HB2754 - 541R

Be it enacted by the Legislature of the State of Arizona:

Section 1. Section 13-4512, Arizona Revised Statutes, is amended to read:

START_STATUTE13-4512. Competency restoration treatment; order; commitment; costs

A. The court may order a defendant to undergo out of custody competency restoration treatment. If the court determines that confinement is necessary for treatment, the court shall commit the defendant for competency restoration treatment to the competency restoration treatment program designated by the county board of supervisors.

B. If the county board of supervisors has not designated a program to provide competency restoration treatment, the court may commit the defendant for competency restoration treatment to the Arizona state hospital, subject to funding appropriated by the legislature to the Arizona state hospital for inpatient competency restoration treatment services, or to any other facility that is approved by the court.

C. A county board of supervisors that has designated a county restoration treatment program may enter into contracts with providers, including the Arizona state hospital, for inpatient, in custody in‑custody competency restoration treatment. A county competency restoration treatment program may do the following:

1. Provide competency restoration treatment to a defendant in the county jail, including inpatient treatment.

2. Obtain court orders to transport the defendant to other providers, including the Arizona state hospital, for inpatient, in custody in‑custody competency restoration treatment.

D. In determining the type and location of the treatment, the court shall select the least restrictive treatment alternative after considering the following:

1. If Whether confinement is necessary for treatment.

2. The likelihood that the defendant is a threat to public safety.

3. The defendant's participation in and cooperation during an outpatient examination of competency to stand trial conducted pursuant to section 13‑4507.

4. The defendant's willingness to submit to outpatient competency restoration treatment as a condition of pretrial release, if the defendant is eligible for pretrial release.

E. An order entered pursuant to this section shall state if whether the defendant is incompetent to refuse treatment, including medication, pursuant to section 13‑4511.

F. A defendant shall pay the cost of inpatient, in custody in‑custody competency restoration treatment unless otherwise ordered by the court. If the court finds the defendant is unable to pay all or a portion of the costs of inpatient, in custody in‑custody treatment, the state city, town or county shall pay the costs of inpatient, in custody in‑custody competency restoration treatment at the Arizona state hospital that are incurred until:

1. Seven days, excluding Saturdays, Sundays or other legal holidays, after the hospital submits a report to the court stating that the defendant has regained competency or that there is no substantial probability that the defendant will regain competency within twenty-one months after the date of the original finding of incompetency.

2. The treatment order expires.

3. Seven days, excluding Saturdays, Sundays or other legal holidays, after the charges are dismissed.

G. The county, or the city if the competency proceedings arise out of a municipal court proceeding, shall pay the hospital costs that are incurred after the period of time designated in subsection F of this section and shall also pay for the costs of inpatient, in custody in‑custody competency restoration treatment in court approved court‑approved programs that are not programs at the Arizona state hospital.

H. Payment for the cost of outpatient community treatment shall be is the responsibility of the defendant unless:

1. The defendant is enrolled in a program which that covers the treatment and which that has funding available for the provision of treatment to the defendant, and the defendant is eligible to receive the treatment. Defendants in these circumstances may be required to share in the cost of the treatment if cost sharing is required by the program in which the defendant is enrolled.

2. The court finds that the defendant is unable to pay all or a portion of treatment costs or that outpatient treatment is not otherwise available to the defendant. For defendants in these circumstances, all or a portion of the costs of outpatient community treatment shall be borne by the county or the city if the competency proceedings arise out of a municipal court proceeding.

I. A treatment order issued pursuant to this section is valid for one hundred eighty days or until one of the following occurs:

1. The treating facility submits a report that the defendant has regained competency or that there is no substantial probability that the defendant will regain competency within twenty-one months after the date of the original finding of incompetency.

2. The charges are dismissed.

3. The maximum sentence for the offense charged has expired.

4. A qualified physician who represents the Arizona state hospital determines that the defendant is not suffering from a mental illness and is competent to stand trial.

J. The Arizona state hospital shall collect census data for adult restoration to competency treatment programs to establish maximum capacity and the allocation formula required pursuant to section 36‑206, subsection D. The Arizona state hospital or the department of health services is not required to provide restoration to competency treatment that exceeds the funded capacity. If the Arizona state hospital reaches its funded capacity in either or both the adult male or adult female restoration to competency treatment programs, the superintendent of the state hospital shall establish a waiting list for admission based on the date of the court order issued pursuant to this section.

K. Notwithstanding any other law, a county may meet any statutory funding requirements of this section from any source of county revenue designated by the county, including funds of any countywide special taxing district of which the board of supervisors serves as the board of directors. END_STATUTE

Sec. 2. Section 36-273, Arizona Revised Statutes, is amended to read:

START_STATUTE36-273. Powers and duties

A. The department may:

1. Use monies in the disease control research fund established pursuant to by section 36‑274 to contract with individuals, organizations, corporations and institutions, public or private, in this state for any projects or services that the department determines may advance research into the causes, the epidemiology and diagnosis, the formulation of cures, the medically accepted treatment or the prevention of diseases, including new drug discovery and development, and for acquired immune deficiency syndrome reporting and surveillance. Public monies in the disease control research fund shall not be used for capital construction projects.

2. Enter into research and development agreements, royalty agreements, development agreements, licensing agreements and profit sharing agreements concerning the research, development and production of new products developed or to be developed through department funded department‑funded research.

3. Accept or receive monies from any source, including restricted or unrestricted gifts and contributions from individuals, foundations, corporations and other organizations and institutions.

4. Obtain expert services to assist in the evaluation of evaluating requests and proposals.

5. Request cooperation from any state agency for the purposes of this article.

6. Provide information and technical assistance to other jurisdictions and agencies.

7. Subject to title 41, chapter 4, article 4, employ personnel needed to carry out the duties of this article.

B. The department shall:

1. Review and evaluate proposals or requests for projects or services.

2. Establish a mechanism to review the contracts awarded to ensure that the monies are used in accordance with the proposals approved by the department.

