RELATING TO HEALTH CARE.

HB1875

HOUSE OF REPRESENTATIVES

H.B. NO.

1875

THIRTY-THIRD LEGISLATURE, 2026

STATE OF HAWAII

A BILL FOR AN ACT

relating
to health care
.

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

����
SECTION 1.
�
Chapter 323J, Hawaii Revised Statutes, is
amended by adding three new sections to be appropriately designated and to read
as follows:

����
"
�323J-
�
Abusive
litigation; prohibited; remedies.
�
(a)
�
If
a person or entity, whether or not acting under the color of law, engages in or
attempts to engage in abusive litigation, or attempts to enforce any order or
judgment issued in connection with any such abusive litigation, any aggrieved
person may bring a civil action in the circuit court of the circuit in which
the aggrieved person resides against that person or entity for:

����
(1)
�
Injunctive
relief;

����
(2)
�
Actual damages,
including the amount of any judgment issued in connection with the abusive
litigation;

����
(3)
�
Expenses,
costs, and reasonable attorney's fees incurred in connection with the abusive
litigation;

����
(4)
�
Expenses,
costs, and reasonable attorney's fees incurred to bring an action under this
section; and

����
(5)
�
Punitive
damages.

����
(b)
�
Any civil action filed pursuant to this
section shall be filed within six years after the date the abusive litigation
is commenced, or if the person or entity is attempting to enforce an order or a
judgment, within six years after the date enforcement is attempted.

����
(c)
�
As used in this section:

����
"Abusive litigation"
means any litigation or other legal action, including civil, criminal, or
administrative action, brought against another person or entity for accessing,
receiving, providing, facilitating, or attempting to access, receive, provide,
or facilitate reproductive health care services or gender-affirming health care
services that are lawful under the laws of this State.

����
"Aggrieved person"
means:

����
(1)
�
A person or
entity against whom abusive litigation is filed or prosecuted or against whom
an order or judgment issued in connection with such abusive litigation is
attempted to be enforced; or

����
(2)
�
The employer or
principal of a person against whom abusive litigation is filed or prosecuted or
against whom an order or a judgment issued in connection with such abusive
litigation is attempted to be enforced if the action that forms the basis of
the abusive litigation was performed within the scope of the person's
employment or agency relationship.

����
�
323J-
�
Medical malpractice insurance; prohibited
actions.
�
(a)
�
Any insurer that issues medical malpractice
insurance in the State shall not take a prohibited action against an applicant
for, or the named insured under, a medical malpractice policy in this State
solely because the applicant or insured has provided, or assisted in the
provision of, reproductive health care services or gender-affirming health care
services or made a referral for reproductive health care services or
gender-affirming health care services; provided that the care provided by the
applicant or insured was consistent with generally accepted standards of
practice under the laws of this State and did not otherwise violate the laws of
this State.

����
(b)
�
As used in this section, "prohibited
action" means:

����
(1)
�
Refusing to
issue a medical malpractice policy;

����
(2)
�
Canceling or
terminating a medical malpractice policy;

����
(3)
�
Refusing to
renew a medical malpractice policy; or

����
(4)
�
Imposing any
sanctions, fines, penalties, rate increases, or another type of unfavorable
change.

����
�
323J-
�
Health carriers; prohibitions.
�
No group health plan or health
insurance insurer offering or renewing a health plan in this State shall
terminate or refuse to renew a health care contract with a participating health
care provider on the sole basis that the participating provider provides, or
assists in the provision of, reproductive health care services or
gender-affirming health care services.
"

����
SECTION
2
.
�
Chapter 323J,
Hawaii Revised Statutes, is amended to read as follows:

"
[
[
]CHAPTER
323J[
]
]

REPRODUCTIVE
HEALTH CARE SERVICES
AND GENDER-AFFIRMING HEALTH CARE SERVICES

����
[
[
]�
323J-1[
]
]
�
Definitions.
�
As used in this chapter, unless the context
otherwise requires:

����
"Gender-affirming
health care services" includes:

����
(1)
�
Medically necessary health care that
respects the gender identity of the patient, as experienced and defined by the
patient, and may include the following interventions to:

���������
(A)
�
Suppress the development of
endogenous secondary sex characteristics;

���������
(B)
�
Align the patient's appearance or
physical body with the patient's gender identity; or

���������
(C)
�
Alleviate symptoms of clinically
significant distress resulting from gender dysphoria, as defined by the most
recent edition of the Diagnostic and Statistical Manual of Mental Disorders; or

����
(2)
�
Mental health care or behavioral
health care that respects the gender identity of the patient, as experienced
and defined by the patient, and may include developmentally appropriate
exploration and integration of identity, reduction of distress, adaptive
coping, or strategies to increase family acceptance.

