mental health evaluations; health professionals

HB2436 - 572R - I Ver

REFERENCE TITLE:
mental health evaluations; health professionals

State of Arizona

House of Representatives

Fifty-seventh Legislature

Second Regular Session

2026

HB 2436

Introduced by

Representative
Bliss

AN
ACT

Amending sections 36-501 and 36-543,
Arizona Revised Statutes; relating to mental health care.

(TEXT OF BILL BEGINS ON NEXT PAGE)

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

Section 1. Section 36-501, Arizona Revised
Statutes, is amended to read:

START_STATUTE
36-501.

Definitions

In this chapter, unless the context otherwise requires:

1. "Administration" means the Arizona
health care cost containment system administration.

2. "Admitting officer" means a
psychiatrist or other physician or psychiatric and mental health nurse
practitioner with experience in performing psychiatric examinations who has
been designated as an admitting officer of the evaluation agency by the person
in charge of the evaluation agency.

3. "Authorized transporter" means a
transportation entity that is

contracted with a city,
town or county to provide services pursuant to this chapter and that is either:

(a) An ambulance service that holds a valid
certificate of necessity.

(b) A transportation provider authorized by this
state to provide safe behavioral health transportation for individuals
requiring transportation pursuant to this chapter.

4. "Chief medical officer" means the chief
medical officer under the supervision of the superintendent of the state
hospital.

5. "Contraindicated" means that access is
reasonably likely to endanger the life or physical safety of the patient or
another person.

6. "Court" means the superior court in the
county in this state in which the patient resides or was found before screening
or emergency admission under this title.

7. "Criminal history" means police
reports, lists of prior arrests and convictions, criminal case pleadings and
court orders, including a determination that the person has been found
incompetent to stand trial pursuant to section 13-4510.

8. "Danger to others" means that the
judgment of a person who has a mental disorder is so impaired that the person
is unable to understand the person's need for treatment and as a result of the
person's mental disorder the person's continued behavior can reasonably be
expected, on the basis of competent medical opinion, to result in serious
physical harm.

9. "Danger to self":

(a) Means behavior that, as a result of a mental
disorder:

(i) Constitutes a danger of inflicting serious
physical harm on oneself, including attempted suicide or the serious threat
thereof
of attempted suicide
, if the
threat is such that, when considered in the light of its context and in light
of the individual's previous acts, it is substantially supportive of an
expectation that the threat will be carried out.

(ii) Without hospitalization will result in serious
physical harm or serious illness to the person.

(b) Does not include behavior that establishes only
the condition of having a grave disability.

10. "Department" means the department of
health services.

11. "Detention" means the taking into
custody of a patient or proposed patient.

12. "Director" means the director of the
administration.

13. "Evaluation" means:

(a) A professional multidisciplinary analysis that
may include firsthand observations or remote observations by interactive
audiovisual media and that is based on data describing the person's identity,
biography and medical, psychological and social conditions carried out by a
group of persons consisting of at least the following:

(i) Two licensed physicians who are qualified
psychiatrists, if possible, or at least experienced in psychiatric matters, who
shall examine and report their findings independently.� The person against whom
a petition has been filed shall be notified that the person may select one of
the physicians. A psychiatric resident in a training program
approved by the American medical association or by the American osteopathic
association may examine the person in place of one of the psychiatrists if the
resident is supervised in the examination and preparation of the affidavit and
testimony in court by a qualified psychiatrist appointed to assist in the
resident's training, and if the supervising psychiatrist is available for
discussion with the attorneys for all parties and for court appearance and
testimony if requested by the court or any of the attorneys.
� In
a county with a population of less than five hundred thousand persons, the
evaluation may be performed by one physician and either one physician assistant
who is experienced in psychiatric matters or one psychiatric and mental health
nurse practitioner who shall examine and report their findings independently.

