outpatient treatment
for the assisted outpatient throughout the period of the order.   ORDERS
ISSUED  ON OR AFTER THE EFFECTIVE DATE OF THE CHAPTER OF THE LAWS OF TWO
THOUSAND THIRTEEN THAT AMENDED THIS SECTION SHALL REQUIRE THE  APPROPRI-
ATE  DIRECTOR  "AS  DETERMINED BY THE PROGRAM COORDINATOR" TO PROVIDE OR
ARRANGE FOR ALL CATEGORIES OF  ASSISTED  OUTPATIENT  TREATMENT  FOR  THE
ASSISTED OUTPATIENT THROUGHOUT THE PERIOD OF THE ORDER.
  (6) The director shall cause a copy of any court order issued pursuant
to  this section to be served personally, or by mail, facsimile or elec-
tronic means, upon the assisted outpatient,  the  mental  hygiene  legal
service  or  anyone  acting  on  the  assisted  outpatient's behalf, the
original petitioner, identified service providers, and all others  enti-
tled to notice under subdivision [(f)] (G) of this section.
  [(k)]  (L)  RELOCATION OF ASSISTED OUTPATIENTS. THE COMMISSIONER SHALL
PROMULGATE REGULATIONS REQUIRING THAT, DURING THE PERIOD OF  THE  ORDER,
AN  ASSISTED  OUTPATIENT  AND ANY OTHER APPROPRIATE PERSONS SHALL NOTIFY
THE PROGRAM COORDINATOR WITHIN A REASONABLE TIME PRIOR TO SUCH  ASSISTED
OUTPATIENT RELOCATING WITHIN THE STATE OF NEW YORK TO AN AREA NOT SERVED
BY  THE  DIRECTOR  WHO  HAS  BEEN DIRECTED TO PROVIDE OR ARRANGE FOR THE
ASSISTED OUTPATIENT TREATMENT. UPON RECEIVING NOTIFICATION OF SUCH RELO-
CATION, THE PROGRAM COORDINATOR SHALL REDETERMINE  WHO  THE  APPROPRIATE
DIRECTOR SHALL BE AND CAUSE A COPY OF THE COURT ORDER AND TREATMENT PLAN
TO BE TRANSMITTED TO SUCH DIRECTOR.
  (M)  Petition  for  [additional  periods of] CONTINUED treatment.  (1)
WITHIN THIRTY DAYS PRIOR TO THE EXPIRATION OF AN ORDER PURSUANT TO  THIS
SECTION,  THE  APPROPRIATE  DIRECTOR  SHALL  REVIEW WHETHER THE ASSISTED
OUTPATIENT CONTINUES TO MEET THE CRITERIA FOR ASSISTED OUTPATIENT TREAT-
MENT.  UPON DETERMINING THAT ONE OR MORE OF SUCH CRITERIA ARE NO  LONGER
MET,  SUCH DIRECTOR SHALL NOTIFY THE PROGRAM COORDINATOR IN WRITING THAT

S. 2225                            10

A PETITION FOR CONTINUED ASSISTED OUTPATIENT TREATMENT IS NOT WARRANTED.
UPON DETERMINING THAT SUCH CRITERIA CONTINUE TO BE MET, HE OR SHE  SHALL
PETITION  THE COURT TO ORDER CONTINUED ASSISTED OUTPATIENT TREATMENT FOR
A  PERIOD NOT TO EXCEED ONE YEAR FROM THE EXPIRATION DATE OF THE CURRENT
ORDER. IF THE COURT'S DISPOSITION OF SUCH PETITION DOES NOT OCCUR  PRIOR
TO  THE  EXPIRATION  DATE  OF THE CURRENT ORDER, THE CURRENT ORDER SHALL
REMAIN IN EFFECT UNTIL SUCH DISPOSITION. THE  PROCEDURES  FOR  OBTAINING
ANY  ORDER  PURSUANT TO THIS SUBDIVISION SHALL BE IN ACCORDANCE WITH THE
PROVISIONS OF THE FOREGOING SUBDIVISION OF THIS SECTION;  PROVIDED  THAT
THE  TIME  RESTRICTIONS INCLUDED IN PARAGRAPH FOUR OF SUBDIVISION (C) OF
THIS SECTION SHALL NOT BE APPLICABLE. THE NOTICE PROVISIONS SET FORTH IN
PARAGRAPH SIX OF SUBDIVISION (K) OF THIS SECTION  SHALL  BE  APPLICABLE.
ANY  COURT  ORDER  REQUIRING  PERIODIC BLOOD TESTS OR URINALYSIS FOR THE
PRESENCE OF ALCOHOL OR ILLEGAL DRUGS SHALL BE SUBJECT  TO  REVIEW  AFTER
SIX  MONTHS BY THE PHYSICIAN WHO DEVELOPED THE WRITTEN TREATMENT PLAN OR
ANOTHER PHYSICIAN DESIGNATED BY THE DIRECTOR, AND SUCH  PHYSICIAN  SHALL
BE  AUTHORIZED  TO  TERMINATE  SUCH  BLOOD  TESTS  OR URINALYSIS WITHOUT
FURTHER ACTION BY THE COURT.
  (2) Within thirty days prior to the expiration of an order of assisted
outpatient treatment, [the appropriate director or]  the  current  peti-
tioner,  if  the current petition was filed pursuant to subparagraph (i)
or (ii) of paragraph one of subdivision [(e)] (F) of this  section,  and
the  current  petitioner  retains his or her original status pursuant to
the applicable subparagraph, may petition the court to  order  continued
assisted  outpatient  treatment for a period not to exceed one year from
the expiration date of the current order. If the court's disposition  of
such petition does not occur prior to the expiration date of the current
order,  the current order shall remain in effect until such disposition.
The procedures for obtaining any  order  pursuant  to  this  subdivision
shall be in accordance with the provisions of the foregoing subdivisions
of  this  section; provided that the time restrictions included in para-
graph four of subdivision (c) of this section shall not  be  applicable.
The  notice  provisions  set forth in paragraph six of subdivision [(j)]
(K) of this section shall be applicable.    Any  court  order  requiring
periodic  blood tests or urinalysis for the presence of alcohol or ille-
gal drugs shall be subject to review after six months by  the  physician
who developed the written treatment plan or another physician designated
by  the  director,  and  such physician shall be authorized to terminate
such blood tests or urinalysis without further action by the court.
  (3) IF NEITHER THE APPROPRIATE DIRECTOR  NOR  THE  CURRENT  PETITIONER
PETITION  FOR  CONTINUED  ASSISTED OUTPATIENT TREATMENT PURSUANT TO THIS
PARAGRAPH AND THE ORDER OF THE COURT EXPIRES, ANY OTHER  PERSON  AUTHOR-
IZED  TO  PETITION  PURSUANT TO PARAGRAPH ONE OF SUBDIVISION (F) OF THIS
SECTION MAY BRING A NEW PETITION FOR ASSISTED OUTPATIENT TREATMENT.   IF
SUCH  NEW PETITION IS FILED LESS THAN SIXTY DAYS AFTER THE EXPIRATION OF
SUCH ORDER, THE TIME RESTRICTIONS PROVIDED IN PARAGRAPH FOUR OF SUBDIVI-
SION (C) OF THIS SECTION SHALL NOT BE APPLICABLE TO THE NEW PETITION.
  (4) IF, THIRTY DAYS PRIOR TO THE EXPIRATION OF AN ORDER, THE  ASSISTED
OUTPATIENT  IS  DEEMED  BY  THE  APPROPRIATE  DIRECTOR TO BE MISSING AND
THEREBY UNAVAILABLE FOR EVALUATION AS TO WHETHER HE OR SHE CONTINUES  TO
MEET THE CRITERIA FOR ASSISTED OUTPATIENT TREATMENT, SUCH DIRECTOR SHALL
PETITION  THE  COURT TO EXTEND THE TERM OF THE CURRENT ORDER UNTIL SIXTY
DAYS AFTER SUCH TIME AS THE ASSISTED OUTPATIENT IS LOCATED. IF THE COURT
GRANTS THE EXTENSION, THE DIRECTOR SHALL CONTINUE REASONABLE EFFORTS  TO
LOCATE  THE  ASSISTED OUTPATIENT.   UPON LOCATION OF THE ASSISTED OUTPA-
TIENT, THE DIRECTOR SHALL REVIEW WHETHER THE ASSISTED OUTPATIENT CONTIN-

S. 2225                            11

UES TO MEET THE CRITERIA FOR ASSISTED OUTPATIENT TREATMENT, PURSUANT  TO
PARAGRAPH TWO OF THIS SUBDIVISION.
  [(l)]  (N)  Petition  for  an  order to stay, vacate or modify. (1) In
addition to any other right or remedy available by law with  respect  to
the  order  for  assisted outpatient treatment, the assisted outpatient,
the mental hygiene legal service,  or  anyone  acting  on  the  assisted
outpatient's  behalf  may  petition the court on notice to the director,
the original petitioner, and all others entitled to notice under  subdi-
vision [(f)] (G) of this section to stay, vacate or modify the order.
  (2)  The  appropriate  director  shall petition the court for approval
before instituting a proposed material change in the assisted outpatient
treatment plan, unless such change is authorized by  the  order  of  the
court. Such petition shall be filed on notice to all parties entitled to
notice  under subdivision [(f)] (G) of this section. Not later than five
days after receiving such petition,  excluding  Saturdays,  Sundays  and
holidays,  the court shall hold a hearing on the petition; provided that
if the assisted outpatient informs the court that he or  she  agrees  to
the  proposed material change, the court may approve such change without
a hearing. Non-material changes may be instituted by the director  with-
out  court  approval.  For  the  purposes  of this paragraph, a material
change is an addition or deletion of a category of services to or from a
current assisted outpatient treatment plan, or any deviation without the
assisted outpatient's consent from the terms of a current order relating
to the administration of psychotropic drugs.
  [(m)] (O) Appeals. Review of an order issued pursuant to this  section
shall  be  had  in  like  manner  as  specified  in section 9.35 of this
article; PROVIDED THAT NOTICE SHALL BE PROVIDED TO ALL PARTIES  ENTITLED
TO NOTICE UNDER SUBDIVISION (G) OF THIS SECTION.
  [(n)]  (P) Failure to comply with assisted outpatient treatment. Where
in the clinical judgment of a physician, (i)  the  assisted  outpatient,
has  failed or refused to comply with the assisted outpatient treatment,
(ii) efforts were made to solicit compliance, and  (iii)  such  assisted
outpatient  may be in need of involuntary admission to a hospital pursu-
ant to section 9.27 of this article or immediate observation,  care  and
treatment  pursuant to section 9.39 or 9.40 of this article, such physi-
cian may request the director  of  community  services,  the  director's
designee,  or  any  physician  designated  by  the director of community
services pursuant to section 9.37 of this article, to direct the removal
of such assisted outpatient to an appropriate hospital for  an  examina-
tion  to  determine  if such person has a mental illness for which HE OR
SHE IS IN NEED OF hospitalization is necessary pursuant to section 9.27,
9.39 or 9.40 of this article[. Furthermore, if such assisted  outpatient
refuses to take medications as required by the court order, or he or she
refuses  to  take, or fails a blood test, urinalysis, or alcohol or drug
test as required by the court order, such physician  may  consider  such
refusal  or  failure  when determining whether]; PROVIDED THAT IF, AFTER
EFFORTS TO  SOLICIT  COMPLIANCE,  SUCH  PHYSICIAN  DETERMINES  THAT  THE
ASSISTED  OUTPATIENT'S  FAILURE  TO  COMPLY WITH THE ASSISTED OUTPATIENT
TREATMENT INCLUDES A SUBSTANTIAL FAILURE TO  TAKE  MEDICATION,  PASS  OR
SUBMIT  TO BLOOD TESTING OR URINALYSIS, OR RECEIVE TREATMENT FOR ALCOHOL
OR SUBSTANCE ABUSE, SUCH PHYSICIAN MAY PRESUME THAT the assisted  outpa-
tient  is in need of an examination to determine whether he or she has a
mental illness for which hospitalization is necessary. Upon the  request
of  such physician, the director, the director's designee, or any physi-
cian designated pursuant to section 9.37 of  this  article,  may  direct
peace officers, acting pursuant to their special duties, or police offi-

S. 2225                            12

cers who are members of an authorized police department or force or of a
sheriff's  department  to  take the assisted outpatient into custody and
transport him or her to the hospital operating the  assisted  outpatient
treatment  program  or  to  any  hospital  authorized by the director of
community services to receive such persons. Such law  enforcement  offi-
cials  shall  carry  out such directive. Upon the request of such physi-
cian, the director, the director's designee, or any physician designated
pursuant to section 9.37 of  this  article,  an  ambulance  service,  as
defined  by  subdivision two of section three thousand one of the public
health law, or an approved mobile crisis outreach  team  as  defined  in
section  9.58  of  this article shall be authorized to take into custody
and transport any such person to the  hospital  operating  the  assisted
outpatient treatment program, or to any other hospital authorized by the
director  of community services to receive such persons. Any director of
community services, or designee,  shall  be  authorized  to  direct  the
removal of an assisted outpatient who is present in his or her county to
an  appropriate  hospital,  in  accordance  with  the provisions of this
subdivision, based upon a determination of the appropriate  director  of
community  services  directing  the  removal of such assisted outpatient
pursuant to this subdivision. Such person may be retained  for  observa-
tion,  care and treatment and further examination in the hospital for up
to seventy-two hours to permit a physician  to  determine  whether  such
person  has  a  mental  illness  and  is in need of involuntary care and
treatment in a hospital pursuant to the provisions of this article.  Any
continued  involuntary  retention  OF  THE  ASSISTED  OUTPATIENT in such
hospital beyond the initial seventy-two hour period shall be in  accord-
ance  with  the  provisions  of this article relating to the involuntary
admission and retention of a person. If at any time during the  seventy-
two  hour  period  the  person is determined not to meet the involuntary
admission and retention provisions of this article, and does  not  agree
to  stay  in  the hospital as a voluntary or informal patient, he or she
must be released. Failure to comply with an order of assisted outpatient
treatment shall not be grounds for involuntary  civil  commitment  or  a
finding of contempt of court.
  [(o)] (Q) Effect of determination that a person is in need of assisted
outpatient  treatment.  The determination by a court that a person is in
need of assisted outpatient treatment  shall  not  be  construed  as  or
deemed  to be a determination that such person is incapacitated pursuant
to article eighty-one of this chapter.
  [(p)] (R) False petition. A person making a false statement or provid-
ing false information or false testimony in a petition or hearing  under
this  section shall be subject to criminal prosecution pursuant to arti-
cle one hundred seventy-five or article two hundred  ten  of  the  penal
law.
  [(q)]  (S)  Exception.  Nothing  in this section shall be construed to
affect the ability of the director of a hospital to receive,  admit,  or
retain  patients  who  otherwise  meet  the  provisions  of this article
regarding receipt, retention or admission.
  [(r)] (T) Education and training. (1) The office [of  mental  health],
in  consultation  with the office of court administration, shall prepare
educational and training materials on the use  of  this  section,  which
shall  be  made  available  to  local  governmental  units, providers of
services, judges, court personnel, law  enforcement  officials  and  the
general public.
  (2)  The  office,  in  consultation  with the office of court adminis-
tration, shall establish a mental health training  program  for  supreme

S. 2225                            13

and  county  court  judges  and  court personnel, AND SHALL PROVIDE SUCH
TRAINING WITH SUCH FREQUENCY AND IN SUCH LOCATIONS AS MAY BE APPROPRIATE
TO MEET STATEWIDE NEEDS.  Such training shall focus on the use  of  this
section  and  generally  address  issues  relating to mental illness and
mental health treatment.
  S 6. Section 29.15 of the mental hygiene law is amended  by  adding  a
new subdivision (o) to read as follows:
  (O)  IF  THE  DIRECTOR  OF A DEPARTMENT FACILITY DOES NOT PETITION FOR
ASSISTED OUTPATIENT TREATMENT PURSUANT TO SECTION 9.60 OF  THIS  CHAPTER
UPON  THE  DISCHARGE  OF AN INPATIENT ADMITTED PURSUANT TO SECTION 9.27,
9.39 OR 9.40 OF THIS CHAPTER, OR UPON THE  EXPIRATION  OF  A  PERIOD  OF
CONDITIONAL  RELEASE FOR SUCH INPATIENT, SUCH DIRECTOR SHALL REPORT SUCH
DISCHARGE OR SUCH EXPIRATION IN WRITING TO  THE  DIRECTOR  OF  COMMUNITY
SERVICES  OF  THE  LOCAL  GOVERNMENTAL  UNIT  IN  WHICH THE INPATIENT IS
EXPECTED TO RESIDE.
  S 7. Subdivision 1 of section 404 of the correction law, as amended by
chapter 7 of the laws of 2007, is amended to read as follows:
  1. Whenever an inmate committed to a hospital  in  the  department  of
mental  hygiene or whenever an inmate is examined in anticipation of his
or her conditional release, release to parole supervision, or  when  his
or  her sentence to a term of imprisonment expires and such inmate shall
continue to be mentally ill and in need of care  and  treatment  at  the
time  of  his or her conditional release, release to parole supervision,
or when his or her sentence to  a  term  of  imprisonment  expires,  the
director of the hospital or the superintendent of a correctional facili-
ty  [may] SHALL, WHERE APPROPRIATE, EITHER apply for the person's admis-
sion to a hospital for the care and treatment of the mentally ill in the
department of mental hygiene pursuant to  article  nine  of  the  mental
hygiene  law[,]  or  [alternatively]  INITIATE  A  PETITION FOR AN ORDER
AUTHORIZING ASSISTED OUTPATIENT TREATMENT, PURSUANT TO SECTION  9.60  OF
THE  MENTAL  HYGIENE LAW, OR the commissioner may apply for the person's
admission to a secure treatment facility pursuant to article ten of  the
mental hygiene law.
  S  8.  Section  18  of  chapter  408 of the laws of 1999, constituting
Kendra's Law, as amended by chapter 139 of the laws of 2010, is  amended
to read as follows:
  S  18.  This  act shall take effect immediately, provided that section
fifteen of this act shall take effect April 1, 2000, provided,  further,
that  subdivision (e) of section 9.60 of the mental hygiene law as added
by section six of this act shall be effective 90  days  after  this  act
shall become law[; and that this act shall expire and be deemed repealed
June 30, 2015].
  S 9. Severability. If any clause, sentence, paragraph, section or part
of  this act shall be adjudged by any court of competent jurisdiction to
be invalid, and after exhaustion of all  further  judicial  review,  the
judgment  shall  not affect, impair or invalidate the remainder thereof,
but shall be confined in its operation to the  clause,  sentence,  para-
graph, section or part thereof directly involved in the controversy.
  S 10.  This act shall take effect immediately.

Co-Sponsors

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S2225A - Bill Details

Current Committee:
Law Section:
Mental Hygiene Law
Laws Affected:
Amd §§7.17, 9.47, 9.48, 9.60 & 29.15, Ment Hyg L; amd §404, Cor L; amd §18, Chap 408 of 1999
Versions Introduced in 2011-2012 Legislative Session:
S4881A

S2225A - Bill Texts

view summary

Enhances the assisted outpatient treatment program; eliminates the expiration and repeal of Kendra's Law.

view sponsor memo
BILL NUMBER:S2225A

TITLE OF BILL: An act to amend the mental hygiene law and the
correction law, in relation to enhancing the assisted outpatient
treatment program; and to amend Kendra's Law, in relation to making
the provisions thereof permanent

PURPOSE OR GENERAL IDEA OF BILL: To improve care for people with
serious mental illness, and protect the safety of patients and the
public by streamlining and improving New York's Assisted Outpatient
Treatment (AOT) program (Kendra's Law).

SUMMARY OF SPECIFIC PROVISIONS:

Section 1 amends Mental Hygiene Law (MHL) § 7.17(f) to require that
AOT program coordinators monitor local programs to ensure that
expiring AOT orders are adequately reviewed to consider the need for
renewal of the order; to ensure appropriate assignment of a director
for each outpatient; and to monitor local needs for training of judges
and court personnel in order for the office of mental health to
adequately provide such training.

Section 2 provides that the Commissioner of Mental Health shall
develop an educational pamphlet on the process of petitioning for AOT
to be made available to persons wishing to submit reports of
individuals who may be in need of ACT, as well as disseminated to
family members and other individuals eligible to petition for AOT.

Section 3 amends § 9.47(b) of the MHL to clarify that directors of
community services shall be responsible for ensuring that reports of
persons who may be in need of continued AOT orders are subject to a
timely investigation. It also provides that directors of community
services shall notify program coordinators when AOT patients cannot be
located or are believed to have taken residence outside of the local
governmental unit served.

Section 4 amends MHL § 9.48 to require that AOT program directors'
quarterly reports to program coordinators include information on any
expired AOT court orders, including the determination made as to
whether to petition for renewal of the AOT, the basis for such
determination, and the court's disposition of the renewal petition, if
any.

Section 5 amends MHL § 9.60 to clarify that assisted outpatient
treatment services provided may include: medication education or
symptom management education; appointment of a representative payee;
and that tests for alcohol or drugs may be random.

This section also requires the Commissioner to establish by regulation
a procedure to ensure that reports of persons who may be in need of
ACT that are made by family and community members of such person are,
if warranted, investigated in a timely manner, and that ACT petitions
are filed, where appropriate.

This section also provides that the parties to the treatment order may
stipulate, upon mutual consent, that an examining physician need not


testify in court. The bill also provides that the appointed physician
shall make a reasonable effort to gather relevant information for the
development of a treatment plan from a member or members of the
patient's family or significant other.

This section also clarifies that directors of hospitals or
superintendents of correctional facilities may initiate a petition.

This section also provides that the Commissioner shall promulgate
regulations to require that prior to an assisted outpatient relocating
to a location within the state of New York which is not served by his
or her current director of community services, that patient or other
appropriate party must notify the program coordinator. The program
coordinator shall then redetermine who the appropriate director shall
be, and cause a copy of the court order and treatment plan to be
transmitted to the new director.

This section also provides that a director shall review whether the
assisted outpatient continues to meet ACT criteria within 30 days
before the expiration of an order for ACT. If the director determines
that such assisted outpatient no longer meets the criteria, such
director is required to give notice to the program coordinator that a
petition for continued AOT is unnecessary. However, if such assisted
outpatient continues to meet the criteria, as determined by the
director, such director shall file a petition for continued treatment.

This provision clarifies procedures any other person authorized to
petition for continued ACT may use to bring such petition in the event
that the appropriate director or current petitioner does not petition
for continued ACT prior to the expiration of the court order.

This section also provides that if thirty days prior to the expiration
of an order, the assisted outpatient is deemed by the appropriate
direct to be missing and thereby unavailable for evaluation, such
director shall petition the court to extend the term of the current
order until sixty days after such time as the assisted outpatient out
is located.

Section 6 amends NHL § 29.15 to provide that if the director of a
department facility does not petition for AOT upon the discharge of an
involuntarily committed inpatient or upon the expiration of a period
of conditional release for such inpatient, such director shall report
the discharge in writing to the director of community services of the
local government unit where the inpatient is expected to reside.

Section 7 amends subdivision 3 of section 404 of the correction law to
require that, prior to discharging an inmate committed from a hospital
in the department of mental hygiene to the community, the director
shall ensure that a clinical assessment has been completed to
determine whether the inmate meets the criteria for AOT. This section
also provides that if, as a result of such assessment, the director
determines that the inmate meets such criteria, prior to the discharge
the director of the hospital shall either petition for a court order
or report in writing to the director of community services of the
local governmental unit in which the inmate is expected to reside so
that an investigation may be conducted.


Section 8 would repeal the current sunset date of June 30, 2017 to
make the provisions of Kendra's Law permanent.

Section 9 Severability.

Section 10 states that this act shall take effect immediately.

JUSTIFICATION: In 1999, the legislature enacted "Kendra's Law,"
establishing a statewide court-ordered assisted outpatient treatment
(AOT) program to improve outcomes for persons with severe mental
illness who, in view of their treatment history and Present
circumstances, are likely to have difficulty living safely in the
community. At the approach of the law's original 2005 expiration date,
the legislature took note of the Office of Mental Health (OMH)
research documenting declines in rates of homelessness,
hospitalization, substance abuse, alcoholism, violence, arrest and
incarceration, and documented increases in treatment compliance,
service engagement and positive consumer perceptions. In 2005 and
2010, the legislature opted to extend Kendra's Law for an additional
five years to further evaluate the program. The New York SAFE Act,
which was signed into law on January 15, 2013, also extended Kendra's
Law for an additional two years, making the law expire on June 30,
2017.

On June 30, 2009, a team of independent researchers released the
report of their long term study of AOT throughout New York State and
in October, 2010 Psychiatric Services published six peer reviewed
studies on the AOT program. These reports confirm the earlier OMH
data. These studies found patients given mandatory outpatient
treatment who were more violent to begin with, were nevertheless four
times less likely than members of the control group to perpetrate
serious violence after undergoing assisted outpatient treatment. The
studies also found less frequent psychiatric hospitalizations, shorter
length of hospitalizations, reduction in the likelihood of arrest,
higher social functioning, slightly less stigma and no increase in
perceived coercion. These studies confirmed that AOT stimulates
service provider's efforts to prioritize care for AOT recipients;
judges hearing AOT cases could benefit from additional AOT training;
counties favored increasing the availability of stipulations to reduce
the court burden, costs, and transportation burdens; recipients are
far more likely than other patients to consistently receive
psychotropic medications appropriate to their psychiatric condition;
that those who receive AOT for periods of at least one year are more
likely than those who receive AOT for shorter Periods to sustain gains
after leaving the program; that the law has been applied in a
non-discriminatory manner; and that the court order itself, in
addition to high quality services, is a significant factor in the
program's success.

The experience of thousands of patients, treatment providers and
families who have utilized Kendra's Law since 1999 point to several
areas where the law should be improved to achieve costs savings,
promote smoother functioning of the AOT program and easier access to
those who stand to benefit from it.

Although the New York SAFE Act addresses many of these concerns,
loopholes still exist in the law. The amendments included in this act


are intended to close these loopholes and maximize the unique
potential of this legislation, while simultaneously serving the goals
of compassionate care, fiscal responsibility, and public safety.

PRIOR LEGISLATIVE HISTORY: 2011,2012: S.4881B Referred to Mental
Health/Developmental Disabilities

FISCAL IMPLICATIONS: None.

EFFECTIVE DATE: This act shall take effect immediately.

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                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 2225--A

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                            January 14, 2013
                               ___________

Introduced by Sens. YOUNG, ADAMS, ADDABBO, AVELLA, BALL, BONACIC, BOYLE,
  DeFRANCISCO,    FARLEY,    FUSCHILLO,    GALLIVAN,   GOLDEN,   GRIFFO,
  HASSELL-THOMPSON,   LANZA,   LARKIN,   LIBOUS,   LITTLE,   MARCELLINO,
  MARCHIONE,  MARTINS,  MAZIARZ, NOZZOLIO, RANZENHOFER, RITCHIE, ROBACH,
  SEWARD, STAVISKY, VALESKY, ZELDIN -- read twice and  ordered  printed,
  and when printed to be committed to the Committee on Mental Health and
  Developmental  Disabilities  --  committee  discharged,  bill amended,
  ordered reprinted as amended and recommitted to said committee

AN ACT to amend the mental  hygiene  law  and  the  correction  law,  in
  relation  to  enhancing the assisted outpatient treatment program; and
  to amend Kendra's Law, in relation to making  the  provisions  thereof
  permanent

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Paragraph 2 of subdivision  (f)  of  section  7.17  of  the
mental  hygiene  law,  as amended by chapter 158 of the laws of 2005, is
amended to read as follows:
  (2) The oversight and monitoring role of the  program  coordinator  of
the  assisted  outpatient  treatment  program  shall include each of the
following:
  (i) that each assisted outpatient receives the treatment provided  for
in  the  court  order  issued pursuant to section 9.60 of this [chapter]
TITLE;
  (ii) that existing  services  located  in  the  assisted  outpatient's
community are utilized whenever practicable;
  (iii)  that  a  case  manager or assertive community treatment team is
designated for each assisted outpatient;
  (iv) that a mechanism exists  for  such  case  manager,  or  assertive
community  treatment team, to regularly report the assisted outpatient's
compliance, or lack of compliance with treatment, to the director of the
assisted outpatient treatment program;

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD02670-04-3

S. 2225--A                          2

  (v) that directors of community services establish procedures  [which]
THAT  provide  that  reports  of  persons who may be in need of assisted
outpatient treatment are appropriately investigated in a timely  manner;
[and]
  (vi)  that  assisted  outpatient treatment services are delivered in a
timely manner[.];
  (VII) THAT, PRIOR TO THE EXPIRATION OF ASSISTED  OUTPATIENT  TREATMENT
ORDERS,  THE  CLINICAL  NEEDS  OF  ASSISTED  OUTPATIENTS  ARE ADEQUATELY
REVIEWED IN DETERMINING THE NEED  TO  PETITION  FOR  CONTINUED  ASSISTED
OUTPATIENT TREATMENT PURSUANT TO SUBDIVISION (M) OF SECTION 9.60 OF THIS
TITLE;
  (VIII)  THAT  THE APPROPRIATE DIRECTOR IS DETERMINED FOR EACH ASSISTED
OUTPATIENT, PURSUANT TO SUBDIVISIONS (K) AND (L) OF SECTION 9.60 OF THIS
TITLE; AND
  (IX) THAT THE OFFICE FULFILLS ITS DUTIES PURSUANT TO  SUBDIVISION  (T)
OF SECTION 9.60 OF THIS TITLE TO MEET LOCAL NEEDS FOR TRAINING OF JUDGES
AND COURT PERSONNEL.
  S  2.  Subdivision  (f)  of  section 7.17 of the mental hygiene law is
amended by adding a new paragraph 5 to read as follows:
  (5) THE COMMISSIONER SHALL DEVELOP  AN  EDUCATIONAL  PAMPHLET  ON  THE
PROCESS  OF  PETITIONING  FOR  ASSISTED OUTPATIENT TREATMENT FOR DISSEM-
INATION TO INDIVIDUALS SEEKING TO SUBMIT REPORTS OF PERSONS WHO  MAY  BE
IN  NEED  OF  ASSISTED  OUTPATIENT TREATMENT, AND INDIVIDUALS SEEKING TO
FILE A PETITION PURSUANT TO SUBPARAGRAPH (I) OR (II) OF PARAGRAPH ONE OF
SUBDIVISION (F) OF SECTION 9.60 OF THIS TITLE. SUCH PAMPHLET  SHALL  SET
FORTH,  IN  PLAIN  LANGUAGE: THE CRITERIA FOR ASSISTED OUTPATIENT TREAT-
MENT, RESOURCES AVAILABLE TO SUCH INDIVIDUALS, THE  RESPONSIBILITIES  OF
PROGRAM  COORDINATORS  AND DIRECTORS OF COMMUNITY SERVICES, A SUMMARY OF
CURRENT LAW, THE PROCESS FOR PETITIONING FOR CONTINUED  ASSISTED  OUTPA-
TIENT  TREATMENT, AND OTHER SUCH INFORMATION THE COMMISSIONER DETERMINES
TO BE PERTINENT.
  S 3.  Subdivision (b) of section 9.47 of the mental  hygiene  law,  as
amended  by chapter 158 of the laws of 2005, paragraphs 5 and 6 as added
and paragraph 7 as renumbered by chapter 1  of  the  laws  of  2013,  is
amended to read as follows:
  (b) All directors of community services shall be responsible for:
  (1) receiving reports of persons who may be in need of assisted outpa-
tient treatment PURSUANT TO SECTION 9.60 OF THIS ARTICLE and documenting
the receipt date of such reports;
  (2) conducting timely investigations of such reports RECEIVED PURSUANT
TO  PARAGRAPH  ONE OF THIS SUBDIVISION and providing written notice upon
the completion of investigations to reporting persons and program  coor-
dinators,  appointed  by the commissioner [of mental health] pursuant to
subdivision (f) of section 7.17  of  this  title,  and  documenting  the
initiation  and completion dates of such investigations and the disposi-
tions;
  (3) filing of petitions for assisted outpatient treatment pursuant  to
[paragraph] SUBPARAGRAPH (vii) of PARAGRAPH ONE OF subdivision [(e)] (F)
of  section  9.60  of  this article, and documenting the petition filing
[date] DATES and the [date] DATES of the court [order] ORDERS;
  (4) coordinating the timely delivery of court  ordered  services  with
program coordinators and documenting the date assisted outpatients begin
to receive the services mandated in the court order; [and]
  (5)  ensuring  evaluation  of the need for ongoing assisted outpatient
treatment pursuant to subdivision [(k)] (M)  of  section  9.60  of  this

