HOUSE OF REPRESENTATIVES

H.B. NO.

1072

TWENTY-EIGHTH LEGISLATURE, 2015

H.D. 1

STATE OF HAWAII

S.D. 1

 

Proposed

 

 

 

A BILL FOR AN ACT

 

 

RELATING TO PRESCRIPTIVE AUTHORITY FOR CERTAIN PSYCHOLOGISTS.

 

 

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

 


     SECTION 1.  The legislature finds there are an insufficient number of prescribing mental health care providers available to serve the needs of Hawaii's people.  The delivery of quality, comprehensive, accessible, and affordable health care is enhanced by collaborative practice between licensed clinical psychologists and medical doctors.  Providing advanced training in psychopharmacology to certain psychologists who wish to become prescribing psychologists would be beneficial to residents of Hawaii, particularly those who live in rural or medically underserved communities where mental health professionals with prescriptive authority are in short supply.

     The legislature further finds that the mental health needs of the State continue to outweigh present capacity.  According to the federal Centers for Disease Control and Prevention, suicide is the third leading cause of death for youth between the ages of ten and twenty-four and the tenth leading cause of death in the United States.  Suicide was the single leading cause of fatal injuries in Hawaii from 2004 to 2013, with a generally increasing trend in the annual suicide rate among residents.  On average, one hundred seventy people die from suicide and eight hundred fifty-two people attempt suicide in Hawaii each year.  Studies have shown that many people who commit suicide had received little or no treatment for their mental health problems due to barriers to accessing appropriate and effective care in the community, including lengthy wait times for appointments and a lack of accessible mental health care providers.  While causes for suicide are complex, the most commonly reported contributing factors include depression, relationship problems, and serious medical problems.  These are conditions that occur frequently but have been found to respond favorably to evidence-based treatments, such as cognitive behavioral therapy and psychotropic medications, when identified and treated early.

     A 2015 article in the Honolulu Star-Advertiser reported that fifty-one per cent of all people arrested in 2013 in Honolulu suffered from serious mental illness or severe substance intoxication.  This represents an almost two-fold increase in arrests of individuals with psychiatric illness or substance abuse issues in the period following substantial cuts to state-supported mental health services in 2009.  A 2014 survey by the Treatment Advocacy Center indicates that there are ten times more people with serious mental illness in jails and prisons than there are in state psychiatric institutions across the country.

     The legislature additionally finds that according to the National Alliance on Mental Illness and the federal Substance Abuse and Mental Health Services Administration, approximately thirty-two thousand adults in Hawaii, representing more than three per cent of the population, live with serious mental illness.  However, this figure may not completely reflect the scope of need, as it does not include individuals with other clinical diagnoses such as unipolar depression, anxiety disorders, adjustment disorders, substance abuse, or post-traumatic stress disorder.

     The legislature also finds that clinical psychologists are licensed health professionals with 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 clinical psychologists' practice does not include prescribing medications, these providers' patients must consult with and pay for another provider to obtain psychotropic medications when indicated.

     The legislature has previously authorized prescription privileges to advanced practice registered nurses, optometrists, dentists, and naturopathic physicians.  Licensed clinical psychologists with 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.  In recent years, Illinois, Louisiana, and New Mexico adopted legislation authorizing prescriptive authority for advanced trained psychologists.  There are approximately one hundred thirty psychologists with prescriptive authority in Louisiana and New Mexico. Furthermore, there have been no adverse events or complaints brought against any of these prescribing psychologists regarding their practice.  In Louisiana and New Mexico, prescribing psychologists have been able to fill positions that were vacant for a number of years and continue to serve predominant indigent or rural populations.

     The legislature further finds that 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 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 Louisiana and New Mexico, have found that appropriately trained prescribing psychologists can prescribe medications safely and effectively.  A master of science in clinical psychopharmacology is currently offered at the University of Hawaii at Hilo college of pharmacy.

     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" shall have the same meaning as in section 457-2.

     "Advanced practice registered nurse with prescriptive authority" means an advanced practice registered nurse 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 are learned and which are conducted and supervised as part of a post-doctoral master of science degree in clinical psychopharmacology training.

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

     "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 licensed pursuant to section 457-8.6.

     "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.

     §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.

     (c)  The board shall grant or renew prescriptive authority privilege, as applicable, to every applicant who meets the requirements for licensure or renewal under section 465-7 or 465-11, as applicable, and the requirements of this part.

     (d)  The board shall determine the exclusionary formulary for prescribing psychologists.

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

     §465-    Prescriptive authority privilege; requirements.  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 four hundred hours completed in no less than twelve months and no more than forty-eight months;

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

            (iii)  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 Exam for Psychologists developed by the American Psychological Association's Practice Organization's College of Professional Psychology relevant to establish competence across the following content areas:  neuroscience, nervous system pathology, 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 American Psychological Association's Practice Organization's College of Professional Psychology.

     §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.

     (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;

     (2)  Consult with the patient's primary care provider regarding changes to a medication treatment plan, including dosage adjustments, addition of medications, or discontinuation of medications; and

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

     (e)  A prescribing psychologist shall not prescribe 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 may only prescribe 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 promulgated by the board.

     (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 schedule I controlled substances pursuant to section 329-14, schedule II controlled substances pursuant to section 329-16, or schedule III controlled substances pursuant to section 329-18, including all narcotic drugs and opiates; provided that prescribing psychologists may prescribe stimulants for the treatment of attention deficit hyperactivity disorder.

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

     (b)  Every 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, on conviction, fined not more than $1,000 or imprisoned not more than one year, or both."

     SECTION 3.  Section 346-59.9, Hawaii Revised Statutes, is amended by amending subsection (i) to read as follows:

     "(i)  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 4.  Chapter 465, Hawaii Revised Statutes, is amended by designating sections 465-1 to 465-15, as part I and inserting a title before section 465-1, to read as follows:

"Part I.  General Provisions"

     SECTION 5.  Section 465-3, Hawaii Revised Statutes, is amended by amending subsection (e) to read as follows:

     "(e)  [Nothing] Other than 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 6.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 7.  This Act shall take effect on July 1, 2016.


 


 

Report Title:

Psychologists; Prescribing Psychologists; Prescriptive Authority; Board of Psychology

 

Description:

Authorizes the board of psychology to grant prescriptive authority to prescribing psychologists who meet specific education, training, and registration requirements.  (Proposed SD1)

 

 

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