An Act To Increase the Availability of Mental Health Services
Maine Legislature, Session 127, LD 1577
Committee Amendment CA_A_H636 (House)
Amends: 15 MRSA §101-D, 15 MRSA §103

COMMITTEE AMENDMENT "~" to H.P. 1070, L.D. 1577, Bill, "An Act To 
Increase the Availability of Mental Health Services" 
Amend the bill by striking out everything after the enacting clause and before the 
summary and inserting the following: 
'Sec. 1. 15 MRSA §101-D, sub-§5, ,A, as amended by PL 2013, c. 434, §1 and 
affected by § 15, is further amended to read: 
A. Commit the defendant to the custody of the Commissioner of Health and Human 
Services for placement in an appropriate program for observation, care and treatment 
of people with mental illness or persons with intellectual disabilities or autism. An 
appropriate program may be in an institution for the care and treatment of people 
with mental illness, an intermediate care facility for persons who have intellectual 
disabilities or autism, a crisis stabilization unit, a nursing home, a residential care 
facility, an assisted living facility, a hospice, a hospital, an intensive outpatient 
treatment program or any program specifically approved by the court. 
The 
Commissioner of Health and Human Services shall place the defendant in a state 
mental health institute if a suitable bed is available. If a suitable bed is not available 
in a state mental health institute, the Commissioner of Health and Human Services 
shall place the defendant at an in-state facility that at the time of placement possesses 
accreditation by a nationally recognized health care organization accrediting body 
whose standards for accreditation meet or exceed the requirements for a health care 
facility to be eligible to receive payment from the Medicare or Medicaid program if a 
suitable bed is available. If a suitable bed is not available in a state mental health 
institute or at an in-state facility that possesses accreditation by a nationally 
recognized health care organization accrediting body whose standards for 
accreditation meet or exceed the requirements for a health care facility to be eligible 
to receive payment from the Medicare or Medicaid program, the Commissioner of 
Health and Human Services shall place the defendant at an out-of-state facility that at 
the time of placement possesses accreditation by a nationally recognized health care 
organization accrediting body whose standards for accreditation meet or exceed the 
requirements for a health care facility to be eligible to receive payment from the 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT" /+'to H.P. 1070,L.D.1577 
Medicare or Medicaid program. At the end of 30 days or sooner, and again~ in the 
event of recommitment, at the end of 60 days and 180 days, the State Forensic 
Service or other appropriate office of the Department of Health and Human Services 
shall forward a report to the Commissioner of Health and Human Services relative to 
the defendant's competence to stand trial and its reasons. The Commissioner of 
Health and Human Services shall without delay file the report with the court having 
jurisdiction of the case. The court shall hold a hearing on the question of the 
defendant's competence to stand trial and receive all relevant testimony bearing on 
the question. 
If the State Forensic Service's report or the report of another 
appropriate office of the Department of Health and Human Services to the court 
states that the defendant is either now competent or not restorable, the court shall 
within 30 days hold a hearing. If the court determines that the defendant is not 
competent to stand trial, but there does exist a substantial probability that the 
defendant will be competent to stand trial in the foreseeable future, the court shall 
recommit the defendant to the custody of the Commissioner of Health and Human 
Services for placement in an appropriate program for observation, care and treatment 
of people with mental illness or persons with intellectual disabilities or autism. An 
appropriate program may be in an institution for the care and treatment of people 
with mental illness, an intermediate care facility for persons who have intellectual 
disabilities or autism, a crisis stabilization unit, a nursing home, a residential care 
facility, an assisted living facility, a hospice, a hospital, an intensive outpatient 
treatment program or any program specifically approved by the court. 
