1.1                          A bill for an act 
  1.2             relating to civil commitment; specifying certain 
  1.3             patient rights and examination requirements; providing 
  1.4             for treatment coverage; expanding voluntary consent 
  1.5             procedures; requiring collection of information for an 
  1.6             emergency hold; amending Minnesota Statutes 2000, 
  1.7             sections 253B.03, subdivisions 5, 10, by adding a 
  1.8             subdivision; 253B.04, subdivisions 1, 1a, by adding a 
  1.9             subdivision; 253B.045, subdivision 6; 253B.05, 
  1.10            subdivision 1; 253B.07, subdivision 1; 253B.09, 
  1.11            subdivision 1; 253B.10, subdivision 4. 
  1.12  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.13     Section 1.  Minnesota Statutes 2000, section 253B.03, 
  1.14  subdivision 5, is amended to read: 
  1.15     Subd. 5.  [PERIODIC ASSESSMENT.] A patient has the right to 
  1.16  periodic medical assessment, including assessment of the medical 
  1.17  necessity of continuing care and, if the treatment facility 
  1.18  declines to provide continuing care, the right to receive 
  1.19  specific written reasons why continuing care is declined at the 
  1.20  time of the assessment.  The treatment facility shall assess the 
  1.21  physical and mental condition of every patient as frequently as 
  1.22  necessary, but not less often than annually.  If the patient 
  1.23  refuses to be examined, the facility shall document in the 
  1.24  patient's chart its attempts to examine the patient.  If a 
  1.25  person is committed as mentally retarded for an indeterminate 
  1.26  period of time, the three-year judicial review must include the 
  1.27  annual reviews for each year as outlined in Minnesota Rules, 
  1.28  part 9525.0075, subpart 6.  
  2.1      Sec. 2.  Minnesota Statutes 2000, section 253B.03, 
  2.2   subdivision 10, is amended to read: 
  2.3      Subd. 10.  [NOTIFICATION.] All persons admitted or 
  2.4   committed to a treatment facility shall be notified in writing 
  2.5   of their rights under this chapter regarding hospitalization and 
  2.6   other treatment at the time of admission.  This notification 
  2.7   must include: 
  2.8      (1) patient rights specified in this section and section 
  2.9   144.651, including nursing home discharge rights; 
  2.10     (2) the right to obtain treatment and services voluntarily 
  2.11  under this chapter; 
  2.12     (3) the right to voluntary admission and release under 
  2.13  section 253B.04; 
  2.14     (4) rights in case of an emergency admission under section 
  2.15  253B.05, including the right to documentation in support of an 
  2.16  emergency hold and the right to a summary hearing before a judge 
  2.17  if the patient believes an emergency hold is improper; 
  2.18     (5) the right to request expedited review under section 
  2.19  62M.05 if additional days of inpatient stay are denied; 
  2.20     (6) the right to continuing benefits pending appeal and to 
  2.21  an expedited administrative hearing under section 256.045 if the 
  2.22  patient is a recipient of medical assistance, general assistance 
  2.23  medical care, or MinnesotaCare; and 
  2.24     (7) the right to an external appeal process under section 
  2.25  62Q.73, including the right to a second opinion.  
  2.26     Sec. 3.  Minnesota Statutes 2000, section 253B.03, is 
  2.27  amended by adding a subdivision to read: 
  2.28     Subd. 11.  [PROXY.] A legally authorized health care proxy, 
  2.29  agent, guardian, or conservator may exercise the patient's 
  2.30  rights on the patient's behalf.  
  2.31     Sec. 4.  Minnesota Statutes 2000, section 253B.04, 
  2.32  subdivision 1, is amended to read: 
  2.33     Subdivision 1.  [VOLUNTARY ADMISSION AND TREATMENT.] (a) 
  2.34  Voluntary admission is preferred over involuntary commitment and 
  2.35  treatment.  Any person 16 years of age or older may request to 
  2.36  be admitted to a treatment facility as a voluntary patient for 
  3.1   observation, evaluation, diagnosis, care and treatment without 
  3.2   making formal written application.  Any person under the age of 
  3.3   16 years may be admitted as a patient with the consent of a 
  3.4   parent or legal guardian if it is determined by independent 
  3.5   examination that there is reasonable evidence that (1) the 
  3.6   proposed patient has a mental illness, or is mentally retarded 
  3.7   or chemically dependent; and (2) the proposed patient is 
  3.8   suitable for treatment.  The head of the treatment facility 
  3.9   shall not arbitrarily refuse any person seeking admission as a 
  3.10  voluntary patient.  In making decisions regarding admissions, 
  3.11  the facility shall use clinical admission criteria consistent 
  3.12  with the current applicable inpatient admission standards 
  3.13  established by the American Psychiatric Association or the 
  3.14  American Academy of Child and Adolescent Psychiatry.  These 
  3.15  criteria must be no more restrictive than, and must be 
  3.16  consistent with, the requirements of section 62Q.53.  The 
  3.17  facility may not refuse to admit a person voluntarily because 
  3.18  the person does not meet the criteria for involuntary holds 
  3.19  under section 253B.05 or the definition of mental illness under 
  3.20  section 253B.02, subdivision 13.  