3. Prepare and submit a report on or before January 15 of each year to the governor, the president of the senate and the speaker of the house of representatives that describes the projects or services proposed to the department pursuant to this article, the projects or services for which the department has awarded a contract and the amount of monies necessary for each proposal, the cost of each proposal for which a contract was awarded, the names and addresses of the recipients of each contract and the purpose for which each contract was made. The department shall provide a copy of this report to the secretary of state. END_STATUTE

Sec. 3. Section 36‑405.02, Arizona Revised Statutes, as added by Laws 2019, chapter 215, section 4, is amended to read:

START_STATUTE36-405.02. Outpatient behavioral health and other related health care services; employees; rules

The department shall allow a person who is employed at a health care institution that provides outpatient behavioral health services, who is not a licensed behavioral health professional and who is at least eighteen years of age to provide outpatient behavioral health or other related health care services pursuant to all applicable department rules. The director shall adopt rules consistent with this section. END_STATUTE

Sec. 4. Title 36, chapter 4, article 2, Arizona Revised Statutes, is amended by adding section 36-425.06, to read:

START_STATUTE36-425.06. Secure behavioral health residential facilities; license; definition

A. The department shall license secure behavioral health residential facilities to provide secure twenty‑four‑hour on‑site supportive treatment and supervision by staff with behavioral health training for persons who have been determined to be seriously mentally ill, who are chronically resistant to treatment for a mental disorder and who are placed in the facility pursuant to a court order issued pursuant to section 36‑550.09. A secure behavioral health residential facility may provide services only to persons placed in the facility pursuant to a court order issued pursuant to section 36‑550.09 and may not provide services to any other persons on that facility's premises. A secure behavioral health residential facility may not have more than sixteen beds.

B. For the purposes of this section, "secure" means premises that limit a patient's egress in the least restrictive manner consistent with the patient's court‑ordered treatment plan. END_STATUTE

Sec. 5. Section 36-540, Arizona Revised Statutes, is amended to read:

START_STATUTE36-540. Court options

A. If the court finds by clear and convincing evidence that the proposed patient, as a result of mental disorder, is a danger to self, is a danger to others, has a persistent or acute disability or a grave disability and is in need of treatment, and is either unwilling or unable to accept voluntary treatment, the court shall order the patient to undergo one of the following:

1. Treatment in a program of outpatient treatment.

2. Treatment in a program consisting of combined inpatient and outpatient treatment.

3. Inpatient treatment in a mental health treatment agency, in a hospital operated by or under contract with the United States department of veterans affairs to provide treatment to eligible veterans pursuant to article 9 of this chapter, in the state hospital or in a private hospital, if the private hospital agrees, subject to the limitations of section 36‑541.

B. The court shall consider all available and appropriate alternatives for the treatment and care of the patient. The court shall order the least restrictive treatment alternative available.

C. The court may order the proposed patient to undergo outpatient or combined inpatient and outpatient treatment pursuant to subsection A, paragraph 1 or 2 of this section if the court:

1. Determines that all of the following apply:

(a) The patient does not require continuous inpatient hospitalization.

(b) The patient will be more appropriately treated in an outpatient treatment program or in a combined inpatient and outpatient treatment program.

(d) The patient will not likely become dangerous or suffer more serious physical harm or serious illness or further deterioration if the patient follows a prescribed outpatient treatment plan.

2. Is presented with and approves a written treatment plan that conforms with the requirements of section 36‑540.01, subsection B. If the court determines that the patient meets the requirements of section 36‑550.09, the court may order the patient to be placed in a secure behavioral health residential facility that is licensed by the department pursuant to section 36-425.06. If the treatment plan presented to the court pursuant to this subsection provides for supervision of the patient under court order by a mental health agency that is other than the mental health agency that petitioned or requested the county attorney to petition the court for treatment pursuant to section 36‑531, the treatment plan must be approved by the medical director of the mental health agency that will supervise the treatment pursuant to subsection E of this section.

D. An order to receive treatment pursuant to subsection A, paragraph 1 or 2 of this section shall not exceed three hundred sixty‑five days. The period of inpatient treatment under a combined treatment order pursuant to subsection A, paragraph 2 of this section shall not exceed the maximum period allowed for an order for inpatient treatment pursuant to subsection F of this section.

E. If the court enters an order for treatment pursuant to subsection A, paragraph 1 or 2 of this section, all of the following apply:

1. The court shall designate the medical director of the mental health treatment agency that will supervise and administer the patient's treatment program.

2. The medical director shall not use the services of any person, agency or organization to supervise a patient's outpatient treatment program unless the person, agency or organization has agreed to provide these services in the individual patient's case and unless the department has determined that the person, agency or organization is capable and competent to do so.

3. The person, agency or organization assigned to supervise an outpatient treatment program or the outpatient portion of a combined treatment program shall be notified at least three days before a referral. The medical director making the referral and the person, agency or organization assigned to supervise the treatment program shall share relevant information about the patient to provide continuity of treatment.

4. The court may order the medical director to provide notice to the court of any noncompliance with the terms of a treatment order.

5. During any period of outpatient treatment under subsection A, paragraph 2 of this section, if the court, on its own motion or on motion by the medical director of the patient's outpatient mental health treatment facility, determines that the patient is not complying with the terms of the order or that the outpatient treatment plan is no longer appropriate and the patient needs inpatient treatment, the court, without a hearing and based on the court record, the patient's medical record, the affidavits and recommendations of the medical director, and the advice of staff and physicians or the psychiatric and mental health nurse practitioner familiar with the treatment of the patient, may enter an order amending its original order. The amended order may alter the outpatient treatment plan or order the patient to inpatient treatment pursuant to subsection A, paragraph 3 of this section. The amended order shall not increase the total period of commitment originally ordered by the court or, when added to the period of inpatient treatment provided by the original order and any other amended orders, exceed the maximum period allowed for an order for inpatient treatment pursuant to subsection F of this section. If the patient refuses to comply with an amended order for inpatient treatment, the court, on its own motion or on the request of the medical director, may authorize and direct a peace officer to take the patient into protective custody and transport the patient to the agency for inpatient treatment. Any authorization, directive or order issued to a peace officer to take the patient into protective custody shall include the patient's criminal history and the name and telephone numbers of the patient's case manager, guardian, spouse, next of kin or significant other, as applicable. When reporting to or being returned to a treatment agency for inpatient treatment pursuant to an amended order, the patient shall be informed of the patient's right to judicial review and the patient's right to consult with counsel pursuant to section 36‑546.