����
"Person" includes an
individual, partnership, joint venture, corporation, association, business,
trust, or any organized group of persons or legal entity, or any combination
thereof.

����
"Reproductive health care
services" includes all medical, surgical, pharmaceutical, counseling, or
referral services relating to the human reproductive system, including but not
limited to services relating to pregnancy, contraception, or the termination of
a pregnancy.

����
[
[
]�
323J-2[
]
�
Disclosures prohibited.
]
Protected
health information; disclosure or use, when prohibited; covered entities;
written consent.
�
(a)
�
[
Except as provided in rules 504, 504.1,
and 505.5 of the Hawaii rules of evidence and subsection (b) or as authorized
under the Health Insurance Portability and Accountability Act of 1996, P.L.
104-191, and federal regulations promulgated thereunder, in any civil action or
any proceeding preliminary thereto or in any probate, legislative, or
administrative proceeding, no covered entity, as defined in title 45 Code of
Federal Regulations section 160.103, or as the same as may be from time to time
amended or modified, shall disclose:

����
(1)
�
Any
communication made to the covered entity, or any information obtained by the
covered entity from a patient or the conservator, guardian, or other authorized
legal representative of a patient relating to reproductive health care services
that are permitted under the laws of the State; or

����
(2)
�
Any information
obtained by personal examination of a patient relating to reproductive health
care services that are permitted under the laws of the State,

unless the patient or that patient's conservator,
guardian, or other authorized legal representative explicitly consents to the
disclosure in writing in the form of a release of protected health information
compliant with the federal Health Insurance Portability and Accountability Act
of 1996, P.L. 104-191, as amended.
�
A
covered entity shall inform the patient or the patient's conservator, guardian,
or other authorized legal representative of the patient's right to withhold the
written consent.

����
(b)
�
Written consent of the patient or the
patient's conservator, guardian, or other authorized legal representative shall
not be required for the disclosure of the communication or information:

����
(1)
�
If the records
relate to a patient who is a plaintiff in a complaint pending before a court of
competent jurisdiction alleging health care negligence and a request for
records has been served on a named defendant in that litigation;

����
(2)
�
If the records
are requested by a licensing authority, as defined in section 436B-2, and the
request is made in connection with an investigation of a complaint to the
licensing authority and the records are related to the complaint, unless the
complaint is made solely on the basis that the licensee, acting within the
licensee's scope of practice, provided reproductive health care services that
are lawful in this State;

����
(3)
�
To the director
of health for records of a patient of a covered entity in connection with an
investigation of a complaint, if the records are related to the complaint; or

����
(4)
�
If child abuse,
abuse of an individual who is sixty years of age or older, abuse of an
individual who is physically disabled or incompetent, or abuse of an individual
with an intellectual disability is known or in good faith suspected.
]

No covered entity shall use or disclose protected
health information for purposes or activities relating to conducting a
criminal, civil, or administrative investigation into any person for the mere
act of seeking, obtaining, providing, or facilitating reproductive health care
services or gender-affirming health care services, or for purposes or
activities relating to imposing criminal, civil, or administrative liability on
any person for the mere act of seeking, obtaining, providing, or facilitating
reproductive health care services or gender-affirming health care services,
where the reproductive health care services or gender-affirming health care
services are:

����
(1)
�
Lawful under
the laws of this State; or

����
(2)
�
Protected,
required, or authorized by federal law, including the United States
Constitution, under the circumstances in which such services are provided,
regardless of the state in which they are provided.

����
For purposes of this subsection,
reproductive health care services or gender-affirming health care services are
presumed lawful unless the covered entity has actual knowledge that the
reproductive health care services or gender-affirming health care services were
not lawful under the circumstances in which they were provided, or factual
information supplied by the person requesting the use or disclosure of
protected health information that demonstrates a substantial factual basis that
the reproductive health care services or gender-affirming health care services
were not lawful under the specific circumstances in which they were provided.

����
(b)
�

When a covered entity receives a request for protected health
information relating to reproductive health care services or gender-affirming
health care services and the request is for:

����
(1)
�
Health
oversight activities, as described in title 45 Code of Federal Regulations
section 164.512(d), as that section may be amended or modified from time to
time;

����
(2)
�
Judicial and
administrative proceedings, as described in title 45 Code of Federal
Regulations section 164.512(e), as that section may be amended or modified from
time to time;

����
(3)
�
Law enforcement
purposes, as described in title 45 Code of Federal Regulations section
164.512(f), as that section may be amended or modified from time to time; or

����
(4)
�
Coroners and
medical examiners, as described in title 45 Code of Federal Regulations section
164.512(g)(1), as that section may be amended or modified from time to time,

the
covered entity may disclose the requested protected health information;
provided that the covered entity obtains from the person requesting the
protected health information a written, signed attestation that the disclosure
is not otherwise prohibited by subsection (a).
�

Any person who knowingly provides a false attestation under this section
is guilty of a misdemeanor.