  3.21     (b) In addition to the consent provisions of paragraph (a), 
  3.22  a person who is 16 or 17 years of age who refuses to consent 
  3.23  personally to admission may be admitted as a patient for mental 
  3.24  illness or chemical dependency treatment with the consent of a 
  3.25  parent or legal guardian if it is determined by an independent 
  3.26  examination that there is reasonable evidence that the proposed 
  3.27  patient is chemically dependent or has a mental illness and is 
  3.28  suitable for treatment.  The person conducting the examination 
  3.29  shall notify the proposed patient and the parent or legal 
  3.30  guardian of this determination. 
  3.31     Sec. 5.  Minnesota Statutes 2000, section 253B.04, 
  3.32  subdivision 1a, is amended to read: 
  3.33     Subd. 1a.  [VOLUNTARY TREATMENT OR ADMISSION FOR PERSONS 
  3.34  WITH MENTAL ILLNESS.] (a) A person with a mental illness may 
  3.35  seek or voluntarily agree to accept treatment or admission to a 
  3.36  facility.  If the mental health provider determines that the 
  4.1   person lacks the capacity to give informed consent for the 
  4.2   treatment or admission, and in the absence of a health care 
  4.3   power of attorney that authorizes consent, the designated agency 
  4.4   or its designee may give informed consent for mental health 
  4.5   treatment or admission to a treatment facility on behalf of the 
  4.6   person. 
  4.7      (b) The designated agency shall apply the following 
  4.8   criteria in determining the person's ability to give informed 
  4.9   consent: 
  4.10     (1) whether the person demonstrates an awareness of the 
  4.11  person's illness, and the reasons for treatment, its risks, 
  4.12  benefits and alternatives, and the possible consequences of 
  4.13  refusing treatment; and 
  4.14     (2) whether the person communicates verbally or nonverbally 
  4.15  a clear choice concerning treatment that is a reasoned one, not 
  4.16  based on delusion, even though it may not be in the person's 
  4.17  best interests. 
  4.18     (c) The basis for the designated agency's decision that the 
  4.19  person lacks the capacity to give informed consent for treatment 
  4.20  or admission, and that the patient has voluntarily accepted 
  4.21  treatment or admission, must be documented in writing. 
  4.22     (d) A mental health provider that provides treatment in 
  4.23  reliance on the written consent given by the designated agency 
  4.24  under this subdivision or by a substitute decision maker 
  4.25  appointed by the court is not civilly or criminally liable for 
  4.26  performing treatment without consent.  This paragraph does not 
  4.27  affect any other liability that may result from the manner in 
  4.28  which the treatment is performed. 
  4.29     (e) A person who receives treatment or is admitted to a 
  4.30  facility under this subdivision or subdivision 1b has the right 
  4.31  to refuse treatment at any time or to be released from a 
  4.32  facility as provided under subdivision 2.  The person or any 
  4.33  interested person acting on the person's behalf may seek court 
  4.34  review within five days for a determination of whether the 
  4.35  person's agreement to accept treatment or admission is 
  4.36  voluntary.  At the time a person agrees to treatment or 
  5.1   admission to a facility under this subdivision, the designated 
  5.2   agency or its designee shall inform the person in writing of the 
  5.3   person's rights under this paragraph. 
  5.4      (f) This subdivision does not authorize the administration 
  5.5   of neuroleptic medications.  Neuroleptic medications may be 
  5.6   administered only as provided in section 253B.092. 