(ii) Two other individuals, one of whom, if
available, is a psychologist and in any event a social worker familiar with
mental health and human services that may be available placement alternatives
appropriate for treatment. An evaluation may be conducted on an
inpatient basis, an outpatient basis or a combination of both, and every
reasonable attempt shall be made to conduct the evaluation in any language
preferred by the person.

(b) A physical examination that is consistent with
the existing standards of care and that is performed by one of the evaluating
physicians or by or under the supervision of a physician who is licensed
pursuant to title 32, chapter 13 or 17 or a registered nurse practitioner who
is licensed pursuant to title 32, chapter 15 if the results of that examination
are reviewed or augmented by one of the evaluating physicians.

14. "Evaluation
agency" means either of the following:

(a) A health care
agency that is licensed by the department and that has been approved pursuant
to this title to provide the services required of that agency by this chapter.

(b) A facility that is exempt from licensure
pursuant to section 36-402, that possesses an accreditation from either a
national commission on correctional health care or an American correctional
association and that has been approved pursuant to this title to provide the
services required of that facility by this chapter.

15. "Family member" means a spouse,
parent, adult child, adult sibling or other blood relative of a person
undergoing treatment or evaluation pursuant to this chapter.

16. "Grave disability" means a condition
evidenced by behavior in which a person, as a result of a mental disorder, is
likely to come to serious physical harm or serious illness because the person
is unable to provide for the person's own basic physical needs.

17. "Health care decision maker" has the
same meaning prescribed in section 12-2801.

18. "Health care entity" means a health
care provider, the department, the administration or a regional behavioral
health authority that is under contract with the administration.

19. "Health care provider" means a health
care institution as defined in section 36-401 that is licensed as a
behavioral health provider pursuant to department rules or a mental health
provider.

20. "Independent evaluator" means a
licensed physician, psychiatric and mental health nurse practitioner or
psychologist who is selected by the person to be evaluated or by the person's
attorney.

21. "Informed consent" means a voluntary
decision following
the
presentation of all facts
necessary to form the basis of an intelligent consent by the patient or
guardian with no minimizing of known dangers of any procedures.

22. "Least restrictive treatment
alternative" means the treatment plan and setting that infringe in the
least possible degree with the patient's right to liberty and that are
consistent with providing needed treatment in a safe and humane manner.

23. "Licensed physician" means any medical
doctor or doctor of osteopathy who is either:

(a) Licensed in this state.

(b) A full-time hospital physician licensed in
another state and serving on the staff of a hospital operated or licensed by
the United States government.

24. "Medical director of an evaluation
agency" means a psychiatrist, or other licensed physician experienced in
psychiatric matters, who is designated in writing by the governing body of the
agency as the person in charge of the medical services of the agency for the
purposes of this chapter and may include the chief medical officer of the state
hospital.

25. "Medical director of a mental health
treatment agency" means a psychiatrist, or other licensed physician
experienced in psychiatric matters, who is designated in writing by the
governing body of the agency as the person in charge of the medical services of
the agency for the purposes of this chapter and includes the chief medical
officer of the state hospital.

26. "Mental disorder" means a substantial
disorder of the person's emotional processes, thought, cognition or
memory. Mental disorder is distinguished from:

(a) Conditions that are primarily those of drug
abuse, alcoholism or intellectual disability, unless, in addition to one or
more of these conditions, the person has a mental disorder.

(b) The declining mental abilities that directly
accompany impending death.

(c) Character and
personality disorders characterized by lifelong and deeply ingrained antisocial
behavior patterns, including sexual behaviors that are abnormal and prohibited
by statute unless the behavior results from a mental disorder.

27. "Mental health provider" means any
physician or provider of mental health or behavioral health services who is
involved in evaluating, caring for, treating or rehabilitating a patient.

28. "Mental health treatment agency" means
any of the following:

(a) The state hospital.

(b) A health care agency that is licensed by the
department and that provides the services that are required of the agency by
this chapter.

