Bill Text: HI HB1432 | 2024 | Regular Session | Introduced

Hawaii House Bill 1432

Introduced

Bill Title: Relating To Prescriptive Authority For Psychologists.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced) 2023-12-11 - Carried over to 2024 Regular Session. [HB1432 Detail]

Download: Hawaii-2024-HB1432-Introduced.html

HOUSE OF REPRESENTATIVES	H.B. NO.	1432
THIRTY-SECOND LEGISLATURE, 2023
STATE OF HAWAII

A BILL FOR AN ACT

RELATING TO PRESCRIPTIVE AUTHORITY FOR PSYCHOLOGISTS.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

SECTION 1. The legislature finds that the mental health of Hawaii's people is of great importance to the productivity and overall wellbeing of the State. Presently, Hawaii's collective mental health ranks among the lowest in the nation, especially for Americans of Asian, Hawaiian, and Pacific Island ancestry. For many years, Hawaii has repeatedly and consistently been recognized as a health professional shortage area by the federal government. This designation indicates that there is an insufficient number of prescribing mental health care providers available to serve the needs of Hawaii's people. Throughout the State as a whole, but especially on islands having significant rural populations, mental illness has reached catastrophic proportions, with the lack of treatment options for residents at crisis levels.

The legislature further finds that the National Institutes of Mental Health divides mental illness into two primary groups: "Any mental illness" and "serious mental illness". "Any mental illness" is defined as a mental, behavioral, or emotional disorder that can vary in impact, ranging from no impairment to mild or moderate impairment. "Serious mental illness" is defined as a mental, behavioral, or emotional disorder resulting in serious functional impairment that substantially interferes with or limits one or more major life activity. The burden of mental illnesses is particularly concentrated among those who experience disability due to serious mental illness. According to the National Alliance on Mental Illness, one in five adults has reported experiencing a mental health condition in a given year, with the majority of those conditions being within the category of any mental illness.

The legislature also finds that, according to the department of health, the State's reported levels of anxiety and depression have doubled since the onset of the coronavirus disease 2019 pandemic, to a statewide average of forty per cent. This sharp rise, which occurred over a relatively short period of time, indicates that many more people in the State fall under the category of individuals having any mental illness.

The legislature believes that no level of suffering from mental illness should be tolerated in a modern society where the professional tools, abilities, and desire to address these issues exist. The legislature finds that, given the current rise in mental illness levels, it is time to grant certain licensed psychologists limited prescriptive authority to expeditiously meet the needs of this population. These qualified psychologists can work in collaboration with psychiatrists and other mental health professionals to achieve the goal of better patient outcomes for all who are forced to deal with the struggles of mental illness, regardless of where these individuals may exist on the mental health spectrum.

Accordingly, the legislature finds that allowing certain psychologists who elect to undergo or have already obtained further and extensive training in psychopharmacology an opportunity to become prescribing psychologists would benefit the State on many levels. This benefit would especially be felt by individuals living in rural or medically underserved communities where there is the shortage of mental health professionals having prescriptive authority is most severe.

The legislature further finds that clinical psychologists are licensed health professionals having an average of seven years of post-baccalaureate study and three thousand hours of post-graduate supervised practice in the diagnosis and treatment of mental illness. However, because the current scope of a clinical psychologist practice does not include the prescription of medication, their patients must consult with and pay for additional providers and services to obtain psychotropic medications when necessary.

The legislature notes that advanced practice registered nurses, optometrists, dentists, and naturopathic physicians currently have prescriptive privileges. Furthermore, licensed clinical psychologists having specialized education and training in preparation for prescriptive practice have been allowed to prescribe psychotropic medications to active-duty military personnel and their families in federal facilities and the United States Public Health Service, including the Indian Health Service, for decades. Similarly, in recent years, Illinois, Louisiana, New Mexico, Idaho, and Iowa have all adopted legislation authorizing prescriptive authority for advanced trained psychologists. Furthermore, records indicate that there have been few adverse events or complaints brought against any of the prescribing psychologists in these states. By expanding the role of the traditional psychologist to allow for prescriptive authority after proper advanced training and licensure, critical needs in predominantly indigent and rural populations that have gone unmet for many years may now finally be addressed.

