1. A. The health plan shall perform, either directly or by contract, all treatment required by A.R.S. Title 36, Chapter 5, Article 5 and this Article. In order to perform these functions, the health plan or its contractor must be licensed by the Department of Health Services.

2. B. A mental health agency may provide court-ordered treatment pursuant to A.R.S. Title 36, Chapter 5, Article 5, other than through contract with the health plan, provided that:

   1. 1. The mental health agency is licensed by the Department to provide the court-ordered treatment;
   2. 2. The mental health agency complies with all applicable requirements under A.R.S. Title 36, Chapter 5, Article 5; and
   3. 3. The individual ordered to undergo treatment is not a client of the health plan.

3. C. Upon a determination that an individual is a danger to self or others, gravely disabled, or persistently or acutely disabled, and if no alternatives to court-ordered treatment exist, the medical director of the agency that provided the court-ordered evaluation shall file the appropriate affidavits on AHCCCS form MH-112, set forth in Exhibit E, with the court, together with one of the following petitions:

   1. 1. A petition for court-ordered treatment for an individual alleged to be gravely disabled, which shall be filed on AHCCCS form MH-110, set forth in Exhibit F.
   2. 2. A petition for court-ordered treatment for an individual alleged to be a danger to self or others, which shall be filed on AHCCCS form MH-110, set forth in Exhibit F.
   3. 3. A petition for court-ordered treatment for an individual alleged to be persistently or acutely disabled, which shall be filed on AHCCCS form MH-110, set forth in Exhibit F.
4. D. Any mental health agency filing a petition for court-ordered treatment of a client pursuant to subsection (A) shall do so in consultation with the client and the client’s clinical team prior to filing the petition.
5. E. With respect to inpatient and outpatient treatment, the petition filed with the court shall request that the individual be committed to the care and supervision of the health plan, if the individual is a client, or to an appropriate mental health treatment agency, if the individual is not a client.

6. 1. Does the person have a severe mental disorder that, 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 that significantly impairs judgment, reason, behavior, or capacity to recognize reality?

   Yes _____ No _____

   If yes, provide the facts that support this conclusion: __________________________________________________________________

   ____________________________________________________________________________________________________________

   ____________________________________________________________________________________________________________

   ____________________________________________________________________________________________________________

   2 . Does the severe mental disorder substantially impair the person’s capacity to make an informed decision regarding treatment?

   Yes _____ No _____

   If yes, provide the facts that support this conclusion: __________________________________________________________________

   ____________________________________________________________________________________________________________

   ____________________________________________________________________________________________________________

   ____________________________________________________________________________________________________________

   2a. Does this impairment cause 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?

   Yes _____ No _____

   If yes, provide the facts that support this conclusion: __________________________________________________________________

   ____________________________________________________________________________________________________________

   ____________________________________________________________________________________________________________

   ____________________________________________________________________________________________________________

   2b . Were the advantages and disadvantages of accepting treatment explained to the person?

   Yes _____ No _____

   2c. Were the alternatives to treatment and the advantages and disadvantages of such alternatives explained to the person?

   Yes _____ No _____

   2d. Explain the specific reasons why the person is incapable of understanding and expressing an understanding of the explanations described in 2a, 2b, and 2c:______________________________________________________________________________________

   ____________________________________________________________________________________________________________

   ____________________________________________________________________________________________________________

   ____________________________________________________________________________________________________________

   3 . Is there a reasonable prospect that the severe mental disorder is treatable by outpatient, inpatient, or combined inpatient and outpatient treatment?

   Yes _____ No _____

   If yes, please provide the facts that support this conclusion:_____________________________________________________________

   ____________________________________________________________________________________________________________

   ____________________________________________________________________________________________________________

   ____________________________________________________________________________________________________________

   ADHS/BHS Form MH-112 Addendum No. 1 (9/93)

   GRAVELY DISABLED (EXHIBIT E, ADDENDUM NO. 2)

   RE:

   IF GRAVELY DISABLED:

7. 1. Is the person’s condition evidenced by behavior in which s/he, as a result of a mental disorder, is likely to come to serious physical harm or serious illness because s/he would be unable to provide for his/her basic physical needs without hospitalization?

   Yes _____ No _____

8. 2. If Yes, explain how his/her mental disability affects his/her ability to do the following and how any inability might harm him/her. Provide examples, if available, to support your conclusion:

   1. a. Provide for food:
   2. b. Provide for clothing and maintain hygiene:
   3. c. Provide for shelter:
   4. d. Obtain and maintain steady employment:
   5. e. Respond in an emergency:
   6. f. Care for present or future medical problems:
   7. g. Manage money:

   8. h. Other:

      ADHS/BHS Form MH-112 Addendum No. 2 (9/93)

Exhibit E. Affidavit

AFFIDAVIT

PERSISTENTLY OR ACUTELY DISABLED (EXHIBIT E, ADDENDUM NO. 1)

RE: ________________________________________________________________________________________________________

IF PERSISTENTLY OR ACUTELY DISABLED:

Historical Note

Adopted under an exemption from A.R.S. Title 41, Chapter 6 pursuant to Laws 1992, Ch. 301, § 61, effective October 7, 1992; received in the Office of the Secretary of State October 14, 1992 (Supp. 92-4). Exhibit E repealed, new Exhibit E with Addenda 1 and 2 adopted under an exemption from A.R.S. Title 41, Chapter 6 pursuant to Laws 1992, Ch. 301, § 61, effective September 30, 1993 (Supp. 93-3). Renumbered from a position after R9-21-505 by exempt rulemaking at 9 A.A.R. 3296, effective June 30, 2003 (Supp. 03-2).

Exhibit F. Petition for Court-ordered Treatment

PETITION FOR COURT-ORDERED TREATMENT
Gravely Disabled Person

Historical Note

Adopted under an exemption from A.R.S. Title 41, Chapter 6 pursuant to Laws 1992, Ch. 301, § 61, effective October 7, 1992; received in the Office of the Secretary of State October 14, 1992 (Supp. 92-4). Exhibit F repealed, new Exhibit F adopted under an exemption from A.R.S. Title 41, Chapter 6 pursuant to Laws 1992, Ch. 301, § 61, effective September 30, 1993 (Supp. 93-3). Renumbered from a position after R9-21-505 by exempt rulemaking at 9 A.A.R. 3296, effective June 30, 2003 (Supp. 03-2).

Historical Note

Adopted under an exemption from A.R.S. Title 41, Chapter 6 pursuant to Laws 1992, Ch. 301, § 61, effective October 7, 1992; received in the Office of the Secretary of State October 14, 1992 (Supp. 92-4). Former Section R9-21-504 renumbered to R9-21-503; new Section R9-21-504 renumbered from R9-21-505 and amended by exempt rulemaking at 9 A.A.R. 3296, effective June 30, 2003 (Supp. 03-2). Amended by final rulemaking at 29 A.A.R. 898 (April 21, 2023), effective May 30, 2023 (Supp. 23-1).