  5.7      Sec. 6.  Minnesota Statutes 2000, section 253B.04, is 
  5.8   amended by adding a subdivision to read: 
  5.9      Subd. 1b.  [COURT APPOINTMENT OF SUBSTITUTE DECISION 
  5.10  MAKER.] If the designated agency or its designee declines or 
  5.11  refuses to give informed consent under subdivision 1a, the 
  5.12  person who is seeking treatment or admission, or an interested 
  5.13  person acting on behalf of the person, may petition the court 
  5.14  for appointment of a substitute decision maker who may give 
  5.15  informed consent for voluntary treatment and services.  In 
  5.16  making this determination, the court shall apply the criteria in 
  5.17  subdivision 1a, paragraph (b). 
  5.18     Sec. 7.  Minnesota Statutes 2000, section 253B.045, 
  5.19  subdivision 6, is amended to read: 
  5.20     Subd. 6.  [COVERAGE.] A health plan company must provide 
  5.21  coverage, according to the terms of the policy, contract, or 
  5.22  certificate of coverage, for all medically necessary covered 
  5.23  services as determined by section 62Q.53 provided to an enrollee 
  5.24  that are ordered by the court under this chapter.  (a) For 
  5.25  purposes of this section, "mental health services" means all 
  5.26  covered services that are intended to treat or ameliorate an 
  5.27  emotional, behavioral, or psychiatric condition and that are 
  5.28  covered by the policy, contract, or certificate of coverage of 
  5.29  the enrollee's health plan company or by law. 
  5.30     (b) All health plan companies that provide coverage for 
  5.31  mental health services must cover or provide mental health 
  5.32  services ordered by a court of competent jurisdiction under a 
  5.33  court order that is issued on the basis of a behavioral care 
  5.34  evaluation performed by a licensed psychiatrist or a doctoral 
  5.35  level licensed psychologist, which includes a diagnosis and an 
  5.36  individual treatment plan for care in the most appropriate, 
  6.1   least restrictive environment.  The health plan company must be 
  6.2   given a copy of the court order and the behavioral care 
  6.3   evaluation.  The health plan company shall be financially liable 
  6.4   for the evaluation if performed by a participating provider of 
  6.5   the health plan company and shall be financially liable for the 
  6.6   care included in the court-ordered individual treatment plan if 
  6.7   the care is covered by the health plan company and ordered to be 
  6.8   provided by a participating provider or another provider as 
  6.9   required by rule or law.  This court-ordered coverage must not 
  6.10  be subject to a separate medical necessity determination by a 
  6.11  health plan company under its utilization procedures. 
  6.12     Sec. 8.  Minnesota Statutes 2000, section 253B.05, 
  6.13  subdivision 1, is amended to read: 
  6.14     Subdivision 1.  [EMERGENCY HOLD.] (a) Any person may be 
  6.15  admitted or held for emergency care and treatment in a treatment 
  6.16  facility with the consent of the head of the treatment facility 
  6.17  upon a written statement by an examiner that: 
  6.18     (1) the examiner has examined the person not more than 15 
  6.19  days prior to admission,; 
  6.20     (2) the examiner is of the opinion, for stated reasons, 
  6.21  that the person is mentally ill, mentally retarded or chemically 
  6.22  dependent, and is in imminent danger of causing injury to self 
  6.23  or others if not immediately restrained, detained; and 
  6.24     (3) an order of the court cannot be obtained in time to 
  6.25  prevent the anticipated injury.  
  6.26     (b) If the proposed patient has been brought to the 
  6.27  treatment facility by another person, the examiner shall obtain 
  6.28  a statement of information that is available from that person, 
  6.29  which must be taken into consideration in deciding whether to 
  6.30  place the proposed patient on an emergency hold.  The statement 
  6.31  of information must include direct observations of the proposed 
  6.32  patient's behaviors, reliable knowledge of recent and past 
  6.33  behavior, and information regarding psychiatric history, past 
  6.34  treatment, and current mental health providers.  The examiner 
  6.35  shall also inquire into the existence of health care directives 
  6.36  under chapter 145, and advance psychiatric directives under 
  7.1   section 253B.03, subdivision 6d. 
  7.2      (c) The examiner's statement shall be:  (1) sufficient 
  7.3   authority for a peace or health officer to transport a patient 
  7.4   to a treatment facility, (2) stated in behavioral terms and not 
  7.5   in conclusory language, and (3) of sufficient specificity to 
  7.6   provide an adequate record for review.  If imminent danger to 
  7.7   specific individuals is a basis for the emergency hold, the 
  7.8   statement must identify those individuals, to the extent 
  7.9   practicable.  A copy of the examiner's statement shall be 
  7.10  personally served on the person immediately upon admission and a 
  7.11  copy shall be maintained by the treatment facility.  