S. 2225--A                          3

article  prior  to  the  expiration of any assisted outpatient treatment
order;
  (6)  if  he  or  she  has  been  ordered to provide for or arrange for
assisted outpatient treatment pursuant to paragraph five of  subdivision
[(j)]  (K)  of  section  9.60  of this article or became the appropriate
director pursuant to this paragraph or subdivision (c) of  section  9.48
of this article, notifying the director of community services of the new
county  of  residence  when  he  or  she  has  reason to believe that an
assisted outpatient has or will change his or her  county  of  residence
during the pendency of an assisted outpatient treatment order. Upon such
change  of  residence, the director of the new county of residence shall
become the appropriate director, as such term is defined in section 9.60
of this article; [and]
  (7) NOTIFYING PROGRAM COORDINATORS WHEN ASSISTED OUTPATIENTS CANNOT BE
LOCATED AFTER REASONABLE EFFORTS OR ARE BELIEVED TO HAVE TAKEN RESIDENCE
OUTSIDE OF THE LOCAL GOVERNMENTAL UNIT SERVED; AND
  (8) reporting on a quarterly basis to program coordinators the  infor-
mation collected pursuant to this subdivision.
  S 4.  Paragraphs (viii) and (ix) of subdivision (b) of section 9.48 of
the  mental hygiene law are renumbered paragraphs (ix) and (x) and a new
paragraph (viii) is added to read as follows:
  (VIII) AN ACCOUNT OF ANY COURT ORDER  EXPIRATION,  INCLUDING  BUT  NOT
LIMITED  TO  THE  DIRECTOR'S DETERMINATION AS TO WHETHER TO PETITION FOR
CONTINUED ASSISTED OUTPATIENT TREATMENT, PURSUANT  TO  SECTION  9.60  OF
THIS  ARTICLE,  THE BASIS FOR SUCH DETERMINATION, AND THE DISPOSITION OF
ANY SUCH PETITION;
  S 5. Section 9.60 of the mental hygiene law, as amended by chapter 158
of the laws of 2005, paragraph  1  of  subdivision  (a)  as  amended  by
section  1  of part E of chapter 111 of the laws of 2010, paragraph 3 of
subdivision (a), paragraphs 2 and 5 of subdivision (j), and subdivisions
(k) and (n) as amended by chapter 1 of the laws of 2013, paragraph 5  of
subdivision  (c)  as  amended  by  chapter  137  of the laws of 2005, is
amended to read as follows:
S 9.60 Assisted outpatient treatment.
  (a) Definitions. For purposes of this  section,  the  following  defi-
nitions shall apply:
  (1)  "assisted  outpatient  treatment" shall mean categories of outpa-
tient services [which] THAT have been ordered by the court  pursuant  to
this  section.  Such treatment shall include case management services or
assertive community treatment team  services  to  provide  care  coordi-
nation,  and  may  also  include  any  of  the  following  categories of
services: medication SUPPORT; MEDICATION EDUCATION OR SYMPTOM MANAGEMENT
EDUCATION; periodic blood tests or urinalysis  to  determine  compliance
with prescribed medications; individual or group therapy; day or partial
day  programming  activities;  educational  and  vocational  training or
activities; APPOINTMENT OF A REPRESENTATIVE  PAYEE  OR  OTHER  FINANCIAL
MANAGEMENT  SERVICES,  SUBJECT  TO FINAL APPROVAL OF THE SOCIAL SECURITY
ADMINISTRATION, WHERE APPLICABLE; alcohol or substance  abuse  treatment
and  counseling and periodic OR RANDOM tests for the presence of alcohol
or illegal drugs for persons with a  history  of  alcohol  or  substance
abuse; supervision of living arrangements; and any other services within
a  local  services  plan developed pursuant to article forty-one of this
chapter, CLINICAL OR NON-CLINICAL,  prescribed  to  treat  the  person's
mental illness and to assist the person in living and functioning in the
community,  or to attempt to prevent a relapse or deterioration that may

S. 2225--A                          4

reasonably be predicted to result in [suicide] SERIOUS PHYSICAL HARM  TO
ANY PERSON or the need for hospitalization.
  (2)  "director"  shall  mean  the  director of community services of a
local governmental unit, or the director of a hospital licensed or oper-
ated by the office of mental health which operates, directs  and  super-
vises an assisted outpatient treatment program.
  (3)  "director  of  community  services" and "local governmental unit"
shall have the same meanings as provided in article  forty-one  of  this
chapter. The "appropriate director" shall mean the director of community
services of the county where the assisted outpatient resides, even if it
is  a  different  county  than  the county where the assisted outpatient
treatment order was originally issued.
  (4) "assisted outpatient treatment program" shall  mean  a  system  to
arrange  for  and coordinate the provision of assisted outpatient treat-
ment, to monitor treatment compliance by assisted outpatients, to evalu-
ate the condition or needs of assisted outpatients, to take  appropriate
steps to address the needs of such individuals, and to ensure compliance
with court orders.
  (5) "assisted outpatient" shall mean the person under a court order to
receive assisted outpatient treatment.
  (6)  "subject  of the petition" or "subject" shall mean the person who
is alleged in a petition, filed  pursuant  to  the  provisions  of  this
section, to meet the criteria for assisted outpatient treatment.
  (7)  "correctional  facility"  and "local correctional facility" shall
have the same meanings as provided in section two of the correction law.
  (8) "health care proxy" and "health care agent" shall  have  the  same
meanings as provided in article twenty-nine-C of the public health law.
  (9)  "program  coordinator"  shall mean an individual appointed by the
commissioner [of mental health], pursuant to subdivision (f) of  section
7.17  of this chapter, who is responsible for the oversight and monitor-
ing of assisted outpatient treatment programs.
  (b) Programs. The director of community services of each local govern-
mental unit shall operate, direct and supervise an  assisted  outpatient
treatment  program.  The  director of a hospital licensed or operated by
the office [of mental health]  may  operate,  direct  and  supervise  an
assisted  outpatient treatment program, upon approval by the commission-
er. Directors of community services shall be permitted  to  satisfy  the
provisions  of  this subdivision through the operation of joint assisted
outpatient treatment programs. Nothing  in  this  subdivision  shall  be
interpreted  to  preclude  the  combination  or  coordination of efforts
between and among local governmental units and  hospitals  in  providing
and coordinating assisted outpatient treatment.
  (c)  Criteria.  A person may be ordered to receive assisted outpatient
treatment if the court finds that such person:
  (1) is eighteen years of age or older; and
  (2) is suffering from a mental illness; and
  (3) is unlikely to survive safely  in  the  community  without  super-
vision, based on a clinical determination; and
  (4)  has  a  history  of  lack of compliance with treatment for mental
illness that has:
  (i) [prior to the filing of the petition,] at least twice  within  the
[last]  thirty-six  months  PRIOR  TO  THE FILING OF THE PETITION been a
significant factor in necessitating hospitalization in  a  hospital,  or
receipt  of  services  in  a  forensic  or other mental health unit of a
correctional facility or a local correctional facility[, not including];
PROVIDED THAT SUCH THIRTY-SIX MONTH PERIOD  SHALL  BE  EXTENDED  BY  THE

S. 2225--A                          5

LENGTH  OF  any current period[, or period ending] OF HOSPITALIZATION OR
INCARCERATION, AND ANY SUCH  PERIOD  THAT  ENDED  within  the  last  six
months[,  during  which the person was or is hospitalized or incarcerat-
ed]; or
  (ii)  WITHIN  FORTY-EIGHT  MONTHS prior to the filing of the petition,
resulted in one or more acts of serious violent behavior toward self  or
others  or  threats of, or attempts at, serious physical harm to self or
others [within the last forty-eight  months,  not  including];  PROVIDED
THAT  SUCH  FORTY-EIGHT  MONTH PERIOD SHALL BE EXTENDED BY THE LENGTH OF
any current period[, or period ending] OF HOSPITALIZATION OR  INCARCERA-
TION,  AND  ANY  SUCH  PERIOD THAT ENDED within the last six months[, in
which the person was or is hospitalized or incarcerated]; and
  (5) is, as a result of his or her mental illness, unlikely  to  volun-
tarily  participate in outpatient treatment that would enable him or her
to live safely in the community; and
  (6) in view of his or her treatment history and current  behavior,  is
in  need  of assisted outpatient treatment in order to prevent a relapse
or deterioration which would be likely to result in serious harm to  the
person or others as defined in section 9.01 of this article; and
  (7) is likely to benefit from assisted outpatient treatment.
  (d) Health care proxy. Nothing in this section shall preclude a person
with  a  health  care proxy from being subject to a petition pursuant to
this chapter and consistent with article  twenty-nine-C  of  the  public
health law.
  (e)  INVESTIGATION OF REPORTS. THE COMMISSIONER SHALL PROMULGATE REGU-
LATIONS ESTABLISHING A PROCEDURE TO ENSURE THAT REPORTS OF A PERSON  WHO
MAY  BE  IN  NEED  OF  ASSISTED  OUTPATIENT  TREATMENT,  INCLUDING THOSE
RECEIVED FROM FAMILY AND COMMUNITY MEMBERS OF SUCH PERSON, ARE  INVESTI-
GATED IN A TIMELY MANNER AND, WHERE APPROPRIATE, RESULT IN THE FILING OF
PETITIONS FOR ASSISTED OUTPATIENT TREATMENT.
  (F)  Petition  to  the  court. (1) A petition for an order authorizing
assisted outpatient treatment may be filed  in  the  supreme  or  county
court  in  the county in which the subject of the petition is present or
reasonably believed to be present. Such petition may be  initiated  only
by the following persons:
  (i) any person eighteen years of age or older with whom the subject of
the petition resides; or
  (ii)  the  parent,  spouse, sibling eighteen years of age or older, or
child eighteen years of age or older of the subject of the petition; or
  (iii) the director of a hospital in which the subject of the  petition
is hospitalized; or
  (iv)  the director of any public or charitable organization, agency or
home providing mental health services to the subject of the petition  or
in whose institution the subject of the petition resides; or
  (v)  a  qualified psychiatrist who is either supervising the treatment
of or treating the subject of the petition for a mental illness; or
  (vi) a psychologist, licensed pursuant to article one  hundred  fifty-
three  of  the  education  law, or a social worker, licensed pursuant to
article one hundred fifty-four of the education law, who is treating the
subject of the petition for a mental illness; or
  (vii) the director of community services, or his or her  designee,  or
the  social services official, as defined in the social services law, of
the city or county in which the subject of the petition  is  present  or
reasonably believed to be present; or
  (viii) a parole officer or probation officer assigned to supervise the
subject of the petition[.]; OR

S. 2225--A                          6

  (IX)  THE  DIRECTOR OF THE HOSPITAL OR THE SUPERINTENDENT OF A CORREC-
TIONAL FACILITY IN WHICH THE SUBJECT  OF  THE  PETITION  IS  IMPRISONED,
PURSUANT TO SECTION FOUR HUNDRED FOUR OF THE CORRECTION LAW.
  (2)  THE  COMMISSIONER  SHALL PROMULGATE REGULATIONS PURSUANT TO WHICH
PERSONS INITIATING A PETITION, PURSUANT TO SUBPARAGRAPHS (I) AND (II) OF
PARAGRAPH ONE OF THIS SUBDIVISION, MAY RECEIVE ASSISTANCE IN FILING SUCH
PETITIONS, WHERE APPROPRIATE, AS DETERMINED PURSUANT TO SUBDIVISION  (E)
OF THIS SECTION.
  (3) The petition shall state:
  (i)  each  of  the  criteria  for assisted outpatient treatment as set
forth in subdivision (c) of this section;
  (ii) facts which support the petitioner's belief that the  subject  of
the  petition  meets  each  criterion,  provided that the hearing on the
petition need not be limited to the stated facts; and
  (iii) that the subject of the petition is present,  or  is  reasonably
believed to be present, within the county where such petition is filed.
  [(3)] (4) The petition shall be accompanied by an affirmation or affi-
davit of a physician, who shall not be the petitioner, stating THAT SUCH
PHYSICIAN  IS WILLING AND ABLE TO TESTIFY AT THE HEARING ON THE PETITION
AND THAT either [that]:
  (i) such physician has personally examined the subject of the petition
no more than ten days prior to the submission  of  the  petition[,]  AND
recommends  assisted  outpatient  treatment for the subject of the peti-
tion[, and is willing and able to testify at the hearing  on  the  peti-
tion]; or
  (ii)  no  more than ten days prior to the filing of the petition, such
physician or his or her designee has made appropriate attempts  but  has
not  been  successful in eliciting the cooperation of the subject of the
petition to submit to an  examination,  such  physician  has  reason  to
suspect that the subject of the petition meets the criteria for assisted
outpatient  treatment, and such physician is willing and able to examine
the subject of the petition [and testify at the hearing on the petition]
PRIOR TO PROVIDING TESTIMONY.
  [(4)] (5) In counties with a  population  of  less  than  seventy-five
thousand,  the  affirmation  or  affidavit required by paragraph [three]
FOUR of this subdivision may be made by a physician who is  an  employee
of the office.  The office is authorized AND DIRECTED to make available,
at  no  cost  to  the  county,  a qualified physician for the purpose of
making such affirmation or affidavit consistent with the  provisions  of
such paragraph.
  [(f)]  (G)  Service.  The petitioner shall cause written notice of the
petition to be given to the subject of the petition and a  copy  thereof
to  be given personally or by mail to the persons listed in section 9.29
of this article, the mental hygiene legal service, the health care agent
if any such agent is known to the petitioner,  the  appropriate  program
coordinator, and the appropriate director of community services, if such
director is not the petitioner.
  [(g)] (H) Right to counsel. The subject of the petition shall have the
right to be represented by the mental hygiene legal service, or private-
ly  financed counsel, at all stages of a proceeding commenced under this
section.
  [(h)] (I) Hearing. (1) Upon receipt of the petition, the  court  shall
fix  the date for a hearing. Such date shall be no later than three days
from the date such petition is received by the court,  excluding  Satur-
days,  Sundays  and  holidays.  Adjournments shall be permitted only for
good cause shown. In granting adjournments, the court shall consider the

S. 2225--A                          7

need for further examination by a physician or  the  potential  need  to
provide  assisted  outpatient  treatment  expeditiously. The court shall
cause the subject of the petition, any  other  person  receiving  notice
pursuant  to  subdivision [(f)] (G) of this section, the petitioner, the
physician whose affirmation or affidavit accompanied the  petition,  and
such  other  persons  as  the  court may determine to be advised of such
date. Upon such date, or upon such other date to  which  the  proceeding
may  be  adjourned,  the court shall hear testimony and, if it be deemed
advisable and the subject of the  petition  is  available,  examine  the
subject  of the petition in or out of court. If the subject of the peti-
tion does not appear at the hearing, and appropriate attempts to  elicit
the  attendance  of  the  subject have failed, the court may conduct the
hearing in the subject's absence. In such  case,  the  court  shall  set
forth  the factual basis for conducting the hearing without the presence
of the subject of the petition.
  (2) The court shall not order assisted outpatient treatment unless  an
examining  physician,  who  recommends assisted outpatient treatment and
has personally examined the subject of the petition  no  more  than  ten
days before the filing of the petition, testifies in person at the hear-
ing.  Such  physician  shall state the facts and clinical determinations
which support the allegation that the subject of the petition meets each
of the criteria for assisted outpatient  treatment;  PROVIDED  THAT  THE
PARTIES MAY STIPULATE, UPON MUTUAL CONSENT, THAT SUCH PHYSICIAN NEED NOT
TESTIFY.
  (3)  If  the  subject  of the petition has refused to be examined by a
physician, the court may request the subject to consent to  an  examina-
tion  by a physician appointed by the court. If the subject of the peti-
tion does not consent and the court finds reasonable  cause  to  believe
that the allegations in the petition are true, the court may order peace
officers,  acting  pursuant  to their special duties, or police officers
who are members of an authorized police department or  force,  or  of  a
sheriff's  department  to  take the subject of the petition into custody
and transport him or her to a hospital for examination by  a  physician.
Retention  of  the  subject  of  the petition under such order shall not
exceed twenty-four hours. The examination of the subject of the petition
may be performed by the physician whose affirmation or affidavit  accom-
panied the petition pursuant to paragraph three of subdivision [(e)] (F)
of  this  section,  if  such physician is privileged by such hospital or
otherwise authorized by such hospital to do so. If such  examination  is
performed by another physician, the examining physician may consult with
the physician whose affirmation or affidavit accompanied the petition as
to whether the subject meets the criteria for assisted outpatient treat-
ment.
  (4) A physician who testifies pursuant to paragraph two of this subdi-
vision  shall  state:  (i) the facts [which] AND CLINICAL DETERMINATIONS
THAT support the allegation that the subject meets each of the  criteria
for  assisted outpatient treatment, (ii) that the treatment is the least
restrictive  alternative,  (iii)  the  recommended  assisted  outpatient
treatment,  and  (iv)  the rationale for the recommended assisted outpa-
tient  treatment.  If  the  recommended  assisted  outpatient  treatment
includes medication, such physician's testimony shall describe the types
or  classes of medication which should be authorized, shall describe the
beneficial and detrimental physical and mental effects of  such  medica-
tion,  and shall recommend whether such medication should be self-admin-
istered or administered by authorized personnel.

S. 2225--A                          8

  (5) The subject of the petition shall be afforded  an  opportunity  to
present  evidence, to call witnesses on his or her behalf, and to cross-
examine adverse witnesses.
  [(i)]  (J)  Written  treatment  plan.  (1)  The  court shall not order
assisted outpatient treatment unless a physician appointed by the appro-
priate director,  in  consultation  with  such  director,  develops  and
provides  to  the  court  a proposed written treatment plan. The written
treatment plan shall  include  case  management  services  or  assertive
community  treatment  team  services  to  provide care coordination. The
written treatment plan also shall include all categories of services, as
set forth in paragraph one of subdivision (a)  of  this  section,  which
such  physician recommends that the subject of the petition receive. All
service providers shall be notified regarding  their  inclusion  in  the
written  treatment  plan. If the written treatment plan includes medica-
tion, it shall state whether such medication should be self-administered
or administered by authorized personnel,  and  shall  specify  type  and
dosage  range  of  medication most likely to provide maximum benefit for
the subject. If the written treatment plan includes alcohol or substance
abuse counseling and  treatment,  such  plan  may  include  a  provision
requiring  relevant  testing  for  either  alcohol or illegal substances
provided the physician's  clinical  basis  for  recommending  such  plan
provides sufficient facts for the court to find (i) that such person has
a  history  of  alcohol or substance abuse that is clinically related to
the mental illness; and (ii) that such testing is necessary to prevent a
relapse or deterioration which would be likely to result in serious harm
to the person or others. If a director is the  petitioner,  the  written
treatment  plan shall be provided to the court no later than the date of
the hearing on the petition. If a person other than a  director  is  the
petitioner,  such  plan shall be provided to the court no later than the
date set by the court pursuant to paragraph three of  subdivision  [(j)]
(K) of this section.
  (2)  The  physician  appointed  to  develop the written treatment plan
shall provide the following persons  with  an  opportunity  to  actively
participate  in  the  development of such plan: the subject of the peti-
tion; the treating physician, if  any;  and  upon  the  request  of  the
subject  of  the  petition,  an  individual  significant  to the subject
including any relative, close friend or individual  otherwise  concerned
with  the  welfare  of the subject. THE APPOINTED PHYSICIAN SHALL MAKE A
REASONABLE EFFORT TO GATHER RELEVANT INFORMATION FOR THE DEVELOPMENT  OF
THE  TREATMENT  PLAN FROM THE SUBJECT OF THE PETITION'S FAMILY MEMBER OR
MEMBERS, OR HIS OR HER SIGNIFICANT OTHER. If the subject of the petition
has executed a health care proxy, the appointed physician shall consider
any directions included in such proxy in developing the  written  treat-
ment plan.
  (3)  The  court shall not order assisted outpatient treatment unless a
physician appearing on behalf of a director  testifies  to  explain  the
written  proposed  treatment  plan; PROVIDED THAT THE PARTIES MAY STIPU-
LATE, UPON MUTUAL CONSENT, THAT SUCH PHYSICIAN NEED NOT TESTIFY.    Such
physician  shall  state  the categories of assisted outpatient treatment
recommended, the rationale for each such category, facts which establish
that such treatment is the least restrictive alternative,  and,  if  the
recommended assisted outpatient treatment plan includes medication, such
physician  shall  state  the types or classes of medication recommended,
the beneficial and detrimental physical and mental effects of such medi-
cation, and whether  such  medication  should  be  self-administered  or
administered  by an authorized professional. If the subject of the peti-

S. 2225--A                          9

tion has executed a health care proxy, such physician  shall  state  the
consideration given to any directions included in such proxy in develop-
ing  the written treatment plan. If a director is the petitioner, testi-
mony  pursuant  to  this  paragraph shall be given at the hearing on the
petition. If a person other than a  director  is  the  petitioner,  such
testimony  shall be given on the date set by the court pursuant to para-
graph three of subdivision [(j)] (K) of this section.
  [(j)] (K) Disposition. (1) If after hearing all relevant evidence, the
court does not find by clear and convincing evidence that the subject of
the petition meets the criteria for assisted outpatient  treatment,  the
court shall dismiss the petition.
  (2)  If  after hearing all relevant evidence, the court finds by clear
and convincing evidence that the  subject  of  the  petition  meets  the
criteria  for assisted outpatient treatment, and there is no appropriate
and feasible less restrictive  alternative,  the  court  may  order  the
subject  to  receive assisted outpatient treatment for an initial period
not to exceed one year. In fashioning the order, the court shall specif-
ically make findings by clear and convincing evidence that the  proposed
treatment  is  the  least restrictive treatment appropriate and feasible
for the subject. The order shall state an assisted outpatient  treatment
plan,  which  shall include all categories of assisted outpatient treat-
ment, as set forth in paragraph one of subdivision (a) of this  section,
which  the  assisted outpatient is to receive, but shall not include any
such category that has not been recommended in [both] the proposed writ-
ten treatment plan and [the] IN ANY  testimony  provided  to  the  court
pursuant to subdivision [(i)](J) of this section.
  (3)  If  after hearing all relevant evidence presented by a petitioner
who is not a director, the court finds by clear and convincing  evidence
that  the subject of the petition meets the criteria for assisted outpa-
tient treatment, and the court has yet to be  provided  with  a  written
proposed  treatment plan and testimony pursuant to subdivision [(i)] (J)
of this section, the court  shall  order  the  appropriate  director  to
provide  the  court with such plan and testimony no later than the third
day, excluding Saturdays, Sundays and  holidays,  immediately  following
the  date  of  such  order; PROVIDED THAT THE PARTIES MAY STIPULATE UPON
MUTUAL CONSENT THAT SUCH TESTIMONY NEED NOT BE PROVIDED.  Upon receiving
such plan and ANY REQUIRED  testimony,  the  court  may  order  assisted
outpatient treatment as provided in paragraph two of this subdivision.
  (4)  A  court  may  order  the patient to self-administer psychotropic
drugs or accept the administration of such drugs by authorized personnel
as part of an assisted outpatient  treatment  program.  Such  order  may
specify  the  type  and dosage range of such psychotropic drugs and such
order shall be effective for the duration of  such  assisted  outpatient
treatment.
  (5)  If  the petitioner is the director of a hospital that operates an
assisted outpatient treatment program, the court order shall direct  the
hospital  director  to provide or arrange for all categories of assisted
outpatient treatment for the assisted outpatient throughout  the  period
of the order. In all other instances, the order shall require the appro-
priate  director, as that term is defined in this section, to provide or
arrange for all categories of  assisted  outpatient  treatment  for  the
assisted  outpatient  throughout the period of the order.  ORDERS ISSUED
ON OR AFTER THE EFFECTIVE DATE OF THE CHAPTER OF THE LAWS OF  TWO  THOU-
SAND  THIRTEEN  THAT  AMENDED THIS SECTION SHALL REQUIRE THE APPROPRIATE
DIRECTOR "AS DETERMINED  BY  THE  PROGRAM  COORDINATOR"  TO  PROVIDE  OR

S. 2225--A                         10

ARRANGE  FOR  ALL  CATEGORIES  OF  ASSISTED OUTPATIENT TREATMENT FOR THE
ASSISTED OUTPATIENT THROUGHOUT THE PERIOD OF THE ORDER.
  (6) The director shall cause a copy of any court order issued pursuant
to  this section to be served personally, or by mail, facsimile or elec-
tronic means, upon the assisted outpatient,  the  mental  hygiene  legal
service  or  anyone  acting  on  the  assisted  outpatient's behalf, the
original petitioner, identified service providers, and all others  enti-
tled to notice under subdivision [(f)] (G) of this section.
  [(k)]  (L)  RELOCATION OF ASSISTED OUTPATIENTS. THE COMMISSIONER SHALL
PROMULGATE REGULATIONS REQUIRING THAT, DURING THE PERIOD OF  THE  ORDER,
AN  ASSISTED  OUTPATIENT  AND ANY OTHER APPROPRIATE PERSONS SHALL NOTIFY
THE PROGRAM COORDINATOR WITHIN A REASONABLE TIME PRIOR TO SUCH  ASSISTED
OUTPATIENT RELOCATING WITHIN THE STATE OF NEW YORK TO AN AREA NOT SERVED
BY  THE  DIRECTOR  WHO  HAS  BEEN DIRECTED TO PROVIDE OR ARRANGE FOR THE
ASSISTED OUTPATIENT TREATMENT. UPON RECEIVING NOTIFICATION OF SUCH RELO-
CATION, THE PROGRAM COORDINATOR SHALL REDETERMINE  WHO  THE  APPROPRIATE
DIRECTOR SHALL BE AND CAUSE A COPY OF THE COURT ORDER AND TREATMENT PLAN
TO BE TRANSMITTED TO SUCH DIRECTOR.
  (M)  Petition  for  [additional  periods  of] CONTINUED treatment. (1)
[Prior] WITHIN THIRTY DAYS PRIOR to the expiration of an order  pursuant
to  this  section,  the  appropriate  director  shall review whether the
assisted outpatient continues to meet the criteria for  assisted  outpa-
tient treatment. [If, as documented in the petition, the director deter-
mines  that  such  criteria  continue  to be met or has made appropriate
attempts to, but has not been successful in eliciting,  the  cooperation
of  the subject to submit to an examination, within thirty days prior to
the expiration of an order of assisted outpatient treatment, such direc-
tor may petition the court to order continued assisted outpatient treat-
ment pursuant to paragraph two of  this  subdivision.  Upon  determining
whether such criteria continue to be met, such director shall notify the
program  coordinator  in  writing as to whether a petition for continued
assisted outpatient treatment is warranted and whether such  a  petition
was  or will be filed.] UPON DETERMINING THAT ONE OR MORE OF SUCH CRITE-
RIA ARE NO LONGER MET, SUCH DIRECTOR SHALL NOTIFY THE PROGRAM  COORDINA-
TOR  IN WRITING THAT A PETITION FOR CONTINUED ASSISTED OUTPATIENT TREAT-
MENT IS NOT WARRANTED.  UPON DETERMINING THAT SUCH CRITERIA CONTINUE  TO
BE  MET,  HE OR SHE SHALL PETITION THE COURT TO ORDER CONTINUED ASSISTED
OUTPATIENT TREATMENT FOR A PERIOD NOT TO EXCEED ONE YEAR FROM THE  EXPI-
RATION  DATE  OF  THE  CURRENT ORDER. IF THE COURT'S DISPOSITION OF SUCH
PETITION DOES NOT OCCUR PRIOR TO THE  EXPIRATION  DATE  OF  THE  CURRENT
ORDER,  THE CURRENT ORDER SHALL REMAIN IN EFFECT UNTIL SUCH DISPOSITION.
THE PROCEDURES FOR OBTAINING ANY  ORDER  PURSUANT  TO  THIS  SUBDIVISION
SHALL  BE IN ACCORDANCE WITH THE PROVISIONS OF THE FOREGOING SUBDIVISION
OF THIS SECTION; PROVIDED THAT THE TIME RESTRICTIONS INCLUDED  IN  PARA-
GRAPH  FOUR  OF SUBDIVISION (C) OF THIS SECTION SHALL NOT BE APPLICABLE.
THE NOTICE PROVISIONS SET FORTH IN PARAGRAPH SIX OF SUBDIVISION  (K)  OF
THIS  SECTION  SHALL  BE  APPLICABLE. ANY COURT ORDER REQUIRING PERIODIC
BLOOD TESTS OR URINALYSIS FOR THE PRESENCE OF ALCOHOL OR  ILLEGAL  DRUGS
SHALL  BE SUBJECT TO REVIEW AFTER SIX MONTHS BY THE PHYSICIAN WHO DEVEL-
OPED THE WRITTEN TREATMENT PLAN OR ANOTHER PHYSICIAN DESIGNATED  BY  THE
DIRECTOR, AND SUCH PHYSICIAN SHALL BE AUTHORIZED TO TERMINATE SUCH BLOOD
TESTS OR URINALYSIS WITHOUT FURTHER ACTION BY THE COURT.
  (2) Within thirty days prior to the expiration of an order of assisted
outpatient  treatment,  [the  appropriate director or] the current peti-
tioner, if the current petition was filed pursuant to  subparagraph  (i)
or  (ii)  of paragraph one of subdivision [(e)] (F) of this section, and

