SB708

SECTION 1. The legislature finds that Hawaii needs more mental health professionals having prescriptive authority to provide the State's residents with access to care. The State is experiencing a critical shortage of psychiatrists and primary care physicians. This is especially true on the neighbor islands, which experience shortages of psychiatrists of up to seventy-five per cent. These shortages are leaving significant mental health needs unmet.

Untreated or undertreated mental illnesses and substance abuse disorders contribute to chronic homelessness in Hawaii and are factors in approximately sixty per cent of all arrests on the island of Oahu. Mentally ill persons who receive inadequate or no treatment may also be at higher risk of attempting suicide. According to the department of health, suicide is the number one cause of death among Hawaii residents between fifteen to twenty-four years of age. However, when identified and treated, many mental health conditions respond well to therapy and medication.

Although clinical psychologists in Hawaii currently lack prescriptive authority, psychologists in other states have been given this privilege. Colorado, Idaho, Illinois, Iowa, Louisiana, and New Mexico have authorized prescriptive authority for advanced trained psychologists. The Department of Defense and Indian Health Service also authorize specially trained psychologists to prescribe psychotropic medications. The American Psychological Association has developed a model curriculum for psychologists to earn a master's degree in psychopharmacology.

The legislature recognizes that allowing specially trained psychologists to prescribe certain psychotropic medications would provide more residents with access to needed mental health care.

Accordingly, the purpose of this Act is to authorize and appropriate funds for the board of psychology to grant prescriptive authority to clinical 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 with prescriptive authority" means an advanced practice registered nurse, as defined in section 457-2, with prescriptive authority granted pursuant to section 457-8.6.

"Clinical experience" means a period of supervised clinical training and practice during which clinical diagnoses and interventions can be completed and supervised as part of, or subsequent to, earning a post-doctoral master of science degree in clinical psychopharmacology.

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

"Forensically encumbered" means a person who has been detained by a Hawaii court for forensic examination or committed to a psychiatric facility under the care and custody of the director of health for appropriate placement by any court, has been placed on conditional release or released on conditions by a judge on a Hawaii court, or is involved in mental health court or a jail diversion program.

"Narcotic drug" has the same meaning as in section 329-1.

"Opiate" has the same meaning as in section 329-1.

"Prescribing psychologist" means a clinical 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 and administer psychotropic medication and other directly related procedures within the scope of the practice of psychology in accordance with rules adopted by the board.

"Primary care provider" means a physician or osteopathic physician licensed or exempt from licensure pursuant to section 453-2 or an advanced practice registered nurse with prescriptive authority.

"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 as 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 stimulants' schedule classification.

"Serious mental illness" means bipolar I disorder, bipolar II disorder, delusional disorder, major depressive disorder with psychotic features, psychosis secondary to substance use, schizophrenia, schizophreniform disorder, and schizoaffective disorder, as defined by the most current version of the Diagnostic and Statistical Manual of Mental Disorders.

§465- Administration. (a) The board shall prescribe forms and fees for the application for and renewal of prescriptive authority privilege pursuant to this part.

(b) The board shall develop and implement procedures for reviewing the educational and training credentials of a psychologist applying for or renewing prescriptive authority privilege pursuant to this part, in accordance with current standards of professional practice.

(c) The board shall develop the exclusionary formulary for prescribing psychologists. The board may form an advisory panel for developing the exclusionary formulary and establishing rules.

(d) The board shall adopt rules pursuant to chapter 91 as necessary to implement this part; provided that the board shall establish a rule that, except as otherwise provided in this part, a prescribing psychologist shall collaborate with the patient's primary health care provider.