����
(c)
�

Nothing in this section shall be construed to impede the lawful sharing
of [
medical records
]
protected health information
as [
permitted
by state or
]
required by
federal law or the [
rules of the court,
except in the case of a subpoena or warrant issued by a court, government
agency, or legislative body of another state commanding the production,
copying, or inspection of medical records relating to reproductive health care
services.
]
laws of this State, or as authorized by the patient or the
patient's conservator, guardian, or other authorized legal representative in a
valid, written authorization for the disclosure that complies with the federal
Health Insurance Portability and Accountability Act of 1996, P.L. 104-191, as
amended, and federal regulations promulgated thereunder; provided that a
covered entity shall inform the patient or the patient's conservator, guardian,
or other authorized legal representative of the patient's right to withhold the
written consent.

����
(d)
�
As used in this section:

����
"Covered entity" has
the same meaning as in title 45 Code of Federal Regulations section 160.103, as
that section may be amended or modified from time to time.

����
"Protected health
information" has the same meaning as in title 45 Code of Federal
Regulations section 160.103, as that section may be amended or modified from
time to time.

����
[
[
]�
323J-3[
]
]
�
Subpoenas; when allowed.
�
Notwithstanding sections 624-27 and 624D-3 or
any other law to the contrary, no court or clerk of a court shall order the
issuance of a subpoena requested by an officer, appointed according to the laws
or usages of another state or government, or by any court of the United States
or of another state or government, in connection with an out-of-state or
interstate investigation or proceeding relating to reproductive health care
services [
legally performed in the
]
or gender-affirming health care
services that are lawful under the laws of this
State.

����
[
[
]�
323J-4[
]
]
�
Agencies prohibited from providing
information or expending resources.
�

(a)
�
No agency, as defined in
section 92F-3, or employee, appointee, officer, official, or any other person
acting on behalf of an agency shall provide any
nonpublic
information or
expend or use time, money, facilities, property, equipment, personnel, or other
resources in furtherance of any out-of-state or interstate investigation or
proceeding seeking to impose civil or criminal liability upon a person or
entity for:

����
(1)
�
[
The provision,
seeking,
]
Seeking, receiving,
paying for, [
receipt of,
] or
inquiring about reproductive health care services [
that are legal in the
]

or gender-affirming health care services that are lawful under the laws of
this
State; [
or
]

����
(2)
�
Providing
or responding to an inquiry about reproductive health care services or
gender-affirming health care services that are lawful under the laws of this
State;

���
[
(2)
]

(3)
�
Assisting [
any person or entity
providing, seeking, receiving, paying for, or responding to an inquiry about
reproductive health care services that are legal in the State.
]
or
aiding or abetting in any of the conduct described in paragraph (1) or (2); or

����
(4)
�
Attempting or
intending to engage in or providing material support for (or any other theory
of vicarious, attempt, joint, several, or conspiracy liability derived
therefrom) conduct described in paragraphs (1) to (3).

����
(b)
�

This section shall not apply to any investigation or proceeding where
the conduct subject to potential liability under the investigation or
proceeding would be subject to liability under the laws of this State if
committed in this State.

����
[
[
]�
323J-5[
]
]
�
Prohibition on state action.
�
The State shall not
penalize, prosecute, or otherwise take adverse action against an individual
based on the individual's actual, potential, perceived, or alleged pregnancy
or
gender-affirming health care
outcomes.
�

The State shall not penalize, prosecute, or otherwise take adverse
action against a person for aiding or assisting [
a
]
:

����
(1)
�
A
pregnant
individual accessing reproductive health care services [
in accordance with
]

that are lawful under
the laws of [
the
]
this
State and
with the pregnant individual's voluntary consent[
.
]
; or

����
(2)
�
An individual
accessing gender-affirming health care services that are lawful under the laws
of this State and with the individual's voluntary consent.

����
[
[
]�
323J-6[
]
]
�
Denial of demands for surrender.
�
Notwithstanding any provision of chapter 832
to the contrary, the governor shall deny any demand made by the executive
authority of any state for the surrender of any person charged with a crime
under the laws of that state when the alleged crime involves [
the provision
or receipt of,
]
:

����
(1)
�
Seeking,
receiving,
paying for, or [
assistance with,
]
inquiring about

reproductive health care services[
,
]
or gender-affirming health care
services;

����
(2)
�
Providing or
responding to an inquiry about reproductive health care services or
gender-affirming health care services;

����
(3)
�
Assisting or
aiding or abetting in any of the conduct described in paragraph (1) or (2); or

����
(4)
�
Attempting or
intending to engage in or providing material support for (or any other theory
of vicarious, attempt, joint, several, or conspiracy liability derived
therefrom) conduct described in paragraphs (1) to (3),

unless the acts forming the basis of the prosecution
would also constitute a criminal offense in this State.
�
This section shall not apply to demands made
under Article IV, section 2, of the United States Constitution.

