STAND. COM. REP. NO. 370

Honolulu, Hawaii

RE: S.B. No. 819

S.D. 1

Honorable Ronald D. Kouchi

President of the Senate

Thirtieth State Legislature

Regular Session of 2019

State of Hawaii

Sir:

Your Committee on Commerce, Consumer Protection, and Health, to which was referred S.B. No. 819 entitled:

"A BILL FOR AN ACT RELATING TO PRESCRIPTIVE AUTHORITY FOR CERTAIN CLINICAL PSYCHOLOGISTS,"

begs leave to report as follows:

The purpose and intent of this measure is to authorize and establish procedures and criteria for prescriptive authority for clinical psychologists who meet specific education, training, and registration requirements.

Your Committee received testimony in support of this measure from the Hawai‘i Psychological Association, Mental Health America of Hawai‘i, American Psychological Association, and over forty individuals. Your Committee received testimony in opposition to this measure from the Hawaii Psychiatric Medical Association, Hawaii Medical Association, American Osteopathic Association and Hawaii Association of Osteopathic Physicians and Surgeons, American Psychiatric Association, American Medical Association, and eleven individuals. Your Committee received comments on this measure from the Board of Psychology.

Your Committee finds that there is a critical need in Hawaii for improved access to safe, effective, and comprehensive mental health care services. Due to the shortage of psychiatrists, patients' mental health issues often fall to their primary care provider or family physician for diagnosis and treatment, or they forgo treatment altogether because they lack access to a psychiatrist. The vast majority of Americans who receive medications for treatment of mental disorders do not obtain them from psychiatrists. In fact, studies have shown that nearly sixty percent of psychotropic medications are prescribed by primary care providers for patients with no documented psychiatric diagnosis. Non-psychiatric physicians are not, however, generally trained to diagnose and treat mental health disorders, provide psychotherapy, or other psychological interventions. Furthermore, psychiatrists are the least likely to accept insurance or Medicaid compared to other medical specialties.

Your Committee additionally finds that psychologists with additional post-doctoral training in psychopharmacology are skilled in both the diagnosis and treatment of mental conditions and use of psychotropic medications. They can provide urgently needed psychological interventions and psychopharmacological treatment services to the underserved populations of the State. This measure increases access to care by allowing psychologists with appropriate advanced training in psychopharmacology to provide comprehensive mental health care. This measure further provides necessary safeguards to ensure that only those psychologists with appropriate education, clinical training, and registration will be authorized to prescribe from a limited formulary of psychotropic medications.

Your Committee has amended this measure by:

(1) Clarifying that the clinical experience requirement for eligibility as a prescribing psychologist shall include a minimum of eight hundred hours completed over a fifty-six-month period and an eight-week rotation through specified areas of medicine;

(2) Inserting language delaying implementation to July 1, 2022 to give the Board of Psychology adequate time to prepare for the requirements proposed by this measure;

(3) Clarifying that the repeal date for this measure is intended to be August 31, 2025;

(4) Inserting an effective date of July 1, 2050, to encourage further discussion; and

(5) Making technical, nonsubstantive amendments for the purposes of clarity and consistency.

As affirmed by the record of votes of the members of your Committee on Commerce, Consumer Protection, and Health that is attached to this report, your Committee is in accord with the intent and purpose of S.B. No. 819, as amended herein, and recommends that it pass Second Reading in the form attached hereto as S.B. No. 819, S.D. 1, and be referred to your Committees on Judiciary and Ways and Means.

Respectfully submitted on behalf of the members of the Committee on Commerce, Consumer Protection, and Health,

________________________________

ROSALYN H. BAKER, Chair