6. During any period of outpatient treatment under subsection A, paragraph 2 of this section, if the medical director of the outpatient treatment facility in charge of the patient's care determines, in concert with the medical director of an inpatient mental health treatment facility who has agreed to accept the patient, that the patient is in need of immediate acute inpatient psychiatric care because of behavior that is dangerous to self or to others, the medical director of the outpatient treatment facility may order a peace officer to apprehend and transport the patient to the inpatient treatment facility pending a court determination on an amended order under paragraph 5 of this subsection. The patient may be detained and treated at the inpatient treatment facility for a period of no more than forty‑eight hours, exclusive of weekends and holidays, from the time that the patient is taken to the inpatient treatment facility. The medical director of the outpatient treatment facility shall file the motion for an amended court order requesting inpatient treatment no later than the next working day following the patient being taken to the inpatient treatment facility. Any period of detention within the inpatient treatment facility pending issuance of an amended order shall not increase the total period of commitment originally ordered by the court or, when added to the period of inpatient treatment provided by the original order and any other amended orders, exceed the maximum period allowed for an order for inpatient treatment pursuant to subsection F of this section. If a patient is ordered to undergo inpatient treatment pursuant to an amended order, the medical director of the outpatient treatment facility shall inform the patient of the patient's right to judicial review and to consult with an attorney pursuant to section 36‑546.

F. The maximum periods of inpatient treatment that the court may order, subject to the limitations of section 36‑541, are as follows:

1. Ninety days for a person found to be a danger to self.

2. One hundred eighty days for a person found to be a danger to others.

3. One hundred eighty days for a person found to have a persistent or acute disability.

4. Three hundred sixty‑five days for a person found to have a grave disability.

G. If, on finding that the patient meets the criteria for court‑ordered treatment pursuant to subsection A of this section, the court also finds that there is reasonable cause to believe that the patient is an incapacitated person as defined in section 14‑5101 or is a person in need of protection pursuant to section 14‑5401 and that the patient is or may be in need of guardianship or conservatorship, or both, the court may order an investigation concerning the need for a guardian or conservator, or both, and may appoint a suitable person or agency to conduct the investigation. The appointee may include a court appointed court-appointed guardian ad litem, an investigator appointed pursuant to section 14‑5308 or the public fiduciary if there is no person willing and qualified to act in that capacity. The court shall give notice of the appointment to the appointee within three days of the appointment. The appointee shall submit the report of the investigation to the court within twenty‑one days. The report shall include recommendations as to who should be guardian or who should be conservator, or both, and a report of the findings and reasons for the recommendation. If the investigation and report so indicate, the court shall order the appropriate person to submit a petition to become the guardian or conservator, or both, of the patient.

H. In any proceeding for court‑ordered treatment in which the petition alleges that the patient is in need of a guardian or conservator and states the grounds for that allegation, the court may appoint an emergency temporary guardian or conservator, or both, for a specific purpose or purposes identified in its order and for a specific period of time not to exceed thirty days if the court finds that all of the following are true:

1. The patient meets the criteria for court-ordered treatment pursuant to subsection A of this section.

2. There is reasonable cause to believe that the patient is an incapacitated person as defined in section 14‑5101 or is in need of protection pursuant to section 14‑5401, paragraph 2.

3. The patient does not have a guardian or conservator and the welfare of the patient requires immediate action to protect the patient or the ward's property.

4. The conditions prescribed pursuant to section 14‑5310, subsection B or section 14‑5401.01, subsection B have been met.

I. The court may appoint as a temporary guardian or conservator pursuant to subsection H of this section a suitable person or the public fiduciary if there is no person qualified and willing to act in that capacity. The court shall issue an order for an investigation as prescribed pursuant to subsection G of this section and, unless the patient is represented by independent counsel, the court shall appoint an attorney to represent the patient in further proceedings regarding the appointment of a guardian or conservator. The court shall schedule a further hearing within fourteen days on the appropriate court calendar of a court that has authority over guardianship or conservatorship matters pursuant to this title to consider the continued need for an emergency temporary guardian or conservator and the appropriateness of the temporary guardian or conservator appointed, and shall order the appointed guardian or conservator to give notice to persons entitled to notice pursuant to section 14‑5309, subsection A or section 14‑5405, subsection A. The court shall authorize certified letters of temporary emergency guardianship or conservatorship to be issued on presentation of a copy of the court's order. If a temporary emergency conservator other than the public fiduciary is appointed pursuant to this subsection, the court shall order that the use of the money and property of the patient by the conservator is restricted and not to be sold, used, transferred or encumbered, except that the court may authorize the conservator to use money or property of the patient specifically identified as needed to pay an expense to provide for the care, treatment or welfare of the patient pending further hearing. This subsection and subsection H of this section do not:

1. Prevent the evaluation or treatment agency from seeking guardianship and conservatorship in any other manner allowed by law at any time during the period of court‑ordered evaluation and treatment.

2. Relieve the evaluation or treatment agency from its obligations concerning the suspected abuse of a vulnerable adult pursuant to title 46, chapter 4.