The 
Commissioner of Health and Human Services shall place the defendant in a state 
mental health institute if a suitable bed is available. If a suitable bed is not available 
in a state mental health institute, the Commissioner of Health and Human Services 
shall place the defendant at an in-state facility that at the time of placement possesses 
accreditation by a nationally recognized health care organization accrediting body 
whose standards for accreditation meet or exceed the requirements for a health care 
facility to be eligible to receive payment from the Medicare or Medicaid program if a 
suitable bed is available. If a suitable bed is not available in a state mental health 
institute or at an in-state facility that possesses accreditation by a nationally 
recognized health care organization accrediting body whose standards for 
accreditation meet or exceed the requirements for a health care facility to be eligible 
to receive payment from the Medicare or Medicaid program, the Commissioner of 
Health and Human Services shall place the defendant at an out-of-state facility that at 
the time of placement possesses accreditation by a nationally recognized health care 
organization accrediting body whose standards for accreditation meet or exceed the 
requirements for a health care facility to be eligible to receive payment from the 
Medicare or Medicaid program. When a person who has been evaluated on behalf of 
the court by the State Forensic Service or other appropriate office of the Department 
of Health and Human Services is committed into the custody of the Commissioner of 
Health and Human Services under this paragraph, the court shall order that the State 
Forensic Service or other appropriate office of the Department of Health and Human 
Services share any information that it has collected or generated with respect to the 
person with the institution or residential program in which the person is placed. If the 
defendant is charged with an offense under Title 17-A, chapter 9, 11 or 13 or Title 
17-A, section 506-A, 802 or 803-A and the court determines that the defendant is not 
competent to stand trial and there does not exist a substantial probability that the 
COMMITTEE AMENDMENT 
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COMMITIEEAMENDMENT"A"toH.P.1070,L.D.1577 
defendant can be competent in the foreseeable future, the court shall dismiss all 
charges against the defendant and, unless the defendant is subject to an undischarged 
term of imprisonment, order the Commissioner of Health and Human Services to 
commence proceedings pursuant to Title 34-B, chapter 3, subchapter 4. If the 
defendant is charged with an offense other than an offense under Title 17 -A, chapter 
9, 11 or 13 or Title 17-A, section 506-A, 802 or 803-A and the court determines that 
the defendant is not competent to stand trial and there does not exist a substantial 
probability that the defendant can be competent in the foreseeable future, the court 
shall dismiss all charges against the defendant and, unless the defendant is subject to 
an undischarged term of imprisonment, notify the appropriate authorities~ who may 
institute civil commitment proceedings for the individual. If the defendant is subject 
to an undischarged term of imprisonment, the court shall order the defendant into 
execution of that sentence and the correctional facility to which the defendant must 
be transported shall execute the court's order; or 
Sec. 2. 15 MRSA §103, as amended by PL 2013, c. 424, Pt. B, §3, is further 
amended to read: 
§103. Commitment following acceptance of negotiated insanity plea or following 
verdict or finding of insanity 
When a court accepts a negotiated plea of not criminally responsible by reason of 
insanity or when a defendant is found not criminally responsible by reason of insanity by 
jury verdict or court finding, the judgment must so state. In those cases the court shall 
order the person committed to the custody of the Commissioner of Health and Human 
Services to be placed in an appropriate institution for the care and treatment of persons 
with mental illness or in an appropriate residential program that provides care and 
treatment for persons who have intellectual disabilities or autism for care and treatment. 
The Commissioner of Health and Human Services shall place the person in a state mental 
health institute if a suitable bed is available. If a suitable bed is not available in a state 
mental health institute, the Commissioner of Health and Human Services shall place the 
person at an in-state facility that at the time of placement possesses accreditation by a 
nationally recognized health care organization accrediting body whose standards for 
accreditation meet or exceed the requirements for a health care facility to be eligible to 
receive payment from the Medicare or Medicaid program if a suitable bed is available. If 
a suitable bed is not available in a state mental health institute or at an in-state facility that 
possesses accreditation by a nationally recognized health care organization accrediting 
body whose standards for accreditation meet or exceed the requirements for a health care 
facility to be eligible to receive payment from the Medicare or Medicaid program, the 
Commissioner of Health and Human Services shall place the person at an out-of-state 
facility that at the time of placement possesses accreditation by a nationally recognized 
health care organization accrediting body whose standards for accreditation meet or 
exceed the requirements for a health care facility to be eligible to receive payment from 
the Medicare or Medicaid program. Upon placement in the appropriate institution or 
residential program and in the event of transfer from one institution or residential 
program to another of persons committed under this section, notice of the placement or 
transfer must be given by the commissioner to the committing court. 
