THE SENATE	S.B. NO.	3122
THIRTY-SECOND LEGISLATURE, 2024
STATE OF HAWAII

A BILL FOR AN ACT

RELATING TO PUBLIC HEALTH STANDING ORDERS.

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

SECTION 1. The legislature finds that standing orders are written protocols describing a specific medical practice that will be delegated to non-physicians without a patient-specific order signed by a physician. Standing orders outline procedures that must be followed and identify permissible patient populations, level of required physician supervision, and allowable practice settings.

The legislature also find that Hawaii's well documented physician shortage may restrict patient access to preventative care, resulting in sub-optimal outcomes, increased costs, and decreased quality of life. Population-based care can help reduce provider administrative burden while increasing access to evidence-based clinical preventive services. Secondary prevention is the provision of a clinical preventive service to screen for a condition in an asymptomatic individual, such as mammography to screen for breast cancer. Public health standing orders may help reduce barriers to receiving secondary prevention services.

Standing orders are already used in routine, urgent, or emergent settings upon the occurrence of certain clinical events that take place on an individual patient basis or a population health event. An example of a routine individual patient standing order is certain vaccine administrations, which are evidence-based practices that authorize nurses, pharmacists, and other healthcare providers to assess a client's immunization status and administer vaccinations according to a protocol. Emergent population health crises are also supported by standing orders, specifically for mass prophylaxis following a bioterrorism incident that are activated only when the director of health delares a state of emergency due to a specific bioterrorism incident.

Accordingly, the purpose of this Act is to effectuate public health standing orders with regard to evidence-based healthcare screenings that have received the highest recommendations from the United States Preventive Services Task Force to reduce barriers to access and expand population health-based interventions.

SECTION 2. Chapter 321, Hawaii Revised Statutes, is amended by adding to part II a new section to be appropriately designated and to read as follows:

"§321- Public health standing orders; screening. (a) The director of health may issue public health standing orders authorizing patients who are eighteen years or older to receive evidence-based items or services that have in effect a rating of A or B in the current recommendations of the United States Preventive Services Task Force, as defined by the Affordable Care Act of 2010, P.L. 111-148, section 4106, without patient-specific orders from a licensed healthcare provider.

(b) The director of health shall annually review the items or services that have in effect a rating of A or B as recommended by the United States Preventive Services Task Force and amend public health standing orders as necessary.

(c) The duration of public health standing orders issued pursuant to this section shall remain in effect until repealed by the director of health.

(d) The director of health shall post public health standing orders on the department's website in an easily located manner.

(e) The entity providing the items or services pursuant to the public health standing order shall request from the patient the name of the patient's primary care provider and shall make good faith efforts to transmit the results of the screening to the primary care provider or other healthcare provider identified by the patient.

(f) The entity providing the items or services shall provide any results to the patient in writing. The results shall:

(1) Be written in plain language;

(2) Clearly indicate if the result is normal, abnormal, or undetermined; and

(3) Provide instructions for follow up with a healthcare provider, as appropriate.

For purposes of this section "licensed healthcare provider" means physicians and osteopathic physicians licensed under chapter 453, physician assistants licensed under chapter 453, and advanced practice registered nurses licensed under chapter 457."

SECTION 3. New statutory material is underscored.

SECTION 4. This Act, upon its approval, shall take effect on July 1, 2024.

INTRODUCED BY:	_____________________________
	BY REQUEST

Report Title:

Public Health Standing Orders; United States Preventive Services Task Force; Screenings

Description:

Authorizes the Director of Health to issue public health standing orders for patients to self-refer to certain healthcare screening services.

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