S. 2225--A                         11

the current petitioner retains his or her original  status  pursuant  to
the  applicable  subparagraph, may petition the court to order continued
assisted outpatient treatment for a period not to exceed one  year  from
the  expiration date of the current order. If the court's disposition of
such petition does not occur prior to the expiration date of the current
order, the current order shall remain in effect until such  disposition.
The  procedures  for  obtaining  any  order pursuant to this subdivision
shall be in accordance with the provisions of the foregoing subdivisions
of this section; provided that the time restrictions included  in  para-
graph  four  of subdivision (c) of this section shall not be applicable.
The notice provisions set forth in paragraph six  of  subdivision  [(j)]
(K) of this section shall be applicable. Any court order requiring peri-
odic  blood  tests  or urinalysis for the presence of alcohol or illegal
drugs shall be subject to review after six months by the  physician  who
developed  the written treatment plan or another physician designated by
the director, and such physician shall be authorized to  terminate  such
blood tests or urinalysis without further action by the court.
  (3)  IF  NEITHER  THE  APPROPRIATE DIRECTOR NOR THE CURRENT PETITIONER
PETITION FOR CONTINUED ASSISTED OUTPATIENT TREATMENT  PURSUANT  TO  THIS
PARAGRAPH  AND  THE ORDER OF THE COURT EXPIRES, ANY OTHER PERSON AUTHOR-
IZED TO PETITION PURSUANT TO PARAGRAPH ONE OF SUBDIVISION  (F)  OF  THIS
SECTION  MAY BRING A NEW PETITION FOR ASSISTED OUTPATIENT TREATMENT.  IF
SUCH NEW PETITION IS FILED LESS THAN SIXTY DAYS AFTER THE EXPIRATION  OF
SUCH ORDER, THE TIME RESTRICTIONS PROVIDED IN PARAGRAPH FOUR OF SUBDIVI-
SION (C) OF THIS SECTION SHALL NOT BE APPLICABLE TO THE NEW PETITION.
  (4)  IF, THIRTY DAYS PRIOR TO THE EXPIRATION OF AN ORDER, THE ASSISTED
OUTPATIENT IS DEEMED BY THE  APPROPRIATE  DIRECTOR  TO  BE  MISSING  AND
THEREBY  UNAVAILABLE FOR EVALUATION AS TO WHETHER HE OR SHE CONTINUES TO
MEET THE CRITERIA FOR ASSISTED OUTPATIENT TREATMENT, SUCH DIRECTOR SHALL
PETITION THE COURT TO EXTEND THE TERM OF THE CURRENT ORDER  UNTIL  SIXTY
DAYS AFTER SUCH TIME AS THE ASSISTED OUTPATIENT IS LOCATED. IF THE COURT
GRANTS  THE EXTENSION, THE DIRECTOR SHALL CONTINUE REASONABLE EFFORTS TO
LOCATE THE ASSISTED OUTPATIENT.  UPON LOCATION OF  THE  ASSISTED  OUTPA-
TIENT, THE DIRECTOR SHALL REVIEW WHETHER THE ASSISTED OUTPATIENT CONTIN-
UES  TO MEET THE CRITERIA FOR ASSISTED OUTPATIENT TREATMENT, PURSUANT TO
PARAGRAPH TWO OF THIS SUBDIVISION.
  [(l)] (N) Petition for an order to stay,  vacate  or  modify.  (1)  In
addition  to  any other right or remedy available by law with respect to
the order for assisted outpatient treatment,  the  assisted  outpatient,
the  mental  hygiene  legal  service,  or  anyone acting on the assisted
outpatient's behalf may petition the court on notice  to  the  director,
the  original petitioner, and all others entitled to notice under subdi-
vision [(f)] (G) of this section to stay, vacate or modify the order.
  (2) The appropriate director shall petition  the  court  for  approval
before instituting a proposed material change in the assisted outpatient
treatment  plan,  unless  such  change is authorized by the order of the
court.  SUCH PETITIONS TO CHANGE AN ASSISTED OUTPATIENT TREATMENT  PLAN,
AS  WELL  AS PETITIONS FOR CONTINUED TREATMENT, MAY BE MADE TO ANY JUDGE
OF THE SUPREME OR COUNTY COURTS IN THE COUNTY IN WHICH  THE  SUBJECT  OF
THE PETITION IS PRESENT OR REASONABLY BELIEVED TO BE PRESENT. Such peti-
tion  shall  be  filed on notice to all parties entitled to notice under
subdivision [(f)] (G) of this section. Not later than  five  days  after
receiving  such petition, excluding Saturdays, Sundays and holidays, the
court shall hold a  hearing  on  the  petition;  provided  that  if  the
assisted  outpatient  informs  the  court  that  he or she agrees to the
proposed material change, the court may approve such  change  without  a

S. 2225--A                         12

hearing.  Non-material changes may be instituted by the director without
court approval. For the purposes of this paragraph, a material change is
an addition or deletion of a category of services to or from  a  current
assisted  outpatient  treatment  plan,  or  any  deviation  without  the
assisted outpatient's consent from the terms of a current order relating
to the administration of psychotropic drugs.
  [(m)] (O) Appeals. Review of an order issued pursuant to this  section
shall  be  had  in  like  manner  as  specified  in section 9.35 of this
article; PROVIDED THAT NOTICE SHALL BE PROVIDED TO ALL PARTIES  ENTITLED
TO NOTICE UNDER SUBDIVISION (G) OF THIS SECTION.
  [(n)]  (P) Failure to comply with assisted outpatient treatment. Where
in the clinical judgment of a physician, (i)  the  assisted  outpatient,
has  failed or refused to comply with the assisted outpatient treatment,
(ii) efforts were made to solicit compliance, and  (iii)  such  assisted
outpatient  may be in need of involuntary admission to a hospital pursu-
ant to section 9.27 of this article or immediate observation,  care  and
treatment  pursuant to section 9.39 or 9.40 of this article, such physi-
cian may request the appropriate director  of  community  services,  the
director's  designee,  or  any  physician  designated by the director of
community services pursuant to section 9.37 of this article,  to  direct
the  removal  of such assisted outpatient to an appropriate hospital for
an examination to determine if such person  has  a  mental  illness  for
which  HE  OR SHE IS IN NEED OF hospitalization is necessary pursuant to
section 9.27, 9.39 or  9.40  of  this  article[.  Furthermore,  if  such
assisted outpatient refuses to take medications as required by the court
order,  or he or she refuses to take, or fails a blood test, urinalysis,
or alcohol or drug test as required by the court order,  such  physician
may consider such refusal or failure when determining whether]; PROVIDED
THAT  IF, AFTER EFFORTS TO SOLICIT COMPLIANCE, SUCH PHYSICIAN DETERMINES
THAT THE ASSISTED OUTPATIENT'S  FAILURE  TO  COMPLY  WITH  THE  ASSISTED
OUTPATIENT  TREATMENT INCLUDES A SUBSTANTIAL FAILURE TO TAKE MEDICATION,
PASS OR SUBMIT TO BLOOD TESTING OR URINALYSIS, OR RECEIVE TREATMENT  FOR
ALCOHOL OR SUBSTANCE ABUSE, SUCH PHYSICIAN MAY PRESUME THAT the assisted
outpatient  is  in need of an examination to determine whether he or she
has a mental illness for which hospitalization is  necessary.  Upon  the
request  of  such  physician,  the  appropriate director, the director's
designee, or any physician designated pursuant to section 9.37  of  this
article,  may  direct  peace  officers, acting pursuant to their special
duties, or police officers who  are  members  of  an  authorized  police
department  or  force  or of a sheriff's department to take the assisted
outpatient into custody and transport him or her to the hospital operat-
ing the assisted outpatient treatment program or to any hospital author-
ized by the director of community services to receive such persons. Such
law enforcement officials shall  carry  out  such  directive.  Upon  the
request  of  such  physician,  the  appropriate director, the director's
designee, or any physician designated pursuant to section 9.37  of  this
article,  an ambulance service, as defined by subdivision two of section
three thousand one of the public  health  law,  or  an  approved  mobile
crisis outreach team as defined in section 9.58 of this article shall be
authorized  to  take  into  custody and transport any such person to the
hospital operating the assisted outpatient treatment program, or to  any
other  hospital  authorized  by  the  appropriate  director of community
services to receive such persons. Any director of community services, or
designee, shall be authorized to  direct  the  removal  of  an  assisted
outpatient  who is present in his or her county to an appropriate hospi-
tal, in accordance with the provisions of this subdivision, based upon a

S. 2225--A                         13

determination of the appropriate director of community services  direct-
ing  the  removal  of such assisted outpatient pursuant to this subdivi-
sion. Such person may be retained for observation,  care  and  treatment
and  further  examination in the hospital for up to seventy-two hours to
permit a physician to determine whether such person has a mental illness
and is in need of involuntary care and treatment in a hospital  pursuant
to  the  provisions of this article. Any continued involuntary retention
OF THE ASSISTED OUTPATIENT in such hospital beyond the initial  seventy-
two hour period shall be in accordance with the provisions of this arti-
cle  relating to the involuntary admission and retention of a person. If
at any time during the seventy-two hour period the person is  determined
not  to  meet the involuntary admission and retention provisions of this
article, and does not agree to stay in the hospital as  a  voluntary  or
informal  patient, he or she must be released. Failure to comply with an
order of assisted outpatient treatment shall not be grounds for involun-
tary civil commitment or a finding of contempt of court.
  [(o)] (Q) Effect of determination that a person is in need of assisted
outpatient treatment. The determination by a court that a person  is  in
need  of  assisted  outpatient  treatment  shall  not be construed as or
deemed to be a determination that such person is incapacitated  pursuant
to article eighty-one of this chapter.
  [(p)] (R) False petition. A person making a false statement or provid-
ing  false information or false testimony in a petition or hearing under
this section shall be subject to criminal prosecution pursuant to  arti-
cle  one  hundred  seventy-five  or article two hundred ten of the penal
law.
  [(q)] (S) Exception. Nothing in this section  shall  be  construed  to
affect  the  ability of the director of a hospital to receive, admit, or
retain patients who  otherwise  meet  the  provisions  of  this  article
regarding receipt, retention or admission.
  [(r)]  (T)  Education and training. (1) The office [of mental health],
in consultation with the office of court administration,  shall  prepare
educational  and  training  materials  on the use of this section, which
shall be made  available  to  local  governmental  units,  providers  of
services,  judges,  court  personnel,  law enforcement officials and the
general public.
  (2) The office, in consultation with  the  office  of  court  adminis-
tration,  shall  establish  a mental health training program for supreme
and county court judges and court  personnel,  AND  SHALL  PROVIDE  SUCH
TRAINING WITH SUCH FREQUENCY AND IN SUCH LOCATIONS AS MAY BE APPROPRIATE
TO  MEET  STATEWIDE NEEDS.  Such training shall focus on the use of this
section and generally address issues  relating  to  mental  illness  and
mental health treatment.
  S  6.  Section  29.15 of the mental hygiene law is amended by adding a
new subdivision (o) to read as follows:
  (O) IF THE DIRECTOR OF A DEPARTMENT FACILITY  DOES  NOT  PETITION  FOR
ASSISTED  OUTPATIENT  TREATMENT PURSUANT TO SECTION 9.60 OF THIS CHAPTER
UPON THE DISCHARGE OF AN INPATIENT ADMITTED PURSUANT  TO  SECTION  9.27,
9.39  OR  9.40  OF  THIS  CHAPTER, OR UPON THE EXPIRATION OF A PERIOD OF
CONDITIONAL RELEASE FOR SUCH INPATIENT, SUCH DIRECTOR SHALL REPORT  SUCH
DISCHARGE  OR  SUCH  EXPIRATION  IN WRITING TO THE DIRECTOR OF COMMUNITY
SERVICES OF THE LOCAL  GOVERNMENTAL  UNIT  IN  WHICH  THE  INPATIENT  IS
EXPECTED TO RESIDE.
  S  7.  Subdivision 3 of section 404 of the correction law, as added by
chapter 1 of the laws of 2013, is amended to read as follows:

S. 2225--A                         14

  3. Within a reasonable period prior to discharge of an inmate  commit-
ted  from a [state correctional facility from a] hospital in the depart-
ment of mental hygiene to the community, the director shall ensure  that
a clinical assessment has been completed to determine whether the inmate
meets  the criteria for assisted outpatient treatment pursuant to subdi-
vision (c) of section 9.60 of the mental hygiene law. If, as a result of
such assessment, the director determines  that  the  inmate  meets  such
criteria,  prior  to discharge the director of the hospital shall either
petition for a court order  pursuant  to  section  9.60  of  the  mental
hygiene  law, or report in writing to the director of community services
of the local governmental unit in which the inmate is expected to reside
so that an investigation may be conducted pursuant to  section  9.47  of
the mental hygiene law.
  S  8.  Section  18  of  chapter  408 of the laws of 1999, constituting
Kendra's Law, as amended by chapter 1 of the laws of 2013, is amended to
read as follows:
  S 18. This act shall take effect immediately,  provided  that  section
fifteen  of this act shall take effect April 1, 2000, provided, further,
that subdivision (e) of section 9.60 of the mental hygiene law as  added
by  section  six  of  this act shall be effective 90 days after this act
shall become law[; and that this act shall expire and be deemed repealed
June 30, 2017].
  S 9. Severability. If any clause, sentence, paragraph, section or part
of this act shall be adjudged by any court of competent jurisdiction  to
be  invalid,  and  after  exhaustion of all further judicial review, the
judgment shall not affect, impair or invalidate the  remainder  thereof,
but  shall  be  confined in its operation to the clause, sentence, para-
graph, section or part thereof directly involved in the controversy.
  S 10.  This act shall take effect immediately; provided, however, that
if this act shall take effect prior to the effective date of the  amend-
ments to sections 9.47 and 9.60 of the mental hygiene law and to section
404  of  the  correction  law  made  by  chapter  1 of the laws of 2013,
sections three, five and seven of  this  act  respectively,  shall  take
effect  on  the  same  date and in the same manner as such chapter takes
effect.

Co-Sponsors

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S2225B - Bill Details

Current Committee:
Law Section:
Mental Hygiene Law
Laws Affected:
Amd §§7.17, 9.47, 9.48, 9.60 & 29.15, Ment Hyg L; amd §404, Cor L; amd §18, Chap 408 of 1999
Versions Introduced in 2011-2012 Legislative Session:
S4881A

S2225B - Bill Texts

view summary

Enhances the assisted outpatient treatment program; eliminates the expiration and repeal of Kendra's Law.

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BILL NUMBER:S2225B

TITLE OF BILL: An act to amend the mental hygiene law and the
correction law, in relation to enhancing the assisted outpatient
treatment program; and to amend Kendra's Law, in relation to making
the provisions thereof permanent

PURPOSE OR GENERAL IDEA OF BILL:

To improve care for people with serious mental illness, and protect
the safety of patients and the public by streamlining and improving
New York's Assisted Outpatient Treatment (AOT) program (Kendra's Law).

SUMMARY OF SPECIFIC PROVISIONS:

Section 1 amends Mental Hygiene Law (MHL) § 7.17(f) to require that
AOT program coordinators monitor local programs to ensure that
expiring AOT orders are adequately reviewed to consider the need for
renewal of the order; to ensure appropriate assignment of a director
for each outpatient; and to monitor local needs for training of judges
and court personnel in order for the office of mental health to
adequately provide such training.

Section 2 provides that the Commissioner of Mental Health shall
develop an educational pamphlet on the process of petitioning for AOT
to be made available to persons wishing to submit reports of
individuals who may be in need of AOT, as well as disseminated to
family members and other individuals eligible to petition for AOT

Section 3 amends § 9.47 of the MHL to clarify that directors of
community services shall be responsible for ensuring that reports of
persons who may be in need of continued AOT orders are subject to a
timely investigation.. It also provides that directors of community
services shall notify program coordinators when AOT patients cannot be
located or are believed to have taken residence outside of the local
governmental unit served.

Section 4 amends MHL § 9.48 to require that AOT program directors'
quarterly reports to program coordinators include information on any
expired AOT court orders, including the determination made as to
whether to petition for renewal of the AOT, the basis for such
determination, and the court's disposition of the renewal petition, if
any.

Section 5 amends MHL § 9.60 to clarify that assisted outpatient
treatment services provided may include: medication education or
symptom management education; appointment of a representative payee;
and that tests for alcohol or drugs may be random. This section also
provides that the parties to the treatment order may stipulate, upon
mutual consent, that an examining physician need not testify in court,
The bill also provides that the appointed physician shall make a
reasonable effort to gather relevant information for the development
of a treatment plan from a member or members of the patient's family
or significant other,

This section also clarifies that directors of hospitals or
superintendents of correctional facilities may initiate a petition.


This section also requires the Commissioner to establish by regulation
a procedure to ensure that reports of persons who may be in need of
AOT that are made by family and community members of such person are,
if warranted, investigated in a timely manner, and that AOT petitions
are filed, where appropriate.

This section also provides that the Commissioner shall promulgate
regulations to require that prior to an assisted outpatient relocating
to a location within the state of New York which is not served by his
or her current director of community services, that patient or other
appropriate party must notify the program coordinator. The program
coordinator shall then redetermine who the appropriate director shall
be, and cause a copy of the court order and treatment plan to be
transmitted to the new director.

This section also provides that a director shall review whether the
assisted outpatient continues to meet AOT criteria within 30 days
before the expiration of an order for AOT. If the director determines
that such assisted outpatient no longer meets the criteria, such
director is required to give notice to the program coordinator that a
petition for continued AOT is unnecessary. However, if such assisted
outpatient continues to meet the criteria, as determined by the
director, such director shall file a petition for continued treatment.

This provision clarifies procedures any other person authorized to
petition for continued AOT may use to bring such petition in the event
that the appropriate director or current petitioner does not petition
for continued AOT prior to the expiration of the court order.

This section also provides that counties shall notify the department
when an assisted outpatient is missing and thereby unavailable for an
evaluation as to whether he or she continues to meet AOT criteria. It
also provides that when a patient is missing upon the expiration date
of the order, the order shall be extended until sixty days after such
patient is found.

Section 6 amends MHL § 29.15 to provide that if the director of the
hospital does not petition for AOT upon the discharge of an
involuntarily committed inpatient or upon the expiration of a period
of conditional release for such inpatient, such director shall report
the discharge in writing to the director of community services of the
local government unit where the inpatient is expected to reside.

Section 7 amends subdivision 1 of section 404 of the correction law to
require that, prior to discharging an inmate who is still mentally
ill, the director shall, where appropriate, either apply for a
person's admission to a hospital for care and treatment, or initiate a
petition for an order authorizing assisted outpatient treatment, or
the commissioner may apply for the person's admission to a secure
treatment facility.

Section 8 would repeal the current sunset date of June 30, 2017 to
make the provisions of Kendra's Law permanent.

Section 9 Severability.

Section 10 states that this act shall take effect immediately.


JUSTIFICATION:

In 1999, the legislature enacted "Kendra's Law," establishing a
statewide court-ordered assisted outpatient treatment (AOT) program to
improve outcomes for persons with severe mental illness who, in view
of their treatment history and present circumstances, are likely to
have difficulty living safely in the community. At the approach of the
law's original 2005 expiration date, the legislature took note of the
Office of Mental Health (OMH) research documenting declines in rates
of homelessness, hospitalization, substance abuse, alcoholism,
violence, arrest and incarceration, and documented increases in
treatment compliance, service engagement and positive consumer
perceptions. In 2005 and 2010, the legislature opted to extend
Kendra's Law for an additional five years to further evaluate the
program. The New York SAFE Act, which was signed into law on January
15, 2013, also extended Kendra's Law for an additional two years,
making the law expire on June 30, 2017.

On June 30, 2009, a team of independent researchers released the
report of their long term study of AOT throughout New York State and
in October, 2010 Psychiatric Services published six peer reviewed
studies on the AOT program. These reports confirm the earlier OMH
data. These studies found patients given mandatory outpatient
treatment who were more violent to begin with, were nevertheless four
times less likely than members of the control group to perpetrate
serious violence after undergoing assisted outpatient treatment. The
studies also found less frequent psychiatric hospitalizations, shorter
length of hospitalizations, reduction in the likelihood of arrest,
higher social functioning, slightly less stigma and no increase in
perceived coercion. These studies confirmed that AOT stimulates
service provider's efforts to prioritize care for AOT recipients;
judges hearing AOT cases could benefit from additional AOT training;
counties favored increasing the availability of stipulations to reduce
the court burden, costs, and transportation burdens; recipients are
far more likely than other patients to consistently receive
psychotropic medications appropriate to their psychiatric condition;
that those who receive AOT for periods of at least one year are more
likely than those who receive AOT for shorter periods to sustain gains
after leaving the program; that the law has been applied in a
non-discriminatory manner; and that the court order itself, in
addition to high quality services, is a significant factor in the
program's success.

The experience of thousands of patients, treatment providers and
families who have utilized Kendra's Law since 1999 point to several
areas where the law should be improved to achieve costs savings,
promote smoother functioning of the AOT program and easier access to
those who stand to benefit from it. Although the New York SAFE Act
addresses many of these concerns, loopholes still exist in the law.
The amendments included in this act are intended to close these
loopholes and maximize the unique potential of this legislation, while
simultaneously serving the goals of compassionate care, fiscal
responsibility, and public safety.

PRIOR LEGISLATIVE HISTORY:


2011,2012: S.4881B Referred to Mental Health/Developmental
Disabilities

FISCAL IMPLICATIONS:

To be determined. Cost-savings for the state and local governments are
anticipated following implementation, due to reduced instances of
hospitalizations and incarcerations that would result.

EFFECTIVE DATE:

This act shall take effect immediately.

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                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 2225--B

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                            January 14, 2013
                               ___________

Introduced by Sens. YOUNG, ADAMS, ADDABBO, AVELLA, BALL, BONACIC, BOYLE,
  DeFRANCISCO,    FARLEY,    FUSCHILLO,    GALLIVAN,   GOLDEN,   GRIFFO,
  HASSELL-THOMPSON,   LANZA,   LARKIN,   LIBOUS,   LITTLE,   MARCELLINO,
  MARCHIONE,  MARTINS,  MAZIARZ, NOZZOLIO, RANZENHOFER, RITCHIE, ROBACH,
  SEWARD, STAVISKY, VALESKY, ZELDIN -- read twice and  ordered  printed,
  and when printed to be committed to the Committee on Mental Health and
  Developmental  Disabilities  --  committee  discharged,  bill amended,
  ordered reprinted as amended and  recommitted  to  said  committee  --
  committee  discharged,  bill amended, ordered reprinted as amended and
  recommitted to said committee

AN ACT to amend the mental  hygiene  law  and  the  correction  law,  in
  relation  to  enhancing the assisted outpatient treatment program; and
  to amend Kendra's Law, in relation to making  the  provisions  thereof
  permanent

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Paragraph 2 of subdivision  (f)  of  section  7.17  of  the
mental  hygiene  law,  as amended by chapter 158 of the laws of 2005, is
amended to read as follows:
  (2) The oversight and monitoring role of the  program  coordinator  of
the  assisted  outpatient  treatment  program  shall include each of the
following:
  (i) that each assisted outpatient receives the treatment provided  for
in  the  court  order  issued pursuant to section 9.60 of this [chapter]
TITLE;
  (ii) that existing  services  located  in  the  assisted  outpatient's
community are utilized whenever practicable;
  (iii)  that  a  case  manager or assertive community treatment team is
designated for each assisted outpatient;
  (iv) that a mechanism exists  for  such  case  manager,  or  assertive
community  treatment team, to regularly report the assisted outpatient's

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD02670-06-3

S. 2225--B                          2

compliance, or lack of compliance with treatment, to the director of the
assisted outpatient treatment program;
  (v)  that directors of community services establish procedures [which]
THAT provide that reports of persons who may  be  in  need  of  assisted
outpatient  treatment are appropriately investigated in a timely manner;
[and]
  (vi) that assisted outpatient treatment services are  delivered  in  a
timely manner[.];
  (VII)  THAT,  PRIOR TO THE EXPIRATION OF ASSISTED OUTPATIENT TREATMENT
ORDERS, THE  CLINICAL  NEEDS  OF  ASSISTED  OUTPATIENTS  ARE  ADEQUATELY
REVIEWED  IN  DETERMINING  THE  NEED  TO PETITION FOR CONTINUED ASSISTED
OUTPATIENT TREATMENT PURSUANT TO SUBDIVISION (M) OF SECTION 9.60 OF THIS
TITLE;
  (VIII) THAT THE APPROPRIATE DIRECTOR IS DETERMINED FOR  EACH  ASSISTED
OUTPATIENT, PURSUANT TO SUBDIVISIONS (K) AND (L) OF SECTION 9.60 OF THIS
TITLE; AND
  (IX)  THAT  THE OFFICE FULFILLS ITS DUTIES PURSUANT TO SUBDIVISION (T)
OF SECTION 9.60 OF THIS TITLE TO MEET LOCAL NEEDS FOR TRAINING OF JUDGES
AND COURT PERSONNEL.
  S 2. Subdivision (f) of section 7.17 of  the  mental  hygiene  law  is
amended by adding a new paragraph 5 to read as follows:
  (5)  THE  COMMISSIONER  SHALL  DEVELOP  AN EDUCATIONAL PAMPHLET ON THE
PROCESS OF PETITIONING FOR ASSISTED  OUTPATIENT  TREATMENT  FOR  DISSEM-
INATION  TO  INDIVIDUALS SEEKING TO SUBMIT REPORTS OF PERSONS WHO MAY BE
IN NEED OF ASSISTED OUTPATIENT TREATMENT,  AND  INDIVIDUALS  SEEKING  TO
FILE A PETITION PURSUANT TO SUBPARAGRAPH (I) OR (II) OF PARAGRAPH ONE OF
SUBDIVISION  (F)  OF SECTION 9.60 OF THIS TITLE. SUCH PAMPHLET SHALL SET
FORTH, IN PLAIN LANGUAGE: THE CRITERIA FOR  ASSISTED  OUTPATIENT  TREAT-
MENT,  RESOURCES  AVAILABLE TO SUCH INDIVIDUALS, THE RESPONSIBILITIES OF
PROGRAM COORDINATORS AND DIRECTORS OF COMMUNITY SERVICES, A  SUMMARY  OF
CURRENT  LAW,  THE PROCESS FOR PETITIONING FOR CONTINUED ASSISTED OUTPA-
TIENT TREATMENT, AND OTHER SUCH INFORMATION THE COMMISSIONER  DETERMINES
TO BE PERTINENT.
  S  3.    Subdivision (b) of section 9.47 of the mental hygiene law, as
amended by chapter 158 of the laws of 2005, paragraphs 5 and 6 as  added
and  paragraph  7  as  renumbered  by  chapter 1 of the laws of 2013, is
amended to read as follows:
  (b) All directors of community services shall be responsible for:
  (1) receiving reports of persons who may be in need of assisted outpa-
tient treatment PURSUANT TO SECTION 9.60 OF THIS ARTICLE and documenting
the receipt date of such reports;
  (2) conducting timely investigations of such reports RECEIVED PURSUANT
TO PARAGRAPH ONE OF THIS SUBDIVISION and providing written  notice  upon
the  completion of investigations to reporting persons and program coor-
dinators, appointed by the commissioner [of mental health]  pursuant  to
subdivision  (f)  of  section  7.17  of  this title, and documenting the
initiation and completion dates of such investigations and the  disposi-
tions;
  (3)  filing of petitions for assisted outpatient treatment pursuant to
[paragraph] SUBPARAGRAPH (vii) of PARAGRAPH ONE OF subdivision [(e)] (F)
of section 9.60 of this article, and  documenting  the  petition  filing
[date] DATES and the [date] DATES of the court [order] ORDERS;
  (4)  coordinating  the  timely delivery of court ordered services with
program coordinators and documenting the date assisted outpatients begin
to receive the services mandated in the court order; [and]

S. 2225--B                          3

  (5) ensuring evaluation of the need for  ongoing  assisted  outpatient
treatment  pursuant  to  subdivision  [(k)]  (M) of section 9.60 of this
article prior to the expiration of  any  assisted  outpatient  treatment
order;
  (6)  if  he  or  she  has  been  ordered to provide for or arrange for
assisted outpatient treatment pursuant to paragraph five of  subdivision
[(j)]  (K)  of  section  9.60  of this article or became the appropriate
director pursuant to this paragraph or subdivision (c) of  section  9.48
of this article, notifying the director of community services of the new
county  of  residence  when  he  or  she  has  reason to believe that an
assisted outpatient has or will change his or her  county  of  residence
during the pendency of an assisted outpatient treatment order. Upon such
change  of  residence, the director of the new county of residence shall
become the appropriate director, as such term is defined in section 9.60
of this article; [and]
  (7) NOTIFYING PROGRAM COORDINATORS WHEN ASSISTED OUTPATIENTS CANNOT BE
LOCATED AFTER REASONABLE EFFORTS OR ARE BELIEVED TO HAVE TAKEN RESIDENCE
OUTSIDE OF THE LOCAL GOVERNMENTAL UNIT SERVED; AND
  (8) reporting on a quarterly basis to program coordinators the  infor-
mation collected pursuant to this subdivision.
  S 4.  Paragraphs (viii) and (ix) of subdivision (b) of section 9.48 of
the  mental hygiene law are renumbered paragraphs (ix) and (x) and a new
paragraph (viii) is added to read as follows:
  (VIII) AN ACCOUNT OF ANY COURT ORDER  EXPIRATION,  INCLUDING  BUT  NOT
LIMITED  TO  THE  DIRECTOR'S DETERMINATION AS TO WHETHER TO PETITION FOR
CONTINUED ASSISTED OUTPATIENT TREATMENT, PURSUANT  TO  SECTION  9.60  OF
THIS  ARTICLE,  THE BASIS FOR SUCH DETERMINATION, AND THE DISPOSITION OF
ANY SUCH PETITION;
  S 5. Section 9.60 of the mental hygiene law, as amended by chapter 158
of the laws of 2005, paragraph  1  of  subdivision  (a)  as  amended  by
section  1  of part E of chapter 111 of the laws of 2010, paragraph 3 of
subdivision (a), paragraphs 2 and 5 of subdivision (j), and subdivisions
(k) and (n) as amended by chapter 1 of the laws of 2013, paragraph 5  of
subdivision  (c)  as  amended  by  chapter  137  of the laws of 2005, is
amended to read as follows:
S 9.60 Assisted outpatient treatment.
  (a) Definitions. For purposes of this  section,  the  following  defi-
nitions shall apply:
  (1)  "assisted  outpatient  treatment" shall mean categories of outpa-
tient services [which] THAT have been ordered by the court  pursuant  to
this  section.  Such treatment shall include case management services or
assertive community treatment team  services  to  provide  care  coordi-
nation,  and  may  also  include  any  of  the  following  categories of
services: medication SUPPORT; MEDICATION EDUCATION OR SYMPTOM MANAGEMENT
EDUCATION; periodic blood tests or urinalysis  to  determine  compliance
with prescribed medications; individual or group therapy; day or partial
day  programming  activities;  educational  and  vocational  training or
activities; APPOINTMENT OF A REPRESENTATIVE  PAYEE  OR  OTHER  FINANCIAL
MANAGEMENT  SERVICES,  SUBJECT  TO FINAL APPROVAL OF THE SOCIAL SECURITY
ADMINISTRATION, WHERE APPLICABLE; alcohol or substance  abuse  treatment
and  counseling and periodic OR RANDOM tests for the presence of alcohol
or illegal drugs for persons with a  history  of  alcohol  or  substance
abuse; supervision of living arrangements; and any other services within
a  local  services  plan developed pursuant to article forty-one of this
chapter, CLINICAL OR NON-CLINICAL,  prescribed  to  treat  the  person's
mental illness and to assist the person in living and functioning in the

