Gila River Health Care Corporation
Gila River Health Care Corporation
PROVIDER MANUAL
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Arizona Department of Health Services

Division of Behavioral Health Services
PROVIDER MANUAL
Gila River Regional Behavioral Health Authority Edition


Section 3.18 Pre-Petition Screening, Court-Ordered Evaluation, and Court-Ordered Treatment

3.18.1 Introduction
3.18.2 References
3.18.3 Scope
3.18.4 Did you know…?
3.18.5 Definitions
3.18.6 Objectives
3.18.7 Procedures
3.18.7-A. Licensing Requirements
3.18.7-B. Pre-Petition Screening
3.18.7-C. Court-Ordered Evaluation
3.18.7-D. Court-Ordered Treatment
3.18.7-E. Court-Ordered Treatment for persons charged with, or convicted of, a crime

3.18.7-F. Court-Ordered Treatment for American Indian Tribal Members in Arizona

3.18.1 Introduction
This section is applicable only to behavioral health providers under contract with Gila River Behavioral Health Services, the Tribal Regional Behavioral Health Authority (TRBHA) for the Gila River Indian Community (GRIC). The following information is specific to Court-Ordered Evaluation and Court Ordered Treatment initiated within the Gila River Indian Community (GRIC). Should this process be initiated outside of the GRIC for a behavioral health recipient enrolled with Gila River Behavioral Health Services, the process to be followed is described in the ADHS/DBHS Provider Manual Template and/or the Regional Behavioral Health Authority Provider Manual specific to the geographic service area in which the client is located. For any such court order to be recognized by GRIC, it must first be accepted (domesticated) by the GRIC courts which should be facilitated through the behavioral health recipient’s assigned case manager.

In order to ensure the safety of a person (or the safety of others) due to a person’s mental disorder, it may be necessary to initiate civil commitment proceedings when that person is unable or unwilling to participate in mental health treatment. Per GRIC law, any licensed physician or behavioral health worker employed by Gila River Health Care (GRHC) may (in conjunction with legal counsel for the GRIC) petition the GRIC court for a Court Ordered Mental Health Evaluation (COE) when a person, as a result of a mental disorder, is alleged to be:

  • a danger to self (DTS);
  • a danger to others (DTO);
  • persistently or acutely disabled (PAD); or
  • gravely disabled (GD).

If the person who is the subject of a court ordered commitment proceeding is subject to the jurisdiction of an Indian tribe rather than the state, the laws of that tribe, rather than state law, will govern the commitment process. Information about the tribal court process and the procedures under state law for recognizing and enforcing a tribal court order are found in subsection 3.18.7-F.

A pre-petition screening is the responsibility of a behavioral health worker employed by the GRHC’s Behavioral Health Services (BHS). It includes an examination of the person’s mental status and/or other relevant circumstances. The findings of the pre-petition screening and triage are reviewed with a psychiatrist to determine if the person (as the result of a mental disorder) meets the criteria for DTS, DTO, PAD, or GD.

If the pre-petition screening indicates that the person may be DTS, DTO, PAD, or GD, the behavioral health worker will contact the legal counsel for the GRIC law office to notify of the need to initiate a Petition for Involuntary Mental Health Evaluation. Based on the immediate safety of the person and others, the GRIC police department will be contacted to take the person into custodial detention until an emergency hearing is held, the Petition for Involuntary Mental Health Evaluation is filed, and a bed in an evaluating hospital is secured.

If the evaluating hospital determines that the person meets the criteria for DTS, DTO, PAD or GD, and the person is not willing or is unable to agree to voluntary treatment, the counsel for the GRIC law office will file a Petition for Involuntary Mental Health Treatment. A hearing will be held and will include the person and his/her legal representative, Counsel for the Community, and all persons listed in the Community’s witness list. If, following the hearing on a Petition for Involuntary Mental Health Treatment, the GRIC judge finds clear and convincing evidence that the person (as a result of a mental disorder) is DTS, DTO, PAD, or GD, and is in need of mental health treatment which he/she is unwilling or unable to accept voluntarily, the judge will order the person to undergo one or more of the following:

(a) treatment in an outpatient mental health program, including following an outpatient treatment plan.
(b) treatment in an inpatient mental health program.
(c) treatment consisting of combined inpatient and outpatient mental health modalities.

