Bill Summary – FastDemocracy

SENATE BILL NO. 939
 June 25, 2024, Introduced by Senators BAYER, SHINK, CHANG, GEISS and SANTANA and
    referred to the Committee on Civil Rights, Judiciary, and Public Safety.
      A bill to provide for licensing of adult psychiatric
residential treatment facilities; to allow for psychiatric services
to be provided under a residential psychiatric program in adult
psychiatric residential treatment facilities; to establish
standards of care for adult psychiatric residential treatment
facilities; to provide for the powers and duties of certain state
departments and agencies; to prescribe certain fees; and to provide
for penalties and remedies.
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                   THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
       Sec. 1. This act may be cited as the "adult psychiatric
 residential treatment facility licensing act".
       Sec. 3. As used in this act:
       (a) "Adult" means an individual who is 18 years of age or
 older, other than an individual with a mental disability who is
 between 18 and 21 years of age.
       (b) "Adult psychiatric residential treatment facility" or
 "APRTF" means a facility operated for the primary purpose of
 providing residential psychiatric services to adults under a
 residential psychiatric program. An APRTF does not include any of
 the following:
       (i) A psychiatric hospital as that term is defined in section
 100b of the mental health code, 1974 PA 258, MCL 330.1100b, or a
 psychiatric unit as that term is defined in section 100c of the
 mental health code, 1974 PA 258, MCL 330.1100c.
       (ii) An adult foster care facility as that term is defined in
 section 3 of the adult foster care facility licensing act, 1979 PA
 218, MCL 400.703.
       (iii) A child care organization as that term is defined in
 section 1 of 1973 PA 116, MCL 722.111.
       (iv) A home for the aged, hospice facility, or nursing home
 licensed under part 213, 214, or 217 of the public health code, MCL
 333.21301 to 333.21335, 333.21401 to 333.21420, and 333.21701 to
 333.21799e.
       (v) A facility with a licensed substance use disorder program
 under part 62 of the public health code, MCL 333.6230 to 333.6251.
       (vi) A veterans' facility as that term is defined in section 2
 of the Michigan veterans' facility authority act, 2016 PA 560, MCL
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 36.102.
         (vii) A hospital as that term is defined in section 20106 of
 the public health code, MCL 333.20106.
         (c) "Community mental health services program" means that term
 as defined in section 100a of the mental health code, 1974 PA 258,
 MCL 330.1100a.
         (d) "Department" means the department of licensing and
 regulatory affairs.
         (e) "Director" means the director of the department.
         (f) "Licensed health care professional" means an individual
 licensed or registered under article 15 of the public health code,
 MCL 333.16101 to 333.18838.
         (g) "Licensee" means a person, firm, partnership, agency,
 governing body, association, corporation, or other entity that has
 been issued a license to operate an APRTF.
         (h) "Personal care services" means services including, but not
 limited to, assisting individual's with activities of daily living,
 assisting individual's with self-administration of medication in
 accordance with rules promulgated under this act, and preparing
 special diets, other than complex therapeutic diets, for
 individuals according to the instructions of a physician or a
 licensed dietitian and in accordance with rules promulgated under
 this act. Personal care services does not include skilled nursing
 care.
         (i) "Provisional license" means a license issued to a facility
 that has previously been licensed under this act but is temporarily
 unable to conform to the requirements of a regular license
 prescribed in this act or rules promulgated under this act.
         (j) "Public health code" means the public health code, 1978 PA
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 368, MCL 333.1101 to 333.25211.
        (k) "Regular license" means a license issued to an APRTF that
 is in compliance with this act and the rules promulgated under this
 act.
        (l) "Resident" means an individual residing within an APRTF.
        (m) "Residential psychiatric program" means a program that is
 provided by a public or private APRTF that offers a combination of
 residential, nutritional, supervisory, and personal care services,
 combined with mental health and psychiatric services in a
 comprehensive residential treatment setting. The program must be
 accredited by the Joint Commission on Accreditation of Healthcare
 Organizations, the Commission on Accreditation of Rehabilitation
 Facilities, or any other accrediting organization with comparable
 standards that is recognized by the department.