����
[
[
]�
323J-7[
]
]
�
Laws contrary to the public policy of this
State.
�
(a)
�
A law of another state authorizing a civil
action or criminal prosecution based on any of the following [
is
]
shall
be
declared to be contrary to the public policy of this State:

����
(1)
�
Receiving,
seeking, [
or
] paying for
, or inquiring about
reproductive health
care services[
;
]
or gender-affirming health care services that are
lawful under the laws of this State;

����
(2)
�
Providing
or
responding to an inquiry about
reproductive health care services[
;
]
or
gender-affirming health care services that are lawful under the laws of this
State;

����
(3)
�
[
Engaging in
conduct that assists or aids or abets the provision or receipt of reproductive
health care services;
]
Assisting or aiding or abetting in any of the
conduct described in paragraph (1) or (2);
or

����
(4)
�
Attempting or
intending to engage in or providing material support for (or any other theory
of vicarious, attempt, joint, several or conspiracy liability derived
therefrom) conduct described in paragraphs (1) to (3)[
,

in accordance with the laws of this State
].

����
(b)
�

No law described in subsection (a) shall be applied to a case or
controversy heard in the courts of this State."

����
SECTION 3.
�
Section 451J-11, Hawaii Revised Statutes, is
amended by amending subsection (a) to read as follows:

����
"(a)
�
The department shall deny, revoke, condition,
or suspend a license granted pursuant to this chapter on the following grounds:

����
(1)
�
Conviction by a
court of competent jurisdiction of a crime [
which
]
that
the
department has determined, by rules adopted pursuant to chapter 91, to be of a
nature that renders the person convicted unfit to practice marriage and family
therapy[
;
]
, except when the conviction was based on the provision or
assistance in receipt or provision of gender-affirming health care services, as
defined in section 323J-1, so long as the provision or assistance in receipt or
provision of the services was in accordance with the laws of this State or
would have been in accordance with the laws of this State if it occurred within
this State;

����
(2)
�
Failing to report
in writing to the director any disciplinary decision related to the provision
of mental health services issued against the licensee or the applicant in any
jurisdiction within thirty days of the disciplinary decision, or within thirty
days of licensure;

����
(3)
�
Violation of
recognized ethical standards for marriage and family therapists
or
licensed marriage and family therapists
as set by the association;

����
(4)
�
Fraud or
misrepresentation in obtaining or renewing a license, including making a false
certification of compliance with the continuing education requirement set forth
in section 451J-10;

����
(5)
�
Revocation,
suspension, or other disciplinary action by any state or federal agency against
a licensee or applicant for any reason provided under this section[
;
]
,
except when the revocation, suspension, or other disciplinary action was based
on the provision or assistance in receipt or provision of gender-affirming
health care services, as defined in section 323J-1, so long as the provision or
assistance in receipt or provision of the services was in accordance with the
laws of this State or would have been in accordance with the laws of this State
if it occurred within this State;
or

����
(6)
�
Other just and
sufficient cause that renders a person unfit to practice marriage and family
therapy."

����
SECTION
4
.
�
Section
451J-12, Hawaii Revised Statutes, is amended to read as follows:

����
"
�451J-12
�
Confidentiality and
privileged communications.
�
No person
licensed as a marriage and family therapist or any associate marriage and
family therapist, nor any of the person's employees or associates, shall be
required to disclose any information that the person may have acquired in
rendering marriage and family therapy services except in the following
circumstances:

����
(1)
�
As required by
law;

����
(2)
�
To prevent a clear
and immediate danger to a person or persons;

����
(3)
�
In the course of a
civil, criminal, or disciplinary action arising from the therapy where the
therapist is a defendant[
;
]
, except when the civil, criminal, or
disciplinary action by another state or federal agency is based on the
provision or assistance in receipt or provision of gender-affirming health care
services, as defined in section 323J-1, so long as the provision or assistance
in receipt or provision of the services was in accordance with the laws of this
State or would have been in accordance with the laws of this State if it
occurred within this State;

����
(4)
�
In a criminal
proceeding where the client is a defendant and the use of the privilege would
violate the defendant's right to a compulsory process of the right to present
testimony and witnesses in the defendant's own behalf;

����
(5)
�
In accordance with
the terms of a client's previously written waiver of the privilege; or

����
(6)
�
Where more than
one person in a family jointly receives therapy and each [
family member
]

person
who is legally competent executes a written waiver[
; in
]
.

�
In
that instance, a marriage and
family therapist or an associate marriage and family therapist may disclose
information received from any [
family member
]
person
in
accordance with the terms of the person's waiver."