The maximum periods of combined inpatient and/or outpatient treatment that a GRIC judge can order are as follows:

  • DTS may be ordered up to 90 inpatient days per year;
  • DTO and PAD may be ordered up to 180 inpatient days per year; and:
  • GD may be ordered up to 365 inpatient days per year.

At every stage of the pre-petition screening, court-ordered evaluation, and court-ordered treatment process, a person will be provided an opportunity to change his/her status to voluntary. Under voluntary status, the person is no longer considered to be at risk for DTS/DTO and agrees in writing to receive a voluntary evaluation.

A Petition for Involuntary Mental Health Evaluation must utilize the following Petition for Involuntary Mental Health Evaluation document.

 In addition to court ordered treatment as a result of civil action, an individual may be ordered by a court for evaluation and/or treatment upon: 1) conviction of a domestic violence offense; or 2) upon being charged with a crime when it is determined that the individual is court ordered to treatment, or programs, as a result of being charged with a crime and appears to be an “alcoholic.” RBHAs and RBHA providers responsibilities for the provision and coverage of those services, is described in subsection 3.18.7-E.

The intent of this section is to provide a broad overview of the pre-petition screening, court-ordered evaluation, and court-ordered treatment process as outlined in GRIC Ordinance GR-04-08.

3.18.2 Reference
The following citations can serve as additional resources for this content area:

GRIC ORDINANCE GR-04-08
GRIC BHS Policy and Procedure for Pre-screening
ADHS/DBHS Provider Manual Template
A.R.S. 12-136
A.R.S. 13-3601.01
A.R.S. Title 14, Chapter 5
A.R.S. Title 36, Chapter 5
A.R.S. 36-2005

A.R.S. 36-2027
A.A.C. R9-20-802
A.A.C. R9-20-803
9 A.A.C. 21, Article 5
AHCCCS Contractor Operations Manual, Policy 423
ADHS/RBHA Contracts
Section 3.4, Co-payments
Section 3.9, Assessment and Service Planning
Section 3.10, SMI Eligibility Determination
Section 3.11, General and Informed Consent to Treatment
Section 3.17, Transition of Persons
Section 3.21, Service Package for Non-Title XIX/XXI Persons Determined to Have a Serious Mental Illness (SMI)

Section 4.2, Behavioral Health Medical Record Standards
TAD 5, Information Sharing with Family Members of Adult Behavioral Health

ADHS/DBHS Tribal Court Procedures for Involuntary Commitment webpage

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3.18.3 Scope
To whom does this apply?

Any person who is eighteen (18) years of age or older, who is a member of an Indian tribe or is eligible for membership in an Indian tribe, band, group, pueblo or community recognized by the Secretary of the Interior, or who is an Alaska Native and a member of a regional Corporation (as defined in section 7 of the Alaska Native Claims Settlement Act). The behavior or acts that are described as DTS, DTO, PAD, or GD must occur within the boundaries of the GRIC and are therefore under the jurisdiction of the GRIC court.

3.18.4 Did you know?

  • Arizona law provides for the recognition and enforcement or “domestication” of tribal court orders for involuntary commitment to treatment, including admission to the Arizona State Hospital (AZSH) for American Indians residing on tribal reservations. The Arizona statute (see A.R.S. 12-136) is necessary, as Tribal governments are sovereign and have sole jurisdiction over Tribal members on reservations. Legal, jurisdictional, and continuity of care issues exist related to the coordination of tribal and state courts ordering treatment for American Indians.
  • American Indians living off of or experiencing a crisis off of the Tribal reservation are subject to county jurisdiction and can be court ordered under state law (see A.R.S. Title 36, Chapter 5).
  • Arizona Health Care Cost Containment System/ Arizona Long Term Care Services (AHCCCS/ALTCS) program contractors are responsible for providing and funding services under court-ordered treatment of elderly and physically disabled (EPD) ALTCS-enrolled persons.
  • A person found to be GD who is undergoing court-ordered treatment will receive an annual examination and review to determine whether the continuation of court-ordered treatment is appropriate.
  • Outside of GRIC, Arizona Counties are responsible for managing, providing, and paying for pre- petition screening and court-ordered evaluations and are required to coordinate provision of behavioral health services with the Arizona Department of Health Services/Division of Behavioral Health Services (ADHS/DBHS) system. Some counties contract with RBHAs to process pre-petition screenings and petitions for court-ordered evaluations.