J. If, on finding that a patient meets the criteria for court‑ordered treatment pursuant to subsection A of this section, the court also learns that the patient has a guardian appointed under title 14, the court with notice may impose on the existing guardian additional duties pursuant to section 14‑5312.01. If the court imposes additional duties on an existing guardian as prescribed in this subsection, the court may determine that the patient needs to continue treatment under a court order for treatment and may issue the order or determine that the patient's needs can be adequately met by the guardian with the additional duties pursuant to section 14‑5312.01 and decline to issue the court order for treatment. If at any time after the issuance of a court order for treatment the court finds that the patient's needs can be adequately met by the guardian with the additional duties pursuant to section 14‑5312.01 and that a court order for treatment is no longer necessary to assure ensure compliance with necessary treatment, the court may terminate the court order for treatment. If there is a court order for treatment and a guardianship with additional mental health authority pursuant to section 14‑5312.01 existing at the same time, the treatment and placement decisions made by the treatment agency assigned by the court to supervise and administer the patient's treatment program pursuant to the court order for treatment are controlling unless the court orders otherwise.

K. The court shall file a report as part of the court record on its findings of alternatives for treatment.

L. Treatment shall not include psychosurgery, lobotomy or any other brain surgery without specific informed consent of the patient or the patient's legal guardian and an order of the superior court in the county in which the treatment is proposed, approving with specificity the use of the treatment.

M. The medical director or any person, agency or organization used by the medical director to supervise the terms of an outpatient treatment plan is not civilly liable for any acts committed by a patient while on outpatient treatment if the medical director, person, agency or organization has in good faith followed the requirements of this section.

N. A peace officer who in good faith apprehends and transports a patient to an inpatient treatment facility on the order of the medical director of the outpatient treatment facility pursuant to subsection E, paragraph 6 of this section is not subject to civil liability.

O. If a person has been found, as a result of a mental disorder, to constitute a danger to self or others or to have a persistent or acute disability or a grave disability and the court enters an order for treatment pursuant to subsection A of this section, the court shall transmit the person's name, sex, date of birth, social security number, if available, and date of the order for treatment to the supreme court. The supreme court shall transmit the information to the department of public safety to comply with the requirements of title 13, chapter 31 and title 32, chapter 26. The department of public safety shall transmit the information to the national instant criminal background check system. The superior court may access the information of a person who is ordered into treatment to enforce or facilitate a treatment order.

P. On request, the clerk of the court shall provide certified copies of the commitment order to a law enforcement or prosecuting agency that is investigating or prosecuting a prohibited possessor as defined in section 13‑3101.

Q. If the court does not find a person to be in need of treatment and a prosecutor filed a petition pursuant to section 13‑4517, the evaluation agency, within twenty‑four hours, shall notify the prosecuting agency of its finding. The court shall order the medical director to detain the person for an additional twenty‑four hours to allow the prosecuting agency to be notified. If the court has retained jurisdiction pursuant to section 13‑4517, subsection C, the court may remand the person to the custody of the sheriff for further disposition pursuant to section 13‑4517, subsection A, paragraph 2 or 3.END_STATUTE

Sec. 6. Section 36-550.05, Arizona Revised Statutes, is amended to read:

START_STATUTE36-550.05. Community mental health residential treatment services and facilities; prevention services

A. A residential or day treatment facility shall be designed to provide a homelike environment without sacrificing safety or care. Facilities shall be relatively small, with preferably fifteen or less fewer beds.

B. Individual programs of a community residential treatment system shall include the following:

1. A short‑term crisis residential treatment program. This program is an alternative to hospitalization for persons in an acute episode or situational crisis requiring temporary removal from the home from one to fourteen days. The program shall provide admission capability twenty‑four hour hours a day, seven days a week admission capability in the least restrictive setting possible to reduce the crisis and stabilize the client. Services shall include direct work with the client's family, linkage with prevocational and vocational programs, assistance in applying for income, medical and other benefits and treatment referral.

2. A residential treatment program. This program shall provide a full day full-day treatment program for persons who may require intensive support for a maximum of two years. The program shall provide rehabilitation for chronic clients who need long‑term support to develop independence and for clients who live marginally in the community with little or no support and periodically need rehospitalization. Services shall include intensive diagnostic evaluation, a full day full-day treatment program with prevocational, vocational and special education services, outreach to social services and counseling to assist the client in developing skills to move toward a less structured setting.

3. A secure behavioral health residential facility program. This program shall provide secure twenty‑four‑hour on‑site supportive treatment and supervision by staff with behavioral health training only to persons who have been determined to be seriously mentally ill and chronically resistant to treatment pursuant to a court order issued pursuant to section 36‑550.09.

3. 4. A semi‑supervised semisupervised, structured group living program. This program is a cooperative arrangement in which three to five persons live together in apartments or houses as a transition to independent living. The program shall provide an increase in the level of the client's responsibility for the functioning of the household and an increase in the client's involvement in daytime activities outside the house or apartment which that are relevant to achieving personal goals and greater self‑sufficiency. Services provided by the program shall include counseling and client self‑assessment, the development of support systems in the community, a day program to encourage participation in the larger community, activities to encourage socialization and use of general community resources, rent subsidy and direct linkages to staff support in emergencies.

4. 5. A socialization or day care/partial care program. This program shall provide regular daytime, evening and weekend activities for persons who require long‑term structured support but who do not receive such services in their residential setting. The program shall provide support for persons who only need regular socialization opportunities and referral to social services or treatment services. The program shall provide opportunities to develop skills to achieve more independent functioning and means to reduce social isolation. Services shall include outings, recreational activities, cultural events and contact with community resources, such as prevocational counseling and life skills training.

C. Individual and family support prevention services shall provide assistance to the seriously mentally ill residing in their own home. Such prevention services shall include transportation, recreation, socialization, counseling, respite, companion services and in‑home training.

D. Each individual program shall use appropriate multidisciplinary staff to meet the diagnostic and treatment needs of the seriously mentally ill and shall encourage use of paraprofessionals.

E. Each program shall have an evaluation method to assess the effectiveness of the programs and shall include the following criteria:

1. Prevalence and incidence of the target behavioral problem.

2. Cost effectiveness.

3. Potential for implementing the program using available funds monies and resources through cost‑sharing.

4. Measurability of the benefits.

5. Effectiveness of intervention strategy.

6. Availability of resources and personnel.

F. Each community residential treatment system shall be designed to provide:

1. Coordination between each program and other treatment systems in the community.

2. A case management system to enhance cooperation of elements within the system and provide each client with appropriate services.