����
SECTION
5
.
�
Section 453-8,
Hawaii Revised Statutes, is amended by amending subsections (a), (b), and (c)
to read as follows:

����
"(a)
�
In addition to any other actions authorized
by law, any license to practice medicine and surgery may be revoked, limited,
or suspended by the board at any time in a proceeding before the board, or may
be denied, for any cause authorized by law, including but not limited to the
following:

����
(1)
�
Procuring, or
aiding or abetting in procuring, an abortion that is unlawful under the laws of
this State or that would be unlawful under the laws of this State if performed
within this State;

����
(2)
�
Employing any
person to solicit patients for one's self;

����
(3)
�
Engaging in false,
fraudulent, or deceptive advertising, including but not limited to:

���������
(A)
�
Making excessive
claims of expertise in one or more medical specialty fields;

���������
(B)
�
Assuring a
permanent cure for an incurable disease; or

���������
(C)
�
Making any
untruthful and improbable statement in advertising one's medical or surgical
practice or business;

����
(4)
�
Being habituated
to the excessive use of drugs or alcohol; or being addicted to, dependent on,
or a habitual user of a narcotic, barbiturate, amphetamine, hallucinogen, or
other drug having similar effects;

����
(5)
�
Practicing
medicine while the ability to practice is impaired by alcohol, drugs, physical
disability, or mental instability;

����
(6)
�
Procuring a
license through fraud, misrepresentation, or deceit, or knowingly permitting an
unlicensed person to perform activities requiring a license;

����
(7)
�
Professional
misconduct, hazardous negligence causing bodily injury to another, or manifest
incapacity in the practice of medicine or surgery;

����
(8)
�
Incompetence or
multiple instances of negligence, including but not limited to the consistent
use of medical service, which is inappropriate or unnecessary;

����
(9)
�
Conduct or
practice contrary to recognized standards of ethics of the medical profession
as adopted by the Hawaii Medical Association, the American Medical Association,
the Hawaii Association of Osteopathic Physicians and Surgeons, or the American
Osteopathic Association;

���
(10)
�
Violation of the
conditions or limitations upon which a limited or temporary license is issued;

���
(11)
�
Revocation,
suspension, or other disciplinary action by another state or federal agency of
a license, certificate, or medical privilege, except when the revocation,
suspension, or other disciplinary action was based on the provision or
assistance in receipt or provision of [
medical,
]
:

���������
(A)
�
Medical,

surgical, pharmaceutical, counseling, or referral services relating to the
human reproductive system, including but not limited to services relating to
pregnancy, contraception, or the termination of a pregnancy[
,
]
; or

���������
(B)
�
Gender-affirming
health care services, as defined in section 323J-1,

������
��
so
long as the provision or assistance in receipt or provision of the services was

in accordance with the laws of this State
or would
have been in accordance with the laws of this State if it occurred within this
State;

���
(12)
�
Conviction,
whether by nolo contendere or otherwise, of a penal offense substantially
related to the qualifications, functions, or duties of a physician or
osteopathic physician, notwithstanding any statutory provision to the contrary,
except when the conviction was based on the provision or assistance in receipt
or provision of [
medical,
]
:

���������
(A)
�
Medical,

surgical, pharmaceutical, counseling, or referral services relating to the
human reproductive system, including but not limited to services relating to
pregnancy, contraception, or the termination of a pregnancy[
,
]
; or

���������
(B)
�
Gender-affirming
health care services, as defined in section 323J-1,

���������
so long as the provision or
assistance in receipt or provision of the services was in accordance with the
laws of this State or would have been in accordance with the laws of this State
if it occurred within this State;

���
(13)
�
Violation of
chapter 329, the uniform controlled substances act, or any rule adopted
thereunder except as provided in section 329-122;

���
(14)
�
Failure to report
to the board, in writing, any disciplinary decision issued against the licensee
or the applicant in another jurisdiction within thirty days after the
disciplinary decision is issued; or

���
(15)
�
Submitting to or
filing with the board any notice, statement, or other document required under
this chapter[
, which
]
that
is false or untrue or contains any
material misstatement or omission of fact.

����
(b)
�

If disciplinary action related to the practice of medicine has been
taken against the applicant by another state or federal agency, or if the
applicant reveals a physical or mental condition that would constitute a
violation under this section, then the board may impose one or more of the
following requirements as a condition for licensure:

����
(1)
�
Physical and
mental evaluation of the applicant by a licensed physician or osteopathic
physician approved by the board;

����
(2)
�
Probation,
including conditions of probation as requiring observation of the licensee by
an appropriate group or society of licensed physicians, osteopathic physicians,
or surgeons;

����
(3)
�
Limitation of the
license by restricting the fields of practice in which the licensee may engage;

