Bill Text: HI SB60 | 2024 | Regular Session | Introduced

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Bill Title: Relating To Health.

Spectrum: Partisan Bill (Democrat 6-0)

Status: (Introduced) 2023-12-11 - Carried over to 2024 Regular Session. [SB60 Detail]

Download: Hawaii-2024-SB60-Introduced.html

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THE SENATE	S.B. NO.	60
THIRTY-SECOND LEGISLATURE, 2023
STATE OF HAWAII

A BILL FOR AN ACT

 

 

Relating to Health.

 

 

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

 

     SECTION 1.  The legislature finds that access to psychiatric care on the neighbor islands and in rural Oahu was already difficult before the coronavirus disease 2019 pandemic and has been exacerbated by the pandemic.  According to the University of Hawaii's 2021 Annual Report on Findings from the Hawaii Physician Workforce Assessment Project, while there is an eleven per cent shortage of adult psychiatry practitioners statewide, when unmet demand without overage is not taken into account, there is a forty-six and sixty-two per cent shortage for the counties of Hawaii and Kauai, respectively.  Due to this shortage, a vast number of residents who seek assistance are unable to receive the treatment they need.

     The legislature also finds that to meet this urgent gap in services, health care providers are using telehealth to supplement services.  Contracting with telehealth providers who are licensed and credentialed in the State but not physically residing in the State improves access to meet this need.  However, many individuals in need of outpatient psychiatric assistance are unable to receive medication management to maintain function and prevent potential hospitalization or incarceration.

     The legislature further finds that telehealth providers who do not reside in the State, even if properly licensed and credentialed, are prohibited from prescribing necessary medications to address disorders such as anxiety, depression, and other mood disorders.

     The legislature additionally finds that during the pandemic, when unemployment reached twenty-two per cent statewide, the number of QUEST patients dramatically increased.  At the same time, the number of psychiatric providers residing in the State and who were willing to take QUEST patients decreased.  This remains an ongoing problem, as there are few openings for existing patients to gain access to services, let alone new patients trying to access the system of care with QUEST or medicare coverage.

     The purpose of this Act is to give physicians, advanced practice registered nurses, and physician assistants, who are licensed and credentialed in the State but not physically residing in the State, the ability to treat patients via telehealth modalities.

     SECTION 2.  Chapter 329, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

     "§329-    Prescriptions; physical presence; pharmacies.  (a)  Notwithstanding section 329-38 to the contrary, a physician licensed under chapter 453, a licensed advanced practice registered nurse with prescriptive authority pursuant to section 457-8.6, or a physician assistant licensed under section 453‑5.3, who is not physically in the State, may issue a prescription for a schedule III, schedule IV, or schedule V controlled substance; provided that the physician, advanced practice registered nurse, or physician assistant:

     (1)  Has a valid Drug Enforcement Administration registration number and is registered under section 329-32; and

     (2)  Issues prescriptions pursuant to a written contract with or as an employee of a physician, medical group practice, or health care facility that is located within the State.

     (b)  A pharmacy may dispense a prescription authorized under subsection (a)."

     SECTION 3.  Section 329-38, Hawaii Revised Statutes, is amended by amending subsection (i) to read as follows:

     "(i)  Prescriptions for controlled substances shall be issued only as follows:

     (1)  All prescriptions for controlled substances shall originate from within the State, except as provided by section 329-   , and be dated as of, and signed on, the day when the prescriptions were issued and shall contain:

          (A)  The first and last name and address of the patient; and

          (B)  The drug name, strength, dosage form, quantity prescribed, and directions for use.  Where a prescription is for gamma hydroxybutyric acid, methadone, or buprenorphine, the practitioner shall record as part of the directions for use, the medical need of the patient for the prescription.

          Except for electronic prescriptions, controlled substance prescriptions shall be no larger than eight and one-half inches by eleven inches and no smaller than three inches by four inches.  A practitioner may sign a prescription in the same manner as the practitioner would sign a check or legal document (e.g., J.H. Smith or John H. Smith) and shall use both words and figures (e.g., alphabetically and numerically as indications of quantity, such as five (5)), to indicate the amount of controlled substance to be dispensed.  Where an electronic prescription is permitted, either words or figures (e.g., alphabetically or numerically as indications of quantity, such as five or 5), to indicate the amount of controlled substance to be dispensed shall be acceptable.  Where an oral order or electronic prescription is not permitted, prescriptions shall be written with ink or indelible pencil or typed, shall be manually signed by the practitioner, and shall include the name, address, telephone number, and registration number of the practitioner.  The prescriptions may be prepared by a secretary or agent for the signature of the practitioner, but the prescribing practitioner shall be responsible in case the prescription does not conform in all essential respects to this chapter and any rules adopted pursuant to this chapter.  In receiving an oral prescription from a practitioner, a pharmacist shall promptly reduce the oral prescription to writing, which shall include the following information:  the drug name, strength, dosage form, quantity prescribed in figures only, and directions for use; the date the oral prescription was received; the full name, Drug Enforcement Administration registration number, and oral code number of the practitioner; and the name and address of the person for whom the controlled substance was prescribed or the name of the owner of the animal for which the controlled substance was prescribed.

