Following the enactment of Kendra's Law in August of 1999, OMH AOT program staff developed and disseminated guidelines to counties to assure the appropriate implementation and operation of AOT statewide. In November of 1999, when the law became effective, local governments began to operationalize their AOT programs. OMH promulgated AOT program standards in 2002 and in 2004, providing further guidance to local AOT programs.

In counties other than in New York City, the county Mental Health Directors operate, direct and supervise their AOT programs, either directly or by designation to other local mental health officials. In New York City, the Clinical Director for the New York City Department of Health and Mental Hygiene oversees implementation of the City's AOT program, which is administered by designated teams of employees of the New York City Health and Hospitals Corporation. These local AOT programs accept and investigate reports of persons who may be in need of AOT, prepare and file petitions for AOT in local supreme or county courts, and prepare and/or approve proposed AOT treatment plans. In those instances where an AOT order is granted, the Director of the local AOT program is required to provide or ensure provision of all categories of assisted outpatient treatment included in the order.

Local AOT programs are responsible for the oversight and monitoring of service providers, including case management services and ACT team services. It is the case management or ACT team which directly monitors the recipient's level of compliance, as well as delivery of services by other providers pursuant to the order. The case manager or ACT Team routinely reports to the local AOT Program Director with respect to each recipient's treatment status.

OMH is responsible for statewide oversight and monitoring of the AOT program. The OMH Statewide Director of AOT, appointed by the Commissioner of OMH, is responsible for administering the program. Pursuant to section 7.17(f) of the Mental Hygiene Law, the Commissioner of OMH also appointed OMH AOT Program Coordinators, who report to the Director of AOT, and who monitor and oversee operation of local AOT programs across New York State. The AOT Program Coordinators are located in each of the five OMH Field Offices in different geographic regions throughout the State, and work closely with each county's AOT Program Director within their respective regions. The OMH AOT Program Coordinators oversee and monitor the local AOT programs, provide information and support pertaining to the petition process, and support the local AOT programs in their efforts to provide or arrange for court-ordered services.

As part of its oversight and monitoring efforts, OMH has developed and implemented a system of Verification of Service Delivery. Each calender quarter, a sample of all active AOT cases across the State are chosen randomly and a detailed review is conducted to verify that the local AOT Programs have fulfilled their service delivery obligations. For each case reviewed, OMH AOT Program Coordinators, or their staff, conduct verification visits to all service providers for the AOT service recipient, where they review medical charts, interview employees of the providers, and, when possible, interview the recipient. In some instances, county AOT Program staff accompany the AOT Program Coordinator on verification visits creating even more effective coordination between service providers, and State and local AOT program officials.