The American Psychological Association has developed a model curriculum for a master's degree in psychopharmacology for the education and training for psychologists who already hold a doctoral degree and licensure. Independent evaluations of the federal Department of Defense psychopharmacological demonstration project by the United States General Accounting Office, now known as the Government Accountability Office, and the American College of Neuropsychopharmacology, as well as the experiences of states that have granted psychologists prescriptive authority, have found that appropriately trained prescribing psychologists can prescribe medications safely and effectively.

Accordingly, the purpose of this Act is to authorize the board of psychology to grant prescriptive authority to prescribing psychologists who meet specific education, training, and registration requirements.

SECTION 2. Chapter 465, Hawaii Revised Statutes, is amended by adding a new part to be appropriately designated and to read as follows:

"PART . PRESCRIBING PSYCHOLOGISTS

§465- Definitions. As used in this part, unless the context otherwise requires:

"Advanced practice registered nurse with prescriptive authority" means an advanced practice registered nurse, as defined in section 457-2, with prescriptive authority granted pursuant to section 457-8.6.

"Clinical experience" means a period of supervised clinical training and practice in which clinical diagnoses and interventions, which are conducted and supervised as part of a post-doctoral master of science degree in clinical psychopharmacology training, are learned.

"Controlled substance" shall have the same meaning as in section 329-1.

"Forensically encumbered" means a person who has been found to be detained by Hawaii courts for forensic examination or committed to certain psychiatric facilities under the care and custody of the director of health for appropriate placement by the family courts, district courts, or circuit courts; has been placed on conditional release or released on conditions by a judge in Hawaii courts; or is involved in the mental health court of a jail diversion program.

"Narcotic drug" shall have the same meaning as in section 329‑1.

"Opiate" shall have the same meaning as in section 329-1.

"Prescribing psychologist" means a psychologist who has undergone specialized training in clinical psychopharmacology, passed a national proficiency examination in psychopharmacology approved by the board, and been granted a prescriptive authority privilege by the board.

"Prescription" means an order for a psychotropic medication, or any device or test directly related to the diagnosis and treatment of mental and emotional disorders pursuant to the practice of psychology.

"Prescriptive authority privilege" means the authority granted by the board to prescribe psychotropic medication and other directly related procedures within the scope of practice of psychology in accordance with rules adopted by the board.

"Primary care provider" means a physician or osteopathic physician licensed or exempted from licensure pursuant to section 453-2 or an advanced practice registered nurse with prescriptive authority.

"Psychotropic medication" means only those agents related to the diagnosis and treatment of mental and emotional disorders pursuant to the practice of psychology, except drugs classified into schedule I, II, or III pursuant to chapter 329; opiates; or narcotic drugs; provided that psychotropic medication shall include stimulants for the treatment of attention deficit hyperactivity disorder regardless of the stimulant's schedule classification.

"Serious mental illness" means bipolar I disorder, bipolar II disorder, delusional disorder, major depressive disorder with psychotic features, psychosis secondary to substance use, schizophrenia, schizophreniform disorder, and schizoaffective disorder, as defined by the most current version of the Diagnostic and Statistical Manual of Mental Disorders.

§465- Administration. (a) The board shall prescribe application forms and fees for application for and renewal of prescriptive authority privilege pursuant to this part.

(b) The board shall develop and implement procedures to review the educational and training credentials of a psychologist applying for or renewing prescriptive authority privilege under this part, in accordance with current standards of professional practice.

(d) The board shall have all other powers that may be necessary to carry out the purposes of this part.