        (n) "Residential psychiatric services" means active
 psychiatric treatment provided in an APRTF to a resident with a
 persistent pattern of emotional, psychological, or behavioral
 dysfunction of a severity that requires 24-hour supervised care
 provided under the direction of a physician licensed under part 170
 or 175 of the public health code, MCL 333.17001 to 333.17097 and
 333.17501 to 333.17556. Residential psychiatric services must be
 individualized and designed to achieve a less restrictive level of
 care at the earliest possible time. Residential psychiatric
 services must be certified by the physician in writing to be
 necessary in the setting in which the services will be provided
 such that the services can reasonably be expected to improve the
 resident's condition or prevent further regression.
        (o) "Skilled nursing care" means providing nursing care
 services, health-related services, and social services under the
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 supervision of a licensed registered nurse or licensed advanced
 practice registered nurse on a 24-hour basis.
        (p) "Supervision" means guidance of a resident in the
 activities of daily living, including 1 or more of the following:
        (i) Reminding a resident to maintain the resident's medication
 schedule, as directed by the resident's physician.
        (ii) Reminding a resident of important activities to be carried
 out.
        (iii) Assisting a resident in keeping appointments.
        (q) "Temporary license" means a license issued to a facility
 that has not previously been licensed under this act.
        Sec. 5. (1) A person, firm, partnership, agency, governing
 body, association, corporation, or other entity shall not
 establish, maintain, or operate an adult psychiatric residential
 treatment facility unless licensed under this act. An application
 for a license must be made on forms provided and in the manner
 prescribed by the department. The application must be accompanied
 by the appropriate fee as follows:
        (a) For a temporary or renewal license, $500.00.
        (b) For an initial regular license, $500.00.
        (c) For a provisional license, $500.00.
        (2) Before issuing or renewing a license, the department shall
 investigate the activities and standards of care of the applicant
 and shall make an on-site evaluation of the facility. On-site
 inspections conducted in response to the application may be
 conducted without prior notice to the applicant.
        (3) If the department has revoked, suspended, or refused to
 renew a person's license, or denied an application for a license,
 for an APRTF according to section 13, the department may refuse to
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 issue a license to or renew a license of that applicant for a
 period of 5 years after the suspension, revocation, or nonrenewal
 of the license, or denial of the application. The department may
 refuse to issue a license to or renew the license of an applicant
 if the department determines that the applicant has a relationship
 with a former licensee whose license under this act has been
 suspended, revoked, or nonrenewed under section 13. This subsection
 applies for 5 years after the suspension, revocation, or nonrenewal
 of the former licensee's license. For purposes of this subsection,
 an applicant has a relationship with a former licensee if the
 former licensee is involved with the facility in 1 or more of the
 following ways:
       (a) Participates in the administration or operation of the
 facility.
       (b) Has a financial interest in the operation of the facility.
       (c) Provides care to residents of the facility.
       (d) Has contact with residents or staff on the premises of the
 facility.
       (e) Is employed by the facility.
       (f) Resides in the facility.
       (4) A separate license is not required under this act for a
 separate APRTF on the same campus if that facility is utilized to
 provide residential psychiatric services to adults under a
 residential psychiatric program under the same licensee.
       Sec. 7. (1) A residential psychiatric program being provided
 by an APRTF must meet 1 of the following not later than 3 years
 after its initial regular license and must satisfy all of the
 following thereafter to maintain licensure:
       (a) The standards pertaining to residential services contained
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 in the "Comprehensive Accreditation Manual for Behavioral Health
 Care" published by the Joint Commission on Accreditation of
 Healthcare Organizations.
       (b) The behavioral health standards pertaining to residential
 treatment published by the Commission on Accreditation of
 Rehabilitation Facilities.
       (c) The standards of a similar organization approved by the
 director.
       (2) Only an APRTF that is operated under direction of a
 physician licensed under part 170 or 175 of the public health code,
 MCL 333.17001 to 333.17097 and MCL 333.17501 to 333.17556, may
 administer medication to residents. An APRTF that is operated under
 the direction of an individual other than a physician licensed
 under part 170 or 175 of the public health code, MCL 333.17001 to
 333.17097 and MCL 333.17501 to 333.17556, may do any of the
 following:
       (a) Remind a resident when to take medication and watch to
 ensure that the resident follows the directions on the container.
       (b) Assist a resident in the self-administration of medication
 by taking the medication from the locked area where it is stored,
 in accordance with rules promulgated under this act, and handing it
 to the resident. If the resident is physically unable to open the
 container, a staff member may open the container for the resident.