(c) A facility that is exempt from licensure
pursuant to section 36-402, that possesses an accreditation from either a
national commission on correctional health care or an American correctional
association and that provides the services that are required of the facility by
this chapter.

29. "Outpatient treatment" or
"combined inpatient and outpatient treatment" means any treatment
program
that does
not
requiring

require
continuous inpatient hospitalization.

30. "Outpatient treatment plan" means a
treatment plan that does not require continuous inpatient hospitalization.

31. "Patient" means any person who is
undergoing examination, evaluation or behavioral or mental health treatment
under this chapter.

32. "Peace officers" means sheriffs of
counties, constables, marshals and policemen of cities and towns.

33. "Persistent or acute disability" means
a severe mental disorder that meets all the following criteria:

(a) Significantly impairs judgment, reason, behavior
or capacity to recognize reality.

(b) If not treated, has a substantial probability of
causing the person to suffer or continue to suffer severe and abnormal mental,
emotional or physical harm.

(c) Substantially impairs the person's capacity to
make an informed decision regarding treatment, and this impairment causes the
person to be incapable of understanding and expressing an understanding of the
advantages and disadvantages of accepting treatment and understanding and
expressing an understanding of the alternatives to the particular treatment
offered after the advantages, disadvantages and alternatives are explained to
that person.

(d) Has a reasonable prospect of being treatable by
outpatient, inpatient or combined inpatient and outpatient treatment.

34. "Prepetition screening" means the
review of each application requesting court-ordered evaluation, including
an investigation of facts alleged in the application, an interview with each
applicant and an interview, if possible, with the proposed
patient. The purpose of the interview with the proposed patient is
to assess the problem, explain the application and, when indicated, attempt to
persuade the proposed patient to receive, on a voluntary basis, evaluation or
other services.

35. "Prescribed form" means a form
established by a court or the rules of the administration in accordance with
the laws of this state.

36. "Professional" means a physician who
is licensed pursuant to title 32, chapter 13 or 17, a psychologist who is
licensed pursuant to title 32, chapter 19.1 or a psychiatric and mental health
nurse practitioner who is certified pursuant to title 32, chapter 15.

37. "Proposed patient" means a person for
whom an application for evaluation has been made or a petition for court-ordered
evaluation has been filed.

38. "Prosecuting agency" means the county
attorney, attorney general or city attorney who applied or petitioned for an
evaluation or treatment pursuant to this chapter.

39. "Psychiatric and mental health nurse
practitioner" means a registered nurse practitioner as defined in section
32-1601 who has completed an adult or family psychiatric and mental
health nurse practitioner program and who is certified as an adult or family
psychiatric and mental health nurse practitioner by the state board of nursing.

40. "Psychiatrist" means a licensed
physician who has completed three years of graduate training in psychiatry in a
program approved by the American medical association or the American osteopathic
association.

41. "Psychologist" means a person who is
licensed under title 32, chapter 19.1 and who is experienced in the practice of
clinical psychology.

42. "Records" means all communications
that are recorded in any form or medium and that relate to patient examination,
evaluation or behavioral or mental health treatment.� Records include medical
records that are prepared by a health care provider or other providers.�
Records do not include:

(a) Materials that are prepared in connection with
utilization review, peer review or quality assurance activities, including
records that a health care provider prepares pursuant to section 36-441,
36-445, 36-2402 or 36-2917.

(b) Recorded telephone and radio calls to and from a
publicly operated emergency dispatch office relating to requests for emergency
services or reports of suspected criminal activity.

43. "Regional behavioral health authority"
has the same meaning prescribed in section 36-3401.

44. "Screening agency" means a health care
agency that is licensed by the department and that provides those services
required of the agency by this chapter.

45. "Social worker" means a person who has
completed two years of graduate training in social work in a program approved
by the council of social work education and who has experience in mental
health.

46. "State hospital" means the Arizona
state hospital.

47. "Superintendent" means the
superintendent of the state hospital.