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3.18.5 Definitions
American Indian Tribal Member

Court Ordered Evaluation (COE)

Danger to Self (DTS)

Danger to Others (DTO)

Domestication or Recognition of Tribal Court Order

Gravely Disabled (GD)

Mental Disorder

Persistently or Acutely Disabled (PAD)

Pre-Petition Screening

Tribal sovereignty in the United States

3.18.6 Objectives
To inform behavioral health providers of the pre-petition screening, court-ordered evaluation, and court-ordered treatment processes (as outlined by the GRIC Ordinance GR-04-08) for persons who (as a result of a mental disorder) may be DTS, DTO, PAD, or GD and who are unwilling or unable to seek behavioral health treatment.

3.18.7 Procedures

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3.18.7-A. Licensing Requirements
Behavioral health providers who are licensed by the Arizona Department of Health Services/Division of Assurance and Licensing Services/Office of Behavioral Licensing (OBHL) as a court-ordered evaluation or court-ordered treatment agency must adhere to OBHL requirements.

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3.18.7-B: Pre-Petition Screening
The pre-petition screening includes an examination of the person’s mental status and/or other relevant circumstances by a behavioral health worker. The findings of the pre-petition screening examination are discussed with a BHS Psychiatrist to determine whether the person (as a result of a mental disorder) is DTS, DTO, PAD, or GD and in need of immediate mental health treatment. If it is determined there is a need to file a Petition for Involuntary Mental Health Examination, the behavioral health worker will:

  • Contact the legal counsel for the GRIC law office to notify of the need to initiate a Petition for Involuntary Mental Health Evaluation, and:
  • Complete the Petition for Involuntary Mental Health Evaluation.

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3.18.7-C: Court-Ordered Evaluation (COE)
When a COE is recommended by the court, the behavioral health professional will contact psychiatric hospitals contracting with Gila River Health Care and BHS to secure a hospital bed.

Once a hospital bed is secured, the person will be transported to the evaluating hospital by the GRIC Department of Supervision and Rehabilitation (DRS) staff.

The COE will be forwarded to the GRIC law office within 72 hours (excluding weekends and holidays) of the person’s placement at the evaluating hospital.

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3.18.7-D Court-Ordered Treatment (COT)
If the evaluating hospital recommends COT, counsel from the GRIC law office will file a Petition for Involuntary Mental Health treatment within 72 hours (excluding weekends and holidays) of receiving the COE.

A hearing for Involuntary Mental Health Treatment will be held within 72 hours (excluding weekends and holidays) of the filing of the petition for Involuntary Mental Health Treatment.

In the case of persons who are Title XIX/XXI eligible and/or determined to have a Serious Mental Illness (SMI) who are referred for court-ordered treatment, the TRBHA must:

Transfer from one behavioral health provider to another:

  • A person ordered by the court to undergo treatment can be transferred from one behavioral health provider to another behavioral health provider if:
    • the person does not have a court appointed guardian; and: the medical director of the receiving behavioral health provider accepts the transfer; and:
    • the consent of the court is obtained as necessary for the transfer to occur (see Section 3.17, Transition of Persons, for more details).

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3.18.7-E. Court-Ordered Treatment for persons charged with, or convicted of, a crime
T/RBHAs or T/RBHA providers may be responsible for providing evaluation and/or treatment services when an individual has been ordered by a court due to: 1) conviction of a domestic violence offense; or 2) upon being charged with a crime when it is determined that the individual is court ordered to treatment, or programs, as a result of being charged with a crime and appears to be an “alcoholic.”

Domestic Violence Offender Treatment

Domestic violence offender treatment may be ordered by a court when an individual is convicted of a misdemeanor domestic violence offense. Although the order may indicate that the domestic violence (DV) offender treatment is the financial responsibility of the offender under A.R.S. 13-3601.01, the T/RBHA will cover DV services with Title XIX/XXI funds when the person is Title XIX/XXI eligible, the service is medically necessary, required prior authorization is obtained if necessary, and/or the service is provided by an in-network provider. Additionally, T/RBHAs will cover DV services for Non-Title XIX/XXI eligible persons determined to have SMI who pay premiums for behavioral health coverage in accordance with requirements in PM Section 3.4, Premiums and Co-payments. For Non-TXIX/XXI eligible persons court ordered for DV treatment, the individual can be billed for the DV services.

