Senate committee advances four-bill assisted outpatient treatment package; hospital groups warn of ED boarding problems

The Senate Committee on Health Policy on March 19, 2025, voted unanimously to report four bills (Senate Bills 219, 220, 221 and 222) intended to expand assisted outpatient treatment and related procedures for people with serious mental illness, and heard presentations from the Michigan Health & Hospital Association and Pine Rest about long emergency-department waits for behavioral-health patients.

The package would broaden who may testify about a person’s need for assisted outpatient treatment (AOT), expand mediation options, allow AOT as an alternative for some misdemeanor competency cases, and permit family petitions to extend AOT orders, proponents said.

Supporters told the committee the changes are intended to allow earlier community-based intervention and reduce unnecessary hospitalizations. At the same hearing, hospital and behavioral-health providers described prolonged ED “boarding” for patients, particularly Medicaid beneficiaries, and urged changes to the pre-admission screening process that governs transfers into inpatient psychiatric care.

Judge Milton Mack, a retired probate judge who serves as chair of the governor’s mental health diversion council, told the committee he has conducted thousands of mental-health hearings and said Michigan’s Mental Health Code historically required waiting for crisis before intervening. "We have a shortage of hospital beds in Michigan, and this leads to short hospital stays. And short hospital stays are inadequate to lead to recovery," Judge Milton Mack said. He described the bills as intended to "build on that success and remove barriers in order to maximize the use of assisted outpatient treatment as an alternative to hospitalization." Mack said one statutory barrier is that a psychiatrist must currently testify as to the need for AOT, and he cited less than 5% of current petitions being for AOT only.

Marianne Hough of the Mental Health Association in Michigan said early intervention can prevent incarceration and chronic hospitalization. "AOT is a great tool and I just really wanted to provide support for that," she said, adding that mediation between families, providers and patients can reduce the need for court petitions.

The committee also received a data-driven presentation from Lauren Lapine, senior director of legislative and public policy at the Michigan Health & Hospital Association. Lapine said MHA tracked hospital emergency-department data and found that "on any given day there are over 155 patients that are waiting in emergency departments across the state for access to critical behavioral health services." She told the committee hospitals reported roughly 1.2 million emergency-room visits in the prior year where behavioral health was a reason for care and that Medicaid patients comprised the largest group waiting in EDs; MHA reported more than 8,000 Medicaid patients boarded in EDs over a calendar year compared with about 5,000 commercially insured patients.

Kyle Hoffmaster, director of patient access at Pine Rest Christian Mental Health Services, described repeated cases where Pine Rest had an available bed but a required Community Mental Health (CMH) pre-admission screening assessment or psychiatrist conference delayed transfer. "Pine Rest has services available, but our public behavioral health system is not set up in a way that benefits patients. It is structured entirely based on payment, not on patient care," Hoffmaster said. He described instances in which CMHs required patients to go to an emergency department for assessments that could have been completed at Pine Rest, adding that Pine Rest has "almost 200 inpatient beds" and serves patients statewide.

Committee members questioned whether the CMH pre-admission screening standard — which Lapine said requires a CMH to complete screening for Medicaid patients within three hours — is being met and noted variation among counties and CMHs. Lapine and Hoffmaster said the 3-hour clock is inconsistently applied and that hospitals report weekend delays: "An emergency department is open 24/7. Someone will come into the emergency department and the hospital will call the CMH on a Friday at 4:50 p.m. and they don't get a phone call back until Monday at 8 a.m.," Lapine said.

After testimony, the committee voted to report each bill to the Senate floor with recommendation that the bills pass. Each motion passed by recorded votes of 10 yeas and 0 nays.

Votes at a glance

- Senate Bill 219 (expand who may testify for AOT; psychiatrist still supervises treatment plan): Motion to report carried on a 10-0 roll call. Moved by Senator Santana; recorded yeas: Chairman Hertel; Senator Santana; Senator Bueno; Senator Cherry; Senator Kleinfeld; Senator Geiss; Senator Weber; Senator Haack; Senator Huizenga; Senator Runstead.

- Senate Bill 220 (expand use of mediation for treatment disputes): Motion to report carried on a 10-0 roll call. Moved by Senator Bueno; recorded yeas: Chairman Hertel; Senator Santana; Senator Bueno; Senator Cherry; Senator Kleinfeld; Senator Geiss; Senator Weber; Senator Haack; Senator Huizenga; Senator Runstead.

- Senate Bill 221 (use of AOT as an alternative to forensic center for some misdemeanor competency cases): Motion to report carried on a 10-0 roll call. Moved by Senator Cherry; recorded yeas: Chairman Hertel; Senator Santana; Senator Bueno; Senator Cherry; Senator Kleinfeld; Senator Geiss; Senator Weber; Senator Haack; Senator Huizenga; Senator Runstead.

- Senate Bill 222 (permit family petitions to extend AOT orders): Motion to report carried on a 10-0 roll call. Moved by Senator Kleinfeld; recorded yeas: Chairman Hertel; Senator Santana; Senator Bueno; Senator Cherry; Senator Kleinfeld; Senator Geiss; Senator Weber; Senator Haack; Senator Huizenga; Senator Runstead.

What the committee did and what remains

The committee voted to report the bills to the full Senate with a recommendation that they pass. Committee members and witnesses identified two parallel issues: statutory changes to expand and streamline AOT and operational problems in the state’s public behavioral-health system that contribute to lengthy ED boarding, especially for Medicaid patients. Proponents asked the Legislature to consider both statutory fixes and operational reforms (including clearer expectations for CMH response times and allowing clinically qualified hospital staff to perform pre-admission screenings when CMHs cannot meet the three-hour standard).

The hearing record includes supportive statements from the Michigan Health & Hospital Association, Pine Rest, Disability Rights Michigan, the Michigan Health and Hospital Association’s member hospitals, the Mental Health Association in Michigan, and the Community Mental Health Association of Michigan. The committee adjourned following the votes and presentation.