              A corresponding liability shall rest upon a pharmacist who fills a prescription not prepared in the form prescribed by this section.  A pharmacist may add a patient's missing address or change a patient's address on all controlled substance prescriptions after verifying the patient's identification and noting the identification number on the back of the prescription document on file.  The pharmacist shall not make changes to the patient's name, the controlled substance being prescribed, the quantity of the prescription, the practitioner's Drug Enforcement Administration number, the practitioner's name, the practitioner's electronic signature, or the practitioner's signature;

     (2)  An intern, resident, or foreign-trained physician, or a physician on the staff of a Department of Veterans Affairs facility or other facility serving veterans, exempted from registration under this chapter, shall include on all prescriptions issued by the physician:

          (A)  The registration number of the hospital or other institution; and

          (B)  The special internal code number assigned to the physician by the hospital or other institution in lieu of the registration number of the practitioner required by this section.

          The hospital or other institution shall forward a copy of this special internal code number list to the department as often as necessary to update the department with any additions or deletions.  Failure to comply with this paragraph shall result in the suspension of that facility's privilege to fill controlled substance prescriptions at pharmacies outside of the hospital or other institution.  Each written prescription shall have the name of the physician stamped, typed, or hand-printed on it, as well as the signature of the physician;

     (3)  An official exempted from registration shall include on all prescriptions issued by the official:

          (A)  The official's branch of service or agency (e.g., "U.S. Army" or "Public Health Service"); and

          (B)  The official's service identification number, in lieu of the registration number of the practitioner required by this section.  The service identification number for a Public Health Service employee shall be the employee's social security or other government issued identification number.

          Each prescription shall have the name of the officer stamped, typed, or handprinted on it, as well as the signature of the officer; and

     (4)  A physician assistant registered to prescribe controlled substances under the authorization of a supervising physician shall include on all controlled substance prescriptions issued:

          (A)  The Drug Enforcement Administration registration number of the supervising physician; and

          (B)  The Drug Enforcement Administration registration number of the physician assistant.

          Each written controlled substance prescription issued shall include the printed, stamped, typed, or hand-printed name, address, and phone number of both the supervising physician and physician assistant, and shall be signed by the physician assistant."

     SECTION 4.  Section 329-41, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

     "(a)  It is unlawful for any person:

     (1)  Who is subject to part III to distribute, administer, prescribe, or dispense a controlled substance in violation of section 329-38 or rules authorized under section 329-31; however, a licensed manufacturer or wholesaler may sell or dispense a controlled substance to a master of a transpacific ship or a person in charge of a transpacific aircraft upon which no physician is regularly employed, for the actual medical needs of persons on board [such] the ship or aircraft when not in port; provided schedule I or II controlled substances shall be sold to the master of [such] the ship or person in charge of [such] the aircraft only in accordance with the provisions set forth in 21 Code of Federal Regulations, sections 1301, 1305, and 1307, adopted pursuant to Title 21, United States Code, section 821;

     (2)  Who is a registrant to manufacture a controlled substance not authorized by the registrant's registration or to distribute or dispense a controlled substance not authorized by the registrant's registration to another registrant or another authorized person;

     (3)  To refuse or fail to make available, keep, or furnish any record, notification, order form, prescription, statement, invoice, or information in patient charts relating to the administration, dispensing, or prescribing of controlled substances;

     (4)  To refuse any lawful entry into any premises for any inspection authorized by this chapter;

     (5)  [Knowingly to] To knowingly keep or maintain any store, shop, warehouse, dwelling, building, vehicle, boat, aircraft, or other structure or place for the purpose of using these substances or which is used for keeping or selling them in violation of this chapter or chapter 712, part IV;

     (6)  Who is a practitioner or pharmacist to dispense a controlled substance to any individual not known to the practitioner or pharmacist, except under the following circumstances:

          (A)  When dispensing a controlled substance directly to an individual, the practitioner or pharmacist shall first obtain and document, in a log book or an electronic database, the full name, identification number, identification type, and signature, whether by actual signature or by electronic signature capture device, of the individual obtaining the controlled substance.  If the individual does not have any form of proper identification, the pharmacist shall verify the validity of the prescription and identity of the patient with the prescriber, or their authorized agent, before dispensing the controlled substance; and

          (B)  For mail order prescriptions, the practitioner or pharmacist shall not be subject to subparagraph (A); provided that all other requirements of chapter 329 shall apply and that the practitioner or pharmacist, as part of the initial registration process of an individual in a mail order prescription drug plan and [prior to] before the controlled substance [being] is dispensed, shall obtain all identification information, including the full name, identification number, identification type, signature, and a photocopy of a form of proper identification of the individual obtaining the controlled substance.  The practitioner or pharmacist shall also comply with other requirements set forth by rule.

          For the purpose of this section, "proper identification" means government-issued identification containing the photograph, printed name, identification number, and signature of the individual obtaining the controlled substance;

     (7)  Who is a practitioner to predate or pre-sign prescriptions to facilitate the obtaining or attempted obtaining of controlled substances; or

     (8)  Who is a practitioner to facilitate the issuance or distribution of a written prescription or to issue an oral prescription for a controlled substance when not physically in the State[.], except as authorized under section 329-   ."

     SECTION 5.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 6.  This Act shall take effect upon its approval; provided that the amendments made to section 329-38(i), Hawaii Revised Statutes, by section 3 of this Act shall not be repealed when that section is repealed and reenacted on June 30, 2023, by Act 66, Session Laws of Hawaii 2017.

 

INTRODUCED BY:	_____________________________

 

 

Report Title:

Controlled Substances; Prescriptions; Out-Of-State Prescribers

 

Description:

Authorizes state-licensed and credentialed physicians, advanced practice registered nurses, and physician assistants, who are not physically in the State, to issue prescriptions for certain controlled substances under a limited circumstance.  Authorizes pharmacies to dispense the prescriptions.

 

 

 

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