§465- Prescriptive authority privilege; requirements. (a) The board shall accept applications for prescriptive authority privilege from qualified applicants. Every applicant for prescriptive authority privilege shall submit evidence satisfactory to the board, in a form and manner prescribed by the board, that the applicant meets the following requirements:

(1) The applicant possesses a current license pursuant to section 465-7;

(2) The applicant successfully graduated with a post‑doctoral master's degree in clinical psychopharmacology from a regionally‑accredited institution with a clinical psychopharmacology program designated by the American Psychological Association, or the equivalent of a post‑doctoral master's degree, as approved by the board; provided that any equivalent shall include:

(A) Study in a program offering intensive didactic education, including instruction in anatomy and physiology, biochemistry, neuroanatomy, neurophysiology, neurochemistry, physical assessment and laboratory examinations, clinical medicine and pathophysiology, clinical and research pharmacology and psychopharmacology, clinical pharmacotherapeutics, research, and professional, ethical, and legal issues; and

(B) Clinical experience that includes:

(i) A minimum of five hundred eighty hours completed in no less than twelve months and no more than forty-eight months;

(ii) Supervision of a minimum of one hundred patients;

(iii) A minimum of eighty hours completed in a physical assessment practicum in a primary care, family practice, community, or internal medicine setting;

(iv) A minimum of one hundred hours of community service with homeless, veteran, or low‑income populations; and

(v) No less than two hours per week of supervision by a licensed physician or osteopathic physician, an advanced practice registered nurse with prescriptive authority, or a prescribing psychologist; and

(3) The applicant has successfully passed the nationally recognized Psychopharmacology Examination for Psychologists, which was developed and administered by the Association of State and Provincial Psychology Boards and assesses relevant knowledge to establish competence across the following content areas: neuroscience, nervous system pathology, human physiology and pathophysiology, biopsychosocial and pharmacologic assessment and monitoring, differential diagnosis, pharmacology, clinical psychopharmacology, research, integrating clinical psychopharmacology with the practice of psychology, diversity factors, and professional, legal, ethical, and interprofessional issues; provided that the passing score shall be determined by the Association of State and Provincial Psychology Boards.

(b) A prescribing psychologist may prescribe antidepressants, benzodiazepines, and stimulants to treat depression, anxiety, obsessive‑compulsive disorders, and attention deficit/hyperactivity disorder without specific oversight from another prescriber.

(c) Notwithstanding subsection (a), a psychologist who has been licensed to prescribe for six or more years in another state that authorizes prescriptive authority for psychologists shall be granted prescriptive authority privilege by the board.

(d) Notwithstanding subsection (a), a psychologist who is authorized to prescribe in the United States Military within the United States Department of Health and Human Services or the Indian Health Service shall be granted prescriptive authority privilege by the board.

§465- Prescriptive authority privilege; renewal. (a) The board shall implement a method for the renewal of prescriptive authority privilege in conjunction with the renewal of a license under section 465-11.

(b) To qualify for the renewal of prescriptive authority privilege, a prescribing psychologist shall present evidence satisfactory to the board that the prescribing psychologist has completed at least eighteen hours biennially of acceptable continuing education, as determined by the board, relevant to the pharmacological treatment of mental and emotional disorders; provided that a first‑time prescriptive authority privilege holder shall not be subject to the continuing education requirements under this section for the first prescriptive authority privilege renewal.

(c) The continuing education requirement under this section shall be in addition to the continuing education requirement under section 465-11.

(d) The board may conduct random audits of licensees to determine compliance with the continuing education requirement under this section. The board shall provide written notice of an audit to a licensee randomly selected for audit. Within sixty days of notification, the licensee shall provide the board with documentation verifying compliance with the continuing education requirement established by this section.

§465- Prescriptive authority privilege; prescribing practices. (a) It shall be unlawful for any psychologist not granted prescriptive authority privilege under this part to prescribe, offer to prescribe, or use any sign, card, or device to indicate that the psychologist is so authorized.

