HB516

SECTION 1. The legislature finds that although the State has taken many important steps to make medical cannabis available, further action is needed to ensure access. One way to improve access is to expand the scope for professionals who may provide written certification for qualifying patients to use medical cannabis. The legislature further finds that, as determined by the state board of naturopathic medicine, it is within the scope of naturopathic practice to manage patient's medical cannabis use. Naturopathic physicians are considered primary care providers in Hawaii, and there are many patients in the State whose primary care provider is a naturopathic physician.

Accordingly, the purpose of this Act is to improve patient access to medical cannabis by authorizing naturopathic physicians to provide written certifications to qualifying patients for the medical use of cannabis.

SECTION 2. Section 329-121, Hawaii Revised Statutes, is amended as follows:

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

""Distant site" means the location of the physician, naturopathic physician, or advanced practice registered nurse delivering services through telehealth at the time the services are provided.

"Naturopathic physician" means a person who holds a current license to practice naturopathic medicine under chapter 455.

"Originating site" means the location where the patient is located, whether accompanied or not by a health care provider, at the time services are provided by a physician, naturopathic physician, or advanced practice registered nurse through telehealth, including but not limited to a physician's, naturopathic physician's, nurse's, or other health care provider's office, hospital, health care facility, a patient's home, and other non-medical environments such as school-based health centers, university-based health centers, or the work location of a patient.

"Telehealth" means the use of telecommunications, as that term is defined in section 269-1, to encompass four modalities: store and forward technologies, remote monitoring, live consultation, and mobile health; and which shall include but not be limited to real-time video conferencing-based communication, and secure asynchronous information exchange, to transmit patient medical information, including diagnostic-quality digital images and laboratory results for medical interpretation and diagnosis, for the purposes of delivering enhanced health care services and information, as appropriate to the practitioner's scope of practice described in chapter 453, 455, or 457, while a patient is at an originating site and the physician, naturopathic physician, or advanced practice registered nurse is at a distant site; establishing a physician-patient, naturopathic physician-patient, or advanced practice registered nurse-patient relationship; evaluating a patient; or treating a patient."

2. By amending the definition of "advanced practice registered nurse" to read:

""Advanced practice registered nurse" means [an] a person who holds a current license to practice nursing as an advanced practice registered nurse [~~with prescriptive authority as described in section 457-8.6 and registered under section 329-32.~~] under chapter 457."

3. By amending the definition of "debilitating medical condition" to read:

""Debilitating medical condition" means:

(1) Cancer, glaucoma, lupus, epilepsy, multiple sclerosis, rheumatoid arthritis, positive status for human immunodeficiency virus, acquired immune deficiency syndrome, or the treatment of these conditions;

(2) A chronic or debilitating disease or medical condition or its treatment that produces one or more of the following:

(A) Cachexia or wasting syndrome;

(B) Severe pain;

(D) Seizures, including those characteristic of epilepsy;

(E) Severe and persistent muscle spasms, including those characteristic of multiple sclerosis or Crohn's disease; or

(F) Post-traumatic stress disorder; or

(3) Any other medical condition approved by the department of health pursuant to administrative rules in response to a request from a physician, naturopathic physician, or advanced practice registered nurse or potentially qualifying patient."

4. By amending the definitions of "physician" and "primary caregiver" to read:

""Physician" means a person who [~~is licensed~~] holds a current license to practice medicine under chapter 453 [~~and is licensed with authority to prescribe drugs and is registered under section 329-32~~]. "Physician" does not include a physician assistant as described in section 453-5.3.

"Primary caregiver" means a person eighteen years of age or older, other than the qualifying patient and the qualifying patient's physician, naturopathic physician, or advanced practice registered nurse, who has agreed to undertake responsibility for managing the well-being of the qualifying patient with respect to the medical use of cannabis. In the case of a minor or an adult lacking legal capacity, the primary caregiver shall be a parent, guardian, or person having legal custody."

5. By amending the definition of "qualifying patient" to read:

""Qualifying patient" means a person who has been diagnosed by a physician, naturopathic physician, or advanced practice registered nurse as having a debilitating medical condition."

6. By amending the definition of "written certification" to read:

""Written certification" means the qualifying patient's medical records or a statement signed by a qualifying patient's physician, naturopathic physician, or advanced practice registered nurse, stating that in the physician's, naturopathic physician's, or advanced practice registered nurse's professional opinion, the qualifying patient has a debilitating medical condition and the potential benefits of the medical use of cannabis would likely outweigh the health risks for the qualifying patient. The department of health may require, through its rulemaking authority, that all written certifications comply with a designated form. "Written certifications" are valid for one year from the time of signing; provided that the department of health may allow for the validity of any written certification for up to three years if the qualifying patient's physician, naturopathic physician, or advanced practice registered nurse states that the patient's debilitating medical condition is chronic in nature."