����
(4)
�
Further education
or training or proof of performance competency; and

����
(5)
�
Limitation of the
medical practice of the licensee in any reasonable manner to assure the safety
and welfare of the consuming public;

provided
that the board shall not impose as a condition for licensure any of the
requirements pursuant to this subsection if the disciplinary action related to
the practice of medicine taken against the applicant was based on the provision
or assistance in receipt or provision of medical, surgical,
pharmaceutical,
counseling, or referral services
relating to the human reproductive system, including but not limited to
services relating to pregnancy, contraception, or the termination of a
pregnancy,
or the provision or assistance in receipt or provision of
gender-affirming health care services, as defined in section 323J-1,
so
long as the provision or assistance in receipt or provision of the services was
in accordance with the laws of this State or would have been in accordance with
the laws of this State if it occurred within this State.

����
(c)
�
Notwithstanding
any other law to the contrary, the board may deny a license to any applicant
who has been disciplined by another state or federal agency, except on the
basis of discipline for the provision or assistance in receipt or provision of
medical, surgical, pharmaceutical, counseling, or referral services relating to
the human reproductive system, including but not limited to services relating
to pregnancy, contraception, or the termination of a pregnancy,
or the provision or assistance in
receipt or provision of gender-affirming health care services, as defined in
section 323J-1,

so
long as the provision or assistance in receipt or provision of the services was
in accordance with the laws of this State or would have been in accordance with
the laws of this State if it occurred within this State.
�
Any final order of discipline taken pursuant
to this subsection shall be a matter of public record."

����
SECTION
6
.
�
Section
453-8.6, Hawaii Revised Statutes, is amended as follows:

����
1.
�

By amending subsection (a) to read:

����
"
(a)
�
Upon receipt of evidence of
revocation, suspension, or other disciplinary action against a licensee by
another state or federal agency, the board may issue an order imposing
disciplinary action upon the licensee on the following conditions:

����
(1)
�
The board shall serve the licensee with
a proposed order imposing disciplinary action as required by chapter 91;

����
(2)
�
The licensee shall have the right to
request a hearing pursuant to chapter 91 to show cause why the action described
in the proposed order should not be imposed;

����
(3)
�
Any request for a hearing shall be made
in writing and filed with the board within twenty days after mailing of the
proposed order to the licensee; and

����
(4)
�
If the licensee does not submit a
written request for a hearing within twenty days after mailing of the proposed
order, the board may issue a final order imposing the disciplinary action
described in the proposed order;

provided that the board shall not issue an order
imposing disciplinary action upon the licensee if the revocation, suspension,
or other disciplinary action against a licensee by another state was based on
the provision or assistance in receipt or provision of medical, surgical,
pharmaceutical, counseling, or referral services relating to the human
reproductive system, including but not limited to services relating to
pregnancy, contraception, or the termination of a pregnancy,
or the
provision or assistance in receipt or provision of gender-affirming health care
services, as defined in section 323J-1,
so long as the provision or
assistance in receipt or provision of the services was in accordance with the
laws of this State or would have been in accordance with the laws of this State
if it occurred within this State."

����
2.
�

By amending subsection (c) to read:

����
"
(c)
�

A licensee against whom the board has issued a proposed order under this
section shall be prohibited from practicing in this State until the board
issues a final order if:

����
(1)
�
The licensee was the subject of
disciplinary action by another state
, except where the disciplinary
action against the licensee by another state was based on the provision or
assistance in receipt or provision of [
medical,
]
:

���������
(A)
�
Medical,

surgical, pharmaceutical, counseling, or referral services relating to the
human reproductive system, including but not limited to services relating to
pregnancy, contraception, or the termination of a pregnancy[
,
]
; or

���������
(B)
�
Gender-affirming
health care services, as defined in section 323J-1,

���������
so long as the provision or
assistance in receipt or provision of the services was in accordance with the
laws of this State or would have been in accordance with the laws
of this State if it occurred within
this State; and

����
(2)
�
The disciplinary action by another
state prohibits the licensee from practicing in that state.
"

����
SECTION
7
.
�
Section
453D-12, Hawaii Revised Statutes, is amended by amending subsection (a) to read
as follows:

����
"(a)
�
In addition to any other acts or conditions
provided by law, the director may refuse to renew, reinstate, or restore, and
may deny, revoke, suspend, or condition in any manner, any license for any one
or more of the following acts or conditions on the part of a licensee or
license applicant:

����
(1)
�
Failing to meet or
maintain the conditions and requirements necessary to qualify for the granting
of a license;

����
(2)
�
Engaging in false,
fraudulent, or deceptive advertising, or making untruthful or improbable
statements;

����
(3)
�
Being addicted to,
dependent on, or a habitual user of a narcotic, barbiturate, amphetamine,
hallucinogen, opium, cocaine, or other drugs or derivatives of a similar
nature;