(b) A valid prescription issued by a prescribing psychologist shall be legibly written and contain, at a minimum, the following:

(1) Date of issuance;

(2) Original signature of the prescribing psychologist;

(3) Prescribing psychologist's name and business address;

(4) Name, strength, quantity, and specific instructions for the psychotropic medication to be dispensed;

(5) Name and address of the person for whom the prescription was written;

(6) Room number and route of administration if the patient is in an institutional facility; and

(7) Number of allowable refills, if applicable.

(c) A prescribing psychologist shall comply with all applicable state and federal laws and rules relating to the prescription and administration of psychotropic medication.

(d) A prescribing psychologist shall:

(1) Prescribe only in consultation and collaboration with a patient's primary care provider; provided that a written collaborative agreement between a patient's primary care provider and a prescribing psychologist shall be established and signed prior to the prescribing psychologist prescribing any psychotropic medication for the patient;

(2) Prescribe only in consultation and collaboration with a patient's primary care provider regarding changes to a medication treatment plan, including dosage adjustments, addition of medications, or discontinuation of medications; provided that for patients who are forensically encumbered or for patients having a diagnosis of serious mental illness:

(A) A prescribing psychologist shall prescribe only in accordance with a treatment protocol agreed to by the prescribing psychologist and the treating department of health psychiatrist, and with notification to all other health care providers treating the patient; and

(B) A prescribing psychologist may enter into a collaborative agreement with the department of health; and

(3) Document the consultation in the patient's medical record.

(e) A prescribing psychologist shall not prescribe psychotropic medication for any patient who does not have a primary care provider.

(f) A prescribing psychologist shall not delegate prescriptive authority to any other person.

§465- Prescriptive authority privilege; exclusionary formulary. (a) A prescribing psychologist shall only prescribe psychotropic medications for the treatment of mental health disorders as defined by the most current version of the Diagnostic and Statistical Manual of Mental Disorders.

(b) The exclusionary formulary for prescribing psychologists shall consist of drugs or categories of drugs described by the board pursuant to rules adopted under chapter 91.

(c) The exclusionary formulary and any revised formularies shall be made available to licensed pharmacies at the request of the pharmacies at no cost.

(d) Under the exclusionary formulary, prescribing psychologists shall not prescribe:

(1) Schedule I controlled substances pursuant to section 329‑14;

(2) Schedule II controlled substances pursuant to section 329-16;

(3) Schedule III controlled substances pursuant to section 329-18, including all narcotic drugs and opiates; and

(4) For indications other than those stated in the labeling approved by the United States Food and Drug Administration for patients seventeen years of age or younger; provided that prescribing psychologists may prescribe stimulants for the treatment of attention deficit hyperactivity disorder, regardless of the stimulant's schedule classification.

§465- Drug Enforcement Administration; registration. (a) A prescribing psychologist shall comply with all federal and state registration requirements to prescribe and administer psychotropic medication.

(b) Each prescribing psychologist shall file with the board the prescribing psychologist's federal Drug Enforcement Administration registration number. The registration number shall be filed before the prescribing psychologist issues a prescription for a controlled substance.

§465- Violation; penalties. Any person who violates this part shall be guilty of a misdemeanor and, upon conviction, fined not more than $1,000 or imprisoned not more than one year, or both. Any person who violates this part may also be subject to disciplinary action by the board."

SECTION 3. Section 329-1, Hawaii Revised Statutes, is amended as follows:

1. By adding two new definitions to be appropriately inserted and to read:

""Psychologist with prescriptive authority privilege" means a clinical psychologist who has undergone specialized training in clinical psychopharmacology, has passed a national proficiency examination in psychopharmacology approved by the board of psychology, and has been granted prescriptive authority privilege to prescribe psychotropic medication by the board of psychology pursuant to part of chapter 465.

"Psychotropic medication" means only those agents related to the diagnosis and treatment of mental and emotional disorders pursuant to the practice of psychology, as defined in section 465-1, except drugs classified into schedule I, II, or III pursuant to this chapter; opiates; or narcotic drugs; provided that psychotropic medication shall include stimulants for the treatment of attention deficit hyperactivity disorder regardless of the stimulant's schedule classification."