SECTION 3. Section 329-122, Hawaii Revised Statutes, is amended by amending subsections (a) and (b) to read as follows:

"(a) Notwithstanding any law to the contrary, the medical use of cannabis by a qualifying patient shall be permitted only if:

(1) The qualifying patient has been diagnosed by a physician, naturopathic physician, or advanced practice registered nurse as having a debilitating medical condition;

(2) The qualifying patient's physician, naturopathic physician, or advanced practice registered nurse has obtained a registration issued by the department of public safety under section 329-32;

[~~(2)~~] (3) The qualifying patient's physician, naturopathic physician, or advanced practice registered nurse has certified in writing that, in the physician's, naturopathic physician's, or advanced practice registered nurse's professional opinion, the potential benefits of the medical use of cannabis would likely outweigh the health risks for the particular qualifying patient; and

[~~(3)~~] (4) The amount of cannabis possessed by the qualifying patient does not exceed an adequate supply.

(b) Subsection (a) shall not apply to a qualifying patient under the age of eighteen years, unless:

(1) The qualifying patient's physician, naturopathic physician, or advanced practice registered nurse has explained the potential risks and benefits of the medical use of cannabis to the qualifying patient and to a parent, guardian, or person having legal custody of the qualifying patient; and

(2) A parent, guardian, or person having legal custody consents in writing to:

(A) Allow the qualifying patient's medical use of cannabis;

(B) Serve as the qualifying patient's primary caregiver; and

(C) Control the acquisition of the cannabis, the dosage, and the frequency of the medical use of cannabis by the qualifying patient."

SECTION 4. Section 329-123, Hawaii Revised Statutes, is amended by amending subsections (a) and (b) to read as follows:

"(a) Physicians, naturopathic physicians, or advanced practice registered nurses who issue written certifications shall provide, in each written certification, the name, address, patient identification number, and other identifying information of the qualifying patient. The department of health shall require, in rules adopted pursuant to chapter 91, that all written certifications comply with a designated form completed by or on behalf of a qualifying patient. The form shall require information from the applicant, primary caregiver, and physician, naturopathic physician, or advanced practice registered nurse as specifically required or permitted by this chapter. The form shall require the address of the location where the cannabis is grown and shall appear on the registry card issued by the department of health. The certifying physician, naturopathic physician, or advanced practice registered nurse shall be required to have a bona fide physician-patient relationship, bona fide naturopathic physician-patient relationship, or bona fide advanced practice registered nurse-patient relationship, as applicable, with the qualifying patient. All current active medical cannabis permits shall be honored through their expiration date.

(b) Qualifying patients shall register with the department of health. The registration shall be effective until the expiration of the certificate issued by the department of health and signed by the physician, naturopathic physician, or advanced practice registered nurse. Every qualifying patient shall provide sufficient identifying information to establish the personal identities of the qualifying patient and the primary caregiver. Qualifying patients shall report changes in information within ten working days. Every qualifying patient shall have only one primary caregiver at any given time. The department of health shall issue to the qualifying patient a registration certificate and may charge a fee for the certificate in an amount adopted by rules pursuant to chapter 91."

SECTION 5. Section 329-126, Hawaii Revised Statutes, is amended to read as follows:

"§329-126 Protections afforded to a treating physician, naturopathic physician, or advanced practice registered nurse. (a) No physician, naturopathic physician, or advanced practice registered nurse shall be subject to arrest or prosecution, penalized in any manner, or denied any right or privilege for providing written certification for the medical use of cannabis for a qualifying patient; provided that:

(1) The physician, naturopathic physician, or advanced practice registered nurse has diagnosed the patient as having a debilitating medical condition, as defined in section 329-121;

(2) The physician, naturopathic physician, or advanced practice registered nurse has explained the potential risks and benefits of the medical use of cannabis, as required under section 329-122;

(3) The written certification is based upon the physician's, naturopathic physician's, or advanced practice registered nurse's professional opinion after having completed a full assessment of the patient's medical history and current medical condition made in the course of a bona fide physician-patient relationship, bona fide naturopathic physician-patient relationship, or bona fide advanced practice registered nurse-patient relationship, as applicable; and

(4) The physician, naturopathic physician, or advanced practice registered nurse has complied with the registration requirements of section 329-123.

(b) For purposes of this section, a bona fide physician-patient relationship, [~~may be established via telehealth, as defined in section 453-1.3(j), and a~~] bona fide naturopathic physician-patient relationship, or bona fide advanced practice registered nurse-patient relationship may be established via telehealth[~~, as defined in section 457-2~~]; provided that treatment recommendations that include certifying a patient for the medical use of cannabis via telehealth shall be allowed only after an initial in-person consultation between the certifying physician, naturopathic physician, or advanced practice registered nurse and the patient."

SECTION 6. Section 329-128, Hawaii Revised Statutes, is amended by amending subsection (b) to read as follows:

"(b) Notwithstanding any law to the contrary, fraudulent misrepresentation to a law enforcement official of any fact or circumstance relating to the issuance of a written certificate by a physician, naturopathic physician, or advanced practice registered nurse not covered under section 329-126 for the medical use of cannabis shall be a misdemeanor. This penalty shall be in addition to any other penalties that may apply for the non-medical use of cannabis."

SECTION 7. This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date.

SECTION 8. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 9. This Act shall take effect on July 1, 2023.

INTRODUCED BY:	_____________________________

HOUSE OF REPRESENTATIVES	H.B. NO.	516
THIRTY-SECOND LEGISLATURE, 2023
STATE OF HAWAII