  7.12     Sec. 9.  Minnesota Statutes 2000, section 253B.07, 
  7.13  subdivision 1, is amended to read: 
  7.14     Subdivision 1.  [PREPETITION SCREENING.] (a) Prior to 
  7.15  filing a petition for commitment of or early intervention for a 
  7.16  proposed patient, an interested person shall apply to the 
  7.17  designated agency in the county of the proposed patient's 
  7.18  residence or presence for conduct of a preliminary 
  7.19  investigation, except when the proposed patient has been 
  7.20  acquitted of a crime under section 611.026 and the county 
  7.21  attorney is required to file a petition for commitment.  The 
  7.22  designated agency shall appoint a screening team to conduct an 
  7.23  investigation which shall include.  The petitioner may not be a 
  7.24  member of the screening team.  The investigation must include: 
  7.25     (i) a personal interview with the proposed patient and 
  7.26  other individuals who appear to have knowledge of the condition 
  7.27  of the proposed patient.  If the proposed patient is not 
  7.28  interviewed, specific reasons must be documented; 
  7.29     (ii) identification and investigation of specific alleged 
  7.30  conduct which is the basis for application; 
  7.31     (iii) identification, exploration, and listing of 
  7.32  the specific reasons for rejecting or recommending alternatives 
  7.33  to involuntary placement; 
  7.34     (iv) in the case of a commitment based on mental illness, 
  7.35  the following information, if it is known or available:  
  7.36  information, that may be relevant to the administration of 
  8.1   neuroleptic medications, if necessary, including the existence 
  8.2   of a declaration under section 253B.03, subdivision 6d, or a 
  8.3   health care directive under chapter 145C or a guardian, 
  8.4   conservator, proxy, or agent with authority to make health care 
  8.5   decisions for the proposed patient; information regarding the 
  8.6   capacity of the proposed patient to make decisions regarding 
  8.7   administration of neuroleptic medication; and whether the 
  8.8   proposed patient is likely to consent or refuse consent to 
  8.9   administration of the medication; and 
  8.10     (v) seeking input from the proposed patient's health plan 
  8.11  company to provide the court with information about services the 
  8.12  enrollee needs and the least restrictive alternatives. 
  8.13     (vi) in the case of a commitment based on mental illness, 
  8.14  information listed in clause (iv) for other purposes relevant to 
  8.15  treatment. 
  8.16     (b) In conducting the investigation required by this 
  8.17  subdivision, the screening team shall have access to all 
  8.18  relevant medical records of proposed patients currently in 
  8.19  treatment facilities.  Data collected pursuant to this clause 
  8.20  shall be considered private data on individuals.  The 
  8.21  prepetition screening report is not admissible as evidence 
  8.22  except by agreement of counsel and is not admissible in any 
  8.23  court proceedings unrelated to the commitment proceedings. 
  8.24     (c) The prepetition screening team shall provide a notice, 
  8.25  written in easily understood language, to the proposed patient, 
  8.26  the petitioner, persons named in a declaration under chapter 
  8.27  145C or section 253B.03, subdivision 6d, and, with the proposed 
  8.28  patient's consent, other interested parties.  The team shall ask 
  8.29  the patient if the patient wants the notice read and shall read 
  8.30  the notice to the patient upon request.  The notice must contain 
  8.31  information regarding the process, purpose, and legal effects of 
  8.32  civil commitment and early intervention.  The notice must inform 
  8.33  the proposed patient that: 
  8.34     (1) if a petition is filed, the patient has certain rights, 
  8.35  including the right to a court-appointed attorney, the right to 
  8.36  request a second examiner, the right to attend hearings, and the 
  9.1   right to oppose the proceeding and to present and contest 
  9.2   evidence; and 
  9.3      (2) if the proposed patient is committed to a state 
  9.4   regional treatment center or group home, the patient will be 
  9.5   billed for the cost of care and the state has the right to make 
  9.6   a claim against the patient's estate for this cost. 
  9.7      The ombudsman for mental health and mental retardation 
  9.8   shall develop a form for the notice, which includes the 
  9.9   requirements of this paragraph.  
  9.10     (d) When the prepetition screening team recommends 
  9.11  commitment, a written report shall be sent to the county 
  9.12  attorney for the county in which the petition is to be 
  9.13  filed.  The statement of facts contained in the written report 
  9.14  must meet the requirements of subdivision 2, paragraph (b). 
