STAND. COM. REP. NO. 474

Honolulu, Hawaii

RE: S.B. No. 677

S.D. 1

Honorable Ronald D. Kouchi

President of the Senate

Thirty-Second State Legislature

Regular Session of 2023

State of Hawaii

Sir:

Your Committee on Health and Human Services, to which was referred S.B. No. 677 entitled:

"A BILL FOR AN ACT RELATING TO PRESCRIPTIVE AUTHORITY FOR CLINICAL PSYCHOLOGISTS,"

begs leave to report as follows:

The purpose and intent of this measure is to authorize and establish procedures and criteria for prescriptive authority for certain clinical psychologists who meet specific education, training, and registration requirements.

Your Committee received testimony in support of this measure from the Board of Psychology; American Psychological Association Services, Inc.; Society for Prescribing Psychology; Hawai‘i Psychological Association; Illinois Psychological Association; Iowa Psychological Association; Wegierek Psychology Center, Inc.; iNetMedRx², Inc.; and seventy-two individuals. Your Committee received testimony in opposition to this measure from the Hawai‘i Association of Professional Nurses; ‘Ahahui o nā Kauka Association of Native Hawaiian Physicians; Ka Lama Kukui; Hawai‘i Psychiatric Medical Association; Hawaii Medical Association; and forty-four individuals. Your Committee received comments on this measure from the Department of Health and two individuals.

Your Committee finds that there is a significant shortage of prescribing mental health care providers in the State, particularly in rural and medically underserved communities. Collaborative practice between licensed clinical psychologists and medical doctors has the potential to address this shortfall. To increase access to prescriptive mental health treatment, this measure authorizes qualified clinical psychologists with appropriate advanced training to prescribe from a limited formulary of psychotropic medication.

Your Committee notes the concerns raised by the Department of Health regarding the scope of this measure, in particular, the inclusion of minors, pregnant women, and persons who are Seriously and Persistently Mentally Ill (SPMI). To reduce the risk for numerous complications that require a full array of services, the Department of Health recommends excluding SPMI individuals and those served by the Department's Child and Adolescent Mental Health Division. The Department additionally recommends amending the reporting requirements, as currently written, to include specific medications and prescription frequency. Your Committee further notes the testimony submitted by Dr. Judi Steinman, which proposes granting prescriptive authority privilege to a psychologist who has been licensed to prescribe for at least five years in another state that authorizes prescriptive authority for psychologists or the United States Armed Forces within the United States Department of Health and Human Services or Indian Health Service. Your Committee respectfully requests your Committees on Commerce and Consumer Protection and Ways and Means consider these concerns, should they choose to deliberate on this measure.

Your Committee additionally notes the Board of Psychology's concern that it would be unable to implement this measure, as currently written, until July 1, 2025, due to the substantial amendments to licensing schemes this measure entails. In addition to establishing administrative rules, application processes, and formularies, the Board will also require additional staff. Amendments to this measure are therefore necessary to address these concerns.

Accordingly, your Committee has amended this measure by:

(1) Inserting language requiring the Board of Psychology to adopt rules to implement prescriptive authority privilege for certain clinical psychologists; provided that the board shall establish a rule that, whenever possible, a prescribing psychologist shall collaborate with the patient's primary health care provider;

(2) Clarifying that the Board of Psychology shall accept applications for prescriptive authority privilege beginning on July 1, 2025, rather than July 1, 2023;

(3) Inserting an appropriation of an unspecified amount for the Board of Psychology to implement prescriptive authority privilege for certain clinical psychologists;

(4) Inserting an effective date of December 31, 2050, to encourage further discussion;

(5) Amending section 1 to reflect its amended purpose; and

(6) Making technical, nonsubstantive amendments for the purposes of clarity and consistency.

As affirmed by the record of votes of the members of your Committee on Health and Human Services that is attached to this report, your Committee is in accord with the intent and purpose of S.B. No. 677, as amended herein, and recommends that it pass Second Reading in the form attached hereto as S.B. No. 677, S.D. 1, and be referred to your Committees on Commerce and Consumer Protection and Ways and Means.

Respectfully submitted on behalf of the members of the Committee on Health and Human Services,

________________________________

JOY A. SAN BUENAVENTURA, Chair