Court ordered substance abuse evaluation and treatment

Substance abuse evaluation and/or treatment (i.e., DUI services) ordered by a court under A.R.S. 36-2027 is the financial responsibility of the county, city, town or charter city whose court issued the order for evaluation and/or treatment. Accordingly, if ADHS/DBHS or a T/RBHA receives a claim for such services, the claim will be denied with instructions to the provider to bill the responsible county, city or town.

3.18.7-F. Court-Ordered Treatment for American Indian Tribal Members in Arizona
Arizona tribes are sovereign nations, and tribal courts have jurisdiction over their members residing on reservation. Tribal court jurisdiction, however, does not extend to tribal members residing off the reservation or to state court ordered evaluation or treatment ordered because of a behavioral health crisis occurring off reservation.

Although some Arizona tribes have adopted procedures in their tribal codes, which are similar to Arizona law for court ordered evaluation and treatment, each tribe has its own laws which must be followed for the tribal court process. Tribal court ordered treatment for American Indian tribal members in Arizona is initiated by tribal behavioral health staff, the tribal prosecutor or other person authorized under tribal laws. In accordance with tribal codes, tribal members who may be a danger to themselves or others and in need of treatment due to a mental health disorder are evaluated and recommendations are provided to the tribal judge for a determination of whether court ordered treatment is necessary. Tribal court orders specify the type of treatment needed.

Additional information on the history of the tribal court process, legal documents and forms as well as contact information for the tribes, T/RBHA liaisons, and tribal court representatives can be found on the ADHS/DBHS web page titled, Tribal Court Procedures for Involuntary Commitment - Information Center.

The process specific to Gila River is described throughout this Provider Manual section.

Since many tribes do not have treatment facilities on reservation to provide the treatment ordered by the tribal court, tribes may need to secure treatment off reservation for tribal members. To secure court ordered treatment off reservation, the court order must be “recognized” or transferred to the jurisdiction of the state.

The process for establishing a tribal court order for treatment under the jurisdiction of the state is a process of recognition, or “domestication” of the tribal court order (see A.R.S. 12-136). Once this process occurs, the state recognized tribal court order is enforceable off reservation. The state recognition process is not a rehearing of the facts or findings of the tribal court. Treatment facilities, including the Arizona State Hospital, must provide treatment, as identified by the tribe and recognized by the state. Attachment 3.18.1, A.R.S. 12-136 Domestication or Recognition of Tribal Court Order is a flow chart demonstrating the communication between tribal and state entities.

Regional Behavioral Health Authorities and RBHA providers must comply with state recognized tribal court orders for Title XIX/XXI and Non-Title XIX SMI persons. When tribal providers are also involved in the care and treatment of court ordered tribal members, RBHAs and RBHA providers must involve tribal providers to ensure the coordination and continuity of care of the members for the duration of court ordered treatment and when members are transitioned to services on the reservation, as applicable. RBHAs are encouraged to enter into agreements with tribes to address behavioral health needs and improve the coordination of care for tribal members.

This process must run concurrently with the tribal staff’s initiation of the tribal court ordered process in an effort to communicate and ensure clinical coordination with the appropriate RBHA. This clinical communication and coordination with the RBHA is necessary to assure continuity of care and to avoid delays in admission to an appropriate facility for treatment upon state/county court recognition of the tribal court order. The Arizona State Hospital should be the last placement alternative considered and used in this process.

A.R.S. 36-540(B) states, “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.” RBHAs are expected to partner with American Indian tribes and tribal courts in their geographic service areas to collaborate in finding appropriate treatment settings for American Indians in need of behavioral health services.

Due to the options American Indians have regarding their health care, including behavioral health services, payment of behavioral health services for AHCCCS eligible American Indians may be covered through a TRBHA, RBHA or IHS/638 provider (see Behavioral Health Services Payment Responsibilities on the ADHS/DBHS Tribal Court Procedures for Involuntary Commitment web page for a diagram of these different payment structures).

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3.18 Pre-Petition COE/COT
Last Revised: 03/28/2011
Effective Date: 04/01/2011

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