Bill Text: HI SB1219 | 2014 | Regular Session | Introduced

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Bill Title: Prescriptive Authority; Psychologists; Pilot Program

Spectrum: Partisan Bill (Democrat 10-0)

Status: (Introduced - Dead) 2013-12-18 - Carried over to 2014 Regular Session. [SB1219 Detail]

Download: Hawaii-2014-SB1219-Introduced.html

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THE SENATE	S.B. NO.	1219
TWENTY-SEVENTH LEGISLATURE, 2013
STATE OF HAWAII

A BILL FOR AN ACT

 

 

relating to psychologists.

 

 

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

 

     SECTION 1.  The legislature finds that there is limited access to mental health care treatment services for residents across the State of Hawaii.  The delivery of comprehensive, accessible, and affordable mental health medical care may be enhanced by providing trained medical psychologists, licensed in Hawaii, with prescriptive authority.  The legislature has previously authorized prescription privileges to advanced practice registered nurses, optometrists, dentists, podiatrists, osteopaths, and physician assistants.  Further, psychologists with appropriate credentials have been allowed to prescribe medications to active duty military personnel and their families in federal facilities and the Indian Health Service for years.

     The legislature acknowledges that the United States Public Health Service, Health Resources and Services Administration, has officially designated much of the State of Hawaii as a mental health professional shortage area.  The nearly statewide shortage designations indicate that rural and urban areas suffer when it comes to accessing mental health care.

     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.  Because the current scope of psychologists' practice does not include prescribing medications, patients must consult with and pay for another provider to obtain psychotropic medications.  However, practitioners with prescriptive authority are not readily available in some areas and to some populations such as the un- or under-insured, who are too often turned away from psychiatrists in the community who do not accept certain forms of health insurance.

     The legislature acknowledges that the mental health needs of the State continue to outweigh present capacity.  The purpose of this Act is to create a prescriptive authority pilot program to authorize appropriately trained and supervised psychologists to prescribe psychotropic medications for the treatment of mental illness.

     SECTION 2.  As used in this Act, unless the context otherwise requires:

     "Board" means the board of psychology established pursuant to section 465-4, Hawaii Revised Statutes.

     "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 the training program.

     "Narcotics" means natural and synthetic opioid analgesics, and their derivatives used to relieve pain.

     "Participating psychologist" means a licensed psychologist who has been selected by the board to participate in the prescriptive authority pilot program established by this Act.

     "Prescription" means an order for a drug, laboratory test, or any medicine, device, or treatment, including a controlled substance, as defined by state law.

     "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 and regulations adopted by the board.

     "Psychologist certified to prescribe" means a participating psychologist who been granted prescriptive authority by the board, which has not been revoked or suspended.

     "Psychotropic medication" means only those agents related to the diagnosis and treatment of mental and emotional disorders, including controlled substances, except narcotics.

     "Supervising physician" means a medically trained and licensed physician or psychiatrist who accepts professional responsibility for the provision of psychopharmacotherapy.

     SECTION 3.  (a)  There is established a four-year prescriptive authority pilot program to be administered by the board to allow participating psychologists licensed under chapter 465, Hawaii Revised Statutes, to prescribe psychotropic medications under the supervision of a licensed physician at a federally qualified health center established pursuant to title 42 United States Code section 1396.

     (b)  The pilot program shall operate as follows:

     (1)  In the first two years, participating psychologists shall practice only at Waianae Coast Comprehensive Health Center and shall receive training and be directly supervised by a physician at that location;

     (2)  After the first two years of the pilot program, the supervising physician at Waianae Coast Comprehensive Health Center shall continue to train and supervise participating psychologists and may recruit additional physicians at other federally qualified health centers in the State to train and supervise participating psychologists at those locations;

     (3)  Participating psychologists shall be directly supervised by supervising physicians at a federally qualified health center for the first two years of the psychologists' participation in the pilot program; and

     (4)  After completing two years of direct supervision, participating psychologists shall maintain a collaborative and collegial relationship with a supervising physician and with the medical doctors who oversee the general medical care of the participating psychologist's patients at a federally qualified health center and shall exercise prescriptive authority only for patients treated by the psychologist at the federally qualified health center.

     SECTION 4.  (a)  To participate in the prescriptive authority pilot program, a psychologist shall demonstrate all of the following by official transcript or other official evidence satisfactory to the board:

     (1)  The psychologist holds a current license in good standing to practice psychology in Hawaii;

     (2)  As defined by the board, and consistent with established policies of the American Psychological Association for educating and training psychologists in preparation for prescriptive authority:

         (A)  The psychologist shall have completed a master's degree in psychopharmacology, which shall consist of an organized sequence of study in an organized program offering intensive didactic education, and including the following core areas of instruction:  basic life sciences, neurosciences, clinical and research pharmacology and psychopharmacology, clinical medicine and pathophysiology, physical assessment and laboratory examinations, clinical pharmacotherapeutics, research, and professional, ethical, and legal issues; and

         (B)  The psychologist shall have obtained relevant clinical experience sufficient to attain competency in the psychopharmacological treatment of a diverse patient population under the direction of a supervising physician.  This experience shall consist of at least one year, involving four hundred hours treating a diverse population of no fewer than one hundred patients with mental disorders including at least two hours of weekly supervision.  The supervising physician shall not be in the employ of the person being directed or supervised;

     (3)  The psychologist shall pass an examination developed by a nationally recognized body (e.g., the American Psychological Association's Practice Organization's College of Professional Psychology) and approved by the board;

     (4)  The psychologist shall obtain a federal Drug Enforcement Administration registration number for limited use as restricted by state law;

     (5)  The psychologist shall have malpractice insurance in place sufficient to satisfy the rules adopted by the board, that covers the applicant during the period the conditional prescription certificate is in effect;

     (6)  The psychologist has met all other requirements, as determined by rules adopted by the board pursuant to chapter 91, Hawaii Revised Statutes, for obtaining a conditional prescription certificate; and

     (7)  The psychologist is employed or contracted by and will practice the prescribing authority at a federally qualified health center established pursuant to title 42 United States Code section 1396.