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

§465- Prescriptive authority privilege; requirements. Beginning on July 1, 2026, the board shall accept applications for prescriptive authority privilege. Each applicant for prescriptive authority privilege shall submit evidence, in a form and manner prescribed by the board, satisfying the board that the applicant:

(1) Has clinical experience that includes:

(A) A minimum of eight hundred hours completed in a clinical prescribing practicum, including geriatric, pediatric, and pregnant patients, completed in no fewer than twelve months and not more than fifty-six months;

(B) The supervision of a minimum of one hundred patients, including geriatric, pediatric, and pregnant patients;

(C) A minimum of eighty hours completed in a physical assessment practicum in a primary care, family practice, community, or internal medicine setting;

(D) A minimum of one hundred hours of community service working with populations who are low‑income, homeless, or veterans; and

(E) A minimum of two hours per week of supervision by a primary care provider or prescribing psychologist; and

(2) Has demonstrated competency in neuroscience; nervous system pathology; physiology and pathophysiology; biopsychosocial and pharmacologic assessment and monitoring; differential diagnosis; pharmacology; clinical psychopharmacology; research; and in integrating clinical psychopharmacology with the practice of psychology and other diverse factors including professional, legal, ethical, and interprofessional concerns, by successfully passing the nationally recognized Psychopharmacology Examination for Psychologists, as determined by:

(A) The American Psychological Association Practice Organization, if the examination was taken prior to 2017;

(B) The Association of State and Provincial Psychology Boards, if the examination was taken after 2018; or

§465- Prescriptive authority privilege; renewal. (a) The board shall develop and implement processes for renewing 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; provided that the continuing education requirement shall not apply to a prescribing psychologist who is applying for the psychologist's first prescriptive authority renewal.

(c) The continuing education required pursuant to subsection (b) shall be in addition to the continuing education requirement in section 465-11.

(d) The board may conduct random audits of licensees to determine compliance with the continuing education required by subsection (b). The board shall provide written notice of an audit to each randomly selected licensee. Within ninety days of notification, the licensee shall provide the board with documentation verifying compliance with the continuing education requirement established by subsection (b).

(e) The board shall grant prescriptive authority, without examination, to a psychologist who:

(1) Has been licensed to prescribe for five or more years in a state that authorizes prescriptive authority for psychologists;

(2) Is authorized to prescribe by any branch of the United States Armed Services;

(3) Is authorized to prescribe by the United States Department of Health; or

(4) Is authorized to prescribe by the Indian Health Service.

§465- Prescriptive authority privilege; prescribing practices. (a) It shall be unlawful for any psychologist not granted prescriptive authority privilege pursuant to this part to prescribe, offer to prescribe, administer, or offer to administer any medication; or to use any sign, card, or device to indicate that the psychologist is authorized to prescribe or administer medication.

(b) A valid prescription issued by a prescribing psychologist shall be legibly written and shall include the:

(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) Except as provided in paragraph (3), prescribe and administer psychotropic medication only in consultation with and pursuant to a written and signed collaborative agreement with the patient's primary care provider;

(2) Make any changes to a medication treatment plan, including dosage adjustments, additions of medications, or discontinuations of medications, only in consultation and collaboration with the patient's primary care provider;

(3) Prescribe and administer psychotropic medication for a patient who is forensically encumbered or who has a diagnosis of a serious mental illness and is subject to the jurisdiction of the department of health, only:

(A) After entering into a written and signed collaborative agreement with the department of health;

(B) In accordance with a treatment protocol agreed to by the prescribing psychologist and the treating psychologist at the department of health; and

(4) Document all consultations in the patient's medical record.

(e) A prescribing psychologist shall not prescribe or administer a psychotropic medication to 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 shall only prescribe and administer 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 adopted by the board.

(c) The exclusionary formulary and any revised formularies shall be made available to licensed pharmacies at the request of the pharmacy and at no cost.

(d) Under the exclusionary formulary, prescribing psychologists shall not prescribe or administer:

(1) Schedule I controlled substances pursuant to section 329-14;

(2) Schedule II controlled substances pursuant to section 329-16;

(3) Schedule III controlled substances pursuant to section 329-18, including any narcotic drugs or opiates; and

(4) For indications other than those stated in labeling approved by the United States Food and Drug Administration if the patient is seventeen years of age or younger;

provided that a prescribing psychologist may prescribe and administer stimulants for the treatment of attention deficit hyperactivity disorder, regardless of the stimulants' schedule classification and buprenorphine for the treatment of opioid use disorder.

§465- Violation; penalties. Any person who violates this part shall be guilty of a misdemeanor and, upon conviction, subject to penalties as provided in section 465-15(b). Any person who violates this part may also be subject to disciplinary action by the board."