S. 2225--B                          4

community,  or to attempt to prevent a relapse or deterioration that may
reasonably be predicted to result in [suicide] SERIOUS PHYSICAL HARM  TO
ANY PERSON or the need for hospitalization.
  (2)  "director"  shall  mean  the  director of community services of a
local governmental unit, or the director of a hospital licensed or oper-
ated by the office of mental health which operates, directs  and  super-
vises an assisted outpatient treatment program.
  (3)  "director  of  community  services" and "local governmental unit"
shall have the same meanings as provided in article  forty-one  of  this
chapter. The "appropriate director" shall mean the director of community
services of the county where the assisted outpatient resides, even if it
is  a  different  county  than  the county where the assisted outpatient
treatment order was originally issued.
  (4) "assisted outpatient treatment program" shall  mean  a  system  to
arrange  for  and coordinate the provision of assisted outpatient treat-
ment, to monitor treatment compliance by assisted outpatients, to evalu-
ate the condition or needs of assisted outpatients, to take  appropriate
steps to address the needs of such individuals, and to ensure compliance
with court orders.
  (5) "assisted outpatient" shall mean the person under a court order to
receive assisted outpatient treatment.
  (6)  "subject  of the petition" or "subject" shall mean the person who
is alleged in a petition, filed  pursuant  to  the  provisions  of  this
section, to meet the criteria for assisted outpatient treatment.
  (7)  "correctional  facility"  and "local correctional facility" shall
have the same meanings as provided in section two of the correction law.
  (8) "health care proxy" and "health care agent" shall  have  the  same
meanings as provided in article twenty-nine-C of the public health law.
  (9)  "program  coordinator"  shall mean an individual appointed by the
commissioner [of mental health], pursuant to subdivision (f) of  section
7.17  of this chapter, who is responsible for the oversight and monitor-
ing of assisted outpatient treatment programs.
  (b) Programs. The director of community services of each local govern-
mental unit shall operate, direct and supervise an  assisted  outpatient
treatment  program.  The  director of a hospital licensed or operated by
the office [of mental health]  may  operate,  direct  and  supervise  an
assisted  outpatient treatment program, upon approval by the commission-
er. Directors of community services shall be permitted  to  satisfy  the
provisions  of  this subdivision through the operation of joint assisted
outpatient treatment programs. Nothing  in  this  subdivision  shall  be
interpreted  to  preclude  the  combination  or  coordination of efforts
between and among local governmental units and  hospitals  in  providing
and coordinating assisted outpatient treatment.
  (c)  Criteria.  A person may be ordered to receive assisted outpatient
treatment if the court finds that such person:
  (1) is eighteen years of age or older; and
  (2) is suffering from a mental illness; and
  (3) is unlikely to survive safely  in  the  community  without  super-
vision, based on a clinical determination; and
  (4)  has  a  history  of  lack of compliance with treatment for mental
illness that has:
  (i) [prior to the filing of the petition,] at least twice  within  the
[last]  thirty-six  months  PRIOR  TO  THE FILING OF THE PETITION been a
significant factor in necessitating hospitalization in  a  hospital,  or
receipt  of  services  in  a  forensic  or other mental health unit of a
correctional facility or a local correctional facility[, not including];

S. 2225--B                          5

PROVIDED THAT SUCH THIRTY-SIX MONTH PERIOD  SHALL  BE  EXTENDED  BY  THE
LENGTH  OF  any current period[, or period ending] OF HOSPITALIZATION OR
INCARCERATION, AND ANY SUCH  PERIOD  THAT  ENDED  within  the  last  six
months[,  during  which the person was or is hospitalized or incarcerat-
ed]; or
  (ii) WITHIN FORTY-EIGHT MONTHS prior to the filing  of  the  petition,
resulted  in one or more acts of serious violent behavior toward self or
others or threats of, or attempts at, serious physical harm to  self  or
others  [within  the  last  forty-eight months, not including]; PROVIDED
THAT SUCH FORTY-EIGHT MONTH PERIOD SHALL BE EXTENDED BY  THE  LENGTH  OF
any  current period[, or period ending] OF HOSPITALIZATION OR INCARCERA-
TION, AND ANY SUCH PERIOD THAT ENDED within the  last  six  months[,  in
which the person was or is hospitalized or incarcerated]; and
  (5)  is,  as a result of his or her mental illness, unlikely to volun-
tarily participate in outpatient treatment that would enable him or  her
to live safely in the community; and
  (6)  in  view of his or her treatment history and current behavior, is
in need of assisted outpatient treatment in order to prevent  a  relapse
or  deterioration which would be likely to result in serious harm to the
person or others as defined in section 9.01 of this article; and
  (7) is likely to benefit from assisted outpatient treatment.
  (d) Health care proxy. Nothing in this section shall preclude a person
with a health care proxy from being subject to a  petition  pursuant  to
this  chapter  and  consistent  with article twenty-nine-C of the public
health law.
  (e) INVESTIGATION OF REPORTS. THE COMMISSIONER SHALL PROMULGATE  REGU-
LATIONS  ESTABLISHING A PROCEDURE TO ENSURE THAT REPORTS OF A PERSON WHO
MAY BE  IN  NEED  OF  ASSISTED  OUTPATIENT  TREATMENT,  INCLUDING  THOSE
RECEIVED  FROM FAMILY AND COMMUNITY MEMBERS OF SUCH PERSON, ARE INVESTI-
GATED IN A TIMELY MANNER AND, WHERE APPROPRIATE, RESULT IN THE FILING OF
PETITIONS FOR ASSISTED OUTPATIENT TREATMENT.
  (F) Petition to the court. (1) A petition  for  an  order  authorizing
assisted  outpatient  treatment  may  be  filed in the supreme or county
court in the county in which the subject of the petition is  present  or
reasonably  believed  to  be  present.    WHEN  A  DIRECTOR OF COMMUNITY
SERVICES HAS REASON TO BELIEVE THAT AN ASSISTED OUTPATIENT  HAS  CHANGED
HIS  OR HER COUNTY OF RESIDENCE, FUTURE PETITIONS AND APPLICATIONS UNDER
THIS SECTION MAY BE FILED IN THE SUPREME OR  COUNTY  COURT  IN  THE  NEW
COUNTY  OF  RESIDENCE, WHICH SHALL HAVE CONCURRENT JURISDICTION WITH THE
COURT THAT INITIALLY ORDERED SUCH TREATMENT. Such petition may be initi-
ated only by the following persons:
  (i) any person eighteen years of age or older with whom the subject of
the petition resides; or
  (ii) the parent, spouse, sibling eighteen years of age  or  older,  or
child eighteen years of age or older of the subject of the petition; or
  (iii)  the director of a hospital in which the subject of the petition
is hospitalized; or
  (iv) the director of any public or charitable organization, agency  or
home  providing mental health services to the subject of the petition or
in whose institution the subject of the petition resides; or
  (v) a qualified psychiatrist who is either supervising  the  treatment
of or treating the subject of the petition for a mental illness; or
  (vi)  a  psychologist, licensed pursuant to article one hundred fifty-
three of the education law, or a social  worker,  licensed  pursuant  to
article one hundred fifty-four of the education law, who is treating the
subject of the petition for a mental illness; or

S. 2225--B                          6

  (vii)  the  director of community services, or his or her designee, or
the social services official, as defined in the social services law,  of
the  city  or  county in which the subject of the petition is present or
reasonably believed to be present; or
  (viii) a parole officer or probation officer assigned to supervise the
subject of the petition[.]; OR
  (IX)  THE  DIRECTOR OF THE HOSPITAL OR THE SUPERINTENDENT OF A CORREC-
TIONAL FACILITY IN WHICH THE SUBJECT  OF  THE  PETITION  IS  IMPRISONED,
PURSUANT TO SECTION FOUR HUNDRED FOUR OF THE CORRECTION LAW.
  (2)  THE  COMMISSIONER  SHALL PROMULGATE REGULATIONS PURSUANT TO WHICH
PERSONS INITIATING A PETITION, PURSUANT TO SUBPARAGRAPHS (I) AND (II) OF
PARAGRAPH ONE OF THIS SUBDIVISION, MAY RECEIVE ASSISTANCE IN FILING SUCH
PETITIONS, WHERE APPROPRIATE, AS DETERMINED PURSUANT TO SUBDIVISION  (E)
OF THIS SECTION.
  (3) The petition shall state:
  (i)  each  of  the  criteria  for assisted outpatient treatment as set
forth in subdivision (c) of this section;
  (ii) facts which support the petitioner's belief that the  subject  of
the  petition  meets  each  criterion,  provided that the hearing on the
petition need not be limited to the stated facts; and
  (iii) that the subject of the petition is present,  or  is  reasonably
believed to be present, within the county where such petition is filed.
  [(3)] (4) The petition shall be accompanied by an affirmation or affi-
davit of a physician, who shall not be the petitioner, stating THAT SUCH
PHYSICIAN  IS WILLING AND ABLE TO TESTIFY AT THE HEARING ON THE PETITION
AND THAT either [that]:
  (i) such physician has personally examined the subject of the petition
no more than ten days prior to the submission  of  the  petition[,]  AND
recommends  assisted  outpatient  treatment for the subject of the peti-
tion[, and is willing and able to testify at the hearing  on  the  peti-
tion]; or
  (ii)  no  more than ten days prior to the filing of the petition, such
physician or his or her designee has made appropriate attempts  but  has
not  been  successful in eliciting the cooperation of the subject of the
petition to submit to an  examination,  such  physician  has  reason  to
suspect that the subject of the petition meets the criteria for assisted
outpatient  treatment, and such physician is willing and able to examine
the subject of the petition [and testify at the hearing on the petition]
PRIOR TO PROVIDING TESTIMONY.
  [(4)] (5) In counties with a  population  of  less  than  seventy-five
thousand,  the  affirmation  or  affidavit required by paragraph [three]
FOUR of this subdivision may be made by a physician who is  an  employee
of the office.  The office is authorized AND DIRECTED to make available,
at  no  cost  to  the  county,  a qualified physician for the purpose of
making such affirmation or affidavit consistent with the  provisions  of
such paragraph.
  [(f)]  (G)  Service.  The petitioner shall cause written notice of the
petition to be given to the subject of the petition and a  copy  thereof
to  be given personally or by mail to the persons listed in section 9.29
of this article, the mental hygiene legal service, the health care agent
if any such agent is known to the petitioner,  the  appropriate  program
coordinator, and the appropriate director of community services, if such
director is not the petitioner.
  [(g)] (H) Right to counsel. The subject of the petition shall have the
right to be represented by the mental hygiene legal service, or private-

S. 2225--B                          7

ly  financed counsel, at all stages of a proceeding commenced under this
section.
  [(h)]  (I)  Hearing. (1) Upon receipt of the petition, the court shall
fix the date for a hearing. Such date shall be no later than three  days
from  the  date such petition is received by the court, excluding Satur-
days, Sundays and holidays. Adjournments shall  be  permitted  only  for
good cause shown. In granting adjournments, the court shall consider the
need  for  further  examination  by a physician or the potential need to
provide assisted outpatient treatment  expeditiously.  The  court  shall
cause  the  subject  of  the petition, any other person receiving notice
pursuant to subdivision [(f)] (G) of this section, the  petitioner,  the
physician  whose  affirmation or affidavit accompanied the petition, and
such other persons as the court may determine  to  be  advised  of  such
date.  Upon  such  date, or upon such other date to which the proceeding
may be adjourned, the court shall hear testimony and, if  it  be  deemed
advisable  and  the  subject  of  the petition is available, examine the
subject of the petition in or out of court. If the subject of the  peti-
tion  does not appear at the hearing, and appropriate attempts to elicit
the attendance of the subject have failed, the  court  may  conduct  the
hearing  in  the  subject's  absence.  In such case, the court shall set
forth the factual basis for conducting the hearing without the  presence
of the subject of the petition.
  (2)  The court shall not order assisted outpatient treatment unless an
examining physician, who recommends assisted  outpatient  treatment  and
has  personally  examined  the  subject of the petition no more than ten
days before the filing of the petition, testifies in person at the hear-
ing. Such physician shall state the facts  and  clinical  determinations
which support the allegation that the subject of the petition meets each
of  the  criteria  for  assisted outpatient treatment; PROVIDED THAT THE
PARTIES MAY STIPULATE, UPON MUTUAL CONSENT, THAT SUCH PHYSICIAN NEED NOT
TESTIFY.
  (3) If the subject of the petition has refused to  be  examined  by  a
physician,  the  court may request the subject to consent to an examina-
tion by a physician appointed by the court. If the subject of the  peti-
tion  does  not  consent and the court finds reasonable cause to believe
that the allegations in the petition are true, the court may order peace
officers, acting pursuant to their special duties,  or  police  officers
who  are  members  of  an authorized police department or force, or of a
sheriff's department to take the subject of the  petition  into  custody
and  transport  him or her to a hospital for examination by a physician.
Retention of the subject of the petition  under  such  order  shall  not
exceed twenty-four hours. The examination of the subject of the petition
may  be performed by the physician whose affirmation or affidavit accom-
panied the petition pursuant to paragraph three of subdivision [(e)] (F)
of this section, if such physician is privileged  by  such  hospital  or
otherwise  authorized  by such hospital to do so. If such examination is
performed by another physician, the examining physician may consult with
the physician whose affirmation or affidavit accompanied the petition as
to whether the subject meets the criteria for assisted outpatient treat-
ment.
  (4) A physician who testifies pursuant to paragraph two of this subdi-
vision shall state: (i) the facts [which]  AND  CLINICAL  DETERMINATIONS
THAT  support the allegation that the subject meets each of the criteria
for assisted outpatient treatment, (ii) that the treatment is the  least
restrictive  alternative,  (iii)  the  recommended  assisted  outpatient
treatment, and (iv) the rationale for the  recommended  assisted  outpa-

S. 2225--B                          8

tient  treatment.  If  the  recommended  assisted  outpatient  treatment
includes medication, such physician's testimony shall describe the types
or classes of medication which should be authorized, shall describe  the
beneficial  and  detrimental physical and mental effects of such medica-
tion, and shall recommend whether such medication should be  self-admin-
istered or administered by authorized personnel.
  (5)  The  subject  of the petition shall be afforded an opportunity to
present evidence, to call witnesses on his or her behalf, and to  cross-
examine adverse witnesses.
  [(i)]  (J)  Written  treatment  plan.  (1)  The  court shall not order
assisted outpatient treatment unless a physician appointed by the appro-
priate director,  in  consultation  with  such  director,  develops  and
provides  to  the  court  a proposed written treatment plan. The written
treatment plan shall  include  case  management  services  or  assertive
community  treatment  team  services  to  provide care coordination. The
written treatment plan also shall include all categories of services, as
set forth in paragraph one of subdivision (a)  of  this  section,  which
such  physician recommends that the subject of the petition receive. All
service providers shall be notified regarding  their  inclusion  in  the
written  treatment  plan. If the written treatment plan includes medica-
tion, it shall state whether such medication should be self-administered
or administered by authorized personnel,  and  shall  specify  type  and
dosage  range  of  medication most likely to provide maximum benefit for
the subject. If the written treatment plan includes alcohol or substance
abuse counseling and  treatment,  such  plan  may  include  a  provision
requiring  relevant  testing  for  either  alcohol or illegal substances
provided the physician's  clinical  basis  for  recommending  such  plan
provides sufficient facts for the court to find (i) that such person has
a  history  of  alcohol or substance abuse that is clinically related to
the mental illness; and (ii) that such testing is necessary to prevent a
relapse or deterioration which would be likely to result in serious harm
to the person or others. If a director is the  petitioner,  the  written
treatment  plan shall be provided to the court no later than the date of
the hearing on the petition. If a person other than a  director  is  the
petitioner,  such  plan shall be provided to the court no later than the
date set by the court pursuant to paragraph three of  subdivision  [(j)]
(K) of this section.
  (2)  The  physician  appointed  to  develop the written treatment plan
shall provide the following persons  with  an  opportunity  to  actively
participate  in  the  development of such plan: the subject of the peti-
tion; the treating physician, if  any;  and  upon  the  request  of  the
subject  of  the  petition,  an  individual  significant  to the subject
including any relative, close friend or individual  otherwise  concerned
with  the  welfare  of the subject. THE APPOINTED PHYSICIAN SHALL MAKE A
REASONABLE EFFORT TO GATHER RELEVANT INFORMATION FOR THE DEVELOPMENT  OF
THE  TREATMENT  PLAN FROM THE SUBJECT OF THE PETITION'S FAMILY MEMBER OR
MEMBERS, OR HIS OR HER SIGNIFICANT OTHER. If the subject of the petition
has executed a health care proxy, the appointed physician shall consider
any directions included in such proxy in developing the  written  treat-
ment plan.
  (3)  The  court shall not order assisted outpatient treatment unless a
physician appearing on behalf of a director  testifies  to  explain  the
written  proposed  treatment  plan; PROVIDED THAT THE PARTIES MAY STIPU-
LATE, UPON MUTUAL CONSENT, THAT SUCH PHYSICIAN NEED NOT TESTIFY.    Such
physician  shall  state  the categories of assisted outpatient treatment
recommended, the rationale for each such category, facts which establish

S. 2225--B                          9

that such treatment is the least restrictive alternative,  and,  if  the
recommended assisted outpatient treatment plan includes medication, such
physician  shall  state  the types or classes of medication recommended,
the beneficial and detrimental physical and mental effects of such medi-
cation,  and  whether  such  medication  should  be self-administered or
administered by an authorized professional. If the subject of the  peti-
tion  has  executed  a health care proxy, such physician shall state the
consideration given to any directions included in such proxy in develop-
ing the written treatment plan. If a director is the petitioner,  testi-
mony  pursuant  to  this  paragraph shall be given at the hearing on the
petition. If a person other than a  director  is  the  petitioner,  such
testimony  shall be given on the date set by the court pursuant to para-
graph three of subdivision [(j)] (K) of this section.
  [(j)] (K) Disposition. (1) If after hearing all relevant evidence, the
court does not find by clear and convincing evidence that the subject of
the petition meets the criteria for assisted outpatient  treatment,  the
court shall dismiss the petition.
  (2)  If  after hearing all relevant evidence, the court finds by clear
and convincing evidence that the  subject  of  the  petition  meets  the
criteria  for assisted outpatient treatment, and there is no appropriate
and feasible less restrictive  alternative,  the  court  may  order  the
subject  to  receive assisted outpatient treatment for an initial period
not to exceed one year. In fashioning the order, the court shall specif-
ically make findings by clear and convincing evidence that the  proposed
treatment  is  the  least restrictive treatment appropriate and feasible
for the subject. The order shall state an assisted outpatient  treatment
plan,  which  shall include all categories of assisted outpatient treat-
ment, as set forth in paragraph one of subdivision (a) of this  section,
which  the  assisted outpatient is to receive, but shall not include any
such category that has not been recommended in [both] the proposed writ-
ten treatment plan and [the] IN ANY  testimony  provided  to  the  court
pursuant to subdivision [(i)](J) of this section.
  (3)  If  after hearing all relevant evidence presented by a petitioner
who is not a director, the court finds by clear and convincing  evidence
that  the subject of the petition meets the criteria for assisted outpa-
tient treatment, and the court has yet to be  provided  with  a  written
proposed  treatment plan and testimony pursuant to subdivision [(i)] (J)
of this section, the court  shall  order  the  appropriate  director  to
provide  the  court with such plan and testimony no later than the third
day, excluding Saturdays, Sundays and  holidays,  immediately  following
the  date  of  such  order; PROVIDED THAT THE PARTIES MAY STIPULATE UPON
MUTUAL CONSENT THAT SUCH TESTIMONY NEED NOT BE PROVIDED.  Upon receiving
such plan and ANY REQUIRED  testimony,  the  court  may  order  assisted
outpatient treatment as provided in paragraph two of this subdivision.
  (4)  A  court  may  order  the patient to self-administer psychotropic
drugs or accept the administration of such drugs by authorized personnel
as part of an assisted outpatient  treatment  program.  Such  order  may
specify  the  type  and dosage range of such psychotropic drugs and such
order shall be effective for the duration of  such  assisted  outpatient
treatment.
  (5)  If  the petitioner is the director of a hospital that operates an
assisted outpatient treatment program, the court order shall direct  the
hospital  director  to provide or arrange for all categories of assisted
outpatient treatment for the assisted outpatient throughout  the  period
of the order. In all other instances, the order shall require the appro-
priate  director, as that term is defined in this section, to provide or

S. 2225--B                         10

arrange for all categories of  assisted  outpatient  treatment  for  the
assisted  outpatient  throughout the period of the order.  ORDERS ISSUED
ON OR AFTER THE EFFECTIVE DATE OF THE CHAPTER OF THE LAWS OF  TWO  THOU-
SAND  THIRTEEN  THAT  AMENDED THIS SECTION SHALL REQUIRE THE APPROPRIATE
DIRECTOR "AS DETERMINED  BY  THE  PROGRAM  COORDINATOR"  TO  PROVIDE  OR
ARRANGE  FOR  ALL  CATEGORIES  OF  ASSISTED OUTPATIENT TREATMENT FOR THE
ASSISTED OUTPATIENT THROUGHOUT THE PERIOD OF THE ORDER.
  (6) The director shall cause a copy of any court order issued pursuant
to this section to be served personally, or by mail, facsimile or  elec-
tronic  means,  upon  the  assisted outpatient, the mental hygiene legal
service or anyone  acting  on  the  assisted  outpatient's  behalf,  the
original  petitioner, identified service providers, and all others enti-
tled to notice under subdivision [(f)] (G) of this section.
  [(k)] (L) RELOCATION OF ASSISTED OUTPATIENTS. THE  COMMISSIONER  SHALL
PROMULGATE  REGULATIONS  REQUIRING THAT, DURING THE PERIOD OF THE ORDER,
AN ASSISTED OUTPATIENT AND ANY OTHER APPROPRIATE  PERSONS  SHALL  NOTIFY
THE  PROGRAM COORDINATOR WITHIN A REASONABLE TIME PRIOR TO SUCH ASSISTED
OUTPATIENT RELOCATING WITHIN THE STATE OF NEW YORK TO AN AREA NOT SERVED
BY THE DIRECTOR WHO HAS BEEN DIRECTED TO  PROVIDE  OR  ARRANGE  FOR  THE
ASSISTED OUTPATIENT TREATMENT. UPON RECEIVING NOTIFICATION OF SUCH RELO-
CATION,  THE  PROGRAM  COORDINATOR SHALL REDETERMINE WHO THE APPROPRIATE
DIRECTOR SHALL BE AND CAUSE A COPY OF THE COURT ORDER AND TREATMENT PLAN
TO BE TRANSMITTED TO SUCH DIRECTOR.
  (M) Petition for [additional  periods  of]  CONTINUED  treatment.  (1)
[Prior]  WITHIN THIRTY DAYS PRIOR to the expiration of an order pursuant
to this section, the  appropriate  director  shall  review  whether  the
assisted  outpatient  continues to meet the criteria for assisted outpa-
tient treatment. [If, as documented in the petition, the director deter-
mines that such criteria continue to be  met  or  has  made  appropriate
attempts  to,  but has not been successful in eliciting, the cooperation
of the subject to submit to an examination, within thirty days prior  to
the expiration of an order of assisted outpatient treatment, such direc-
tor may petition the court to order continued assisted outpatient treat-
ment  pursuant  to  paragraph  two of this subdivision. Upon determining
whether such criteria continue to be met, such director shall notify the
program coordinator in writing as to whether a  petition  for  continued
assisted  outpatient  treatment is warranted and whether such a petition
was or will be filed.] UPON DETERMINING THAT ONE OR MORE OF SUCH  CRITE-
RIA  ARE NO LONGER MET, SUCH DIRECTOR SHALL NOTIFY THE PROGRAM COORDINA-
TOR IN WRITING THAT A PETITION FOR CONTINUED ASSISTED OUTPATIENT  TREAT-
MENT  IS NOT WARRANTED.  UPON DETERMINING THAT SUCH CRITERIA CONTINUE TO
BE MET, HE OR SHE SHALL PETITION THE COURT TO ORDER  CONTINUED  ASSISTED
OUTPATIENT  TREATMENT FOR A PERIOD NOT TO EXCEED ONE YEAR FROM THE EXPI-
RATION DATE OF THE CURRENT ORDER. IF THE  COURT'S  DISPOSITION  OF  SUCH
PETITION  DOES  NOT  OCCUR  PRIOR  TO THE EXPIRATION DATE OF THE CURRENT
ORDER, THE CURRENT ORDER SHALL REMAIN IN EFFECT UNTIL SUCH  DISPOSITION.
THE  PROCEDURES  FOR  OBTAINING  ANY  ORDER PURSUANT TO THIS SUBDIVISION
SHALL BE IN ACCORDANCE WITH THE PROVISIONS OF THE FOREGOING  SUBDIVISION
OF  THIS  SECTION; PROVIDED THAT THE TIME RESTRICTIONS INCLUDED IN PARA-
GRAPH FOUR OF SUBDIVISION (C) OF THIS SECTION SHALL NOT  BE  APPLICABLE.
THE  NOTICE  PROVISIONS SET FORTH IN PARAGRAPH SIX OF SUBDIVISION (K) OF
THIS SECTION SHALL BE APPLICABLE. ANY  COURT  ORDER  REQUIRING  PERIODIC
BLOOD  TESTS  OR URINALYSIS FOR THE PRESENCE OF ALCOHOL OR ILLEGAL DRUGS
SHALL BE SUBJECT TO REVIEW AFTER SIX MONTHS BY THE PHYSICIAN WHO  DEVEL-
OPED  THE  WRITTEN TREATMENT PLAN OR ANOTHER PHYSICIAN DESIGNATED BY THE

S. 2225--B                         11

DIRECTOR, AND SUCH PHYSICIAN SHALL BE AUTHORIZED TO TERMINATE SUCH BLOOD
TESTS OR URINALYSIS WITHOUT FURTHER ACTION BY THE COURT.
  (2) Within thirty days prior to the expiration of an order of assisted
outpatient  treatment,  [the  appropriate director or] the current peti-
tioner, if the current petition was filed pursuant to  subparagraph  (i)
or  (ii)  of paragraph one of subdivision [(e)] (F) of this section, and
the current petitioner retains his or her original  status  pursuant  to
the  applicable  subparagraph, may petition the court to order continued
assisted outpatient treatment for a period not to exceed one  year  from
the  expiration date of the current order. If the court's disposition of
such petition does not occur prior to the expiration date of the current
order, the current order shall remain in effect until such  disposition.
The  procedures  for  obtaining  any  order pursuant to this subdivision
shall be in accordance with the provisions of the foregoing subdivisions
of this section; provided that the time restrictions included  in  para-
graph  four  of subdivision (c) of this section shall not be applicable.
The notice provisions set forth in paragraph six  of  subdivision  [(j)]
(K) of this section shall be applicable. Any court order requiring peri-
odic  blood  tests  or urinalysis for the presence of alcohol or illegal
drugs shall be subject to review after six months by the  physician  who
developed  the written treatment plan or another physician designated by
the director, and such physician shall be authorized to  terminate  such
blood tests or urinalysis without further action by the court.
  (3)  IF  NEITHER  THE  APPROPRIATE DIRECTOR NOR THE CURRENT PETITIONER
PETITION FOR CONTINUED ASSISTED OUTPATIENT TREATMENT  PURSUANT  TO  THIS
PARAGRAPH  AND  THE ORDER OF THE COURT EXPIRES, ANY OTHER PERSON AUTHOR-
IZED TO PETITION PURSUANT TO PARAGRAPH ONE OF SUBDIVISION  (F)  OF  THIS
SECTION  MAY BRING A NEW PETITION FOR ASSISTED OUTPATIENT TREATMENT.  IF
SUCH NEW PETITION IS FILED LESS THAN SIXTY DAYS AFTER THE EXPIRATION  OF
SUCH ORDER, THE TIME RESTRICTIONS PROVIDED IN PARAGRAPH FOUR OF SUBDIVI-
SION (C) OF THIS SECTION SHALL NOT BE APPLICABLE TO THE NEW PETITION.
  (4)  IF, THIRTY DAYS PRIOR TO THE EXPIRATION OF AN ORDER, THE ASSISTED
OUTPATIENT IS DEEMED BY THE  APPROPRIATE  DIRECTOR  TO  BE  MISSING  AND
THEREBY  UNAVAILABLE FOR EVALUATION AS TO WHETHER HE OR SHE CONTINUES TO
MEET THE CRITERIA FOR ASSISTED OUTPATIENT TREATMENT, SUCH DIRECTOR SHALL
PETITION THE COURT TO EXTEND THE TERM OF THE CURRENT ORDER  UNTIL  SIXTY
DAYS AFTER SUCH TIME AS THE ASSISTED OUTPATIENT IS LOCATED. IF THE COURT
GRANTS  THE EXTENSION, THE DIRECTOR SHALL CONTINUE REASONABLE EFFORTS TO
LOCATE THE ASSISTED OUTPATIENT.  UPON LOCATION OF  THE  ASSISTED  OUTPA-
TIENT, THE DIRECTOR SHALL REVIEW WHETHER THE ASSISTED OUTPATIENT CONTIN-
UES  TO MEET THE CRITERIA FOR ASSISTED OUTPATIENT TREATMENT, PURSUANT TO
PARAGRAPH TWO OF THIS SUBDIVISION.
  [(l)] (N) Petition for an order to stay,  vacate  or  modify.  (1)  In
addition  to  any other right or remedy available by law with respect to
the order for assisted outpatient treatment,  the  assisted  outpatient,
the  mental  hygiene  legal  service,  or  anyone acting on the assisted
outpatient's behalf may petition the court on notice  to  the  director,
the  original petitioner, and all others entitled to notice under subdi-
vision [(f)] (G) of this section to stay, vacate or modify the order.
  (2) The appropriate director shall petition  the  court  for  approval
before instituting a proposed material change in the assisted outpatient
treatment  plan,  unless  such  change is authorized by the order of the
court.  SUCH PETITIONS TO CHANGE AN ASSISTED OUTPATIENT TREATMENT  PLAN,
AS  WELL  AS PETITIONS FOR CONTINUED TREATMENT, MAY BE MADE TO ANY JUDGE
OF THE SUPREME OR COUNTY COURTS IN THE COUNTY IN WHICH  THE  SUBJECT  OF
THE PETITION IS PRESENT OR REASONABLY BELIEVED TO BE PRESENT. Such peti-

S. 2225--B                         12

tion  shall  be  filed on notice to all parties entitled to notice under
subdivision [(f)] (G) of this section. Not later than  five  days  after
receiving  such petition, excluding Saturdays, Sundays and holidays, the
court  shall  hold  a  hearing  on  the  petition;  provided that if the
assisted outpatient informs the court that  he  or  she  agrees  to  the
proposed  material  change,  the court may approve such change without a
hearing. Non-material changes may be instituted by the director  without
court approval. For the purposes of this paragraph, a material change is
an  addition  or deletion of a category of services to or from a current
assisted  outpatient  treatment  plan,  or  any  deviation  without  the
assisted outpatient's consent from the terms of a current order relating
to the administration of psychotropic drugs.
  [(m)]  (O) Appeals. Review of an order issued pursuant to this section
shall be had in like  manner  as  specified  in  section  9.35  of  this
article;  PROVIDED THAT NOTICE SHALL BE PROVIDED TO ALL PARTIES ENTITLED
TO NOTICE UNDER SUBDIVISION (G) OF THIS SECTION.
  [(n)] (P) Failure to comply with assisted outpatient treatment.  Where
in  the  clinical  judgment of a physician, (i) the assisted outpatient,
has failed or refused to comply with the assisted outpatient  treatment,
(ii)  efforts  were  made to solicit compliance, and (iii) such assisted
outpatient may be in need of involuntary admission to a hospital  pursu-
ant  to  section 9.27 of this article or immediate observation, care and
treatment pursuant to section 9.39 or 9.40 of this article, such  physi-
cian  may  request  the  appropriate director of community services, the
director's designee, or any physician  designated  by  the  director  of
community  services  pursuant to section 9.37 of this article, to direct
the removal of such assisted outpatient to an appropriate  hospital  for
an  examination  to  determine  if  such person has a mental illness for
which HE OR SHE IS IN NEED OF hospitalization is necessary  pursuant  to
section  9.27,  9.39  or  9.40  of  this  article[. Furthermore, if such
assisted outpatient refuses to take medications as required by the court
order, or he or she refuses to take, or fails a blood test,  urinalysis,
or  alcohol  or drug test as required by the court order, such physician
may consider such refusal or failure when determining whether]; PROVIDED
THAT IF, AFTER EFFORTS TO SOLICIT COMPLIANCE, SUCH PHYSICIAN  DETERMINES
THAT  THE  ASSISTED  OUTPATIENT'S  FAILURE  TO  COMPLY WITH THE ASSISTED
OUTPATIENT TREATMENT INCLUDES A SUBSTANTIAL FAILURE TO TAKE  MEDICATION,
PASS  OR SUBMIT TO BLOOD TESTING OR URINALYSIS, OR RECEIVE TREATMENT FOR
ALCOHOL OR SUBSTANCE ABUSE, SUCH PHYSICIAN MAY PRESUME THAT the assisted
outpatient is in need of an examination to determine whether he  or  she
has  a  mental  illness for which hospitalization is necessary. Upon the
request of such physician,  the  appropriate  director,  the  director's
designee,  or  any physician designated pursuant to section 9.37 of this
article, may direct peace officers, acting  pursuant  to  their  special
duties,  or  police  officers  who  are  members of an authorized police
department or force or of a sheriff's department to  take  the  assisted
outpatient into custody and transport him or her to the hospital operat-
ing the assisted outpatient treatment program or to any hospital author-
ized by the director of community services to receive such persons. Such
law  enforcement  officials  shall  carry  out  such directive. Upon the
request of such physician,  the  appropriate  director,  the  director's
designee,  or  any physician designated pursuant to section 9.37 of this
article, an ambulance service, as defined by subdivision two of  section
three  thousand  one  of  the  public  health law, or an approved mobile
crisis outreach team as defined in section 9.58 of this article shall be
authorized to take into custody and transport any  such  person  to  the

