SB847 CD1

PART I

SECTION 1. The legislature finds that there is limited access to mental health care treatment services for residents across the State. The delivery of comprehensive, accessible, and affordable mental health care has been demonstrably enhanced by collaborative practice among licensed clinical psychologists with prescriptive authority and medical doctors in federal facilities and programs and in states that have authorized prescriptive authority for psychologists. The legislature finds that providing limited prescriptive authority to qualified, licensed clinical psychologists, subject to supervision by a licensed medical doctor, could help make comprehensive mental health care more accessible to medically underserved residents of the State. The legislature acknowledges that the Health Resources and Services Administration of the United States Department of Health and Human Services has officially designated much of the State, including isolated rural locations and urban areas with high population densities, as a mental health professional shortage area. This designation highlights the critical need for expansion of available mental health services and development of a corps of mental health professionals to serve the currently unmet needs of Hawaii's population.

The legislature has previously authorized prescription privileges for advanced practice registered nurses, optometrists, dentists, podiatrists, and physician assistants. These practitioners have been granted prescriptive authority based on demonstration of specific training, education, and practical competency. Education and training criteria, such as passage of national board examinations and degree and minimum experience requirements, have worked well to assure quality of services. Limitations on authority including the use of approved formularies, limited practice areas, and prohibitions on accepting or distributing drug samples have served to deter abuses in the system and to prevent the inappropriate practice of general medicine. Prescriptive authority for non-physician practitioners with varying types of limitations and supervision requirements has proven manageable and has expanded access to important health care services for patients across the State.

Clinical psychologists with appropriate training have been allowed to prescribe medications to active duty military personnel and their families in federal facilities and the federal Indian health service program for years. In recent years, Colorado, Idaho, Illinois, Iowa, Louisiana, New Mexico, and Utah have adopted legislation authorizing prescriptive authority for appropriately trained psychologists without regard to the service setting.

Since 2000, psychologists in Hawaii have received psychopharmacological training through the Tripler Army Medical Center psychology training program. These psychologists have actively collaborated with primary care physicians to provide combined therapy and psychopharmacological care to medically underserved patient populations at eleven federally qualified health centers: Bay Clinic, Hana, Molokai, Kauai, Waianae, Kalihi-Palama, Waimanalo, Koolauloa, West Hawaii, Kokua Kalihi Valley, and Waikiki, as well as a Native Hawaiian health care system clinic located in a federally designated medically underserved area on Molokai.

The American Psychological Association has developed a model curriculum for a master's degree in psychopharmacology for the education and training of prescribing psychologists. Independent evaluations of the United States 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 Idaho, Illinois, Iowa, Louisiana, and New Mexico, have demonstrated that appropriately trained clinical psychologists can prescribe psychotropic medications safely and effectively.

Accordingly, the purpose of this Act is to:

(1) Establish a three-year pilot program to allow qualified psychologists under the supervision of a supervising physician or psychiatrist to prescribe certain psychotropic medications for the treatment of mental illness to patients between the ages of eighteen and sixty-five who are under the psychologist's care at a federally qualified health center located in the county of Kauai or county of Hawaii; and

(2) Require the state health planning and development agency to submit a report to the legislature to determine whether the pilot program should be expanded, made permanent statewide, or terminated.

PART II

SECTION 2. (a) There is established a three-year pilot program to be administered by the state health planning and development agency, in partnership with the board of psychology, to allow clinical psychologists licensed pursuant to chapter 465, Hawaii Revised Statutes, to prescribe psychotropic medications under the supervision of a supervising physician or psychiatrist only to patients between the ages of eighteen and sixty-five years who are being treated by the psychologist at a federally qualified health center located in the county of Kauai or the county of Hawaii; provided that psychotropic medications prescribed under this pilot program shall be eligible for medicaid reimbursement to the extent such prescriptions would otherwise be eligible if prescribed by a physician or psychiatrist.

(b) A licensed clinical psychologist shall be eligible to apply to participate in the pilot program established pursuant to this Act if the psychologist:

(1) Meets the requirements for licensure set forth in section 465-7, Hawaii Revised Statutes;

(2) Completed specialized education and training in preparation for prescriptive practice approved by the American Psychological Association and the board of psychology;

(3) Has passed the Psychopharmacology Examination for Psychologists or an equivalent national examination approved by the board of psychology that is relevant to establishing competence for prescriptive practice;

(4) Is employed by, including as a contract provider, a federally qualified health center as defined in title 42 United States Code section 1396d located in the county of Kauai or county of Hawaii; and

(5) Meets any other requirements established by the board of psychology.

(c) The pilot program established pursuant to this Act shall be a three-year program that shall allow participating psychologists to prescribe psychotropic medications under a supervising physician or psychiatrist.

(d) The board of psychology shall adopt rules pursuant to chapter 91, Hawaii Revised Statutes, to implement the purpose of this Act.

(e) The state health planning and development agency shall submit a report of its findings and recommendations, including any proposed legislation, on the pilot program to the legislature no later than twenty days prior to the convening of the regular session of 2029. The report shall include a recommendation on whether to:

(1) Expand the pilot program to other underserved areas in the State;

(2) Make prescriptive authority for qualified psychologists permanent statewide; or

(3) Permanently end the pilot program.

(f) For the purposes of this Act:

"Prescriptive authority" means the authority to prescribe, administer, discontinue, or distribute without charge, drugs or controlled substances recognized in or customarily used in the diagnosis, treatment, and management of individuals with psychiatric, mental, cognitive, nervous, emotional, or behavioral disorders, or other procedures directly related thereto within the scope of practice of psychology in accordance with rules adopted by the board of psychology.

"Psychopharmacology" means the use of psychoactive drugs in the treatment and control of mental disorders or psychiatric disease.

"Psychotropic medication" means only those agents related to the diagnosis and treatment of mental and emotional disorders including controlled substances but not including narcotics.

"Supervising physician or psychiatrist" means a medically trained and licensed physician or psychiatrist who accepts professional responsibility for the provision of psychopharmacology by a psychologist certified to prescribe.

PART III

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

1. By adding a new definition to be appropriately inserted and to read:

""Psychologist certified to prescribe" means a person approved by the board of psychology to participate in the pilot program established pursuant to Act , Session Laws of Hawaii 2026, but who is not authorized to request, receive, or sign for professional controlled substance samples."

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;

(3) A licensed midwife practicing as a certified midwife registered under section 329-32 to prescribe and administer controlled substances in the course of professional practice in this State; [~~and~~]

(4) A licensed psychologist certified to prescribe and registered under section 329-32 to prescribe and dispense controlled substances in accordance with the requirements and limitations of the pilot program established pursuant to Act , Session Laws of Hawaii 2026; and

[~~(4)~~] (5) 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."

PART IV

SECTION 4. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 5. This Act shall take effect upon its approval.

THE SENATE	S.B. NO.	847
THIRTY-THIRD LEGISLATURE, 2025		S.D. 2
STATE OF HAWAII		H.D. 2
		C.D. 1