2. By amending the definition of "practitioner" to read:

""Practitioner" means:

(1) A physician, dentist, veterinarian, scientific investigator, or other person licensed and registered under section 329-32 to distribute, dispense, or conduct research with respect to a controlled substance in the course of professional practice or research in this State;

(2) An advanced practice registered nurse with prescriptive authority licensed and registered under section 329-32 to prescribe and administer controlled substances in the course of professional practice in this State; [~~and~~]

(3) A psychologist with prescriptive authority licensed and registered under section 329-32 to prescribe and administer psychotropic medication in the course of professional practice in the State; and

[~~(3)~~] (4) A pharmacy, hospital, or other institution licensed, registered, or otherwise permitted to distribute, dispense, conduct research with respect to or to administer a controlled substance in the course of professional practice or research in this State."

SECTION 4. Section 329-38, Hawaii Revised Statutes, is amended by amending subsection (i) to read as follows:

"(i) Prescriptions for controlled substances shall be issued only as follows:

(1) All prescriptions for controlled substances shall originate from within the State and be dated as of, and signed on, the day when the prescriptions were issued and shall contain:

(A) The first and last name and address of the patient; and

(B) The drug name, strength, dosage form, quantity prescribed, and directions for use. Where a prescription is for gamma hydroxybutyric acid, methadone, or buprenorphine, the practitioner shall record as part of the directions for use, the medical need of the patient for the prescription.

Except for electronic prescriptions, controlled substance prescriptions shall be no larger than eight and one-half inches by eleven inches and no smaller than three inches by four inches. A practitioner may sign a prescription in the same manner as the practitioner would sign a check or legal document (e.g., J.H. Smith or John H. Smith) and shall use both words and figures (e.g., alphabetically and numerically as indications of quantity, such as five (5)), to indicate the amount of controlled substance to be dispensed. Where an electronic prescription is permitted, either words or figures (e.g., alphabetically or numerically as indications of quantity, such as five or 5), to indicate the amount of controlled substance to be dispensed shall be acceptable. Where an oral order or electronic prescription is not permitted, prescriptions shall be written with ink or indelible pencil or typed, shall be manually signed by the practitioner, and shall include the name, address, telephone number, and registration number of the practitioner. The prescriptions may be prepared by a secretary or agent for the signature of the practitioner, but the prescribing practitioner shall be responsible in case the prescription does not conform in all essential respects to this chapter and any rules adopted pursuant to this chapter. In receiving an oral prescription from a practitioner, a pharmacist shall promptly reduce the oral prescription to writing, which shall include the following information: the drug name, strength, dosage form, quantity prescribed in figures only, and directions for use; the date the oral prescription was received; the full name, Drug Enforcement Administration registration number, and oral code number of the practitioner; and the name and address of the person for whom the controlled substance was prescribed or the name of the owner of the animal for which the controlled substance was prescribed.

A corresponding liability shall rest upon a pharmacist who fills a prescription not prepared in the form prescribed by this section. A pharmacist may add a patient's missing address or change a patient's address on all controlled substance prescriptions after verifying the patient's identification and noting the identification number on the back of the prescription document on file. The pharmacist shall not make changes to the patient's name, the controlled substance being prescribed, the quantity of the prescription, the practitioner's Drug Enforcement Administration number, the practitioner's name, the practitioner's electronic signature, or the practitioner's signature;

(2) An intern, resident, or foreign-trained physician, or a physician on the staff of a Department of Veterans Affairs facility or other facility serving veterans, exempted from registration under this chapter, shall include on all prescriptions issued by the physician:

(A) The registration number of the hospital or other institution; and

(B) The special internal code number assigned to the physician by the hospital or other institution in lieu of the registration number of the practitioner required by this section.