S. 2225--B                         13

hospital  operating the assisted outpatient treatment program, or to any
other hospital authorized  by  the  appropriate  director  of  community
services to receive such persons. Any director of community services, or
designee,  shall  be  authorized  to  direct  the removal of an assisted
outpatient who is present in his or her county to an appropriate  hospi-
tal, in accordance with the provisions of this subdivision, based upon a
determination  of the appropriate director of community services direct-
ing the removal of such assisted outpatient pursuant  to  this  subdivi-
sion.  Such  person  may be retained for observation, care and treatment
and further examination in the hospital for up to seventy-two  hours  to
permit a physician to determine whether such person has a mental illness
and  is in need of involuntary care and treatment in a hospital pursuant
to the provisions of this article. Any continued  involuntary  retention
OF  THE ASSISTED OUTPATIENT in such hospital beyond the initial seventy-
two hour period shall be in accordance with the provisions of this arti-
cle relating to the involuntary admission and retention of a person.  If
at  any time during the seventy-two hour period the person is determined
not to meet the involuntary admission and retention provisions  of  this
article,  and  does  not agree to stay in the hospital as a voluntary or
informal patient, he or she must be released. Failure to comply with  an
order of assisted outpatient treatment shall not be grounds for involun-
tary civil commitment or a finding of contempt of court.
  [(o)] (Q) Effect of determination that a person is in need of assisted
outpatient  treatment.  The determination by a court that a person is in
need of assisted outpatient treatment  shall  not  be  construed  as  or
deemed  to be a determination that such person is incapacitated pursuant
to article eighty-one of this chapter.
  [(p)] (R) False petition. A person making a false statement or provid-
ing false information or false testimony in a petition or hearing  under
this  section shall be subject to criminal prosecution pursuant to arti-
cle one hundred seventy-five or article two hundred  ten  of  the  penal
law.
  [(q)]  (S)  Exception.  Nothing  in this section shall be construed to
affect the ability of the director of a hospital to receive,  admit,  or
retain  patients  who  otherwise  meet  the  provisions  of this article
regarding receipt, retention or admission.
  [(r)] (T) Education and training. (1) The office [of  mental  health],
in  consultation  with the office of court administration, shall prepare
educational and training materials on the use  of  this  section,  which
shall  be  made  available  to  local  governmental  units, providers of
services, judges, court personnel, law  enforcement  officials  and  the
general public.
  (2)  The  office,  in  consultation  with the office of court adminis-
tration, shall establish a mental health training  program  for  supreme
and  county  court  judges  and  court personnel, AND SHALL PROVIDE SUCH
TRAINING WITH SUCH FREQUENCY AND IN SUCH LOCATIONS AS MAY BE APPROPRIATE
TO MEET STATEWIDE NEEDS.  Such training shall focus on the use  of  this
section  and  generally  address  issues  relating to mental illness and
mental health treatment.
  S 6. Section 29.15 of the mental hygiene law is amended  by  adding  a
new subdivision (o) to read as follows:
  (O)  IF  THE  DIRECTOR  OF A DEPARTMENT FACILITY DOES NOT PETITION FOR
ASSISTED OUTPATIENT TREATMENT PURSUANT TO SECTION 9.60 OF  THIS  CHAPTER
UPON  THE  DISCHARGE  OF AN INPATIENT ADMITTED PURSUANT TO SECTION 9.27,
9.39 OR 9.40 OF THIS CHAPTER, OR UPON THE  EXPIRATION  OF  A  PERIOD  OF
CONDITIONAL  RELEASE FOR SUCH INPATIENT, SUCH DIRECTOR SHALL REPORT SUCH

S. 2225--B                         14

DISCHARGE OR SUCH EXPIRATION IN WRITING TO  THE  DIRECTOR  OF  COMMUNITY
SERVICES  OF  THE  LOCAL  GOVERNMENTAL  UNIT  IN  WHICH THE INPATIENT IS
EXPECTED TO RESIDE.
  S  7.  Subdivision 3 of section 404 of the correction law, as added by
chapter 1 of the laws of 2013, is amended to read as follows:
  3. Within a reasonable period prior to discharge of an inmate  commit-
ted  from a [state correctional facility from a] hospital in the depart-
ment of mental hygiene to the community, the director shall ensure  that
a clinical assessment has been completed to determine whether the inmate
meets  the criteria for assisted outpatient treatment pursuant to subdi-
vision (c) of section 9.60 of the mental hygiene law. If, as a result of
such assessment, the director determines  that  the  inmate  meets  such
criteria,  prior  to discharge the director of the hospital shall either
petition for a court order  pursuant  to  section  9.60  of  the  mental
hygiene  law, or report in writing to the director of community services
of the local governmental unit in which the inmate is expected to reside
so that an investigation may be conducted pursuant to  section  9.47  of
the mental hygiene law.
  S  8.  Section  18  of  chapter  408 of the laws of 1999, constituting
Kendra's Law, as amended by chapter 1 of the laws of 2013, is amended to
read as follows:
  S 18. This act shall take effect immediately,  provided  that  section
fifteen  of this act shall take effect April 1, 2000, provided, further,
that subdivision (e) of section 9.60 of the mental hygiene law as  added
by  section  six  of  this act shall be effective 90 days after this act
shall become law[; and that this act shall expire and be deemed repealed
June 30, 2017].
  S 9. Severability. If any clause, sentence, paragraph, section or part
of this act shall be adjudged by any court of competent jurisdiction  to
be  invalid,  and  after  exhaustion of all further judicial review, the
judgment shall not affect, impair or invalidate the  remainder  thereof,
but  shall  be  confined in its operation to the clause, sentence, para-
graph, section or part thereof directly involved in the controversy.
  S 10.  This act shall take effect immediately.

Co-Sponsors

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S2225C - Bill Details

Current Committee:
Law Section:
Mental Hygiene Law
Laws Affected:
Amd §§7.17, 9.47, 9.48, 9.60 & 29.15, Ment Hyg L; amd §404, Cor L; amd §18, Chap 408 of 1999
Versions Introduced in 2011-2012 Legislative Session:
S4881A

S2225C - Bill Texts

view summary

Enhances the assisted outpatient treatment program; eliminates the expiration and repeal of Kendra's Law.

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BILL NUMBER:S2225C

TITLE OF BILL: An act to amend the mental hygiene law and the
correction law, in relation to enhancing the assisted outpatient
treatment program; and to amend Kendra's Law, in relation to making
the provisions thereof permanent

PURPOSE OR GENERAL IDEA OF BILL:

To improve care for people with serious mental illness, and protect
the safety of patients and the public by streamlining and improving
New York's Assisted Outpatient Treatment (AOT) program (Kendra's Law).

SUMMARY OF SPECIFIC PROVISIONS:

Section 1 amends Mental Hygiene Law (MHL) § 7.17(f) to require that
AOT program coordinators monitor local programs to ensure that
expiring AOT orders are adequately reviewed to consider the need for
renewal of the order; to ensure appropriate assignment of a director
for each outpatient; and to monitor local needs for training of judges
and court personnel in order for the office of mental health to
adequately provide such training.

Section 2 provides that the Commissioner of Mental Health shall
develop an educational pamphlet on the process of petitioning for AOT
to be made available to persons wishing to submit reports of
individuals who may be in need of AOT, as well as disseminated to
family members and other individuals eligible to petition for AOT.

Section 3 amends § 9.47 of the MHL to clarify that directors of
community services shall be responsible for ensuring that reports of
persons who may be in need of continued AOT orders are subject to a
timely investigation. It also provides that directors of community
services shall notify program coordinators when AOT patients cannot be
located or are believed to have taken residence outside of the local
governmental unit served.

Section 4 amends MHL § 9.48 to require that AOT program directors'
quarterly reports to program coordinators include information on any
expired AOT court orders, including the determination made as to
whether to petition for renewal of the AOT, the basis for such
determination, and the court's disposition of the renewal petition, if
any.

Section 5 amends MHL § 9.60 to clarify that assisted outpatient
treatment services provided may include: medication education or
symptom management education; appointment of a representative payee;
and that tests for alcohol or drugs may be random. This section also
provides that the parties to the treatment order may stipulate, upon
mutual consent, that an examining physician need not testify in court.
The bill also provides that the appointed physician shall make a
reasonable effort to gather relevant information for the development
of a treatment plan from a member or members of the patient's family
or significant other.

This section also clarifies that directors of hospitals or
superintendents of correctional facilities may initiate a petition.


This section also requires the Commissioner to establish by regulation
a procedure to ensure that reports of persons who may be in need of
POT that are made by family and community members of such person are,
if warranted, investigated in a timely manner, and that AOT petitions
are filed, where appropriate.

This section also provides that the Commissioner shall promulgate
regulations to require that prior to an assisted outpatient relocating
to a location within the state of New York which is not served by his
or her current director of community services, that patient or other
appropriate Party must notify the program coordinator. The program
coordinator shall then redetermine who the appropriate director shall
he, and cause a copy of the court order and treatment plan to be
transmitted to the new director. This section also provides that a
director shall review whether the assisted outpatient continues to
meet AOT criteria within 30 days before the expiration of an order for
AOT. If the director determines that such assisted outpatient no
longer meets the criteria, such director is required to give notice to
the program coordinator that a petition for continued ACT is
unnecessary. However, if such assisted outpatient continues to meet
the criteria, as determined by the director, such director shall file
a petition for continued treatment.

This provision clarifies procedures any other person authorized to
petition for continued AOT may use to bring such petition in the event
that the appropriate director or current petitioner does not petition
for continued AOT prior to the expiration of the court order.

This section also provides that counties shall notify the department
when an assisted outpatient is missing and thereby unavailable for an
evaluation as to whether he or she continues to meet AOT criteria. It
also Provides that when a patient is missing upon the expiration date
of the order, the order shall be extended until sixty days after such
patient is found.

Section 6 amends MHL § 29.15 to provide that if the director of the
hospital does not petition for AOT upon the discharge of an
involuntarily committed inpatient or upon the expiration of a period
of conditional release for such inpatient, such director shall report
the discharge in writing to the director of community services of the
local government unit where the inpatient is expected to reside.

Section 7 amends subdivision 1 of section 404 of the correction law to
require that, prior to discharging an inmate who is still mentally
ill, the director shall, where appropriate, either apply for a
person's admission to a hospital for care and treatment, or initiate a
petition for an order authorizing assisted outpatient treatment, or
the commissioner may apply for the person's admission to a secure
treatment facility.

Section 8 would repeal the current sunset date of June 30, 2017 to
make the provisions of Kendra's Law permanent.

Section 9 Severability.

Section 10 states that this act shall take effect immediately.


JUSTIFICATION:

In 1999, the legislature enacted "Kendra's Law," establishing a
statewide court-ordered assisted outpatient treatment (AOT) program to
improve outcomes for persons with severe mental illness who, in view
of their treatment history and present circumstances, axe likely to
have difficulty living safely in the community. At the approach of the
law's original 2005 expiration date, the legislature took note of the
Office of Mental Health (OMH) research documenting declines in rates
of homelessness, hospitalization, substance abuse, alcoholism,
violence, arrest and incarceration, and documented increases in
treatment compliance, service engagement and positive consumer
perceptions. In 2005 and 2010, the legislature opted to extend
Kendra's Law for an additional five years to further evaluate the
program. The New York SAFE Act, which was signed into law on January
15, 2013, also extended Kendra's Law for an additional two years,
making the law expire on June 30, 2017.

On June 30, 2009, a team of independent researchers released the
report of their long term study of AOT throughout New York State and
in October, 2010 Psychiatric Services published six peer reviewed
studies on the AOT program. These reports confirm the earlier OMH
data. These studies found patients given mandatory outpatient
treatment who were more violent to begin with, were nevertheless four
times less likely than members of the control group to perpetrate
serious violence after undergoing assisted outpatient treatment. The
studies also found less frequent psychiatric hospitalizations, shorter
length of hospitalizations, reduction in the likelihood of arrest,
higher social functioning, slightly less stigma and no increase in
perceived coercion. These studies confirmed that AOT stimulates
service provider's efforts to prioritize care for AOT recipients;
judges hearing AOT cases could benefit from additional AOT training;
counties favored increasing the availability of stipulations to reduce
the court burden, costs, and transportation burdens; recipients are
far more likely than other patients to consistently receive
psychotropic medications appropriate to their psychiatric condition;
that those who receive AOT for periods of at least one year are more
likely than those who receive AOT for shorter periods to sustain gains
after leaving the program; that the law has been applied in a
non-discriminatory manner; and that the court order itself, in
addition to high quality services, is a significant factor in the
program's success.

The experience of thousands of patients, treatment providers and
families who have utilized Kendra's Law since 1999 point to several
areas where the law should be .improved to achieve costs savings,
promote smoother functioning of the AOT program and easier access to
those who stand to benefit from it. Although the New York SAFE Act
addresses many of these concerns, loopholes still exist in the law.
The amendments included in this act are intended to close these
loopholes and maximize the unique potential of this legislation, while
simultaneously serving the goals of compassionate care, fiscal
responsibility, and public safety.

PRIOR LEGISLATIVE HISTORY:


2011,2012: S.4881B Referred to Mental Health/Developmental
Disabilities

FISCAL IMPLICATIONS:

To be determined. Cost-savings for the state and local governments are
anticipated following implementation, due to reduced instances of
hospitalizations and incarcerations that would result.

EFFECTIVE DATE:

This act shall take effect immediately.

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                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 2225--C

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                            January 14, 2013
                               ___________

Introduced  by  Sens.  YOUNG,  ADDABBO,  AVELLA,  BALL,  BONACIC, BOYLE,
  DeFRANCISCO,  FARLEY,  GALLIVAN,  GOLDEN,  GRIFFO,   HASSELL-THOMPSON,
  LANZA,   LARKIN,   LIBOUS,  LITTLE,  MARCELLINO,  MARCHIONE,  MARTINS,
  MAZIARZ, NOZZOLIO, RANZENHOFER,  RITCHIE,  ROBACH,  SEWARD,  STAVISKY,
  VALESKY, ZELDIN -- read twice and ordered printed, and when printed to
  be committed to the Committee on Mental Health and Developmental Disa-
  bilities  --  committee discharged, bill amended, ordered reprinted as
  amended and recommitted to said  committee  --  committee  discharged,
  bill  amended,  ordered  reprinted  as amended and recommitted to said
  committee -- recommitted to the Committee on Mental Health and  Devel-
  opmental  Disabilities  in  accordance  with  Senate Rule 6, sec. 8 --
  committee discharged, bill amended, ordered reprinted as  amended  and
  recommitted to said committee

AN  ACT  to  amend  the  mental  hygiene  law and the correction law, in
  relation to enhancing the assisted outpatient treatment  program;  and
  to  amend  Kendra's  Law, in relation to making the provisions thereof
  permanent

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1.  Paragraph  2  of  subdivision  (f) of section 7.17 of the
mental hygiene law, as amended by chapter 158 of the laws  of  2005,  is
amended to read as follows:
  (2)  The  oversight  and monitoring role of the program coordinator of
the assisted outpatient treatment program  shall  include  each  of  the
following:
  (i)  that each assisted outpatient receives the treatment provided for
in the court order issued pursuant to section  9.60  of  this  [chapter]
TITLE;
  (ii)  that  existing  services  located  in  the assisted outpatient's
community are utilized whenever practicable;

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD02670-08-4

S. 2225--C                          2

  (iii) that a case manager or assertive  community  treatment  team  is
designated for each assisted outpatient;
  (iv)  that  a  mechanism  exists  for  such case manager, or assertive
community treatment team, to regularly report the assisted  outpatient's
compliance, or lack of compliance with treatment, to the director of the
assisted outpatient treatment program;
  (v)  that directors of community services establish procedures [which]
THAT provide that reports of persons who may  be  in  need  of  assisted
outpatient  treatment are appropriately investigated in a timely manner;
[and]
  (vi) that assisted outpatient treatment services are  delivered  in  a
timely manner[.];
  (VII)  THAT,  PRIOR TO THE EXPIRATION OF ASSISTED OUTPATIENT TREATMENT
ORDERS, THE  CLINICAL  NEEDS  OF  ASSISTED  OUTPATIENTS  ARE  ADEQUATELY
REVIEWED  IN  DETERMINING  THE  NEED  TO PETITION FOR CONTINUED ASSISTED
OUTPATIENT TREATMENT PURSUANT TO SUBDIVISION (M) OF SECTION 9.60 OF THIS
TITLE;
  (VIII) THAT THE APPROPRIATE DIRECTOR IS DETERMINED FOR  EACH  ASSISTED
OUTPATIENT, PURSUANT TO SUBDIVISIONS (K) AND (L) OF SECTION 9.60 OF THIS
TITLE; AND
  (IX)  THAT  THE OFFICE FULFILLS ITS DUTIES PURSUANT TO SUBDIVISION (T)
OF SECTION 9.60 OF THIS TITLE TO MEET LOCAL NEEDS FOR TRAINING OF JUDGES
AND COURT PERSONNEL.
  S 2. Subdivision (f) of section 7.17 of  the  mental  hygiene  law  is
amended by adding a new paragraph 5 to read as follows:
  (5)  THE  COMMISSIONER  SHALL  DEVELOP  AN EDUCATIONAL PAMPHLET ON THE
PROCESS OF PETITIONING FOR ASSISTED  OUTPATIENT  TREATMENT  FOR  DISSEM-
INATION  TO  INDIVIDUALS SEEKING TO SUBMIT REPORTS OF PERSONS WHO MAY BE
IN NEED OF ASSISTED OUTPATIENT TREATMENT,  AND  INDIVIDUALS  SEEKING  TO
FILE A PETITION PURSUANT TO SUBPARAGRAPH (I) OR (II) OF PARAGRAPH ONE OF
SUBDIVISION  (F)  OF SECTION 9.60 OF THIS TITLE. SUCH PAMPHLET SHALL SET
FORTH, IN PLAIN LANGUAGE: THE CRITERIA FOR  ASSISTED  OUTPATIENT  TREAT-
MENT,  RESOURCES  AVAILABLE TO SUCH INDIVIDUALS, THE RESPONSIBILITIES OF
PROGRAM COORDINATORS AND DIRECTORS OF COMMUNITY SERVICES, A  SUMMARY  OF
CURRENT  LAW,  THE PROCESS FOR PETITIONING FOR CONTINUED ASSISTED OUTPA-
TIENT TREATMENT, AND OTHER SUCH INFORMATION THE COMMISSIONER  DETERMINES
TO BE PERTINENT.
  S  3.    Subdivision (b) of section 9.47 of the mental hygiene law, as
amended by chapter 158 of the laws of 2005, paragraphs 5 and 6 as  added
and  paragraph  7  as  renumbered  by  chapter 1 of the laws of 2013, is
amended to read as follows:
  (b) All directors of community services shall be responsible for:
  (1) receiving reports of persons who may be in need of assisted outpa-
tient treatment PURSUANT TO SECTION 9.60 OF THIS ARTICLE and documenting
the receipt date of such reports;
  (2) conducting timely investigations of such reports RECEIVED PURSUANT
TO PARAGRAPH ONE OF THIS SUBDIVISION and providing written  notice  upon
the  completion of investigations to reporting persons and program coor-
dinators, appointed by the commissioner [of mental health]  pursuant  to
subdivision  (f)  of  section  7.17  of  this title, and documenting the
initiation and completion dates of such investigations and the  disposi-
tions;
  (3)  filing of petitions for assisted outpatient treatment pursuant to
[paragraph] SUBPARAGRAPH (vii) of PARAGRAPH ONE OF subdivision [(e)] (F)
of section 9.60 of this article, and  documenting  the  petition  filing
[date] DATES and the [date] DATES of the court [order] ORDERS;

S. 2225--C                          3

  (4)  coordinating  the  timely delivery of court ordered services with
program coordinators and documenting the date assisted outpatients begin
to receive the services mandated in the court order; [and]
  (5)  ensuring  evaluation  of the need for ongoing assisted outpatient
treatment pursuant to subdivision [(k)] (M)  of  section  9.60  of  this
article  prior  to  the  expiration of any assisted outpatient treatment
order;
  (6) if he or she has been  ordered  to  provide  for  or  arrange  for
assisted  outpatient treatment pursuant to paragraph five of subdivision
[(j)] (K) of section 9.60 of this  article  or  became  the  appropriate
director  pursuant  to this paragraph or subdivision (c) of section 9.48
of this article, notifying the director of community services of the new
county of residence when he  or  she  has  reason  to  believe  that  an
assisted  outpatient  has  or will change his or her county of residence
during the pendency of an assisted outpatient treatment order. Upon such
change of residence, the director of the new county of  residence  shall
become the appropriate director, as such term is defined in section 9.60
of this article; [and]
  (7) NOTIFYING PROGRAM COORDINATORS WHEN ASSISTED OUTPATIENTS CANNOT BE
LOCATED AFTER REASONABLE EFFORTS OR ARE BELIEVED TO HAVE TAKEN RESIDENCE
OUTSIDE OF THE LOCAL GOVERNMENTAL UNIT SERVED; AND
  (8)  reporting on a quarterly basis to program coordinators the infor-
mation collected pursuant to this subdivision.
  S 4.  Paragraphs (viii) and (ix) of subdivision (b) of section 9.48 of
the mental hygiene law are renumbered paragraphs (ix) and (x) and a  new
paragraph (viii) is added to read as follows:
  (VIII)  AN  ACCOUNT  OF  ANY COURT ORDER EXPIRATION, INCLUDING BUT NOT
LIMITED TO THE DIRECTOR'S DETERMINATION AS TO WHETHER  TO  PETITION  FOR
CONTINUED  ASSISTED  OUTPATIENT  TREATMENT,  PURSUANT TO SECTION 9.60 OF
THIS ARTICLE, THE BASIS FOR SUCH DETERMINATION, AND THE  DISPOSITION  OF
ANY SUCH PETITION;
  S 5. Section 9.60 of the mental hygiene law, as amended by chapter 158
of  the  laws  of  2005,  paragraph  1  of subdivision (a) as amended by
section 1 of part E of chapter 111 of the laws of 2010, paragraph  3  of
subdivision (a), paragraphs 2 and 5 of subdivision (j), and subdivisions
(k)  and (n) as amended by chapter 1 of the laws of 2013, paragraph 5 of
subdivision (c) as amended by chapter  137  of  the  laws  of  2005,  is
amended to read as follows:
S 9.60 Assisted outpatient treatment.
  (a)  Definitions.  For  purposes  of this section, the following defi-
nitions shall apply:
  (1) "assisted outpatient treatment" shall mean  categories  of  outpa-
tient  services  [which] THAT have been ordered by the court pursuant to
this section.  Such treatment shall include case management services  or
assertive  community  treatment  team  services  to provide care coordi-
nation, and  may  also  include  any  of  the  following  categories  of
services: medication SUPPORT; MEDICATION EDUCATION OR SYMPTOM MANAGEMENT
EDUCATION;  periodic  blood  tests or urinalysis to determine compliance
with prescribed medications; individual or group therapy; day or partial
day programming  activities;  educational  and  vocational  training  or
activities;  APPOINTMENT  OF  A  REPRESENTATIVE PAYEE OR OTHER FINANCIAL
MANAGEMENT SERVICES, SUBJECT TO FINAL APPROVAL OF  THE  SOCIAL  SECURITY
ADMINISTRATION,  WHERE  APPLICABLE; alcohol or substance abuse treatment
and counseling and periodic OR RANDOM tests for the presence of  alcohol
or  illegal  drugs  for  persons  with a history of alcohol or substance
abuse; supervision of living arrangements; and any other services within

S. 2225--C                          4

a local services plan developed pursuant to article  forty-one  of  this
chapter,  CLINICAL  OR  NON-CLINICAL,  prescribed  to treat the person's
mental illness and to assist the person in living and functioning in the
community,  or to attempt to prevent a relapse or deterioration that may
reasonably be predicted to result in [suicide] SERIOUS PHYSICAL HARM  TO
ANY PERSON or the need for hospitalization.
  (2)  "director"  shall  mean  the  director of community services of a
local governmental unit, or the director of a hospital licensed or oper-
ated by the office of mental health which operates, directs  and  super-
vises an assisted outpatient treatment program.
  (3)  "director  of  community  services" and "local governmental unit"
shall have the same meanings as provided in article  forty-one  of  this
chapter. The "appropriate director" shall mean the director of community
services of the county where the assisted outpatient resides, even if it
is  a  different  county  than  the county where the assisted outpatient
treatment order was originally issued.
  (4) "assisted outpatient treatment program" shall  mean  a  system  to
arrange  for  and coordinate the provision of assisted outpatient treat-
ment, to monitor treatment compliance by assisted outpatients, to evalu-
ate the condition or needs of assisted outpatients, to take  appropriate
steps to address the needs of such individuals, and to ensure compliance
with court orders.
  (5) "assisted outpatient" shall mean the person under a court order to
receive assisted outpatient treatment.
  (6)  "subject  of the petition" or "subject" shall mean the person who
is alleged in a petition, filed  pursuant  to  the  provisions  of  this
section, to meet the criteria for assisted outpatient treatment.
  (7)  "correctional  facility"  and "local correctional facility" shall
have the same meanings as provided in section two of the correction law.
  (8) "health care proxy" and "health care agent" shall  have  the  same
meanings as provided in article twenty-nine-C of the public health law.
  (9)  "program  coordinator"  shall mean an individual appointed by the
commissioner [of mental health], pursuant to subdivision (f) of  section
7.17  of this chapter, who is responsible for the oversight and monitor-
ing of assisted outpatient treatment programs.
  (b) Programs. The director of community services of each local govern-
mental unit shall operate, direct and supervise an  assisted  outpatient
treatment  program.  The  director of a hospital licensed or operated by
the office [of mental health]  may  operate,  direct  and  supervise  an
assisted  outpatient treatment program, upon approval by the commission-
er. Directors of community services shall be permitted  to  satisfy  the
provisions  of  this subdivision through the operation of joint assisted
outpatient treatment programs. Nothing  in  this  subdivision  shall  be
interpreted  to  preclude  the  combination  or  coordination of efforts
between and among local governmental units and  hospitals  in  providing
and coordinating assisted outpatient treatment.
  (c)  Criteria.  A person may be ordered to receive assisted outpatient
treatment if the court finds that such person:
  (1) is eighteen years of age or older; and
  (2) is suffering from a mental illness; and
  (3) is unlikely to survive safely  in  the  community  without  super-
vision, based on a clinical determination; and
  (4)  has  a  history  of  lack of compliance with treatment for mental
illness that has:
  (i) [prior to the filing of the petition,] at least twice  within  the
[last]  thirty-six  months  PRIOR  TO  THE FILING OF THE PETITION been a

S. 2225--C                          5

significant factor in necessitating hospitalization in  a  hospital,  or
receipt  of  services  in  a  forensic  or other mental health unit of a
correctional facility or a local correctional facility[, not including];
PROVIDED  THAT  SUCH  THIRTY-SIX  MONTH  PERIOD SHALL BE EXTENDED BY THE
LENGTH OF any current period[, or period ending] OF  HOSPITALIZATION  OR
INCARCERATION,  AND  ANY  SUCH  PERIOD  THAT  ENDED  within the last six
months[, during which the person was or is hospitalized  or  incarcerat-
ed]; or
  (ii)  WITHIN  FORTY-EIGHT  MONTHS prior to the filing of the petition,
resulted in one or more acts of serious violent behavior toward self  or
others  or  threats of, or attempts at, serious physical harm to self or
others [within the last forty-eight  months,  not  including];  PROVIDED
THAT  SUCH  FORTY-EIGHT  MONTH PERIOD SHALL BE EXTENDED BY THE LENGTH OF
any current period[, or period ending] OF HOSPITALIZATION OR  INCARCERA-
TION,  AND  ANY  SUCH  PERIOD THAT ENDED within the last six months[, in
which the person was or is hospitalized or incarcerated]; and
  (5) is, as a result of his or her mental illness, unlikely  to  volun-
tarily  participate in outpatient treatment that would enable him or her
to live safely in the community; and
  (6) in view of his or her treatment history and current  behavior,  is
in  need  of assisted outpatient treatment in order to prevent a relapse
or deterioration which would be likely to result in serious harm to  the
person or others as defined in section 9.01 of this article; and
  (7) is likely to benefit from assisted outpatient treatment.
  (d) Health care proxy. Nothing in this section shall preclude a person
with  a  health  care proxy from being subject to a petition pursuant to
this chapter and consistent with article  twenty-nine-C  of  the  public
health law.
  (e)  INVESTIGATION OF REPORTS. THE COMMISSIONER SHALL PROMULGATE REGU-
LATIONS ESTABLISHING A PROCEDURE TO ENSURE THAT REPORTS OF A PERSON  WHO
MAY  BE  IN  NEED  OF  ASSISTED  OUTPATIENT  TREATMENT,  INCLUDING THOSE
RECEIVED FROM FAMILY AND COMMUNITY MEMBERS OF SUCH PERSON, ARE  INVESTI-
GATED IN A TIMELY MANNER AND, WHERE APPROPRIATE, RESULT IN THE FILING OF
PETITIONS FOR ASSISTED OUTPATIENT TREATMENT.
  (F)  Petition  to  the  court. (1) A petition for an order authorizing
assisted outpatient treatment may be filed  in  the  supreme  or  county
court  in  the county in which the subject of the petition is present or
reasonably believed to  be  present.    WHEN  A  DIRECTOR  OF  COMMUNITY
SERVICES  HAS  REASON TO BELIEVE THAT AN ASSISTED OUTPATIENT HAS CHANGED
HIS OR HER COUNTY OF RESIDENCE, FUTURE PETITIONS AND APPLICATIONS  UNDER
THIS  SECTION  MAY  BE  FILED  IN THE SUPREME OR COUNTY COURT IN THE NEW
COUNTY OF RESIDENCE, WHICH SHALL HAVE CONCURRENT JURISDICTION  WITH  THE
COURT THAT INITIALLY ORDERED SUCH TREATMENT. Such petition may be initi-
ated only by the following persons:
  (i) any person eighteen years of age or older with whom the subject of
the petition resides; or
  (ii)  the  parent,  spouse, sibling eighteen years of age or older, or
child eighteen years of age or older of the subject of the petition; or
  (iii) the director of a hospital in which the subject of the  petition
is hospitalized; or
  (iv)  the director of any public or charitable organization, agency or
home providing mental health services to the subject of the petition  or
in whose institution the subject of the petition resides; or
  (v)  a  qualified psychiatrist who is either supervising the treatment
of or treating the subject of the petition for a mental illness; or