3. Client movement to the most appropriate and least restrictive service.

4. Direct referral of clients for specific programs which that does not require the client to pass through the entire system to reach the most appropriate service. END_STATUTE

Sec. 7. Title 36, chapter 5, article 10, Arizona Revised Statutes, is amended by adding section 36-550.09, to read:

START_STATUTE36-550.09. Secure behavioral health residential facility; court determination; findings

A. If a court finds that a patient meets the criteria for court‑ordered treatment pursuant to section 36‑540, subsection A, The court may approve the patient's placement in a secure behavioral health residential facility that is licensed by the department pursuant to section 36‑425.06 and that is willing to accept the patient if the patient has been determined to be seriously mentally ill and the court finds that the patient is chronically resistant to treatment as set forth in this section. Placement in a secure behavioral health residential facility for treatment is not a period of inpatient treatment for the purposes of section 36‑540, subsection F.

B. A court may determine that a person is chronically resistant to treatment if the court finds that, within twenty-four months before the issuance of a court order pursuant to this section, excluding any time during this period that the person was hospitalized or incarcerated, the person demonstrated a persistent or recurrent unwillingness or inability to participate in or adhere to treatment for a mental disorder despite having treatment offered, prescribed, recommended or ordered to improve the person's condition or to prevent a relapse or harmful deterioration of the person's condition. The court's finding shall be based on evidence that establishes all of the following by clear and convincing evidence:

1. The person received treatment in the preceding twenty‑four months in other less-restrictive settings, including unsecured residential treatment settings with on-site twenty‑four‑hour supportive treatment and supervision by staff with behavioral health training, and the treatment was unsuccessful or is not likely to be successful due to the person's expressed or demonstrated unwillingness to cooperate with treatment in other less-restrictive or unsecured residential treatment settings.

2. The person's nonadherence to or nonparticipation in treatment over the preceding twenty‑four months resulted in one or more of the following:

(a) Serious harm to self.

(b) Serious harm or threats of serious harm to others.

(d) Recurrent serious medical problems due to poor self‑care or failure to follow medical treatment recommendations.

(e) Recurrent arrests due to behavior resulting from the mental disorder.

3. Any other evidence relevant to the person's willingness or ability to participate in and adhere to treatment or the person's need for treatment in a licensed secure residential setting to ensure the person's compliance with court-ordered treatment.

C. A person's placement in a licensed secure behavioral health residential facility for treatment shall be part of the written treatment plan presented to and approved by the court as required by section 36‑540, subsection C, paragraph 2. The court shall confirm in the order that the person's placement in a licensed secure behavioral health residential facility is the least restrictive environment to ensure the person's compliance with the treatment plan. END_STATUTE

Sec. 8. Section 36-773, Arizona Revised Statutes, is amended to read:

START_STATUTE36-773. Health research account

A. Five cents of each dollar in the tobacco tax and health care fund shall be deposited in the health research account for research on preventing and treating tobacco‑related disease and addiction.

B. The department of health services shall administer the account.

C. Monies that are deposited in the health research account shall only be used only to supplement monies that are appropriated by the legislature for alzheimer's disease research and other health research purposes and shall not be used to supplant those appropriated monies. END_STATUTE

Sec. 9. Title 36, chapter 29, article 1, Arizona Revised Statutes, is amended by adding sections 36-2903.12 and 36-2903.13, to read:

START_STATUTE36-2903.12. Hospital charge master transparency; joint annual report

On or before January 2, 2020 and each year thereafter, the director of the Arizona health care cost containment system administration and the director of the department of health services shall submit a joint report on hospital charge master transparency to the governor, the speaker of the house of representatives and the president of the senate and shall provide a copy to the secretary of state. The report shall do all of the following:

1. Summarize the current charge master reporting process and hospital billed charges compared to costs.

2. Provide examples of how charge masters or hospital prices are reported and used in other states.

3. include recommendations to improve this state's use of hospital charge master information, including reporting and oversight changes. END_STATUTE

START_STATUTE36-2903.13. Inpatient psychiatric treatment; annual report

A. On or before January 2, 2020 and each year thereafter, the director of the Arizona health care cost containment system administration shall submit a report to the director of the joint legislative budget committee on the availability of inpatient psychiatric treatment both for adults and for children and adolescents who receive services from the regional behavioral health authorities. The report shall include all of the following information:

1. The total number of inpatient psychiatric treatment beds available and the occupancy rate for those beds.

2. Expenditures on inpatient psychiatric treatment.

3. The total number of individuals in this state who are sent out of state for inpatient psychiatric treatment.

4. The prevalence of psychiatric boarding or holding psychiatric patients in emergency rooms for at least twenty‑four hours before transferring the patients to a psychiatric facility.

B. The report shall provide the information specified in subsection A of this section separately for adults who are at least twenty‑one years of age and for children and adolescents who are twenty years of age or younger. END_STATUTE

Sec. 10. Section 36-2985, Arizona Revised Statutes, is amended to read:

START_STATUTE36-2985. Notice of program suspension; spending limit

A. If this state's federal medical assistance percentage for the program is less than one hundred percent the director determines that federal and state monies appropriated for the program are insufficient, the administration shall immediately notify the governor, the president of the senate and the speaker of the house of representatives and shall immediately may stop processing all new applications.

B. The total amount of state monies that the administration may be spent spend in any fiscal year by the administration for health care provided under this article shall not exceed the amount appropriated or authorized by section 35‑173.

C. This article does not impose a duty on an officer, agent or employee of this state to discharge a responsibility or create any right in a person or group if the discharge or right would require an expenditure of state monies in excess of the expenditure authorized by legislative appropriation for that specific purpose. END_STATUTE

Sec. 11. Section 41-3955.01, Arizona Revised Statutes, is amended to read:

START_STATUTE41-3955.01. Seriously mentally ill housing trust fund; purpose; report

A. The seriously mentally ill housing trust fund is established. The director of the Arizona health care cost containment system administration shall administer the fund. The fund consists of monies received pursuant to section 44‑313 and investment earnings.