The hospital or other institution shall forward a copy of this special internal code number list to the department as often as necessary to update the department with any additions or deletions. Failure to comply with this paragraph shall result in the suspension of that facility's privilege to fill controlled substance prescriptions at pharmacies outside of the hospital or other institution. Each written prescription shall have the name of the physician stamped, typed, or hand-printed on it, as well as the signature of the physician;

(3) An official exempted from registration shall include on all prescriptions issued by the official:

(A) The official's branch of service or agency (e.g., "U.S. Army" or "Public Health Service"); and

(B) The official's service identification number, in lieu of the registration number of the practitioner required by this section. The service identification number for a Public Health Service employee shall be the employee's social security or other government issued identification number.

Each prescription shall have the name of the officer stamped, typed, or handprinted on it, as well as the signature of the officer; [~~and~~]

(4) A physician assistant registered to prescribe controlled substances under the authorization of a supervising physician shall include on all controlled substance prescriptions issued:

(A) The Drug Enforcement Administration registration number of the supervising physician; and

(B) The Drug Enforcement Administration registration number of the physician assistant.

Each written controlled substance prescription issued shall include the printed, stamped, typed, or hand‑printed name, address, and phone number of both the supervising physician and physician assistant, and shall be signed by the physician assistant[.]; and

(5) A psychologist with prescriptive authority privilege registered to prescribe psychotropic medication pursuant to part of chapter 465 shall include, on any psychotropic medication prescription issued in compliance with this chapter, the Drug Enforcement Administration registration number of the psychologist with prescriptive authority.

Each written psychotropic medication prescription issued in compliance with this chapter shall also include the printed, stamped, typed, or hand-printed name, address, and phone number of the psychologist with prescriptive authority, and shall be signed by the psychologist with prescriptive authority."

SECTION 5. Section 329-39, Hawaii Revised Statutes, is amended by amending subsection (b) to read as follows:

"(b) Whenever a pharmacist sells or dispenses any controlled substance on a prescription issued by a physician, dentist, podiatrist, or veterinarian, or any psychotropic medication on a prescription issued in compliance with this chapter by a psychologist with prescriptive authority privilege, the pharmacist shall affix to the bottle or other container in which the drug is sold or dispensed:

(1) The pharmacy's name and business address;

(2) The serial number of the prescription;

(3) The name of the patient or, if the patient is an animal, the name of the owner of the animal and the species of the animal;

(4) The name of the physician, dentist, podiatrist, psychologist with prescriptive authority privilege, or veterinarian by whom the prescription is written; and

(5) [~~Such~~] Any directions as may be stated on the prescription."

SECTION 6. Section 346-59.9, Hawaii Revised Statutes, is amended by amending subsection (h) to read as follows:

"(h) All psychotropic medications covered by this section shall be prescribed by a psychiatrist, a physician, [or] an advanced practice registered nurse with prescriptive authority under chapter 457 and duly licensed in the State[.], or a prescribing psychologist authorized under part of chapter 465."

SECTION 7. Chapter 465, Hawaii Revised Statutes, is amended by designating sections 465-1 to 465-15 as part I, entitled "General Provisions".

SECTION 8. Section 465-3, Hawaii Revised Statutes, is amended by amending subsection (e) to read as follows:

"(e) [~~Nothing~~] Except as provided in part , nothing in this chapter shall be construed as permitting the administration or prescription of drugs, or in any way engaging in the practice of medicine as defined in the laws of the State."

SECTION 9. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 10. This Act shall take effect upon its approval; provided that the amendments made to section 329-38, Hawaii Revised Statutes, by section 4 of this Act shall not be repealed when that section is reenacted on June 30, 2023, pursuant to section 6 of Act 66, Session Laws of Hawaii 2017.

INTRODUCED BY:	_____________________________

Report Title:

Psychologists; Prescriptive Authority; Licensure; Requirements

Description:

Authorizes the Board of Psychology to grant prescriptive authority to psychologists who meet specific education, training, and registration requirements.

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.