COMMITTEE AMENDMENT 
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COMMITIEE AM.ENDMENT'A"to H.P. 1070, L.D.1577 
When a person who has been evaluated on behalf of a court by the State Forensic 
Service is committed into the custody of the Commissioner of Health and Human 
Services pursuant to this section, the court shall order that the State Forensic Service 
share any information it has collected or generated with respect to the person with the 
institution or residential program in which the person is placed. 
As used in this section, "not criminally responsible by reason of insanity" has the 
same meaning as in Title 17-A, section 39 and includes any comparable plea, finding or 
verdict in this State under former section 102; under a former version of Title 17 -A, 
section 39; under former Title 17-A, section 58; or under former seotioa 17 B, chapter 
149. section 17-B of the Revised Statutes of 1954. 
Sec. 3. Facility development. By December 31, 2016, the Department of Health 
and Human Services shall develop a facility separate from the Riverview Psychiatric 
Center that will provide the least restrictive setting possible for forensic patients in the 
custody of the Commissioner of Health and Human Services and for whom the 
Department of Health and Human Services has verified a hospital level of care is no 
longer needed. 
Sec. 4. Report. By August 1, 2016, and at least every 90 days thereafter, the 
Department of Health and Human Services shall submit a written report to the joint 
standing committee of the Legislature having jurisdiction over matters concerning the 
State's psychiatric hospitals that includes the following information: 
1. The status of any forensic patients who have been placed by the Commissioner of 
Health and Human Services at an in-state facility accredited by a nationally recognized 
health care organization accrediting body whose standards for accreditation meet or 
exceed the requirements for a health care facility to be eligible to receive payment from 
the Medicare or Medicaid program or an out-of-state facility accredited by a nationally 
recognized health care organization accrediting body whose standards for accreditation 
meet or exceed the requirements for a health care facility to be eligible to receive 
payment from the Medicare or Medicaid program pursuant to the Maine Revised Statutes, 
Title 15, section 101-D and section 103, including, to the extent permitted by state and 
federal laws, the names of any patients and the location, timeline and reason for their 
placement; 
2. The status of the Department of Health and Human Services' development of a 
unit separate from the Riverview Psychiatric Center that will provide the least restrictive 
setting possible for forensic patients in the custody of the Commissioner of Health and 
Human Services who no longer need a hospital level of care; 
3. The status of staffing levels at Riverview Psychiatric Center including data about 
any vacancies among the direct care staff positions and licensed professional positions, 
information about any recent hiring that has occurred or efforts that have been made to 
fill any vacancies and information about any recent training provided to current or newly 
hired staff members; and 
4. Any recommendations, including proposed statutory changes, that the Department 
of Health and Human Services determines to be necessary regarding the placement of 
individuals in the custody of the Commissioner of Health and Human Services pursuant 
to the Maine Revised Statutes, Title 15, section 101-D and section 103, the use of the 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A" to H.P. 1070, L.D. 1577 
required new facility that is separate from the Riverview Psychiatric Center for forensic 
patients in the custody of the Commissioner of Health and Human Services who no 
longer need a hospital level of care and the staffing situation at Riverview Psychiatric 
Center.' 
SUMMARY 
This amendment, which is the majority report of the committee, strikes the language 
in the bill and replaces it with the following provisions. 
1. For individuals in the custody of the Commissioner of Health and Human Services 
pursuant to the Maine Revised Statutes, Title 15, section 101-D and section 103, 
placements must be made in the following priority: 
A. In the State at a state-owned hospital; 
B. In the State at another facility accredited by a nationally recognized health care 
organization accrediting body whose standards for accreditation meet or exceed the 
requirements for a health care facility to be eligible to receive payment from the 
Medicare or Medicaid program; 
C. Outside the State at a facility accredited by a nationally recognized health care 
organization accrediting body whose standards for accreditation meet or exceed the 
requirements for a health care facility to be eligible to receive payment from the 
Medicare or Medicaid program. 