B. On notice from the director of the Arizona health care cost containment system administration, the state treasurer shall invest and divest monies in the fund as provided by section 35‑313, and monies earned from investment shall be credited to the fund.

C. Fund monies shall be spent on approval of the Arizona health care cost containment system administration solely for housing projects and rental assistance for seriously mentally ill persons.

D. The director of the Arizona health care cost containment system administration shall report annually to the legislature on the status of the seriously mentally ill housing trust fund. The report shall include a summary of facilities for which funding was provided during the preceding fiscal year and shall show the cost and geographic location of each facility and the number of individuals benefiting from the operation, construction or renovation of the facility. The report shall also include the number of individuals who benefited from rental assistance. The report shall be submitted to the president of the senate and the speaker of the house of representatives no not later than September 1 of each year.

E. Monies in the seriously mentally ill housing trust fund are exempt from the provisions of section 35‑190 relating to lapsing of appropriations.

F. An amount not to exceed ten percent of the seriously mentally ill housing trust fund monies may be appropriated annually by the legislature to the Arizona health care cost containment system for administrative costs in providing services relating to the seriously mentally ill housing trust fund.

G. For any construction project financed by the Arizona health care cost containment system administration pursuant to this section, the administration shall notify a city, town, county or tribal government that a project is planned for its jurisdiction and, before proceeding, shall seek comment from the governing body of the city, town, county or tribal government or an official authorized by the governing body of the city, town, county or tribal government. The Arizona health care cost containment system administration shall not interfere with or attempt to override the local jurisdiction's planning, zoning or land use regulations.END_STATUTE

Sec. 12. Title 46, chapter 2, Arizona Revised Statutes, is amended by adding article 9, to read:

ARTICLE 9. FAMILY CAREGIVER GRANT PROGRAM

START_STATUTE46-341. Definitions

In this article, unless the context otherwise requires:

1. "Department" means the department of economic security.

2. "Director" means the director of the department.

3. "Qualifying expenses":

(a) Means those expenses that relate directly to caring for or supporting a qualifying family member.

(b) Includes:

(i) Improving or altering the individual's primary residence, whether owned or rented by the individual, to enable or assist the qualifying family member to be mobile, safe or independent.

(ii) Purchasing or leasing equipment or assistive care technology to enable or assist the qualifying family member to carry out one or more daily living activities.

(i) Regular food, clothing or transportation expenses or gifts provided to the qualifying family member.

(ii) Ordinary household maintenance or repairs that are not directly related to and necessary for the care of the qualifying family member.

(iii) Any amount that is paid or reimbursed by insurance or by the federal government, this state or a political subdivision of this state.

4. "Qualifying family member" means an individual who meets all of the following requirements:

(a) Is at least eighteen years of age during the calendar year.

(b) Requires assistance with one or more activities of daily living as certified by a physician who is licensed pursuant to title 32, chapter 13 or 17, a registered nurse practitioner who is licensed pursuant to title 32, chapter 15 or a physician assistant who is licensed pursuant to title 32, chapter 25.

(c) Is the individual's spouse or the individual's or spouse's child, grandchild, stepchild, parent, stepparent, grandparent, sibling, uncle or aunt, whether of the whole or half blood or by adoption.END_STATUTE

START_STATUTE46-342. Family caregiver grant program; requirements

A. Beginning January 1, 2020, the family caregiver grant program is established for individuals who have qualifying expenses during a calendar year due to caring for and supporting a qualifying family member in the individual's home.

B. To apply for a family caregiver grant:

1. An individual must submit an application to the department on a form prescribed by the department.

2. Be a resident of this state.

3. The individual's Arizona gross income, together with any Arizona gross income of each qualifying family member, in the taxable year may not exceed:

(a) $75,000 in the case of a single person or a married person filing separately.

(b) $150,000 in the case of a married couple filing a joint return.

4. The individual must incur qualifying expenses during the calendar year in which the individual applies for the grant for the care of one or more qualifying family members.

5. The individual must submit with the claim for the grant the qualifying family member's name and relationship to the individual.

C. The amount of the grant is equal to fifty percent of the qualifying expenses incurred during the calendar year in which the individual applies for the grant but not more than $1,000 for each qualifying family member.

D. An individual who receives a grant under this section is not eligible to apply for a grant under this section again for three consecutive calendar years.

E. The department shall certify applications for the grant on a first‑come, first‑served basis. The department may not award grants under this section that exceed in the aggregate $500,000 for any calendar year. The department shall include questions in the application to help the department determine whether the grants that were provided delayed or prevented a qualifying family member from entering a long‑term care facility or assisted living facility in the calendar year of the application or future calendar years.

F. The department may use the advisory council on aging to provide input on approval of applications for grants and whether an expense is a qualifying expense or other issues relating to the grant program as determined by the department.END_STATUTE

START_STATUTE46-343. Family caregiver grant program fund; report

A. The family caregiver grant program fund is established. The director shall administer the fund. The fund shall consist of grants, gifts, donations and legislative appropriations. Monies in the fund are continuously appropriated. Monies in the fund may be spent only for grants provided to individuals who are caring for and supporting a qualifying family member in the individual's home as specified in this article.

B. Expenditures from the family caregiver grant program fund from the previous calendar year shall be reported to the legislature in the course of the department's annual report. The department shall include aggregated data summarizing the qualifying expenses that were approved for grants, the types of individuals that qualified for the grants and information about the ability for qualified family members to delay entering a long‑term care facility or assisted living facility.

C. The state treasurer shall invest and divest monies in the fund as provided by section 35-313, and monies earned from investment shall be creditED to the fund.