S. 2225--C                          6

  (vi) a psychologist, licensed pursuant to article one  hundred  fifty-
three  of  the  education  law, or a social worker, licensed pursuant to
article one hundred fifty-four of the education law, who is treating the
subject of the petition for a mental illness; or
  (vii)  the  director of community services, or his or her designee, or
the social services official, as defined in the social services law,  of
the  city  or  county in which the subject of the petition is present or
reasonably believed to be present; or
  (viii) a parole officer or probation officer assigned to supervise the
subject of the petition[.]; OR
  (IX) THE DIRECTOR OF THE HOSPITAL OR THE SUPERINTENDENT OF  A  CORREC-
TIONAL  FACILITY  IN  WHICH  THE  SUBJECT OF THE PETITION IS IMPRISONED,
PURSUANT TO SECTION FOUR HUNDRED FOUR OF THE CORRECTION LAW.
  (2) THE COMMISSIONER SHALL PROMULGATE REGULATIONS  PURSUANT  TO  WHICH
PERSONS INITIATING A PETITION, PURSUANT TO SUBPARAGRAPHS (I) AND (II) OF
PARAGRAPH ONE OF THIS SUBDIVISION, MAY RECEIVE ASSISTANCE IN FILING SUCH
PETITIONS,  WHERE APPROPRIATE, AS DETERMINED PURSUANT TO SUBDIVISION (E)
OF THIS SECTION.
  (3) The petition shall state:
  (i) each of the criteria for  assisted  outpatient  treatment  as  set
forth in subdivision (c) of this section;
  (ii)  facts  which support the petitioner's belief that the subject of
the petition meets each criterion, provided  that  the  hearing  on  the
petition need not be limited to the stated facts; and
  (iii)  that  the  subject of the petition is present, or is reasonably
believed to be present, within the county where such petition is filed.
  [(3)] (4) The petition shall be accompanied by an affirmation or affi-
davit of a physician, who shall not be the petitioner, stating THAT SUCH
PHYSICIAN IS WILLING AND ABLE TO TESTIFY AT THE HEARING ON THE  PETITION
AND THAT either [that]:
  (i) such physician has personally examined the subject of the petition
no  more  than  ten  days prior to the submission of the petition[,] AND
recommends assisted outpatient treatment for the subject  of  the  peti-
tion[,  and  is  willing and able to testify at the hearing on the peti-
tion]; or
  (ii) no more than ten days prior to the filing of the  petition,  such
physician  or  his or her designee has made appropriate attempts but has
not been successful in eliciting the cooperation of the subject  of  the
petition  to  submit  to  an  examination,  such physician has reason to
suspect that the subject of the petition meets the criteria for assisted
outpatient treatment, and such physician is willing and able to  examine
the subject of the petition [and testify at the hearing on the petition]
PRIOR TO PROVIDING TESTIMONY.
  [(4)]  (5)  In  counties  with  a population of less than seventy-five
thousand, the affirmation or affidavit  required  by  paragraph  [three]
FOUR  of  this subdivision may be made by a physician who is an employee
of the office.  The office is authorized AND DIRECTED to make available,
at no cost to the county, a  qualified  physician  for  the  purpose  of
making  such  affirmation or affidavit consistent with the provisions of
such paragraph.
  [(f)] (G) Service. The petitioner shall cause written  notice  of  the
petition  to  be given to the subject of the petition and a copy thereof
to be given personally or by mail to the persons listed in section  9.29
of this article, the mental hygiene legal service, the health care agent
if  any  such  agent is known to the petitioner, the appropriate program

S. 2225--C                          7

coordinator, and the appropriate director of community services, if such
director is not the petitioner.
  [(g)] (H) Right to counsel. The subject of the petition shall have the
right to be represented by the mental hygiene legal service, or private-
ly  financed counsel, at all stages of a proceeding commenced under this
section.
  [(h)] (I) Hearing. (1) Upon receipt of the petition, the  court  shall
fix  the date for a hearing. Such date shall be no later than three days
from the date such petition is received by the court,  excluding  Satur-
days,  Sundays  and  holidays.  Adjournments shall be permitted only for
good cause shown. In granting adjournments, the court shall consider the
need for further examination by a physician or  the  potential  need  to
provide  assisted  outpatient  treatment  expeditiously. The court shall
cause the subject of the petition, any  other  person  receiving  notice
pursuant  to  subdivision [(f)] (G) of this section, the petitioner, the
physician whose affirmation or affidavit accompanied the  petition,  and
such  other  persons  as  the  court may determine to be advised of such
date. Upon such date, or upon such other date to  which  the  proceeding
may  be  adjourned,  the court shall hear testimony and, if it be deemed
advisable and the subject of the  petition  is  available,  examine  the
subject  of the petition in or out of court. If the subject of the peti-
tion does not appear at the hearing, and appropriate attempts to  elicit
the  attendance  of  the  subject have failed, the court may conduct the
hearing in the subject's absence. In such  case,  the  court  shall  set
forth  the factual basis for conducting the hearing without the presence
of the subject of the petition.
  (2) The court shall not order assisted outpatient treatment unless  an
examining  physician,  who  recommends assisted outpatient treatment and
has personally examined the subject of the petition  no  more  than  ten
days before the filing of the petition, testifies in person at the hear-
ing.  Such  physician  shall state the facts and clinical determinations
which support the allegation that the subject of the petition meets each
of the criteria for assisted outpatient  treatment;  PROVIDED  THAT  THE
PARTIES MAY STIPULATE, UPON MUTUAL CONSENT, THAT SUCH PHYSICIAN NEED NOT
TESTIFY.
  (3)  If  the  subject  of the petition has refused to be examined by a
physician, the court may request the subject to consent to  an  examina-
tion  by a physician appointed by the court. If the subject of the peti-
tion does not consent and the court finds reasonable  cause  to  believe
that the allegations in the petition are true, the court may order peace
officers,  acting  pursuant  to their special duties, or police officers
who are members of an authorized police department or  force,  or  of  a
sheriff's  department  to  take the subject of the petition into custody
and transport him or her to a hospital for examination by  a  physician.
Retention  of  the  subject  of  the petition under such order shall not
exceed twenty-four hours. The examination of the subject of the petition
may be performed by the physician whose affirmation or affidavit  accom-
panied the petition pursuant to paragraph three of subdivision [(e)] (F)
of  this  section,  if  such physician is privileged by such hospital or
otherwise authorized by such hospital to do so. If such  examination  is
performed by another physician, the examining physician may consult with
the physician whose affirmation or affidavit accompanied the petition as
to whether the subject meets the criteria for assisted outpatient treat-
ment.
  (4) A physician who testifies pursuant to paragraph two of this subdi-
vision  shall  state:  (i) the facts [which] AND CLINICAL DETERMINATIONS

S. 2225--C                          8

THAT support the allegation that the subject meets each of the  criteria
for  assisted outpatient treatment, (ii) that the treatment is the least
restrictive  alternative,  (iii)  the  recommended  assisted  outpatient
treatment,  and  (iv)  the rationale for the recommended assisted outpa-
tient  treatment.  If  the  recommended  assisted  outpatient  treatment
includes medication, such physician's testimony shall describe the types
or  classes of medication which should be authorized, shall describe the
beneficial and detrimental physical and mental effects of  such  medica-
tion,  and shall recommend whether such medication should be self-admin-
istered or administered by authorized personnel.
  (5) The subject of the petition shall be afforded  an  opportunity  to
present  evidence, to call witnesses on his or her behalf, and to cross-
examine adverse witnesses.
  [(i)] (J) Written treatment  plan.  (1)  The  court  shall  not  order
assisted outpatient treatment unless a physician appointed by the appro-
priate  director,  in  consultation  with  such  director,  develops and
provides to the court a proposed written  treatment  plan.  The  written
treatment  plan  shall  include  case  management  services or assertive
community treatment team services  to  provide  care  coordination.  The
written treatment plan also shall include all categories of services, as
set  forth  in  paragraph  one of subdivision (a) of this section, which
such physician recommends that the subject of the petition receive.  All
service  providers  shall  be  notified regarding their inclusion in the
written treatment plan. If the written treatment plan  includes  medica-
tion, it shall state whether such medication should be self-administered
or  administered  by  authorized  personnel,  and shall specify type and
dosage range of medication most likely to provide  maximum  benefit  for
the subject. If the written treatment plan includes alcohol or substance
abuse  counseling  and  treatment,  such  plan  may  include a provision
requiring relevant testing for  either  alcohol  or  illegal  substances
provided  the  physician's  clinical  basis  for  recommending such plan
provides sufficient facts for the court to find (i) that such person has
a history of alcohol or substance abuse that is  clinically  related  to
the mental illness; and (ii) that such testing is necessary to prevent a
relapse or deterioration which would be likely to result in serious harm
to  the  person  or others. If a director is the petitioner, the written
treatment plan shall be provided to the court no later than the date  of
the  hearing  on  the petition. If a person other than a director is the
petitioner, such plan shall be provided to the court no later  than  the
date  set  by the court pursuant to paragraph three of subdivision [(j)]
(K) of this section.
  (2) The physician appointed to  develop  the  written  treatment  plan
shall  provide  the  following  persons  with an opportunity to actively
participate in the development of such plan: the subject  of  the  peti-
tion;  the  treating  physician,  if  any;  and  upon the request of the
subject of the  petition,  an  individual  significant  to  the  subject
including  any  relative, close friend or individual otherwise concerned
with the welfare of the subject. THE APPOINTED PHYSICIAN  SHALL  MAKE  A
REASONABLE  EFFORT TO GATHER RELEVANT INFORMATION FOR THE DEVELOPMENT OF
THE TREATMENT PLAN FROM THE SUBJECT OF THE PETITION'S FAMILY  MEMBER  OR
MEMBERS, OR HIS OR HER SIGNIFICANT OTHER. If the subject of the petition
has executed a health care proxy, the appointed physician shall consider
any  directions  included in such proxy in developing the written treat-
ment plan.
  (3) The court shall not order assisted outpatient treatment  unless  a
physician  appearing  on  behalf  of a director testifies to explain the

S. 2225--C                          9

written proposed treatment plan; PROVIDED THAT THE  PARTIES  MAY  STIPU-
LATE,  UPON  MUTUAL CONSENT, THAT SUCH PHYSICIAN NEED NOT TESTIFY.  Such
physician shall state the categories of  assisted  outpatient  treatment
recommended, the rationale for each such category, facts which establish
that  such  treatment  is the least restrictive alternative, and, if the
recommended assisted outpatient treatment plan includes medication, such
physician shall state the types or classes  of  medication  recommended,
the beneficial and detrimental physical and mental effects of such medi-
cation,  and  whether  such  medication  should  be self-administered or
administered by an authorized professional. If the subject of the  peti-
tion  has  executed  a health care proxy, such physician shall state the
consideration given to any directions included in such proxy in develop-
ing the written treatment plan. If a director is the petitioner,  testi-
mony  pursuant  to  this  paragraph shall be given at the hearing on the
petition. If a person other than a  director  is  the  petitioner,  such
testimony  shall be given on the date set by the court pursuant to para-
graph three of subdivision [(j)] (K) of this section.
  [(j)] (K) Disposition. (1) If after hearing all relevant evidence, the
court does not find by clear and convincing evidence that the subject of
the petition meets the criteria for assisted outpatient  treatment,  the
court shall dismiss the petition.
  (2)  If  after hearing all relevant evidence, the court finds by clear
and convincing evidence that the  subject  of  the  petition  meets  the
criteria  for assisted outpatient treatment, and there is no appropriate
and feasible less restrictive  alternative,  the  court  may  order  the
subject  to  receive assisted outpatient treatment for an initial period
not to exceed one year. In fashioning the order, the court shall specif-
ically make findings by clear and convincing evidence that the  proposed
treatment  is  the  least restrictive treatment appropriate and feasible
for the subject. The order shall state an assisted outpatient  treatment
plan,  which  shall include all categories of assisted outpatient treat-
ment, as set forth in paragraph one of subdivision (a) of this  section,
which  the  assisted outpatient is to receive, but shall not include any
such category that has not been recommended in [both] the proposed writ-
ten treatment plan and [the] IN ANY  testimony  provided  to  the  court
pursuant to subdivision [(i)](J) of this section.
  (3)  If  after hearing all relevant evidence presented by a petitioner
who is not a director, the court finds by clear and convincing  evidence
that  the subject of the petition meets the criteria for assisted outpa-
tient treatment, and the court has yet to be  provided  with  a  written
proposed  treatment plan and testimony pursuant to subdivision [(i)] (J)
of this section, the court  shall  order  the  appropriate  director  to
provide  the  court with such plan and testimony no later than the third
day, excluding Saturdays, Sundays and  holidays,  immediately  following
the  date  of  such  order; PROVIDED THAT THE PARTIES MAY STIPULATE UPON
MUTUAL CONSENT THAT SUCH TESTIMONY NEED NOT BE PROVIDED.  Upon receiving
such plan and ANY REQUIRED  testimony,  the  court  may  order  assisted
outpatient treatment as provided in paragraph two of this subdivision.
  (4)  A  court  may  order  the patient to self-administer psychotropic
drugs or accept the administration of such drugs by authorized personnel
as part of an assisted outpatient  treatment  program.  Such  order  may
specify  the  type  and dosage range of such psychotropic drugs and such
order shall be effective for the duration of  such  assisted  outpatient
treatment.
  (5)  If  the petitioner is the director of a hospital that operates an
assisted outpatient treatment program, the court order shall direct  the

S. 2225--C                         10

hospital  director  to provide or arrange for all categories of assisted
outpatient treatment for the assisted outpatient throughout  the  period
of the order. In all other instances, the order shall require the appro-
priate  director, as that term is defined in this section, to provide or
arrange for all categories of  assisted  outpatient  treatment  for  the
assisted  outpatient  throughout the period of the order.  ORDERS ISSUED
ON OR AFTER THE EFFECTIVE DATE OF THE CHAPTER OF THE LAWS OF  TWO  THOU-
SAND  FOURTEEN  THAT  AMENDED THIS SECTION SHALL REQUIRE THE APPROPRIATE
DIRECTOR "AS DETERMINED  BY  THE  PROGRAM  COORDINATOR"  TO  PROVIDE  OR
ARRANGE  FOR  ALL  CATEGORIES  OF  ASSISTED OUTPATIENT TREATMENT FOR THE
ASSISTED OUTPATIENT THROUGHOUT THE PERIOD OF THE ORDER.
  (6) The director shall cause a copy of any court order issued pursuant
to this section to be served personally, or by mail, facsimile or  elec-
tronic  means,  upon  the  assisted outpatient, the mental hygiene legal
service or anyone  acting  on  the  assisted  outpatient's  behalf,  the
original  petitioner, identified service providers, and all others enti-
tled to notice under subdivision [(f)] (G) of this section.
  [(k)] (L) RELOCATION OF ASSISTED OUTPATIENTS. THE  COMMISSIONER  SHALL
PROMULGATE  REGULATIONS  REQUIRING THAT, DURING THE PERIOD OF THE ORDER,
AN ASSISTED OUTPATIENT AND ANY OTHER APPROPRIATE  PERSONS  SHALL  NOTIFY
THE  PROGRAM COORDINATOR WITHIN A REASONABLE TIME PRIOR TO SUCH ASSISTED
OUTPATIENT RELOCATING WITHIN THE STATE OF NEW YORK TO AN AREA NOT SERVED
BY THE DIRECTOR WHO HAS BEEN DIRECTED TO  PROVIDE  OR  ARRANGE  FOR  THE
ASSISTED OUTPATIENT TREATMENT. UPON RECEIVING NOTIFICATION OF SUCH RELO-
CATION,  THE  PROGRAM  COORDINATOR SHALL REDETERMINE WHO THE APPROPRIATE
DIRECTOR SHALL BE AND CAUSE A COPY OF THE COURT ORDER AND TREATMENT PLAN
TO BE TRANSMITTED TO SUCH DIRECTOR.
  (M) Petition for [additional  periods  of]  CONTINUED  treatment.  (1)
[Prior]  WITHIN THIRTY DAYS PRIOR to the expiration of an order pursuant
to this section, the  appropriate  director  shall  review  whether  the
assisted  outpatient  continues to meet the criteria for assisted outpa-
tient treatment. [If, as documented in the petition, the director deter-
mines that such criteria continue to be  met  or  has  made  appropriate
attempts  to,  but has not been successful in eliciting, the cooperation
of the subject to submit to an examination, within thirty days prior  to
the expiration of an order of assisted outpatient treatment, such direc-
tor may petition the court to order continued assisted outpatient treat-
ment  pursuant  to  paragraph  two of this subdivision. Upon determining
whether such criteria continue to be met, such director shall notify the
program coordinator in writing as to whether a  petition  for  continued
assisted  outpatient  treatment is warranted and whether such a petition
was or will be filed.] UPON DETERMINING THAT ONE OR MORE OF SUCH  CRITE-
RIA  ARE NO LONGER MET, SUCH DIRECTOR SHALL NOTIFY THE PROGRAM COORDINA-
TOR IN WRITING THAT A PETITION FOR CONTINUED ASSISTED OUTPATIENT  TREAT-
MENT  IS NOT WARRANTED.  UPON DETERMINING THAT SUCH CRITERIA CONTINUE TO
BE MET, HE OR SHE SHALL PETITION THE COURT TO ORDER  CONTINUED  ASSISTED
OUTPATIENT  TREATMENT FOR A PERIOD NOT TO EXCEED ONE YEAR FROM THE EXPI-
RATION DATE OF THE CURRENT ORDER. IF THE  COURT'S  DISPOSITION  OF  SUCH
PETITION  DOES  NOT  OCCUR  PRIOR  TO THE EXPIRATION DATE OF THE CURRENT
ORDER, THE CURRENT ORDER SHALL REMAIN IN EFFECT UNTIL SUCH  DISPOSITION.
THE  PROCEDURES  FOR  OBTAINING  ANY  ORDER PURSUANT TO THIS SUBDIVISION
SHALL BE IN ACCORDANCE WITH THE PROVISIONS OF THE FOREGOING  SUBDIVISION
OF  THIS  SECTION; PROVIDED THAT THE TIME RESTRICTIONS INCLUDED IN PARA-
GRAPH FOUR OF SUBDIVISION (C) OF THIS SECTION SHALL NOT  BE  APPLICABLE.
THE  NOTICE  PROVISIONS SET FORTH IN PARAGRAPH SIX OF SUBDIVISION (K) OF
THIS SECTION SHALL BE APPLICABLE. ANY  COURT  ORDER  REQUIRING  PERIODIC

S. 2225--C                         11

BLOOD  TESTS  OR URINALYSIS FOR THE PRESENCE OF ALCOHOL OR ILLEGAL DRUGS
SHALL BE SUBJECT TO REVIEW AFTER SIX MONTHS BY THE PHYSICIAN WHO  DEVEL-
OPED  THE  WRITTEN TREATMENT PLAN OR ANOTHER PHYSICIAN DESIGNATED BY THE
DIRECTOR, AND SUCH PHYSICIAN SHALL BE AUTHORIZED TO TERMINATE SUCH BLOOD
TESTS OR URINALYSIS WITHOUT FURTHER ACTION BY THE COURT.
  (2) Within thirty days prior to the expiration of an order of assisted
outpatient  treatment,  [the  appropriate director or] the current peti-
tioner, if the current petition was filed pursuant to  subparagraph  (i)
or  (ii)  of paragraph one of subdivision [(e)] (F) of this section, and
the current petitioner retains his or her original  status  pursuant  to
the  applicable  subparagraph, may petition the court to order continued
assisted outpatient treatment for a period not to exceed one  year  from
the  expiration date of the current order. If the court's disposition of
such petition does not occur prior to the expiration date of the current
order, the current order shall remain in effect until such  disposition.
The  procedures  for  obtaining  any  order pursuant to this subdivision
shall be in accordance with the provisions of the foregoing subdivisions
of this section; provided that the time restrictions included  in  para-
graph  four  of subdivision (c) of this section shall not be applicable.
The notice provisions set forth in paragraph six  of  subdivision  [(j)]
(K) of this section shall be applicable. Any court order requiring peri-
odic  blood  tests  or urinalysis for the presence of alcohol or illegal
drugs shall be subject to review after six months by the  physician  who
developed  the written treatment plan or another physician designated by
the director, and such physician shall be authorized to  terminate  such
blood tests or urinalysis without further action by the court.
  (3)  IF  NEITHER  THE  APPROPRIATE DIRECTOR NOR THE CURRENT PETITIONER
PETITION FOR CONTINUED ASSISTED OUTPATIENT TREATMENT  PURSUANT  TO  THIS
PARAGRAPH  AND  THE ORDER OF THE COURT EXPIRES, ANY OTHER PERSON AUTHOR-
IZED TO PETITION PURSUANT TO PARAGRAPH ONE OF SUBDIVISION  (F)  OF  THIS
SECTION  MAY BRING A NEW PETITION FOR ASSISTED OUTPATIENT TREATMENT.  IF
SUCH NEW PETITION IS FILED LESS THAN SIXTY DAYS AFTER THE EXPIRATION  OF
SUCH ORDER, THE TIME RESTRICTIONS PROVIDED IN PARAGRAPH FOUR OF SUBDIVI-
SION (C) OF THIS SECTION SHALL NOT BE APPLICABLE TO THE NEW PETITION.
  (4)  IF, THIRTY DAYS PRIOR TO THE EXPIRATION OF AN ORDER, THE ASSISTED
OUTPATIENT IS DEEMED BY THE  APPROPRIATE  DIRECTOR  TO  BE  MISSING  AND
THEREBY  UNAVAILABLE FOR EVALUATION AS TO WHETHER HE OR SHE CONTINUES TO
MEET THE CRITERIA FOR ASSISTED OUTPATIENT TREATMENT, SUCH DIRECTOR SHALL
PETITION THE COURT TO EXTEND THE TERM OF THE CURRENT ORDER  UNTIL  SIXTY
DAYS AFTER SUCH TIME AS THE ASSISTED OUTPATIENT IS LOCATED. IF THE COURT
GRANTS  THE EXTENSION, THE DIRECTOR SHALL CONTINUE REASONABLE EFFORTS TO
LOCATE THE ASSISTED OUTPATIENT.  UPON LOCATION OF  THE  ASSISTED  OUTPA-
TIENT, THE DIRECTOR SHALL REVIEW WHETHER THE ASSISTED OUTPATIENT CONTIN-
UES  TO MEET THE CRITERIA FOR ASSISTED OUTPATIENT TREATMENT, PURSUANT TO
PARAGRAPH TWO OF THIS SUBDIVISION.
  [(l)] (N) Petition for an order to stay,  vacate  or  modify.  (1)  In
addition  to  any other right or remedy available by law with respect to
the order for assisted outpatient treatment,  the  assisted  outpatient,
the  mental  hygiene  legal  service,  or  anyone acting on the assisted
outpatient's behalf may petition the court on notice  to  the  director,
the  original petitioner, and all others entitled to notice under subdi-
vision [(f)] (G) of this section to stay, vacate or modify the order.
  (2) The appropriate director shall petition  the  court  for  approval
before instituting a proposed material change in the assisted outpatient
treatment  plan,  unless  such  change is authorized by the order of the
court.  SUCH PETITIONS TO CHANGE AN ASSISTED OUTPATIENT TREATMENT  PLAN,

S. 2225--C                         12

AS  WELL  AS PETITIONS FOR CONTINUED TREATMENT, MAY BE MADE TO ANY JUDGE
OF THE SUPREME OR COUNTY COURTS IN THE COUNTY IN WHICH  THE  SUBJECT  OF
THE PETITION IS PRESENT OR REASONABLY BELIEVED TO BE PRESENT. Such peti-
tion  shall  be  filed on notice to all parties entitled to notice under
subdivision [(f)] (G) of this section. Not later than  five  days  after
receiving  such petition, excluding Saturdays, Sundays and holidays, the
court shall hold a  hearing  on  the  petition;  provided  that  if  the
assisted  outpatient  informs  the  court  that  he or she agrees to the
proposed material change, the court may approve such  change  without  a
hearing.  Non-material changes may be instituted by the director without
court approval. For the purposes of this paragraph, a material change is
an addition or deletion of a category of services to or from  a  current
assisted  outpatient  treatment  plan,  or  any  deviation  without  the
assisted outpatient's consent from the terms of a current order relating
to the administration of psychotropic drugs.
  [(m)] (O) Appeals. Review of an order issued pursuant to this  section
shall  be  had  in  like  manner  as  specified  in section 9.35 of this
article; PROVIDED THAT NOTICE SHALL BE PROVIDED TO ALL PARTIES  ENTITLED
TO NOTICE UNDER SUBDIVISION (G) OF THIS SECTION.
  [(n)]  (P) Failure to comply with assisted outpatient treatment. Where
in the clinical judgment of a physician, (i)  the  assisted  outpatient,
has  failed or refused to comply with the assisted outpatient treatment,
(ii) efforts were made to solicit compliance, and  (iii)  such  assisted
outpatient  may be in need of involuntary admission to a hospital pursu-
ant to section 9.27 of this article or immediate observation,  care  and
treatment  pursuant to section 9.39 or 9.40 of this article, such physi-
cian may request the appropriate director  of  community  services,  the
director's  designee,  or  any  physician  designated by the director of
community services pursuant to section 9.37 of this article,  to  direct
the  removal  of such assisted outpatient to an appropriate hospital for
an examination to determine if such person  has  a  mental  illness  for
which  HE  OR SHE IS IN NEED OF hospitalization is necessary pursuant to
section 9.27, 9.39 or  9.40  of  this  article[.  Furthermore,  if  such
assisted outpatient refuses to take medications as required by the court
order,  or he or she refuses to take, or fails a blood test, urinalysis,
or alcohol or drug test as required by the court order,  such  physician
may consider such refusal or failure when determining whether]; PROVIDED
THAT  IF, AFTER EFFORTS TO SOLICIT COMPLIANCE, SUCH PHYSICIAN DETERMINES
THAT THE ASSISTED OUTPATIENT'S  FAILURE  TO  COMPLY  WITH  THE  ASSISTED
OUTPATIENT  TREATMENT INCLUDES A SUBSTANTIAL FAILURE TO TAKE MEDICATION,
PASS OR SUBMIT TO BLOOD TESTING OR URINALYSIS, OR RECEIVE TREATMENT  FOR
ALCOHOL OR SUBSTANCE ABUSE, SUCH PHYSICIAN MAY PRESUME THAT the assisted
outpatient  is  in need of an examination to determine whether he or she
has a mental illness for which hospitalization is  necessary.  Upon  the
request  of  such  physician,  the  appropriate director, the director's
designee, or any physician designated pursuant to section 9.37  of  this
article,  may  direct  peace  officers, acting pursuant to their special
duties, or police officers who  are  members  of  an  authorized  police
department  or  force  or of a sheriff's department to take the assisted
outpatient into custody and transport him or her to the hospital operat-
ing the assisted outpatient treatment program or to any hospital author-
ized by the director of community services to receive such persons. Such
law enforcement officials shall  carry  out  such  directive.  Upon  the
request  of  such  physician,  the  appropriate director, the director's
designee, or any physician designated pursuant to section 9.37  of  this
article,  an ambulance service, as defined by subdivision two of section

S. 2225--C                         13

three thousand one of the public  health  law,  or  an  approved  mobile
crisis outreach team as defined in section 9.58 of this article shall be
authorized  to  take  into  custody and transport any such person to the
hospital  operating the assisted outpatient treatment program, or to any
other hospital authorized  by  the  appropriate  director  of  community
services to receive such persons. Any director of community services, or
designee,  shall  be  authorized  to  direct  the removal of an assisted
outpatient who is present in his or her county to an appropriate  hospi-
tal, in accordance with the provisions of this subdivision, based upon a
determination  of the appropriate director of community services direct-
ing the removal of such assisted outpatient pursuant  to  this  subdivi-
sion.  Such  person  may be retained for observation, care and treatment
and further examination in the hospital for up to seventy-two  hours  to
permit a physician to determine whether such person has a mental illness
and  is in need of involuntary care and treatment in a hospital pursuant
to the provisions of this article. Any continued  involuntary  retention
OF  THE ASSISTED OUTPATIENT in such hospital beyond the initial seventy-
two hour period shall be in accordance with the provisions of this arti-
cle relating to the involuntary admission and retention of a person.  If
at  any time during the seventy-two hour period the person is determined
not to meet the involuntary admission and retention provisions  of  this
article,  and  does  not agree to stay in the hospital as a voluntary or
informal patient, he or she must be released. Failure to comply with  an
order of assisted outpatient treatment shall not be grounds for involun-
tary civil commitment or a finding of contempt of court.
  [(o)] (Q) Effect of determination that a person is in need of assisted
outpatient  treatment.  The determination by a court that a person is in
need of assisted outpatient treatment  shall  not  be  construed  as  or
deemed  to be a determination that such person is incapacitated pursuant
to article eighty-one of this chapter.
  [(p)] (R) False petition. A person making a false statement or provid-
ing false information or false testimony in a petition or hearing  under
this  section shall be subject to criminal prosecution pursuant to arti-
cle one hundred seventy-five or article two hundred  ten  of  the  penal
law.
  [(q)]  (S)  Exception.  Nothing  in this section shall be construed to
affect the ability of the director of a hospital to receive,  admit,  or
retain  patients  who  otherwise  meet  the  provisions  of this article
regarding receipt, retention or admission.
  [(r)] (T) Education and training. (1) The office [of  mental  health],
in  consultation  with the office of court administration, shall prepare
educational and training materials on the use  of  this  section,  which
shall  be  made  available  to  local  governmental  units, providers of
services, judges, court personnel, law  enforcement  officials  and  the
general public.
  (2)  The  office,  in  consultation  with the office of court adminis-
tration, shall establish a mental health training  program  for  supreme
and  county  court  judges  and  court personnel, AND SHALL PROVIDE SUCH
TRAINING WITH SUCH FREQUENCY AND IN SUCH LOCATIONS AS MAY BE APPROPRIATE
TO MEET STATEWIDE NEEDS.  Such training shall focus on the use  of  this
section  and  generally  address  issues  relating to mental illness and
mental health treatment.
  S 6. Section 29.15 of the mental hygiene law is amended  by  adding  a
new subdivision (o) to read as follows:
  (O)  IF  THE  DIRECTOR  OF A DEPARTMENT FACILITY DOES NOT PETITION FOR
ASSISTED OUTPATIENT TREATMENT PURSUANT TO SECTION 9.60 OF  THIS  CHAPTER

S. 2225--C                         14

UPON  THE  DISCHARGE  OF AN INPATIENT ADMITTED PURSUANT TO SECTION 9.27,
9.39 OR 9.40 OF THIS CHAPTER, OR UPON THE  EXPIRATION  OF  A  PERIOD  OF
CONDITIONAL  RELEASE FOR SUCH INPATIENT, SUCH DIRECTOR SHALL REPORT SUCH
DISCHARGE  OR  SUCH  EXPIRATION  IN WRITING TO THE DIRECTOR OF COMMUNITY
SERVICES OF THE LOCAL  GOVERNMENTAL  UNIT  IN  WHICH  THE  INPATIENT  IS
EXPECTED TO RESIDE.
  S  7.  Subdivision 3 of section 404 of the correction law, as added by
chapter 1 of the laws of 2013, is amended to read as follows:
  3. Within a reasonable period prior to discharge of an inmate  commit-
ted  from a [state correctional facility from a] hospital in the depart-
ment of mental hygiene to the community, the director shall ensure  that
a clinical assessment has been completed to determine whether the inmate
meets  the criteria for assisted outpatient treatment pursuant to subdi-
vision (c) of section 9.60 of the mental hygiene law. If, as a result of
such assessment, the director determines  that  the  inmate  meets  such
criteria,  prior  to discharge the director of the hospital shall either
petition for a court order  pursuant  to  section  9.60  of  the  mental
hygiene  law, or report in writing to the director of community services
of the local governmental unit in which the inmate is expected to reside
so that an investigation may be conducted pursuant to  section  9.47  of
the mental hygiene law.
  S  8.  Section  18  of  chapter  408 of the laws of 1999, constituting
Kendra's Law, as amended by chapter 1 of the laws of 2013, is amended to
read as follows:
  S 18. This act shall take effect immediately,  provided  that  section
fifteen  of this act shall take effect April 1, 2000, provided, further,
that subdivision (e) of section 9.60 of the mental hygiene law as  added
by  section  six  of  this act shall be effective 90 days after this act
shall become law[; and that this act shall expire and be deemed repealed
June 30, 2017].
  S 9. Severability. If any clause, sentence, paragraph, section or part
of this act shall be adjudged by any court of competent jurisdiction  to
be  invalid,  and  after  exhaustion of all further judicial review, the
judgment shall not affect, impair or invalidate the  remainder  thereof,
but  shall  be  confined in its operation to the clause, sentence, para-
graph, section or part thereof directly involved in the controversy.
  S 10.  This act shall take effect immediately.