2. By December 31, 2016, the Department of Health and Human Services is required 
to develop a facility separate from the Riverview Psychiatric Center that will provide the 
least restrictive setting possible for forensic patients in the custody of the Commissioner 
of Health and Human Services and for whom the Department of Health and Human 
Services has verified a hospital level of care is no longer needed. 
3. By August 1, 2016, and at least every 90 days thereafter, the Department of Health 
and Human Services is required to submit a written report to the joint standing committee 
of the Legislature having jurisdiction over matters concerning the State's psychiatric 
hospitals that includes the following information: 
A. The status of any forensic patients who have been placed by the Commissioner of 
Health and Human Services at an in-state facility accredited by a nationally 
recognized health care organization accrediting body whose standards for 
accreditation meet or exceed the requirements for a health care facility to be eligible 
to receive payment from the Medicare or Medicaid program or an out-of-state facility 
accredited by a nationally recognized health care organization accrediting body 
whose standards for accreditation meet or exceed the requirements for a health care 
facility to be eligible to receive payment from the Medicare or Medicaid program 
pursuant to Title 15, section 101-D and section 103, including, as permitted by law, 
the names of any patients and the location, timeline and reason for their placement; 
B. The status of the Department of Health and Human Services' development of a 
unit separate from the Riverview Psychiatric Center that will provide the least 
restrictive setting possible for forensic patients in the custody of the Commissioner of 
Health and Human Services who no longer need a hospital level of care; 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A" to H.P. 1070, L.D. 1577 
C. The status of staffing levels at Riverview Psychiatric Center, including data about 
any vacancies among the direct care staff positions and licensed professional 
positions, information about any recent hiring that has occurred or efforts that have 
been made to fill any vacancies and information about any recent training provided to 
current or newly hired staff members; and 
D. Any recommendations, including proposed statutory changes, that the Department 
of Health and Human Services determines to be necessary regarding the placement of 
individuals in the custody of the Commissioner of Health and Human Services 
pursuant to Title 15, section 101-D and section 103, the use of the required new 
facility that is separate from the Riverview Psychiatric Center for forensic patients in 
the custody of the Commissioner of Health and Human Services who no longer need 
a hospital level of care and the staffing situation at Riverview Psychiatric Center. 
FISCAL NOTE REQUIRED 
(SeeaUMWl 
COMMITTEE AMENDMENT 
Fiscal Detail and Notes 
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Approved: 04/01/16 
;t¥"ac:. 
LD 1577 
LR 2589(02) 
An Act To Increase the Availability of Mental Health Services 
Fiscal Note for Bill as Amended by Committee Amendment•#}' (Jf-h 3U,) 
Committee: Health and Human Services 
Fiscal Note Required: Yes 
Fiscal Note 
Current biennium cost increase - General Fund 
Current biennium cost increase - Other Special Revenue Funds 
Current biennium revenue increase - Other Special Revenue Funds 
This bill requires the Department of Health and Human Services (DHHS) to create priorities for placement of certain 
individuals in the custody of the Commissioner of Health and Human Services. The bill also requires that the DHHS, 
by December 31, 2016, shall develop a facility separate from the Riverview Psychiatric Center that will provide the 
least restrictive setting possible for forensic patients in the custody of the Commissioner of Health and Human 
Services and for whom the DHHS verified a hospital level of care is no longer needed. For comparison, the DHHS 
currently has a contract with an out of state provider to provide this service to similar individuals at a cost of $494 per 
bed per day. It is not known at this time how many total beds would be needed, what staffing levels would be or when 
it is feasible to assume this unit would be created. Some federal money may be available to offset some of the staffing 
costs of a new facility. Construction of a facility would be a cost of the General Fund. No estimate of the increased 
cost can be made at this time. 
This bill also requires the DHHS, by August 1, 2016 and at least every ninety days thereafter, to submit a written 
report to the joint standing committee of the Legislature having jurisdiction over the State's psychiatric hospitals. Any 
additional costs to the DHHS to fulfill these reporting requirements are expected to be minor and can be absorbed 
within existing budgeted resources. 
LR2589(02) - Fiscal Note - Page 1 of 1