48. "Voluntary evaluation" means the
ongoing collection and analysis of a person's medical, psychological,
psychiatric and social conditions in order to initially determine if a health
disorder exists and if there is a need for behavioral health services and, on
an ongoing basis, to ensure that the person's service plan is designed to meet
the person's and the person's family's current needs and long-term goals.

END_STATUTE

Sec. 2. Section 36-543, Arizona Revised
Statutes, is amended to read:

START_STATUTE
36-543
.
Annual review; patients with a grave disability or a persistent
or acute disability; notice; court order for continued treatment; rules;
immunity

A. Within ninety days before the expiration of a
court order for treatment, the medical director of the mental health treatment
agency shall conduct an annual review of a patient who has been found to have a
grave disability or a persistent or acute disability and who is undergoing
court-ordered treatment to determine whether the continuation of court-ordered
treatment is appropriate and to assess the needs of the patient for
guardianship or conservatorship, or both. The annual review shall
consist of the mental health treatment and clinical records contained in the
patient's treatment file.� The mental health treatment agency shall keep a
record of the annual review. If the medical director
of
the mental health treatment agency
believes that a continuation of court-ordered
treatment is appropriate, the medical director of the mental health treatment
agency shall appoint one or more psychiatrists to carry out a psychiatric
examination of the patient.
In a county with a
population of less than five hundred thousand persons, if no psychiatrist or
physician who is experienced in psychiatric matters is available, the
psychiatric examination of the patient may be performed by a physician
assistant who is experienced in psychiatric matters or by a psychiatric and
mental health nurse practitioner.
In any proceeding conducted
pursuant to this section, a patient has the right to have an analysis of the
patient's mental condition by an independent evaluation pursuant to section 36-538.

B. Each examiner participating in the psychiatric
examination of the patient shall submit a report to the medical director of the
mental health treatment agency that includes the following:

1. The examiner's opinions as to whether the patient
continues to have a grave disability or a persistent or acute disability as the
result of a mental disorder and be in need of continued court-ordered
treatment. In evaluating the patient's need for continued court-ordered
treatment, the examiner must consider, along with all other evidence, the
patient's history before and during the current period of court-ordered
treatment, the patient's compliance with recommended treatment and any other
evidence relevant to the patient's ability and willingness to follow
recommended treatment with or without a court order.

2. A statement as to whether suitable alternatives
to court-ordered treatment are available.

3. A statement as to whether voluntary treatment
would be appropriate.

4. A review of the patient's status as to
guardianship or conservatorship, or both, the adequacy of existing protections
of the patient and the continued need for guardianship or conservatorship, or
both. If the examiner concludes that the patient's needs in these
areas are not being adequately met, the examiner's report shall recommend that
the court order an investigation into the patient's needs.

5. If the patient has an existing guardian who does
not have the mental health powers authorized pursuant to section 14-5312.01,
a recommendation as to whether the additional mental health powers authorized
by section 14-5312.01 should be imposed on the existing guardian and
whether the patient's needs can be adequately addressed by a guardian with
mental health powers without the need for a court order for treatment or
whether the court order for treatment should continue regardless of the
additional mental health powers imposed on the guardian.

6. The results of any physical examination conducted
during the period of court-ordered treatment if relevant to the
psychiatric condition of the patient.

C. After conducting the annual review as prescribed
in this section, if the medical director
of the mental health
treatment agency
believes that continued court-ordered treatment
is necessary or appropriate, not later than thirty days before the expiration
of the court order for treatment, the medical director
of the
mental health treatment agency
shall file with the court an application
for continued court-ordered treatment alleging the basis for the
application and shall file simultaneously with the application any psychiatric
examination conducted as part of the annual review. If the patient
is under guardianship, the medical director
of the mental health
treatment agency
shall mail a copy of the application to the patient's
guardian.