D. Interest or other income derived from the family caregiver grant program fund may be used only for the purposes of this article. Interest or other income derived from the family caregiver grant program fund may not be used to supplant other appropriations. END_STATUTE

Sec. 13. Delayed repeal

Title 46, chapter 2, article 9, Arizona Revised Statutes, as added by this act, is repealed from and after June 30, 2023.

Sec. 14. ALTCS; county contributions; fiscal year 2019-2020

A. Notwithstanding section 11-292, Arizona Revised Statutes, county contributions for the Arizona long-term care system for fiscal year 2019‑2020 are as follows:

1. Apache $ 720,200

2. Cochise $ 5,176,200

3. Coconino $ 2,162,200

4. Gila $ 2,418,200

5. Graham $ 1,684,400

6. Greenlee $ 8,200

7. La Paz $ 822,000

8. Maricopa $185,791,300

9. Mohave $ 9,232,700

10. Navajo $ 2,981,000

11. Pima $ 45,157,400

12. Pinal $ 13,755,300

13. Santa Cruz $ 2,266,800

14. Yavapai $ 8,543,800

15. Yuma $ 9,556,400

B. If the overall cost for the Arizona long-term care system exceeds the amount specified in the general appropriations act for fiscal year 2019‑2020, the state treasurer shall collect from the counties the difference between the amount specified in subsection A of this section and the counties' share of the state's actual contribution. The counties' share of the state's contribution shall comply with any federal maintenance of effort requirements. The director of the Arizona health care cost containment system administration shall notify the state treasurer of the counties' share of the state's contribution and report the amount to the director of the joint legislative budget committee. The state treasurer shall withhold from any other monies payable to a county from whatever state funding source is available an amount necessary to fulfill that county's requirement specified in this subsection. The state treasurer may not withhold distributions from the Arizona highway user revenue fund pursuant to title 28, chapter 18, article 2, Arizona Revised Statutes. The state treasurer shall deposit the amounts withheld pursuant to this subsection and amounts paid pursuant to subsection A of this section in the long-term care system fund established by section 36-2913, Arizona Revised Statutes.

Sec. 15. AHCCCS; disproportionate share payments; fiscal year 2019‑2020

A. Disproportionate share payments for fiscal year 2019-2020 made pursuant to section 36-2903.01, subsection O, Arizona Revised Statutes, include:

1. $113,818,500 for a qualifying nonstate operated public hospital. The Maricopa county special health care district shall provide a certified public expense form for the amount of qualifying disproportionate share hospital expenditures made on behalf of this state to the Arizona health care cost containment system administration on or before May 1, 2020 for all state plan years as required by the Arizona health care cost containment system section 1115 waiver standard terms and conditions. The administration shall assist the district in determining the amount of qualifying disproportionate share hospital expenditures. Once the administration files a claim with the federal government and receives federal financial participation based on the amount certified by the Maricopa county special health care district, if the certification is equal to or less than $113,818,500 and the administration determines that the revised amount is correct pursuant to the methodology used by the administration pursuant to section 36-2903.01, Arizona Revised Statutes, as amended by this act, the administration shall notify the governor, the president of the senate and the speaker of the house of representatives, shall distribute $4,202,300 to the Maricopa county special health care district and shall deposit the balance of the federal financial participation in the state general fund. If the certification provided is for an amount less than $113,818,500 and the administration determines that the revised amount is not correct pursuant to the methodology used by the administration pursuant to section 36-2903.01, Arizona Revised Statutes, as amended by this act, the administration shall notify the governor, the president of the senate and the speaker of the house of representatives and shall deposit the total amount of the federal financial participation in the state general fund. If the certification provided is for an amount greater than $113,818,500, the administration shall distribute $4,202,300 to the Maricopa county special health care district and shall deposit $75,493,400 of the federal financial participation in the state general fund. The administration may make additional disproportionate share hospital payments to the Maricopa county special health care district pursuant to section 36‑2903.01, subsection P, Arizona Revised Statutes, and subsection B of this section.

2. $28,474,900 for the Arizona state hospital. The Arizona state hospital shall provide a certified public expense form for the amount of qualifying disproportionate share hospital expenditures made on behalf of this state to the administration on or before March 31, 2020. The administration shall assist the Arizona state hospital in determining the amount of qualifying disproportionate share hospital expenditures. Once the administration files a claim with the federal government and receives federal financial participation based on the amount certified by the Arizona state hospital, the administration shall deposit the entire amount of federal financial participation in the state general fund. If the certification provided is for an amount less than $28,474,900, the administration shall notify the governor, the president of the senate and the speaker of the house of representatives and shall deposit the entire amount of federal financial participation in the state general fund. The certified public expense form provided by the Arizona state hospital shall contain both the total amount of qualifying disproportionate share hospital expenditures and the amount limited by section 1923(g) of the social security act.

3. $884,800 for private qualifying disproportionate share hospitals. The Arizona health care cost containment system administration shall make payments to hospitals consistent with this appropriation and the terms of the section 1115 waiver, but payments are limited to those hospitals that either:

(a) Meet the mandatory definition of disproportionate share qualifying hospitals under section 1923 of the social security act.

(b) Are located in Yuma county and contain at least three hundred beds.

B. After the distributions made pursuant to subsection A of this section, the allocations of disproportionate share hospital payments made pursuant to section 36‑2903.01, subsection P, Arizona Revised Statutes, shall be made available first to qualifying private hospitals located outside the Phoenix metropolitan statistical area and the Tucson metropolitan statistical area before being made available to qualifying hospitals within the Phoenix metropolitan statistical area and the Tucson metropolitan statistical area.

Sec. 16. AHCCCS transfer; counties; federal monies; fiscal year 2019‑2020

On or before December 31, 2020, notwithstanding any other law, for fiscal year 2019‑2020 the Arizona health care cost containment system administration shall transfer to the counties the portion, if any, as may be necessary to comply with section 10201(c)(6) of the patient protection and affordable care act (P.L. 111‑148), regarding the counties' proportional share of this state's contribution.