Co-Sponsors

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S2225D (ACTIVE) - Bill Details

Current Committee:
Law Section:
Mental Hygiene Law
Laws Affected:
Amd §§7.17, 9.47, 9.48, 9.60 & 29.15, Ment Hyg L; amd §404, Cor L; amd §18, Chap 408 of 1999
Versions Introduced in 2011-2012 Legislative Session:
S4881A

S2225D (ACTIVE) - Bill Texts

view summary

Enhances the assisted outpatient treatment program; eliminates the expiration and repeal of Kendra's Law.

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BILL NUMBER:S2225D

TITLE OF BILL: An act to amend the mental hygiene law and the
correction law, in relation to enhancing the assisted outpatient treat-
ment program; and to amend Kendra's Law, in relation to making the
provisions thereof permanent

PURPOSE OR GENERAL IDEA OF BILL: To improve care for people with seri-
ous mental illness, and protect the safety of patients and the public by
streamlining and improving New York's Assisted Outpatient Treatment
(AOT) program (Kendra's Law).

SUMMARY OF SPECIFIC PROVISIONS:

Section 1 amends Mental Hygiene Law (MHL) § 7.17(f) to require that AOT
program coordinators monitor local programs to ensure that expiring AOT
orders are adequately reviewed to consider the need for renewal of the
order; to ensure appropriate assignment of a director for each outpa-
tient; and to monitor local needs for training of judges and court
personnel in order for the office of mental health to adequately provide
such training.

Section 2 provides that the Commissioner of Mental Health shall develop
an educational pamphlet on the process of petitioning for AOT to be made
available to persons wishing to submit reports of individuals who may be
in need of AOT, as well as disseminated to family members and other
individuals eligible to petition for AOT.

Section 3 amends § 9.47 of the MHL to clarify that directors of communi-
ty services shall be responsible for ensuring that reports of persons
who may be in need of continued AOT orders are subject to a timely
investigation. It also provides that directors of community services
shall notify program coordinators when AOT patients cannot be located or
are believed to have taken residence outside of the local governmental
unit served.

Section 4 amends MHL § 9.48 to require that AOT program directors' quar-
terly reports to program coordinators include information on any expired
AOT court orders, including the determination made as to whether to
petition for renewal of the AOT, the basis for such determination, and
the court's disposition of the renewal petition, if any.

Section 5 amends MHL § 9.60 to clarify that assisted outpatient treat-
ment services provided may include: medication education or symptom
management education; appointment of a representative payee; and that
tests for alcohol or drugs may be random. This section also provides
that the parties to the treatment order may stipulate, upon mutual
consent, that an examining physician need not testify in court. The bill
also provides that the appointed physician shall make a reasonable
effort to gather relevant information for the development of a treatment
plan from a member or members of the patient's family or significant
other.

This section also clarifies that directors of hospitals or superinten-
dents of correctional facilities may initiate a petition.

This section also requires the Commissioner to establish by regulation a
procedure to ensure that reports of persons who may be in need of AOT
that are made by family and community members of such person are, if
warranted, investigated in a timely manner, and that AOT petitions are
filed, where appropriate.

This section also provides that the Commissioner shall promulgate regu-
lations to require that prior to an assisted outpatient relocating to a
location within the state of New York which is not served by his or her
current director of community services, that patient or other appropri-
ate party must notify the program coordinator. The program coordinator
shall then redetermine who the appropriate director shall be, and cause
a copy of the court order and treatment plan to be transmitted to the
new director.

This section also provides that a director shall review whether the
assisted outpatient continues to meet AOT criteria within 30 days before
the expiration of an order for AOT. If the director determines that such
assisted outpatient no longer meets the criteria, such director is
required to give notice to the program coordinator that a petition for
continued AOT is unnecessary. However, if such assisted outpatient
continues to meet the criteria, as determined by the director, such
director shall file a petition for continued treatment.

This provision clarifies procedures any other person authorized to peti-
tion for continued AOT may use to bring such petition in the event that
the appropriate director or current petitioner does not petition for
continued AOT prior to the expiration of the court order.

This section also provides that counties shall notify the department
when an assisted outpatient is missing and thereby unavailable for an
evaluation as to whether he or she continues to meet AOT criteria. It
also provides that when a patient is missing upon the expiration date of
the order, the order shall be extended until sixty days after such
patient is found.

Section 6 amends MHL § 29.15 to provide that if the director of the
hospital does not petition for AOT upon the discharge of an involuntar-
ily committed inpatient or upon the expiration of a period of condi-
tional release for such inpatient, such director shall report the
discharge in writing to the director of community services of the local
government unit where the inpatient is expected to reside.

Section 7 amends subdivision 1 of section 404 of the correction law to
require that, prior to discharging an inmate who is still mentally ill,
the director shall, where appropriate, either apply for a person's
admission to a hospital for care and treatment, or initiate a petition
for an order authorizing assisted outpatient treatment, or the commis-

sioner may apply for the person's admission to a secure treatment facil-
ity.

Subdivision (3)of Section 404 of the corrections law is amended to
require that a director of community services of the local government
unit where the inmate will reside who has received a written report from
a director of a hospital that has completed an AOT clinical assessment
for an inmate being discharged from a hospital in the department of
mental hygiene shall conduct an investigation pursuant to section 9.47
of the mental hygiene law.

A new subdivision (4) of section 404 of the correction law is also added
to require that within a reasonable period before release or discharge
of an inmate with a serious mental illness pursuant to paragraph (e) of
subdivision 6 of section 137 of the correction law, the department shall
notify the director of a hospital who shall ensure that a clinical
assessment has been completed to determine if the inmate meets the
criteria for AOT treatment pursuant to Mental Hygiene law section 9.60.
If the inmate is determined to meet such criteria the hospital director
shall either petition the court for an order pursuant to section 9.60 of
the mental hygiene law, or report in writing to the director of communi-
ty services of the local government unit in which the inmate resides so
that an investigation will be conducted pursuant to section 9.47 of the
mental hygiene law.

Section 8 would repeal the current sunset date of June 30, 2017 to make
the provisions of Kendra's Law permanent.

Section 9 Severability.

Section 10 states that this act shall take effect immediately.

JUSTIFICATION: In 1999, the legislature enacted "Kendra's Law," estab-
lishing a statewide court-ordered assisted outpatient treatment (AOT)
program to improve outcomes for persons with severe mental illness who,
in view of their treatment history and present circumstances, are likely
to have difficulty living safely in the community. At the approach of
the law's original 2005 expiration date, the legislature took note of
the Office of Mental Health (OMH) research documenting declines in rates
of homelessness, hospitalization, substance abuse, alcoholism, violence,
arrest and incarceration, and documented increases in treatment compli-
ance, service engagement and positive consumer perceptions. In 2005 and
2010, the legislature opted to extend Kendra's Law for an additional
five years to further evaluate the program. The New York SAFE Act, which
was signed into law on January 15, 2013, also extended Kendra's Law for
an additional two years, making the law expire on June 30, 2017.

On June 30, 2009, a team of independent researchers released the report
of their long term study of AOT throughout New York State and in Octo-
ber, 2010 Psychiatric Services published six peer reviewed studies on
the AOT program. These reports confirm the earlier OMH data. These
studies found patients given mandatory outpatient treatment who were

more violent to begin with, were nevertheless four times less likely
than members of the control group to perpetrate serious violence after
undergoing assisted outpatient treatment. The studies also found less
frequent psychiatric hospitalizations, shorter length of hospitaliza-
tions, reduction in the likelihood of arrest, higher social functioning,
slightly less stigma and no increase in perceived coercion. These
studies confirmed that AOT stimulates service provider's efforts to
prioritize care for AOT recipients; judges hearing AOT cases could bene-
fit from additional AOT training; counties favored increasing the avail-
ability of stipulations to reduce the court burden, costs, and transpor-
tation burdens; recipients are far more likely than other patients to
consistently receive psychotropic medications appropriate to their
psychiatric condition; that those who receive AOT for periods of at
least one year are more likely than those who receive AOT for shorter
periods to sustain gains after leaving the program; that the law has
been applied in a non-discriminatory manner; and that the court order
itself, in addition to high quality services, is a significant factor in
the program's success.

The experience of thousands of patients, treatment providers and fami-
lies who have utilized Kendra's Law since 1999 point to several areas
where the law should be improved to achieve costs savings, promote
smoother functioning of the AOT program and easier access to those who
stand to benefit from it. Although the New York SAFE Act addresses many
of these concerns, loopholes still exist in the law. The amendments
included in this act are intended to close these loopholes and maximize
the unique potential of this legislation, while simultaneously serving
the goals of compassionate care, fiscal responsibility, and public safe-
ty.

PRIOR LEGISLATIVE HISTORY: 2011, 2012: S.4881B Referred to Mental
Health/Developmental Disabilities

FISCAL IMPLICATIONS: To be determined. Cost-savings for the state and
local governments are anticipated following implementation, due to
reduced instances of hospitalizations and incarcerations that would
result.

EFFECTIVE DATE: This act shall take effect immediately.

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                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 2225--D

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                            January 14, 2013
                               ___________

Introduced  by  Sens.  YOUNG,  ADDABBO,  AVELLA,  BALL,  BONACIC, BOYLE,
  DeFRANCISCO,  FARLEY,  GALLIVAN,  GOLDEN,  GRIFFO,   HASSELL-THOMPSON,
  LANZA,   LARKIN,   LIBOUS,  LITTLE,  MARCELLINO,  MARCHIONE,  MARTINS,
  MAZIARZ, NOZZOLIO, RANZENHOFER,  RITCHIE,  ROBACH,  SEWARD,  STAVISKY,
  VALESKY, ZELDIN -- read twice and ordered printed, and when printed to
  be committed to the Committee on Mental Health and Developmental Disa-
  bilities  --  committee discharged, bill amended, ordered reprinted as
  amended and recommitted to said  committee  --  committee  discharged,
  bill  amended,  ordered  reprinted  as amended and recommitted to said
  committee -- recommitted to the Committee on Mental Health and  Devel-
  opmental  Disabilities  in  accordance  with  Senate Rule 6, sec. 8 --
  committee discharged, bill amended, ordered reprinted as  amended  and
  recommitted  to  said committee -- committee discharged, bill amended,
  ordered reprinted as amended and recommitted to said committee

AN ACT to amend the mental  hygiene  law  and  the  correction  law,  in
  relation  to  enhancing the assisted outpatient treatment program; and
  to amend Kendra's Law, in relation to making  the  provisions  thereof
  permanent

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Paragraph 2 of subdivision  (f)  of  section  7.17  of  the
mental  hygiene  law,  as amended by chapter 158 of the laws of 2005, is
amended to read as follows:
  (2) The oversight and monitoring role of the  program  coordinator  of
the  assisted  outpatient  treatment  program  shall include each of the
following:
  (i) that each assisted outpatient receives the treatment provided  for
in  the  court  order  issued pursuant to section 9.60 of this [chapter]
TITLE;
  (ii) that existing  services  located  in  the  assisted  outpatient's
community are utilized whenever practicable;

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD02670-10-4

S. 2225--D                          2

  (iii)  that  a  case  manager or assertive community treatment team is
designated for each assisted outpatient;
  (iv)  that  a  mechanism  exists  for  such case manager, or assertive
community treatment team, to regularly report the assisted  outpatient's
compliance, or lack of compliance with treatment, to the director of the
assisted outpatient treatment program;
  (v)  that directors of community services establish procedures [which]
THAT provide that reports of persons who may  be  in  need  of  assisted
outpatient  treatment are appropriately investigated in a timely manner;
[and]
  (vi) that assisted outpatient treatment services are  delivered  in  a
timely manner[.];
  (VII)  THAT,  PRIOR TO THE EXPIRATION OF ASSISTED OUTPATIENT TREATMENT
ORDERS, THE  CLINICAL  NEEDS  OF  ASSISTED  OUTPATIENTS  ARE  ADEQUATELY
REVIEWED  IN  DETERMINING  THE  NEED  TO PETITION FOR CONTINUED ASSISTED
OUTPATIENT TREATMENT PURSUANT TO SUBDIVISION (M) OF SECTION 9.60 OF THIS
TITLE;
  (VIII) THAT THE APPROPRIATE DIRECTOR IS DETERMINED FOR  EACH  ASSISTED
OUTPATIENT, PURSUANT TO SUBDIVISIONS (K) AND (L) OF SECTION 9.60 OF THIS
TITLE; AND
  (IX)  THAT  THE OFFICE FULFILLS ITS DUTIES PURSUANT TO SUBDIVISION (T)
OF SECTION 9.60 OF THIS TITLE TO MEET LOCAL NEEDS FOR TRAINING OF JUDGES
AND COURT PERSONNEL.
  S 2. Subdivision (f) of section 7.17 of  the  mental  hygiene  law  is
amended by adding a new paragraph 5 to read as follows:
  (5)  THE  COMMISSIONER  SHALL  DEVELOP  AN EDUCATIONAL PAMPHLET ON THE
PROCESS OF PETITIONING FOR ASSISTED  OUTPATIENT  TREATMENT  FOR  DISSEM-
INATION  TO  INDIVIDUALS SEEKING TO SUBMIT REPORTS OF PERSONS WHO MAY BE
IN NEED OF ASSISTED OUTPATIENT TREATMENT,  AND  INDIVIDUALS  SEEKING  TO
FILE A PETITION PURSUANT TO SUBPARAGRAPH (I) OR (II) OF PARAGRAPH ONE OF
SUBDIVISION  (F)  OF SECTION 9.60 OF THIS TITLE. SUCH PAMPHLET SHALL SET
FORTH, IN PLAIN LANGUAGE: THE CRITERIA FOR  ASSISTED  OUTPATIENT  TREAT-
MENT,  RESOURCES  AVAILABLE TO SUCH INDIVIDUALS, THE RESPONSIBILITIES OF
PROGRAM COORDINATORS AND DIRECTORS OF COMMUNITY SERVICES, A  SUMMARY  OF
CURRENT  LAW,  THE PROCESS FOR PETITIONING FOR CONTINUED ASSISTED OUTPA-
TIENT TREATMENT, AND OTHER SUCH INFORMATION THE COMMISSIONER  DETERMINES
TO BE PERTINENT.
  S  3.    Subdivision (b) of section 9.47 of the mental hygiene law, as
amended by chapter 158 of the laws of 2005, paragraphs 5 and 6 as  added
and  paragraph  7  as  renumbered  by  chapter 1 of the laws of 2013, is
amended to read as follows:
  (b) All directors of community services shall be responsible for:
  (1) receiving reports of persons who may be in need of assisted outpa-
tient treatment PURSUANT TO SECTION 9.60 OF THIS ARTICLE and documenting
the receipt date of such reports;
  (2) conducting timely investigations of such reports RECEIVED PURSUANT
TO PARAGRAPH ONE OF THIS SUBDIVISION and providing written  notice  upon
the  completion of investigations to reporting persons and program coor-
dinators, appointed by the commissioner [of mental health]  pursuant  to
subdivision  (f)  of  section  7.17  of  this title, and documenting the
initiation and completion dates of such investigations and the  disposi-
tions;
  (3)  filing of petitions for assisted outpatient treatment pursuant to
[paragraph] SUBPARAGRAPH (vii) of PARAGRAPH ONE OF subdivision [(e)] (F)
of section 9.60 of this article, and  documenting  the  petition  filing
[date] DATES and the [date] DATES of the court [order] ORDERS;

S. 2225--D                          3

  (4)  coordinating  the  timely delivery of court ordered services with
program coordinators and documenting the date assisted outpatients begin
to receive the services mandated in the court order; [and]
  (5)  ensuring  evaluation  of the need for ongoing assisted outpatient
treatment pursuant to subdivision [(k)] (M)  of  section  9.60  of  this
article  prior  to  the  expiration of any assisted outpatient treatment
order;
  (6) if he or she has been  ordered  to  provide  for  or  arrange  for
assisted  outpatient treatment pursuant to paragraph five of subdivision
[(j)] (K) of section 9.60 of this  article  or  became  the  appropriate
director  pursuant  to this paragraph or subdivision (c) of section 9.48
of this article, notifying the director of community services of the new
county of residence when he  or  she  has  reason  to  believe  that  an
assisted  outpatient  has  or will change his or her county of residence
during the pendency of an assisted outpatient treatment order. Upon such
change of residence, the director of the new county of  residence  shall
become the appropriate director, as such term is defined in section 9.60
of this article; [and]
  (7) NOTIFYING PROGRAM COORDINATORS WHEN ASSISTED OUTPATIENTS CANNOT BE
LOCATED AFTER REASONABLE EFFORTS OR ARE BELIEVED TO HAVE TAKEN RESIDENCE
OUTSIDE OF THE LOCAL GOVERNMENTAL UNIT SERVED; AND
  (8)  reporting on a quarterly basis to program coordinators the infor-
mation collected pursuant to this subdivision.
  S 4.  Paragraphs (viii) and (ix) of subdivision (b) of section 9.48 of
the mental hygiene law are renumbered paragraphs (ix) and (x) and a  new
paragraph (viii) is added to read as follows:
  (VIII)  AN  ACCOUNT  OF  ANY COURT ORDER EXPIRATION, INCLUDING BUT NOT
LIMITED TO THE DIRECTOR'S DETERMINATION AS TO WHETHER  TO  PETITION  FOR
CONTINUED  ASSISTED  OUTPATIENT  TREATMENT,  PURSUANT TO SECTION 9.60 OF
THIS ARTICLE, THE BASIS FOR SUCH DETERMINATION, AND THE  DISPOSITION  OF
ANY SUCH PETITION;
  S 5. Section 9.60 of the mental hygiene law, as amended by chapter 158
of  the  laws  of  2005,  paragraph  1  of subdivision (a) as amended by
section 1 of part E of chapter 111 of the laws of 2010, paragraph  3  of
subdivision (a), paragraphs 2 and 5 of subdivision (j), and subdivisions
(k)  and (n) as amended by chapter 1 of the laws of 2013, paragraph 5 of
subdivision (c) as amended by chapter  137  of  the  laws  of  2005,  is
amended to read as follows:
S 9.60 Assisted outpatient treatment.
  (a)  Definitions.  For  purposes  of this section, the following defi-
nitions shall apply:
  (1) "assisted outpatient treatment" shall mean  categories  of  outpa-
tient  services  [which] THAT have been ordered by the court pursuant to
this section.  Such treatment shall include case management services  or
assertive  community  treatment  team  services  to provide care coordi-
nation, and  may  also  include  any  of  the  following  categories  of
services: medication SUPPORT; MEDICATION EDUCATION OR SYMPTOM MANAGEMENT
EDUCATION;  periodic  blood  tests or urinalysis to determine compliance
with prescribed medications; individual or group therapy; day or partial
day programming  activities;  educational  and  vocational  training  or
activities;  APPOINTMENT  OF  A  REPRESENTATIVE PAYEE OR OTHER FINANCIAL
MANAGEMENT SERVICES, SUBJECT TO FINAL APPROVAL OF  THE  SOCIAL  SECURITY
ADMINISTRATION,  WHERE  APPLICABLE; alcohol or substance abuse treatment
and counseling and periodic OR RANDOM tests for the presence of  alcohol
or  illegal  drugs  for  persons  with a history of alcohol or substance
abuse; supervision of living arrangements; and any other services within

S. 2225--D                          4

a local services plan developed pursuant to article  forty-one  of  this
chapter,  CLINICAL  OR  NON-CLINICAL,  prescribed  to treat the person's
mental illness and to assist the person in living and functioning in the
community,  or to attempt to prevent a relapse or deterioration that may
reasonably be predicted to result in [suicide] SERIOUS PHYSICAL HARM  TO
ANY PERSON or the need for hospitalization.
  (2)  "director"  shall  mean  the  director of community services of a
local governmental unit, or the director of a hospital licensed or oper-
ated by the office of mental health which operates, directs  and  super-
vises an assisted outpatient treatment program.
  (3)  "director  of  community  services" and "local governmental unit"
shall have the same meanings as provided in article  forty-one  of  this
chapter. The "appropriate director" shall mean the director of community
services of the county where the assisted outpatient resides, even if it
is  a  different  county  than  the county where the assisted outpatient
treatment order was originally issued.
  (4) "assisted outpatient treatment program" shall  mean  a  system  to
arrange  for  and coordinate the provision of assisted outpatient treat-
ment, to monitor treatment compliance by assisted outpatients, to evalu-
ate the condition or needs of assisted outpatients, to take  appropriate
steps to address the needs of such individuals, and to ensure compliance
with court orders.
  (5) "assisted outpatient" shall mean the person under a court order to
receive assisted outpatient treatment.
  (6)  "subject  of the petition" or "subject" shall mean the person who
is alleged in a petition, filed  pursuant  to  the  provisions  of  this
section, to meet the criteria for assisted outpatient treatment.
  (7)  "correctional  facility"  and "local correctional facility" shall
have the same meanings as provided in section two of the correction law.
  (8) "health care proxy" and "health care agent" shall  have  the  same
meanings as provided in article twenty-nine-C of the public health law.
  (9)  "program  coordinator"  shall mean an individual appointed by the
commissioner [of mental health], pursuant to subdivision (f) of  section
7.17  of this chapter, who is responsible for the oversight and monitor-
ing of assisted outpatient treatment programs.
  (b) Programs. The director of community services of each local govern-
mental unit shall operate, direct and supervise an  assisted  outpatient
treatment  program.  The  director of a hospital licensed or operated by
the office [of mental health]  may  operate,  direct  and  supervise  an
assisted  outpatient treatment program, upon approval by the commission-
er. Directors of community services shall be permitted  to  satisfy  the
provisions  of  this subdivision through the operation of joint assisted
outpatient treatment programs. Nothing  in  this  subdivision  shall  be
interpreted  to  preclude  the  combination  or  coordination of efforts
between and among local governmental units and  hospitals  in  providing
and coordinating assisted outpatient treatment.
  (c)  Criteria.  A person may be ordered to receive assisted outpatient
treatment if the court finds that such person:
  (1) is eighteen years of age or older; and
  (2) is suffering from a mental illness; and
  (3) is unlikely to survive safely  in  the  community  without  super-
vision, based on a clinical determination; and
  (4)  has  a  history  of  lack of compliance with treatment for mental
illness that has:
  (i) [prior to the filing of the petition,] at least twice  within  the
[last]  thirty-six  months  PRIOR  TO  THE FILING OF THE PETITION been a

S. 2225--D                          5

significant factor in necessitating hospitalization in  a  hospital,  or
receipt  of  services  in  a  forensic  or other mental health unit of a
correctional facility or a local correctional facility[, not including];
PROVIDED  THAT  SUCH  THIRTY-SIX  MONTH  PERIOD SHALL BE EXTENDED BY THE
LENGTH OF any current period[, or period ending] OF  HOSPITALIZATION  OR
INCARCERATION,  AND  ANY  SUCH  PERIOD  THAT  ENDED  within the last six
months[, during which the person was or is hospitalized  or  incarcerat-
ed]; or
  (ii)  WITHIN  FORTY-EIGHT  MONTHS prior to the filing of the petition,
resulted in one or more acts of serious violent behavior toward self  or
others  or  threats of, or attempts at, serious physical harm to self or
others [within the last forty-eight  months,  not  including];  PROVIDED
THAT  SUCH  FORTY-EIGHT  MONTH PERIOD SHALL BE EXTENDED BY THE LENGTH OF
any current period[, or period ending] OF HOSPITALIZATION OR  INCARCERA-
TION,  AND  ANY  SUCH  PERIOD THAT ENDED within the last six months[, in
which the person was or is hospitalized or incarcerated]; and
  (5) is, as a result of his or her mental illness, unlikely  to  volun-
tarily  participate in outpatient treatment that would enable him or her
to live safely in the community; and
  (6) in view of his or her treatment history and current  behavior,  is
in  need  of assisted outpatient treatment in order to prevent a relapse
or deterioration which would be likely to result in serious harm to  the
person or others as defined in section 9.01 of this article; and
  (7) is likely to benefit from assisted outpatient treatment.
  (d) Health care proxy. Nothing in this section shall preclude a person
with  a  health  care proxy from being subject to a petition pursuant to
this chapter and consistent with article  twenty-nine-C  of  the  public
health law.
  (e)  INVESTIGATION OF REPORTS. THE COMMISSIONER SHALL PROMULGATE REGU-
LATIONS ESTABLISHING A PROCEDURE TO ENSURE THAT REPORTS OF A PERSON  WHO
MAY  BE  IN  NEED  OF  ASSISTED  OUTPATIENT  TREATMENT,  INCLUDING THOSE
RECEIVED FROM FAMILY AND COMMUNITY MEMBERS OF SUCH PERSON, ARE  INVESTI-
GATED IN A TIMELY MANNER AND, WHERE APPROPRIATE, RESULT IN THE FILING OF
PETITIONS FOR ASSISTED OUTPATIENT TREATMENT.
  (F)  Petition  to  the  court. (1) A petition for an order authorizing
assisted outpatient treatment may be filed  in  the  supreme  or  county
court  in  the county in which the subject of the petition is present or
reasonably believed to  be  present.    WHEN  A  DIRECTOR  OF  COMMUNITY
SERVICES  HAS  REASON TO BELIEVE THAT AN ASSISTED OUTPATIENT HAS CHANGED
HIS OR HER COUNTY OF RESIDENCE, FUTURE PETITIONS AND APPLICATIONS  UNDER
THIS  SECTION  MAY  BE  FILED  IN THE SUPREME OR COUNTY COURT IN THE NEW
COUNTY OF RESIDENCE, WHICH SHALL HAVE CONCURRENT JURISDICTION  WITH  THE
COURT THAT INITIALLY ORDERED SUCH TREATMENT. Such petition may be initi-
ated only by the following persons:
  (i) any person eighteen years of age or older with whom the subject of
the petition resides; or
  (ii)  the  parent,  spouse, sibling eighteen years of age or older, or
child eighteen years of age or older of the subject of the petition; or
  (iii) the director of a hospital in which the subject of the  petition
is  hospitalized,  OR  PURSUANT  TO  SECTION  FOUR  HUNDRED  FOUR OF THE
CORRECTION LAW; or
  (iv) the director of any public or charitable organization, agency  or
home  providing mental health services to the subject of the petition or
in whose institution the subject of the petition resides; or
  (v) a qualified psychiatrist who is either supervising  the  treatment
of or treating the subject of the petition for a mental illness; or

S. 2225--D                          6

  (vi)  a  psychologist, licensed pursuant to article one hundred fifty-
three of the education law, or a social  worker,  licensed  pursuant  to
article one hundred fifty-four of the education law, who is treating the
subject of the petition for a mental illness; or
  (vii)  the  director of community services, or his or her designee, or
the social services official, as defined in the social services law,  of
the  city  or  county in which the subject of the petition is present or
reasonably believed to be present; or
  (viii) a parole officer or probation officer assigned to supervise the
subject of the petition[.]; OR
  (IX) THE DIRECTOR OF THE HOSPITAL OR THE SUPERINTENDENT OF  A  CORREC-
TIONAL  FACILITY  IN  WHICH  THE  SUBJECT OF THE PETITION IS IMPRISONED,
PURSUANT TO SECTION FOUR HUNDRED FOUR OF THE CORRECTION LAW.
  (2) THE COMMISSIONER SHALL PROMULGATE REGULATIONS  PURSUANT  TO  WHICH
PERSONS INITIATING A PETITION, PURSUANT TO SUBPARAGRAPHS (I) AND (II) OF
PARAGRAPH ONE OF THIS SUBDIVISION, MAY RECEIVE ASSISTANCE IN FILING SUCH
PETITIONS,  WHERE APPROPRIATE, AS DETERMINED PURSUANT TO SUBDIVISION (E)
OF THIS SECTION.
  (3) The petition shall state:
  (i) each of the criteria for  assisted  outpatient  treatment  as  set
forth in subdivision (c) of this section;
  (ii)  facts  which support the petitioner's belief that the subject of
the petition meets each criterion, provided  that  the  hearing  on  the
petition need not be limited to the stated facts; and
  (iii)  that  the  subject of the petition is present, or is reasonably
believed to be present, within the county where such petition is filed.
  [(3)] (4) The petition shall be accompanied by an affirmation or affi-
davit of a physician, who shall not be the petitioner, stating THAT SUCH
PHYSICIAN IS WILLING AND ABLE TO TESTIFY AT THE HEARING ON THE  PETITION
AND THAT either [that]:
  (i) such physician has personally examined the subject of the petition
no  more  than  ten  days prior to the submission of the petition[,] AND
recommends assisted outpatient treatment for the subject  of  the  peti-
tion[,  and  is  willing and able to testify at the hearing on the peti-
tion]; or
  (ii) no more than ten days prior to the filing of the  petition,  such
physician  or  his or her designee has made appropriate attempts but has
not been successful in eliciting the cooperation of the subject  of  the
petition  to  submit  to  an  examination,  such physician has reason to
suspect that the subject of the petition meets the criteria for assisted
outpatient treatment, and such physician is willing and able to  examine
the subject of the petition [and testify at the hearing on the petition]
PRIOR TO PROVIDING TESTIMONY.
  [(4)]  (5)  In  counties  with  a population of less than seventy-five
thousand, the affirmation or affidavit  required  by  paragraph  [three]
FOUR  of  this subdivision may be made by a physician who is an employee
of the office.  The office is authorized AND DIRECTED to make available,
at no cost to the county, a  qualified  physician  for  the  purpose  of
making  such  affirmation or affidavit consistent with the provisions of
such paragraph.
  [(f)] (G) Service. The petitioner shall cause written  notice  of  the
petition  to  be given to the subject of the petition and a copy thereof
to be given personally or by mail to the persons listed in section  9.29
of this article, the mental hygiene legal service, the health care agent
if  any  such  agent is known to the petitioner, the appropriate program