     (b)  The board shall accept the applicant if it finds that the applicant has met all of the requirements of this section and shall immediately remove the psychologist from participation in the pilot program if the psychologist no longer meets the requirements of this section.

     SECTION 5.  (a)  A participating psychologist shall:

     (1)  Continue to hold a current license to practice psychology in Hawaii and continue to maintain malpractice insurance;

     (2)  Inform the board of the name of the supervising physician under whose supervision the psychologist will prescribe psychotropic medication; provided that the psychologist shall promptly inform the board of any change of the supervising physician; and

     (3)  Maintain an ongoing collaborative relationship with the doctor of medicine who oversees the patient's general medical care.

     (b)  A participating psychologist shall be authorized 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 and relevant to the practice of psychology, or other procedures directly related thereto within the scope of the practice of psychology in accordance with rules adopted by the board.  The authorization shall be limited to services provided to patients under the care of the psychologist and who are enrolled at a federally qualified health center identified by the board.

     (c)  When prescribing psychotropic medication for a patient, a participating psychologist shall maintain an ongoing collaborative relationship with the doctor of medicine who oversees the patient's general medical care to ensure that:

     (1)  Necessary medical examinations are conducted;

     (2)  The psychotropic medication is appropriate for the patient's medical condition; and

     (3)  Significant changes in the patient's medical or psychological condition are discussed.

     (d)  A prescription written by a participating psychologist shall:

     (1)  Comply with applicable state and federal laws;

     (2)  Be identified as issued by the psychologist as "psychologist certified to prescribe"; and

     (3)  Include the psychologist's board number or the identification number assigned by the department of commerce and consumer affairs.

     (e)  A participating psychologist shall not delegate prescriptive authority to any person.  Records of all prescriptions shall be maintained in the prescribing psychologist's patient records.

     (f)  When authorized to prescribe controlled substances, a participating psychologist shall file with the board, in a timely manner, all individual federal Drug Enforcement Administration registration numbers.

     (g)  A participating psychologist shall not administer or prescribe any narcotic and shall not request, receive, or sign for professional controlled substance samples.

     SECTION 6.  (a)  The board may adopt rules pursuant to chapter 91, Hawaii Revised Statutes, to further implement the procedures set forth in this Act to implement the prescriptive authority pilot program, including grounds for denial, suspension, or revocation of participation in the pilot program.

     (b)  The board shall maintain current records on every participating psychologist, including federal Drug Enforcement Administration registration numbers.

     (c)  The board shall provide to the board of pharmacy an annual, updated list of participating psychologists that contains information to be agreed upon between the board and the board of pharmacy.

     SECTION 7.  At the end of the fourth year of the pilot program, the board of psychology shall prepare a report, under the direction of the supervising physicians of the pilot program and with input from participating psychologists and the physicians and administrators of participating federally qualified health centers, to be submitted to the legislature no later than twenty days prior to the convening of the regular session of 2018.  The report shall include:

     (1)  The number and type of patients served by participating psychologists;

     (2)  Treatment services outcomes of patients treated by participating psychologists;

     (3)  Whether and how the pilot program improved access to mental health care;

     (4)  Patient satisfaction with mental health care provided by participating psychologists; and

     (5)  Any other findings, recommendations, or proposed legislation regarding the continuation of or any amendments to the pilot program.

     SECTION 8.  Section 465-3, Hawaii Revised Statutes, is amended as follows:

     1.  By amending subsection (c) to read:

     "(c)  A person may use the title of industrial/ organizational psychologist, provided that the person registers with the board, and:

     (1)  Is professionally competent in the practice of industrial/organizational psychology; [and]

     (2)  Holds a doctoral degree from an accredited institution of higher education with training and education in industrial/organizational psychology, satisfactory to the board; and

     (3)  Provides psychological service or consultation to organizations [which] that does not involve the delivery or supervision of direct psychological services to individuals or groups of individuals, without regard to the source or extent of payment for services rendered."

     2.  By amending subsection (e) to read:

     "(e)  [Nothing] Unless otherwise provided by law, 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 9.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 10.  This Act shall take effect on July 1, 2013, and shall be repealed on December 31, 2017.

 

INTRODUCED BY:	_____________________________

 

 

Report Title:

Prescriptive Authority; Psychologists; Pilot Program

 

Description:

Creates a four-year prescriptive authority pilot program to authorize prescriptive authority for qualified psychologists who practice at a federally qualified health center.  Requires the board of psychology to submit a report to the legislature no later than twenty days prior to the convening of the regular session of 2018.  Repeals on December 31, 2017.

 

 

 

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