Sec. 17. County acute care contribution; fiscal year 2019‑2020

A. Notwithstanding section 11-292, Arizona Revised Statutes, for fiscal year 2019-2020 for the provision of hospitalization and medical care, the counties shall contribute the following amounts:

1. Apache $ 268,800

2. Cochise $ 2,214,800

3. Coconino $ 742,900

4. Gila $ 1,413,200

5. Graham $ 536,200

6. Greenlee $ 190,700

7. La Paz $ 212,100

8. Maricopa $18,131,400

9. Mohave $ 1,237,700

10. Navajo $ 310,800

11. Pima $14,951,800

12. Pinal $ 2,715,600

13. Santa Cruz $ 482,800

14. Yavapai $ 1,427,800

15. Yuma $ 1,325,100

B. If a county does not provide funding as specified in subsection A of this section, the state treasurer shall subtract the amount owed by the county to the Arizona health care cost containment system fund and the long‑term care system fund established by section 36-2913, Arizona Revised Statutes, from any payments required to be made by the state treasurer to that county pursuant to section 42-5029, subsection D, paragraph 2, Arizona Revised Statutes, plus interest on that amount pursuant to section 44-1201, Arizona Revised Statutes, retroactive to the first day the funding was due. If the monies the state treasurer withholds are insufficient to meet that county's funding requirements as specified in subsection A of this section, the state treasurer shall withhold from any other monies payable to that county from whatever state funding source is available an amount necessary to fulfill that county's requirement. The state treasurer may not withhold distributions from the Arizona highway user revenue fund pursuant to title 28, chapter 18, article 2, Arizona Revised Statutes.

C. Payment of an amount equal to one-twelfth of the total amount determined pursuant to subsection A of this section shall be made to the state treasurer on or before the fifth day of each month. On request from the director of the Arizona health care cost containment system administration, the state treasurer shall require that up to three months' payments be made in advance, if necessary.

D. The state treasurer shall deposit the amounts paid pursuant to subsection C of this section and amounts withheld pursuant to subsection B of this section in the Arizona health care cost containment system fund and the long-term care system fund established by section 36-2913, Arizona Revised Statutes.

E. If payments made pursuant to subsection C of this section exceed the amount required to meet the costs incurred by the Arizona health care cost containment system for the hospitalization and medical care of those persons defined as an eligible person pursuant to section 36-2901, paragraph 6, subdivisions (a), (b) and (c), Arizona Revised Statutes, the director of the Arizona health care cost containment system administration may instruct the state treasurer either to reduce remaining payments to be paid pursuant to this section by a specified amount or to provide to the counties specified amounts from the Arizona health care cost containment system fund and the long-term care system fund established by section 36‑2913, Arizona Revised Statutes.

F. The legislature intends that the Maricopa county contribution pursuant to subsection A of this section be reduced in each subsequent year according to the changes in the GDP price deflator. For the purposes of this subsection, "GDP price deflator" has the same meaning prescribed in section 41-563, Arizona Revised Statutes.

Sec. 18. Proposition 204 administration; exclusion; county expenditure limitations

County contributions for the administrative costs of implementing sections 36-2901.01 and 36-2901.04, Arizona Revised Statutes, that are made pursuant to section 11-292, subsection O, Arizona Revised Statutes, are excluded from the county expenditure limitations.

Sec. 19. Competency restoration; exclusion; county expenditure limitation

County contributions made pursuant to section 13‑4512, Arizona Revised Statutes, as amended by this act, are excluded from the county expenditure limitations.

Sec. 20. AHCCCS; risk contingency rate setting

Notwithstanding any other law, for the contract year beginning October 1, 2019 and ending September 30, 2020, the Arizona health care cost containment system administration may continue the risk contingency rate setting for all managed care organizations and the funding for all managed care organizations administrative funding levels that were imposed for the contract year beginning October 1, 2010 and ending September 30, 2011.

Sec. 21. Department of health services; fees; increase; intent; rulemaking exemption

A. Notwithstanding any other law, the director of the department of health services may increase fees in fiscal year 2019‑2020 for services provided by the bureau of radiation control in fiscal year 2019‑2020.

B. The legislature intends that the revenue generated by the fees collected pursuant to subsection A of this section not exceed $1,900,000.

C. The department of health services shall deposit monies received from any fees increased pursuant to subsection A of this section in the health services licensing fund established by section 36‑414, Arizona Revised Statutes.

D. The department of health services is exempt from the rulemaking requirements of title 41, chapter 6, Arizona Revised Statutes, until July 1, 2020 for the purpose of increasing fees pursuant to this section.

Sec. 22. Health services lottery monies fund; use; fiscal year 2019-2020

Notwithstanding sections 5‑572 and 36‑108.01, Arizona Revised Statutes, monies in the health services lottery monies fund established by section 36‑108.01, Arizona Revised Statutes, may be used for the purposes specified in the fiscal year 2019‑2020 general appropriations act.

Sec. 23. AHCCCS; secure behavioral health residential facilities; report

On or before January 31, 2022, the Arizona health care cost containment system administration shall issue to the governor, the president of the senate and the speaker of the house of representatives a report that measures the outcomes over a twelve‑month period of persons who have been determined to be seriously mentally ill and who reside in secure behavioral health residential facilities licensed pursuant to section 36‑425.06, Arizona Revised Statutes, as added by this act. The report shall include an analysis of costs and effectiveness of the services provided in secure behavioral health residential facilities that takes into consideration the encounters of the seriously mentally ill residents related to inpatient care, emergency department visits, hospitalization, civil commitment proceedings, incarceration, homelessness, employment, community engagement and encounters with police and fire personnel, including petitioning and contact with crisis centers, citation in lieu of detention, jail bookings and other contact with first responders. The administration may contract with a third‑party entity to collect the data and compile the report. The administration shall provide a copy of the report to the secretary of state.

Sec. 24. Intent; implementation of program

The legislature intends that for fiscal year 2019‑2020 the Arizona health care cost containment system administration implement a program within the available appropriation.