S. 2225--D                          7

coordinator, and the appropriate director of community services, if such
director is not the petitioner.
  [(g)] (H) Right to counsel. The subject of the petition shall have the
right to be represented by the mental hygiene legal service, or private-
ly  financed counsel, at all stages of a proceeding commenced under this
section.
  [(h)] (I) Hearing. (1) Upon receipt of the petition, the  court  shall
fix  the date for a hearing. Such date shall be no later than three days
from the date such petition is received by the court,  excluding  Satur-
days,  Sundays  and  holidays.  Adjournments shall be permitted only for
good cause shown. In granting adjournments, the court shall consider the
need for further examination by a physician or  the  potential  need  to
provide  assisted  outpatient  treatment  expeditiously. The court shall
cause the subject of the petition, any  other  person  receiving  notice
pursuant  to  subdivision [(f)] (G) of this section, the petitioner, the
physician whose affirmation or affidavit accompanied the  petition,  and
such  other  persons  as  the  court may determine to be advised of such
date. Upon such date, or upon such other date to  which  the  proceeding
may  be  adjourned,  the court shall hear testimony and, if it be deemed
advisable and the subject of the  petition  is  available,  examine  the
subject  of the petition in or out of court. If the subject of the peti-
tion does not appear at the hearing, and appropriate attempts to  elicit
the  attendance  of  the  subject have failed, the court may conduct the
hearing in the subject's absence. In such  case,  the  court  shall  set
forth  the factual basis for conducting the hearing without the presence
of the subject of the petition.
  (2) The court shall not order assisted outpatient treatment unless  an
examining  physician,  who  recommends assisted outpatient treatment and
has personally examined the subject of the petition  no  more  than  ten
days before the filing of the petition, testifies in person at the hear-
ing.  Such  physician  shall state the facts and clinical determinations
which support the allegation that the subject of the petition meets each
of the criteria for assisted outpatient  treatment;  PROVIDED  THAT  THE
PARTIES MAY STIPULATE, UPON MUTUAL CONSENT, THAT SUCH PHYSICIAN NEED NOT
TESTIFY.
  (3)  If  the  subject  of the petition has refused to be examined by a
physician, the court may request the subject to consent to  an  examina-
tion  by a physician appointed by the court. If the subject of the peti-
tion does not consent and the court finds reasonable  cause  to  believe
that the allegations in the petition are true, the court may order peace
officers,  acting  pursuant  to their special duties, or police officers
who are members of an authorized police department or  force,  or  of  a
sheriff's  department  to  take the subject of the petition into custody
and transport him or her to a hospital for examination by  a  physician.
Retention  of  the  subject  of  the petition under such order shall not
exceed twenty-four hours. The examination of the subject of the petition
may be performed by the physician whose affirmation or affidavit  accom-
panied the petition pursuant to paragraph three of subdivision [(e)] (F)
of  this  section,  if  such physician is privileged by such hospital or
otherwise authorized by such hospital to do so. If such  examination  is
performed by another physician, the examining physician may consult with
the physician whose affirmation or affidavit accompanied the petition as
to whether the subject meets the criteria for assisted outpatient treat-
ment.
  (4) A physician who testifies pursuant to paragraph two of this subdi-
vision  shall  state:  (i) the facts [which] AND CLINICAL DETERMINATIONS

S. 2225--D                          8

THAT support the allegation that the subject meets each of the  criteria
for  assisted outpatient treatment, (ii) that the treatment is the least
restrictive  alternative,  (iii)  the  recommended  assisted  outpatient
treatment,  and  (iv)  the rationale for the recommended assisted outpa-
tient  treatment.  If  the  recommended  assisted  outpatient  treatment
includes medication, such physician's testimony shall describe the types
or  classes of medication which should be authorized, shall describe the
beneficial and detrimental physical and mental effects of  such  medica-
tion,  and shall recommend whether such medication should be self-admin-
istered or administered by authorized personnel.
  (5) The subject of the petition shall be afforded  an  opportunity  to
present  evidence, to call witnesses on his or her behalf, and to cross-
examine adverse witnesses.
  [(i)] (J) Written treatment  plan.  (1)  The  court  shall  not  order
assisted outpatient treatment unless a physician appointed by the appro-
priate  director,  in  consultation  with  such  director,  develops and
provides to the court a proposed written  treatment  plan.  The  written
treatment  plan  shall  include  case  management  services or assertive
community treatment team services  to  provide  care  coordination.  The
written treatment plan also shall include all categories of services, as
set  forth  in  paragraph  one of subdivision (a) of this section, which
such physician recommends that the subject of the petition receive.  All
service  providers  shall  be  notified regarding their inclusion in the
written treatment plan. If the written treatment plan  includes  medica-
tion, it shall state whether such medication should be self-administered
or  administered  by  authorized  personnel,  and shall specify type and
dosage range of medication most likely to provide  maximum  benefit  for
the subject. If the written treatment plan includes alcohol or substance
abuse  counseling  and  treatment,  such  plan  may  include a provision
requiring relevant testing for  either  alcohol  or  illegal  substances
provided  the  physician's  clinical  basis  for  recommending such plan
provides sufficient facts for the court to find (i) that such person has
a history of alcohol or substance abuse that is  clinically  related  to
the mental illness; and (ii) that such testing is necessary to prevent a
relapse or deterioration which would be likely to result in serious harm
to  the  person  or others. If a director is the petitioner, the written
treatment plan shall be provided to the court no later than the date  of
the  hearing  on  the petition. If a person other than a director is the
petitioner, such plan shall be provided to the court no later  than  the
date  set  by the court pursuant to paragraph three of subdivision [(j)]
(K) of this section.
  (2) The physician appointed to  develop  the  written  treatment  plan
shall  provide  the  following  persons  with an opportunity to actively
participate in the development of such plan: the subject  of  the  peti-
tion;  the  treating  physician,  if  any;  and  upon the request of the
subject of the  petition,  an  individual  significant  to  the  subject
including  any  relative, close friend or individual otherwise concerned
with the welfare of the subject. THE APPOINTED PHYSICIAN  SHALL  MAKE  A
REASONABLE  EFFORT TO GATHER RELEVANT INFORMATION FOR THE DEVELOPMENT OF
THE TREATMENT PLAN FROM THE SUBJECT OF THE PETITION'S FAMILY  MEMBER  OR
MEMBERS, OR HIS OR HER SIGNIFICANT OTHER. If the subject of the petition
has executed a health care proxy, the appointed physician shall consider
any  directions  included in such proxy in developing the written treat-
ment plan.
  (3) The court shall not order assisted outpatient treatment  unless  a
physician  appearing  on  behalf  of a director testifies to explain the

S. 2225--D                          9

written proposed treatment plan; PROVIDED THAT THE  PARTIES  MAY  STIPU-
LATE,  UPON  MUTUAL CONSENT, THAT SUCH PHYSICIAN NEED NOT TESTIFY.  Such
physician shall state the categories of  assisted  outpatient  treatment
recommended, the rationale for each such category, facts which establish
that  such  treatment  is the least restrictive alternative, and, if the
recommended assisted outpatient treatment plan includes medication, such
physician shall state the types or classes  of  medication  recommended,
the beneficial and detrimental physical and mental effects of such medi-
cation,  and  whether  such  medication  should  be self-administered or
administered by an authorized professional. If the subject of the  peti-
tion  has  executed  a health care proxy, such physician shall state the
consideration given to any directions included in such proxy in develop-
ing the written treatment plan. If a director is the petitioner,  testi-
mony  pursuant  to  this  paragraph shall be given at the hearing on the
petition. If a person other than a  director  is  the  petitioner,  such
testimony  shall be given on the date set by the court pursuant to para-
graph three of subdivision [(j)] (K) of this section.
  [(j)] (K) Disposition. (1) If after hearing all relevant evidence, the
court does not find by clear and convincing evidence that the subject of
the petition meets the criteria for assisted outpatient  treatment,  the
court shall dismiss the petition.
  (2)  If  after hearing all relevant evidence, the court finds by clear
and convincing evidence that the  subject  of  the  petition  meets  the
criteria  for assisted outpatient treatment, and there is no appropriate
and feasible less restrictive  alternative,  the  court  may  order  the
subject  to  receive assisted outpatient treatment for an initial period
not to exceed one year. In fashioning the order, the court shall specif-
ically make findings by clear and convincing evidence that the  proposed
treatment  is  the  least restrictive treatment appropriate and feasible
for the subject. The order shall state an assisted outpatient  treatment
plan,  which  shall include all categories of assisted outpatient treat-
ment, as set forth in paragraph one of subdivision (a) of this  section,
which  the  assisted outpatient is to receive, but shall not include any
such category that has not been recommended in [both] the proposed writ-
ten treatment plan and [the] IN ANY  testimony  provided  to  the  court
pursuant to subdivision [(i)](J) of this section.
  (3)  If  after hearing all relevant evidence presented by a petitioner
who is not a director, the court finds by clear and convincing  evidence
that  the subject of the petition meets the criteria for assisted outpa-
tient treatment, and the court has yet to be  provided  with  a  written
proposed  treatment plan and testimony pursuant to subdivision [(i)] (J)
of this section, the court  shall  order  the  appropriate  director  to
provide  the  court with such plan and testimony no later than the third
day, excluding Saturdays, Sundays and  holidays,  immediately  following
the  date  of  such  order; PROVIDED THAT THE PARTIES MAY STIPULATE UPON
MUTUAL CONSENT THAT SUCH TESTIMONY NEED NOT BE PROVIDED.  Upon receiving
such plan and ANY REQUIRED  testimony,  the  court  may  order  assisted
outpatient treatment as provided in paragraph two of this subdivision.
  (4)  A  court  may  order  the patient to self-administer psychotropic
drugs or accept the administration of such drugs by authorized personnel
as part of an assisted outpatient  treatment  program.  Such  order  may
specify  the  type  and dosage range of such psychotropic drugs and such
order shall be effective for the duration of  such  assisted  outpatient
treatment.
  (5)  If  the petitioner is the director of a hospital that operates an
assisted outpatient treatment program, the court order shall direct  the

S. 2225--D                         10

hospital  director  to provide or arrange for all categories of assisted
outpatient treatment for the assisted outpatient throughout  the  period
of the order. In all other instances, the order shall require the appro-
priate  director, as that term is defined in this section, to provide or
arrange for all categories of  assisted  outpatient  treatment  for  the
assisted  outpatient  throughout the period of the order.  ORDERS ISSUED
ON OR AFTER THE EFFECTIVE DATE OF THE CHAPTER OF THE LAWS OF  TWO  THOU-
SAND  FOURTEEN  THAT  AMENDED THIS SECTION SHALL REQUIRE THE APPROPRIATE
DIRECTOR "AS DETERMINED  BY  THE  PROGRAM  COORDINATOR"  TO  PROVIDE  OR
ARRANGE  FOR  ALL  CATEGORIES  OF  ASSISTED OUTPATIENT TREATMENT FOR THE
ASSISTED OUTPATIENT THROUGHOUT THE PERIOD OF THE ORDER.
  (6) The director shall cause a copy of any court order issued pursuant
to this section to be served personally, or by mail, facsimile or  elec-
tronic  means,  upon  the  assisted outpatient, the mental hygiene legal
service or anyone  acting  on  the  assisted  outpatient's  behalf,  the
original  petitioner, identified service providers, and all others enti-
tled to notice under subdivision [(f)] (G) of this section.
  [(k)] (L) RELOCATION OF ASSISTED OUTPATIENTS. THE  COMMISSIONER  SHALL
PROMULGATE  REGULATIONS  REQUIRING THAT, DURING THE PERIOD OF THE ORDER,
AN ASSISTED OUTPATIENT AND ANY OTHER APPROPRIATE  PERSONS  SHALL  NOTIFY
THE  PROGRAM COORDINATOR WITHIN A REASONABLE TIME PRIOR TO SUCH ASSISTED
OUTPATIENT RELOCATING WITHIN THE STATE OF NEW YORK TO AN AREA NOT SERVED
BY THE DIRECTOR WHO HAS BEEN DIRECTED TO  PROVIDE  OR  ARRANGE  FOR  THE
ASSISTED OUTPATIENT TREATMENT. UPON RECEIVING NOTIFICATION OF SUCH RELO-
CATION,  THE  PROGRAM  COORDINATOR SHALL REDETERMINE WHO THE APPROPRIATE
DIRECTOR SHALL BE AND CAUSE A COPY OF THE COURT ORDER AND TREATMENT PLAN
TO BE TRANSMITTED TO SUCH DIRECTOR.
  (M) Petition for [additional  periods  of]  CONTINUED  treatment.  (1)
[Prior]  WITHIN THIRTY DAYS PRIOR to the expiration of an order pursuant
to this section, the  appropriate  director  shall  review  whether  the
assisted  outpatient  continues to meet the criteria for assisted outpa-
tient treatment. [If, as documented in the petition, the director deter-
mines that such criteria continue to be  met  or  has  made  appropriate
attempts  to,  but has not been successful in eliciting, the cooperation
of the subject to submit to an examination, within thirty days prior  to
the expiration of an order of assisted outpatient treatment, such direc-
tor may petition the court to order continued assisted outpatient treat-
ment  pursuant  to  paragraph  two of this subdivision. Upon determining
whether such criteria continue to be met, such director shall notify the
program coordinator in writing as to whether a  petition  for  continued
assisted  outpatient  treatment is warranted and whether such a petition
was or will be filed.] UPON DETERMINING THAT ONE OR MORE OF SUCH  CRITE-
RIA  ARE NO LONGER MET, SUCH DIRECTOR SHALL NOTIFY THE PROGRAM COORDINA-
TOR IN WRITING THAT A PETITION FOR CONTINUED ASSISTED OUTPATIENT  TREAT-
MENT  IS NOT WARRANTED.  UPON DETERMINING THAT SUCH CRITERIA CONTINUE TO
BE MET, HE OR SHE SHALL PETITION THE COURT TO ORDER  CONTINUED  ASSISTED
OUTPATIENT  TREATMENT FOR A PERIOD NOT TO EXCEED ONE YEAR FROM THE EXPI-
RATION DATE OF THE CURRENT ORDER. IF THE  COURT'S  DISPOSITION  OF  SUCH
PETITION  DOES  NOT  OCCUR  PRIOR  TO THE EXPIRATION DATE OF THE CURRENT
ORDER, THE CURRENT ORDER SHALL REMAIN IN EFFECT UNTIL SUCH  DISPOSITION.
THE  PROCEDURES  FOR  OBTAINING  ANY  ORDER PURSUANT TO THIS SUBDIVISION
SHALL BE IN ACCORDANCE WITH THE PROVISIONS OF THE FOREGOING  SUBDIVISION
OF  THIS  SECTION; PROVIDED THAT THE TIME RESTRICTIONS INCLUDED IN PARA-
GRAPH FOUR OF SUBDIVISION (C) OF THIS SECTION SHALL NOT  BE  APPLICABLE.
THE  NOTICE  PROVISIONS SET FORTH IN PARAGRAPH SIX OF SUBDIVISION (K) OF
THIS SECTION SHALL BE APPLICABLE. ANY  COURT  ORDER  REQUIRING  PERIODIC

S. 2225--D                         11

BLOOD  TESTS  OR URINALYSIS FOR THE PRESENCE OF ALCOHOL OR ILLEGAL DRUGS
SHALL BE SUBJECT TO REVIEW AFTER SIX MONTHS BY THE PHYSICIAN WHO  DEVEL-
OPED  THE  WRITTEN TREATMENT PLAN OR ANOTHER PHYSICIAN DESIGNATED BY THE
DIRECTOR, AND SUCH PHYSICIAN SHALL BE AUTHORIZED TO TERMINATE SUCH BLOOD
TESTS OR URINALYSIS WITHOUT FURTHER ACTION BY THE COURT.
  (2) Within thirty days prior to the expiration of an order of assisted
outpatient  treatment,  [the  appropriate director or] the current peti-
tioner, if the current petition was filed pursuant to  subparagraph  (i)
or  (ii)  of paragraph one of subdivision [(e)] (F) of this section, and
the current petitioner retains his or her original  status  pursuant  to
the  applicable  subparagraph, may petition the court to order continued
assisted outpatient treatment for a period not to exceed one  year  from
the  expiration date of the current order. If the court's disposition of
such petition does not occur prior to the expiration date of the current
order, the current order shall remain in effect until such  disposition.
The  procedures  for  obtaining  any  order pursuant to this subdivision
shall be in accordance with the provisions of the foregoing subdivisions
of this section; provided that the time restrictions included  in  para-
graph  four  of subdivision (c) of this section shall not be applicable.
The notice provisions set forth in paragraph six  of  subdivision  [(j)]
(K) of this section shall be applicable. Any court order requiring peri-
odic  blood  tests  or urinalysis for the presence of alcohol or illegal
drugs shall be subject to review after six months by the  physician  who
developed  the written treatment plan or another physician designated by
the director, and such physician shall be authorized to  terminate  such
blood tests or urinalysis without further action by the court.
  (3)  IF  NEITHER  THE  APPROPRIATE DIRECTOR NOR THE CURRENT PETITIONER
PETITION FOR CONTINUED ASSISTED OUTPATIENT TREATMENT  PURSUANT  TO  THIS
PARAGRAPH  AND  THE ORDER OF THE COURT EXPIRES, ANY OTHER PERSON AUTHOR-
IZED TO PETITION PURSUANT TO PARAGRAPH ONE OF SUBDIVISION  (F)  OF  THIS
SECTION  MAY BRING A NEW PETITION FOR ASSISTED OUTPATIENT TREATMENT.  IF
SUCH NEW PETITION IS FILED LESS THAN SIXTY DAYS AFTER THE EXPIRATION  OF
SUCH ORDER, THE TIME RESTRICTIONS PROVIDED IN PARAGRAPH FOUR OF SUBDIVI-
SION (C) OF THIS SECTION SHALL NOT BE APPLICABLE TO THE NEW PETITION.
  (4)  IF, THIRTY DAYS PRIOR TO THE EXPIRATION OF AN ORDER, THE ASSISTED
OUTPATIENT IS DEEMED BY THE  APPROPRIATE  DIRECTOR  TO  BE  MISSING  AND
THEREBY  UNAVAILABLE FOR EVALUATION AS TO WHETHER HE OR SHE CONTINUES TO
MEET THE CRITERIA FOR ASSISTED OUTPATIENT TREATMENT, SUCH DIRECTOR SHALL
PETITION THE COURT TO EXTEND THE TERM OF THE CURRENT ORDER  UNTIL  SIXTY
DAYS AFTER SUCH TIME AS THE ASSISTED OUTPATIENT IS LOCATED. IF THE COURT
GRANTS  THE EXTENSION, THE DIRECTOR SHALL CONTINUE REASONABLE EFFORTS TO
LOCATE THE ASSISTED OUTPATIENT.  UPON LOCATION OF  THE  ASSISTED  OUTPA-
TIENT, THE DIRECTOR SHALL REVIEW WHETHER THE ASSISTED OUTPATIENT CONTIN-
UES  TO MEET THE CRITERIA FOR ASSISTED OUTPATIENT TREATMENT, PURSUANT TO
PARAGRAPH TWO OF THIS SUBDIVISION.
  [(l)] (N) Petition for an order to stay,  vacate  or  modify.  (1)  In
addition  to  any other right or remedy available by law with respect to
the order for assisted outpatient treatment,  the  assisted  outpatient,
the  mental  hygiene  legal  service,  or  anyone acting on the assisted
outpatient's behalf may petition the court on notice  to  the  director,
the  original petitioner, and all others entitled to notice under subdi-
vision [(f)] (G) of this section to stay, vacate or modify the order.
  (2) The appropriate director shall petition  the  court  for  approval
before instituting a proposed material change in the assisted outpatient
treatment  plan,  unless  such  change is authorized by the order of the
court.  SUCH PETITIONS TO CHANGE AN ASSISTED OUTPATIENT TREATMENT  PLAN,

S. 2225--D                         12

AS  WELL  AS PETITIONS FOR CONTINUED TREATMENT, MAY BE MADE TO ANY JUDGE
OF THE SUPREME OR COUNTY COURTS IN THE COUNTY IN WHICH  THE  SUBJECT  OF
THE PETITION IS PRESENT OR REASONABLY BELIEVED TO BE PRESENT. Such peti-
tion  shall  be  filed on notice to all parties entitled to notice under
subdivision [(f)] (G) of this section. Not later than  five  days  after
receiving  such petition, excluding Saturdays, Sundays and holidays, the
court shall hold a  hearing  on  the  petition;  provided  that  if  the
assisted  outpatient  informs  the  court  that  he or she agrees to the
proposed material change, the court may approve such  change  without  a
hearing.  Non-material changes may be instituted by the director without
court approval. For the purposes of this paragraph, a material change is
an addition or deletion of a category of services to or from  a  current
assisted  outpatient  treatment  plan,  or  any  deviation  without  the
assisted outpatient's consent from the terms of a current order relating
to the administration of psychotropic drugs.
  [(m)] (O) Appeals. Review of an order issued pursuant to this  section
shall  be  had  in  like  manner  as  specified  in section 9.35 of this
article; PROVIDED THAT NOTICE SHALL BE PROVIDED TO ALL PARTIES  ENTITLED
TO NOTICE UNDER SUBDIVISION (G) OF THIS SECTION.
  [(n)]  (P) Failure to comply with assisted outpatient treatment. Where
in the clinical judgment of a physician, (i)  the  assisted  outpatient,
has  failed or refused to comply with the assisted outpatient treatment,
(ii) efforts were made to solicit compliance, and  (iii)  such  assisted
outpatient  may be in need of involuntary admission to a hospital pursu-
ant to section 9.27 of this article or immediate observation,  care  and
treatment  pursuant to section 9.39 or 9.40 of this article, such physi-
cian may request the appropriate director  of  community  services,  the
director's  designee,  or  any  physician  designated by the director of
community services pursuant to section 9.37 of this article,  to  direct
the  removal  of such assisted outpatient to an appropriate hospital for
an examination to determine if such person  has  a  mental  illness  for
which  HE  OR SHE IS IN NEED OF hospitalization is necessary pursuant to
section 9.27, 9.39 or  9.40  of  this  article[.  Furthermore,  if  such
assisted outpatient refuses to take medications as required by the court
order,  or he or she refuses to take, or fails a blood test, urinalysis,
or alcohol or drug test as required by the court order,  such  physician
may consider such refusal or failure when determining whether]; PROVIDED
THAT  IF, AFTER EFFORTS TO SOLICIT COMPLIANCE, SUCH PHYSICIAN DETERMINES
THAT THE ASSISTED OUTPATIENT'S  FAILURE  TO  COMPLY  WITH  THE  ASSISTED
OUTPATIENT  TREATMENT INCLUDES A SUBSTANTIAL FAILURE TO TAKE MEDICATION,
PASS OR SUBMIT TO BLOOD TESTING OR URINALYSIS, OR RECEIVE TREATMENT  FOR
ALCOHOL OR SUBSTANCE ABUSE, SUCH PHYSICIAN MAY PRESUME THAT the assisted
outpatient  is  in need of an examination to determine whether he or she
has a mental illness for which hospitalization is  necessary.  Upon  the
request  of  such  physician,  the  appropriate director, the director's
designee, or any physician designated pursuant to section 9.37  of  this
article,  may  direct  peace  officers, acting pursuant to their special
duties, or police officers who  are  members  of  an  authorized  police
department  or  force  or of a sheriff's department to take the assisted
outpatient into custody and transport him or her to the hospital operat-
ing the assisted outpatient treatment program or to any hospital author-
ized by the director of community services to receive such persons. Such
law enforcement officials shall  carry  out  such  directive.  Upon  the
request  of  such  physician,  the  appropriate director, the director's
designee, or any physician designated pursuant to section 9.37  of  this
article,  an ambulance service, as defined by subdivision two of section

S. 2225--D                         13

three thousand one of the public  health  law,  or  an  approved  mobile
crisis outreach team as defined in section 9.58 of this article shall be
authorized  to  take  into  custody and transport any such person to the
hospital  operating the assisted outpatient treatment program, or to any
other hospital authorized  by  the  appropriate  director  of  community
services to receive such persons. Any director of community services, or
designee,  shall  be  authorized  to  direct  the removal of an assisted
outpatient who is present in his or her county to an appropriate  hospi-
tal, in accordance with the provisions of this subdivision, based upon a
determination  of the appropriate director of community services direct-
ing the removal of such assisted outpatient pursuant  to  this  subdivi-
sion.  Such  person  may be retained for observation, care and treatment
and further examination in the hospital for up to seventy-two  hours  to
permit a physician to determine whether such person has a mental illness
and  is in need of involuntary care and treatment in a hospital pursuant
to the provisions of this article. Any continued  involuntary  retention
OF  THE ASSISTED OUTPATIENT in such hospital beyond the initial seventy-
two hour period shall be in accordance with the provisions of this arti-
cle relating to the involuntary admission and retention of a person.  If
at  any time during the seventy-two hour period the person is determined
not to meet the involuntary admission and retention provisions  of  this
article,  and  does  not agree to stay in the hospital as a voluntary or
informal patient, he or she must be released. Failure to comply with  an
order of assisted outpatient treatment shall not be grounds for involun-
tary civil commitment or a finding of contempt of court.
  [(o)] (Q) Effect of determination that a person is in need of assisted
outpatient  treatment.  The determination by a court that a person is in
need of assisted outpatient treatment  shall  not  be  construed  as  or
deemed  to be a determination that such person is incapacitated pursuant
to article eighty-one of this chapter.
  [(p)] (R) False petition. A person making a false statement or provid-
ing false information or false testimony in a petition or hearing  under
this  section shall be subject to criminal prosecution pursuant to arti-
cle one hundred seventy-five or article two hundred  ten  of  the  penal
law.
  [(q)]  (S)  Exception.  Nothing  in this section shall be construed to
affect the ability of the director of a hospital to receive,  admit,  or
retain  patients  who  otherwise  meet  the  provisions  of this article
regarding receipt, retention or admission.
  [(r)] (T) Education and training. (1) The office [of  mental  health],
in  consultation  with the office of court administration, shall prepare
educational and training materials on the use  of  this  section,  which
shall  be  made  available  to  local  governmental  units, providers of
services, judges, court personnel, law  enforcement  officials  and  the
general public.
  (2)  The  office,  in  consultation  with the office of court adminis-
tration, shall establish a mental health training  program  for  supreme
and  county  court  judges  and  court personnel, AND SHALL PROVIDE SUCH
TRAINING WITH SUCH FREQUENCY AND IN SUCH LOCATIONS AS MAY BE APPROPRIATE
TO MEET STATEWIDE NEEDS.  Such training shall focus on the use  of  this
section  and  generally  address  issues  relating to mental illness and
mental health treatment.
  S 6. Section 29.15 of the mental hygiene law is amended  by  adding  a
new subdivision (o) to read as follows:
  (O)  IF  THE  DIRECTOR  OF A DEPARTMENT FACILITY DOES NOT PETITION FOR
ASSISTED OUTPATIENT TREATMENT PURSUANT TO SECTION 9.60 OF  THIS  CHAPTER

S. 2225--D                         14

UPON  THE  DISCHARGE  OF AN INPATIENT ADMITTED PURSUANT TO SECTION 9.27,
9.39 OR 9.40 OF THIS CHAPTER, OR UPON THE  EXPIRATION  OF  A  PERIOD  OF
CONDITIONAL  RELEASE FOR SUCH INPATIENT, SUCH DIRECTOR SHALL REPORT SUCH
DISCHARGE  OR  SUCH  EXPIRATION  IN WRITING TO THE DIRECTOR OF COMMUNITY
SERVICES OF THE LOCAL  GOVERNMENTAL  UNIT  IN  WHICH  THE  INPATIENT  IS
EXPECTED TO RESIDE.
  S  7.  Subdivision 3 of section 404 of the correction law, as added by
chapter 1 of the laws of 2013, is amended and a  new  subdivision  4  is
added to read as follows:
  3.  Within a reasonable period prior to discharge of an inmate commit-
ted from a [state correctional facility from a] hospital in the  depart-
ment  of mental hygiene to the community, the director shall ensure that
a clinical assessment has been completed to determine whether the inmate
meets the criteria for assisted outpatient treatment pursuant to  subdi-
vision (c) of section 9.60 of the mental hygiene law. If, as a result of
such  assessment,  the  director  determines  that the inmate meets such
criteria, prior to discharge the director of the hospital  shall  either
petition  for  a  court  order  pursuant  to  section 9.60 of the mental
hygiene law, or report in writing to the director of community  services
of the local governmental unit in which the inmate is expected to reside
so  that  an  investigation [may] SHALL be conducted pursuant to section
9.47 of the mental hygiene law.
  4. WITHIN A REASONABLE PERIOD PRIOR TO  RELEASE  OR  DISCHARGE  OF  AN
INMATE WHO IS NOT CURRENTLY COMMITTED TO A HOSPITAL IN THE DEPARTMENT OF
MENTAL  HYGIENE  FROM A STATE CORRECTIONAL FACILITY TO THE COMMUNITY, IF
SUCH INMATE HAS A SERIOUS MENTAL ILLNESS PURSUANT TO  PARAGRAPH  (E)  OF
SUBDIVISION SIX OF SECTION ONE HUNDRED THIRTY-SEVEN OF THIS CHAPTER, THE
DEPARTMENT SHALL NOTIFY THE DIRECTOR OF A HOSPITAL WHO SHALL ENSURE THAT
A CLINICAL ASSESSMENT HAS BEEN COMPLETED TO DETERMINE WHETHER THE INMATE
MEETS  THE CRITERIA FOR ASSISTED OUTPATIENT TREATMENT PURSUANT TO SUBDI-
VISION (C) OF SECTION 9.60 OF THE MENTAL HYGIENE LAW. IF, AS A RESULT OF
SUCH ASSESSMENT, THE DIRECTOR DETERMINES  THAT  THE  INMATE  MEETS  SUCH
CRITERIA,  PRIOR  TO  RELEASE OR DISCHARGE, THE DIRECTOR OF THE HOSPITAL
SHALL EITHER PETITION FOR A COURT ORDER PURSUANT TO SECTION 9.60 OF  THE
MENTAL  HYGIENE  LAW,  OR REPORT IN WRITING TO THE DIRECTOR OF COMMUNITY
SERVICES OF THE LOCAL GOVERNMENTAL UNIT IN WHICH THE INMATE IS  EXPECTED
TO  RESIDE  SO  THAT  AN  INVESTIGATION  SHALL  BE CONDUCTED PURSUANT TO
SECTION 9.47 OF THE MENTAL HYGIENE LAW.
  S 8. Section 18 of chapter 408  of  the  laws  of  1999,  constituting
Kendra's Law, as amended by chapter 1 of the laws of 2013, is amended to
read as follows:
  S  18.  This  act shall take effect immediately, provided that section
fifteen of this act shall take effect April 1, 2000, provided,  further,
that  subdivision (e) of section 9.60 of the mental hygiene law as added
by section six of this act shall be effective 90  days  after  this  act
shall become law[; and that this act shall expire and be deemed repealed
June 30, 2017].
  S 9. Severability. If any clause, sentence, paragraph, section or part
of  this act shall be adjudged by any court of competent jurisdiction to
be invalid, and after exhaustion of all  further  judicial  review,  the
judgment  shall  not affect, impair or invalidate the remainder thereof,
but shall be confined in its operation to the  clause,  sentence,  para-
graph, section or part thereof directly involved in the controversy.
  S 10.  This act shall take effect immediately.

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