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

1. By adding two new definitions to be appropriately inserted and to read:

""Prescribing psychologist" means a clinical psychologist licensed under chapter 465 who has:

(1) Undergone specialized training in clinical psychopharmacology;

(2) Passed a national proficiency examination in psychopharmacology, as approved by the board of psychology; and

(3) Been granted prescriptive authority privilege by the board of psychology.

"Psychotropic medication" means only those agents related to the diagnosis and treatment of mental and emotional disorders pursuant to the practice of psychology, as that term is defined in section 465-1, except:

(1) Drugs classified into schedule I, II, or III pursuant to this chapter;

(2) Opiates; or

(3) Narcotics;

provided that psychotropic medication shall include stimulants for the treatment of attention deficit hyperactivity disorder, regardless of the stimulants' schedule classification and buprenorphine for the treatment of opioid use disorder."

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; [~~and~~]

(3) A prescribing psychologist licensed and registered under section 329-32 to prescribe and administer psychotropic medication in the course of professional practice in this State; and

[~~(3)~~] (4) 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."

SECTION 4. Section 329-38, Hawaii Revised Statutes, is amended by amending subsection (h) to read as follows:

"[[](h)[]] Prescriptions for controlled substances shall be issued only as follows:

(1) All prescriptions for controlled substances shall originate from within the State 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 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[.]; and

(5) A prescribing psychologist authorized to prescribe and administer psychotropic medication in consultation and collaboration with a primary care provider pursuant to part of chapter 465 shall include on all psychotropic medication prescriptions issued:

(A) The Drug Enforcement Administration registration number of the primary care provider;

(B) The printed, stamped, typed, or hand-printed name, address, and phone number of both the licensed primary care provider and the prescribing psychologist; and

SECTION 5. Section 329-39, Hawaii Revised Statutes, is amended by amending subsection (b) to read as follows:

"(b) Whenever a pharmacist sells or dispenses any controlled substance on a prescription issued by a physician, dentist, podiatrist, or veterinarian, or any psychotropic medication on a prescription issued by a prescribing psychologist, the pharmacist shall affix to the bottle or other container in which the drug is sold or dispensed:

(1) The pharmacy's name and business address;

(2) The serial number of the prescription;

(3) The name of the patient or, if the patient is an animal, the name of the owner of the animal and the species of the animal;

(4) The name of the physician, dentist, podiatrist, prescribing psychologist, or veterinarian by whom the prescription is written; and

(5) [~~Such~~] The directions as may be stated on the prescription."

SECTION 6. Section 346-59.9, Hawaii Revised Statutes, is amended by amending subsection (h) to read as follows:

"(h) All psychotropic medications covered by this section shall be prescribed by a psychiatrist, a prescribing psychologist with prescriptive authority under part of chapter 465, a physician, or an advanced practice registered nurse with prescriptive authority under chapter 457 and duly licensed in the State."

SECTION 7. 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 8. Section 465-3, Hawaii Revised Statutes, is amended by amending subsection (e) to read as follows:

"(e) [~~Nothing~~] Except 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 9. (a) The board of psychology shall submit a report and any proposed legislation, to the legislature no later than twenty days prior to the convening of the regular session of 2026, on the authorization of prescriptive authority to prescribing psychologists who meet specific education, training, and registration requirements pursuant to this Act.

(b) The board of psychology shall collaborate with the department of health when preparing report data regarding the treatment of patients who are forensically encumbered or who have a diagnosis of serious mental illness and are subject to the department's jurisdiction."

SECTION 10. There is appropriated out of the general revenues of the State of Hawaii the sum of $ or so much thereof as may be necessary for fiscal year 2025-2026 and the same sum or so much thereof as may be necessary for fiscal year 2026-2027 for the board of psychology to implement prescriptive authority privilege for certain psychologists pursuant to this Act, including for the hiring of any necessary staff.

The sums appropriated shall be expended by the department of commerce and consumer affairs for the purposes of this Act.

SECTION 11. This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date.

SECTION 12. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 13. This Act shall take effect on July 1, 2025.

INTRODUCED BY:	_____________________________

THE SENATE	S.B. NO.	708
THIRTY-THIRD LEGISLATURE, 2025
STATE OF HAWAII