       (c) Assist a physically impaired but mentally alert resident,
 including, but not limited to, a resident with arthritis, cerebral
 palsy, or Parkinson's disease, in removing oral or topical
 medication from a container and in consuming or applying the
 medication, upon request by or with the consent of the resident. If
 a resident is physically unable to place a dose of medicine to the
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 resident's own mouth without spilling it, a staff member may place
 the dose in a container and place the container to the mouth of the
 resident.
       (3) Nothing in this section prohibits a licensed health care
 professional from acting within the scope of that individual's
 license to administer medication at the request of a resident.
       Sec. 9. (1) The director, the director's agent, or personnel
 of another department or agency, acting at the request of the
 director, may enter upon the premises of an applicant or licensee
 at a reasonable time to make inspections, as permitted by
 applicable law, for any of the following purposes:
       (a) To determine whether the applicant or licensee is
 complying with this act and the rules promulgated under this act.
       (b) To determine whether the APRTF has completed a plan of
 correction required under subsection (2) and corrected deficiencies
 to the satisfaction of the department.
       (c) Upon complaint.
       (2) In conducting an inspection under this act, the department
 may conduct an on-site examination and evaluation of the APRTF and
 the residential psychiatric program, its personnel, activities, and
 services. The APRTF shall give the department access to examine and
 copy all records, accounts, and any other documents relating to
 operating the APRTF, including records pertaining to residents, and
 access to the APRTF and the residential psychiatric program in
 order to conduct interviews with the owner or operator, staff, and
 residents. Following each inspection and review, the department
 shall complete a report listing any deficiencies and, including,
 when appropriate, a time table within which the owner or operator
 must correct the deficiencies. The department may require the
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 licensee to submit a plan of correction describing how the
 deficiencies will be corrected.
       (3) On-site inspections may be conducted without prior notice
 to the APRTF. A health and sanitation inspection of an APRTF must
 be conducted upon the request of the department by 1 of the
 following:
       (a) Department staff.
       (b) The department of health and human services.
       (c) A local health department.
       (4) The bureau of fire services created in section 1b of the
 fire prevention code, 1941 PA 207, MCL 29.1b, or local authorities,
 in carrying out this act, may visit an APRTF more often than
 annually to advise in matters affecting health or fire protection.
 Inspections must be made as permitted by law.
       Sec. 11. (1) The department shall issue an initial regular,
 temporary, provisional, or renewal license not later than 6 months
 after the applicant files a completed application. Receipt of the
 application is considered the date the application is received by
 an agency or department of this state. If the application is
 considered incomplete by the department, the department shall
 notify the applicant in writing or make notice electronically
 available not later than 30 days after receipt of the incomplete
 application, describing the deficiency and requesting additional
 information. If the department identifies a deficiency or requires
 the fulfillment of a corrective action plan, the 6-month period is
 tolled until either of the following occurs:
       (a) Upon notification by the department of a deficiency, until
 the date the requested information is received by the department.
       (b) Upon notification by the department that a corrective
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 action plan is required, until the date the department determines
 the requirements of the corrective action plan have been met.
       (2) The determination of the completeness of an application
 does not operate as an approval of the application for the license
 and does not confer eligibility of an applicant determined
 otherwise ineligible for issuance of a license.
       (3) If the department fails to issue or deny a license within
 the time required by this section, the department shall return the
 license fee and shall reduce the license fee for the applicant's
 next renewal application, if any, by 15%. Failure to issue or deny
 a license within the time period required under this section does
 not allow the department to otherwise delay processing an
 application. The completed application must be placed in sequence
 with other completed applications received at that same time. The
 department shall not discriminate against an applicant in the
 processing of an application based on the fact that the application
 fee was refunded or discounted under this subsection.
       (4) The department may issue a full, provisional, or temporary
 license or renew a license. A full license expires 1 year after the
 date of issuance, a provisional license expires in a shorter period
 of time as specified by the department, and a temporary license
 expires 90 days after the date of issuance.
       (5) As used in this section, "completed application" means an
 application complete on its face with all requested information
 provided and answers to all questions provided and submitted with
 any applicable licensing fees as well as any other information,
 records, approval, security, or similar item required by law or
 rule from a local unit of government, a federal agency, or a