D. If an application for continued court-ordered
treatment is filed, all of the following apply:

1. If the patient does not have an attorney, the
court shall appoint an attorney to represent the patient.

2. Within ten days after appointment, an attorney
appointed pursuant to this subsection, to the extent possible, shall fulfill
the duties imposed pursuant to section 36-537, review the
medical
director's
report
of the medical director of the mental
health treatment agency
and the patient's medical records, interview any
physician who prepared a report on the annual review and file a response
requesting a hearing or submitting the matter to the court for a ruling based
on the record without a hearing.

3. If a hearing is not requested, the court shall
rule on the application or set the matter for hearing.� If a hearing is
requested, the hearing shall be held within three weeks after the request for
hearing is filed.� The hearing may be continued for good cause on motion of a
party or on the court's own motion, and the expiration of the current court
order for treatment may be extended until a ruling by the court on an
application filed pursuant to this subsection.

4. The patient's attorney must be present at all
hearings and may subpoena and cross-examine witnesses and present evidence.�
The patient has the right to attend all hearings, but may choose not to attend
a hearing.� The patient's attorney may waive the patient's presence after
speaking with the patient and confirming that the patient understands the right
to be present and does not desire to attend. If the patient is
unable to be present at the hearing for medical or psychiatric reasons and the
hearing cannot be conducted where the patient is being treated or confined, or
the patient cannot appear by another reasonably feasible means, the court shall
require clear and convincing evidence that the patient is unable to be present
at the hearing and on such a finding may proceed with the hearing in the
patient's absence.

5. The evidence presented by the applicant includes
the testimony of one or more witnesses acquainted with the patient during the
period of court-ordered treatment, which may be satisfied by a statement
agreed on by the parties, and the testimony of any physician who performed an
annual review of the patient, which may be satisfied by stipulating to the
admission of the examining physicians' written report prepared pursuant to
subsection B of this section.� The court may waive the need for the applicant
to present the testimony of witnesses acquainted with the patient as required
by this subsection, if it finds that the need for a continued court order for
treatment has been established by clear and convincing evidence from the other
testimony and evidence presented at the hearing.

6. At a hearing held pursuant to this subsection,
the court, with notice, may impose on an existing guardian additional powers
pursuant to section 14-5312.01. If the court finds that the
patient's needs can be adequately met by an existing guardian with the
additional powers pursuant to section 14-5312.01 and that a court order
for treatment is not necessary to ensure compliance with necessary treatment,
the court may terminate the court order for treatment or decline to issue an
order continuing court-ordered treatment. The court may also order
an investigation into the need for guardianship or conservatorship, or both,
and may appoint a suitable person or agency to conduct the investigation. The
appointee may include a court-appointed guardian ad litem, a court-appointed
investigator 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
after 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 conservator, or
both, and the findings and reasons for the recommendation.� If the
investigation and report so indicate, the court may authorize an appropriate person
to file a petition for appointment of a guardian or conservator for the
patient.

E. If a hearing is held pursuant to subsection D of
this section, the party seeking the renewal of the court order must prove all
of the following by clear and convincing evidence:

1. The patient continues to have a mental disorder
and, as a result of that disorder, has either a persistent or acute disability
or a grave disability.

2. The patient is in need of continued court-ordered
treatment.

3. The patient is either unwilling or unable to
accept treatment voluntarily.

F. After a hearing held pursuant to subsection D of
this section, the court may order the patient to be released from court-ordered
treatment or to undergo continued court-ordered treatment for a period not to
exceed the time periods prescribed in section 36-540, subsection D.

G. The director shall create and operate a program
to ensure that the examination and review of persons with grave disabilities or
persistent or acute disabilities under court order are carried out in an
effective and timely manner. The director shall adopt rules needed
to operate this program.

H. The medical director of the mental health
treatment agency is not civilly liable for any acts committed by the released
patient if the medical director
of the mental health treatment
agency
has in good faith complied with the requirements of this article.

END_STATUTE