  9.15     (d) (e) The prepetition screening team shall refuse to 
  9.16  support a petition if the investigation does not disclose 
  9.17  evidence sufficient to support commitment.  Notice of the 
  9.18  prepetition screening team's decision shall be provided to the 
  9.19  prospective petitioner and to the proposed patient.  
  9.20     (e) (f) If the interested person wishes to proceed with a 
  9.21  petition contrary to the recommendation of the prepetition 
  9.22  screening team, application may be made directly to the county 
  9.23  attorney, who may shall determine whether or not to proceed with 
  9.24  the petition.  Notice of the county attorney's determination 
  9.25  shall be provided to the interested party.  
  9.26     (f) (g) If the proposed patient has been acquitted of a 
  9.27  crime under section 611.026, the county attorney shall apply to 
  9.28  the designated county agency in the county in which the 
  9.29  acquittal took place for a preliminary investigation unless 
  9.30  substantially the same information relevant to the proposed 
  9.31  patient's current mental condition, as could be obtained by a 
  9.32  preliminary investigation, is part of the court record in the 
  9.33  criminal proceeding or is contained in the report of a mental 
  9.34  examination conducted in connection with the criminal 
  9.35  proceeding.  If a court petitions for commitment pursuant to the 
  9.36  rules of criminal or juvenile procedure or a county attorney 
 10.1   petitions pursuant to acquittal of a criminal charge under 
 10.2   section 611.026, the prepetition investigation, if required by 
 10.3   this section, shall be completed within seven days after the 
 10.4   filing of the petition.  
 10.5      Sec. 10.  Minnesota Statutes 2000, section 253B.09, 
 10.6   subdivision 1, is amended to read: 
 10.7      Subdivision 1.  [STANDARD OF PROOF.] (a) If the court finds 
 10.8   by clear and convincing evidence that the proposed patient is a 
 10.9   mentally ill, mentally retarded, or chemically dependent person 
 10.10  and after careful consideration of reasonable alternative 
 10.11  dispositions, including but not limited to, dismissal of 
 10.12  petition, voluntary outpatient care, voluntary admission to a 
 10.13  treatment facility, appointment of a guardian or conservator, or 
 10.14  release before commitment as provided for in subdivision 4, it 
 10.15  finds that there is no suitable alternative to judicial 
 10.16  commitment, the court shall commit the patient to the least 
 10.17  restrictive treatment program or alternative programs which can 
 10.18  meet the patient's treatment needs consistent with section 
 10.19  253B.03, subdivision 7.  
 10.20     (b) In deciding on the least restrictive program, the court 
 10.21  shall consider a range of treatment alternatives including, but 
 10.22  not limited to, community-based nonresidential treatment, 
 10.23  community residential treatment, partial hospitalization, acute 
 10.24  care hospital, and regional treatment center services.  The 
 10.25  court shall also consider the proposed patient's treatment 
 10.26  preferences and willingness to participate voluntarily in the 
 10.27  treatment ordered.  The court may not commit a patient to a 
 10.28  facility or program that is not capable of meeting the patient's 
 10.29  needs.  
 10.30     (c) For purposes of findings under this chapter, none of 
 10.31  the following constitute a refusal to accept appropriate mental 
 10.32  health treatment: 
 10.33     (1) a willingness to take medication but a reasonable 
 10.34  disagreement about type or dosage; 
 10.35     (2) a good-faith effort to follow a reasonable alternative 
 10.36  treatment plan, including treatment as specified in a valid 
 11.1   advance directive under chapter 145C or section 253B.03, 
 11.2   subdivision 6d; 
 11.3      (3) an inability to obtain access to appropriate treatment 
 11.4   because of inadequate health care coverage or an insurer's 
 11.5   refusal or delay in providing coverage for the treatment; or 
 11.6      (4) an inability to obtain access to needed mental health 
 11.7   services because the provider will only accept patients who are 
 11.8   under a court order or because the provider gives persons under 
 11.9   a court order a priority over voluntary patients in obtaining 
 11.10  treatment and services.  
 11.11     Sec. 11.  Minnesota Statutes 2000, section 253B.10, 
 11.12  subdivision 4, is amended to read: 
 11.13     Subd. 4.  [PRIVATE TREATMENT.] Patients or other 
 11.14  responsible persons are required to pay the necessary charges 
 11.15  for patients committed or transferred to private treatment 
 11.16  facilities.  Private treatment facilities may refuse to accept a 
 11.17  committed person.  Insurers must provide court-ordered treatment 
 11.18  and services as ordered by the court or as required under 
 11.19  chapter 62M.