����
(4)
�
Practicing the
licensed profession while impaired by alcohol, drugs, physical disability, or
mental instability;

����
(5)
�
Procuring a
license through fraud, misrepresentation, or deceit;

����
(6)
�
Aiding and
abetting an unlicensed person to directly or indirectly perform activities
requiring a license;

����
(7)
�
Professional
misconduct, incompetence, gross negligence, or manifest incapacity, in the
practice of the licensed profession;

����
(8)
�
Engaging in
conduct or practice contrary to recognized standards of ethics for the licensed
profession;

����
(9)
�
Violating any
condition or limitation upon which a conditional or temporary license was
issued;

���
(10)
�
Engaging in
business under a past or present license issued pursuant to the licensing laws,
in a manner causing injury to one or more members of the public;

���
(11)
�
Failing to comply
with, observe, or adhere to any law in a manner [
such
] that the director
deems the applicant or holder to be an unfit or improper person to hold a
license;

���
(12)
�
Having had a
license revoked or suspended, or having been the subject of other disciplinary
action, by another state or a federal agency for any reason provided by the
licensing laws or this section[
;
]
, except when the revocation,
suspension, or other disciplinary action was based on the provision or
assistance in receipt or provision of gender-affirming health care services, as
defined in section 323J-1, so long as the provision or assistance in receipt or
provision of the services was in accordance with the laws of this State or
would have been in accordance with the laws of this State if it occurred within
this State;

���
(13)
�
Having been
convicted of a crime, whether by nolo contendere or otherwise, directly related
to the qualifications, functions, or duties of the licensed profession[
;
]
,
except when the revocation, suspension, or other disciplinary action was based
on the provision or assistance in receipt or provision of gender-affirming
health care services, as defined in section 323J-1, so long as the provision or
assistance in receipt or provision of the services was in accordance with the
laws of this State or would have been in accordance with the laws of this State
if it occurred within this State;

���
(14)
�
Failing to report
in writing to the director any disciplinary decision issued against the
licensee or applicant in another jurisdiction within thirty days of the
disciplinary decision;

���
(15)
�
Employing,
utilizing, or attempting to employ or utilize, at any time, any person not
licensed under the licensing laws where licensure is required; or

���
(16)
�
Violating this
chapter, chapter 436B, or any rule or order of the director."

����
SECTION
8
.
�
Section
453D-13, Hawaii Revised Statutes, is amended to read as follows:

����
"
�453D-13
�
Confidentiality and privileged
communications.
�
No person licensed
as a mental health counselor or an associate mental health counselor, nor any
of the person's employees or associates, shall be required to disclose any
information that the person may have acquired in rendering mental health
counseling services, except in the following circumstances:

����
(1)
�
As required by
law;

����
(2)
�
To prevent a clear
and imminent danger to a person or persons;

����
(3)
�
In accordance with
the terms of a previously written waiver of the privilege where the waiver is
executed by the client or by the client's legally recognized representative;

����
(4)
�
Where more than
one person jointly receives counseling and each person who is legally competent
executes a written waiver.
�
In that
instance, information may be disclosed from any person in accordance with that
person's waiver; or

����
(5)
�
In the course of a
disciplinary action or pursuant to a duly authorized subpoena issued by the
department[
.
]
, except when the disciplinary action by another federal
or state agency is based on the provision or assistance in receipt or provision
of gender-affirming health care services, as defined in section 323J-1, so long
as the provision or assistance in receipt or provision of the services was in
accordance with the laws of this State or would have been in accordance with
the laws of this State if it occurred within this State.
"

����
SECTION
9
.
�
Section 457-12,
Hawaii Revised Statutes, is amended by amending subsections (a) and (b) to read
as follows:

����
"(a)
�
In addition to any other actions authorized
by law, the board shall have the power to deny, revoke, limit, or suspend any
license to practice nursing as a registered nurse or as a licensed practical
nurse applied for or issued by the board in accordance with this chapter, and
to fine or to otherwise discipline a licensee for any cause authorized by law,
including but not limited to the following:

����
(1)
�
Fraud or deceit in
procuring or attempting to procure a license to practice nursing as a
registered nurse or as a licensed practical nurse;

����
(2)
�
Gross immorality;

����
(3)
�
Unfitness or
incompetence by reason of negligence, habits, or other causes;

����
(4)
�
Habitual
intemperance, addiction to, or dependency on alcohol or other habit-forming
substances;

����
(5)
�
Mental
incompetence;

����
(6)
�
Unprofessional
conduct as defined by the board in accordance with its own rules;

����
(7)
�
Wilful or repeated
violation of any of the provisions of this chapter or any rule adopted by the
board;

����
(8)
�
Revocation,
suspension, limitation, or other disciplinary action by another state of a
nursing license, except when the revocation, suspension, limitation, or other
disciplinary action by another state was based on the provision or assistance
in receipt or provision of [
medical,
]
:

���������
(A)
�
Medical,

surgical, pharmaceutical, counseling, or referral services relating to the
human reproductive system, including but not limited to services relating to
pregnancy, contraception, or the termination of a pregnancy[
,
]
; or

���������
(B)
�
Gender-affirming
health care services, as defined in section 323J-1,

���������
so long as the provision or
assistance in receipt or provision of the services was in accordance with the
laws of this State or would have been in accordance with the laws of this State
if it occurred within this State;

����
(9)
�
Conviction,
whether by nolo contendere or otherwise, of a penal offense substantially
related to the qualifications, functions, or duties of a nurse, notwithstanding
any statutory provision to the contrary, except when the conviction was based
on the provision or assistance in receipt or provision of [
medical,
]
:

���������
(A)
�
Medical,

surgical, pharmaceutical, counseling, or referral services relating to the
human reproductive system, including but not limited to services relating to
pregnancy, contraception, or the termination of a pregnancy[
,
]
; or

���������
(B)
�
Gender-affirming
health care services, as defined in section 323J-1,

���������
so long as the provision or
assistance in receipt or provision of the services was in accordance with the
laws of this State or would have been in accordance with the laws of this State
if it occurred within this State;

���
(10)
�
Failure to report
to the board any disciplinary action taken against the licensee in another
jurisdiction within thirty days after the disciplinary action becomes final;

���
(11)
�
Submitting to or
filing with the board any notice, statement, or other document required under
this chapter[
, which
]
that
is false or untrue or contains any
material misstatement of fact, including a false attestation of compliance with
continuing competency requirements; or

���
(12)
�
Violation of the
conditions or limitations upon which any license is issued.

����
(b)
�

Notwithstanding any other law to the contrary, the board may deny a
license to any applicant who has been disciplined by another state, except on
the basis of discipline by another state for the provision or assistance in
receipt or provision of [
medical,
]
:

����
(1)
�
Medical,

surgical, pharmaceutical, counseling, or referral services relating to the
human reproductive system, including but not limited to services relating to
pregnancy, contraception, or the termination of a pregnancy[
,
]
; or

����
(2)
�
Gender-affirming
health care services, as defined in section 323J-1,

so long as the provision or assistance in receipt or
provision of the services was in accordance with the laws of this State or
would have been in accordance with the laws of this State if it occurred within
this State.
�
Any final order entered
pursuant to this subsection shall be a matter of public record."

����
SECTION
10
.
�
Section
457-12.5, Hawaii Revised Statutes, is amended as follows:

����
1.
�

By amending subsection (a) to read:

����
"
(a)
�
Upon receipt of evidence of
revocation, suspension, or other disciplinary action against a licensee in
another state, the board may issue an order imposing disciplinary action upon
the licensee on the following conditions:

����
(1)
�
The board shall serve the licensee with
a proposed order imposing disciplinary action as required by chapter 91;

����
(2)
�
The
licensee shall have the right to request a hearing pursuant to chapter 91 to
show cause why the action described in the proposed order should not be
imposed;

����
(3)
�
Any request for a hearing shall be made
in writing and filed with the board within twenty days after mailing of the
proposed order to the licensee; and

����
(4)
�
If the licensee does not submit a
written request for a hearing within twenty days after mailing of the proposed
order, the board shall issue a final order imposing the disciplinary action
described in the proposed order;

provided that the board shall not issue an order
imposing disciplinary action upon the licensee if the revocation, suspension,
or other disciplinary action against a licensee by another state was based on
the provision or assistance in receipt or provision of medical, surgical,
pharmaceutical, counseling, or referral services relating to the human
reproductive system, including but not limited to services relating to
pregnancy, contraception, or the termination of a pregnancy,
or the
provision or assistance in receipt or provision of gender-affirming health care
services, as defined in section 323J-1,
so long as the provision or
assistance in receipt or provision of the services was in accordance with the
laws of this State or would have been in accordance with the laws of this State
if it occurred within this State."

����
2.
�

By amending subsection (c) to read:

����
"
(c)
�
A licensee against whom the board has issued
a proposed order under this section shall be prohibited from practicing in this
State until the board issues a final order if:

����
(1)
�
The licensee was
the subject of disciplinary action by another state, except where the
disciplinary action against the licensee by another state was based on the
provision or assistance in receipt or provision of [
medical,
]
:

���������
(A)
�
Medical,

surgical, pharmaceutical, counseling, or referral services relating to the
human reproductive system, including but not limited to services relating to
pregnancy, contraception, or the termination of a pregnancy[
,
]
; or

���������
(B)
�
Gender-affirming
health care services, as defined in section 323J-1,

���������
so long as the provision or
assistance in receipt or provision of the services was in accordance with the
laws of this State or would have been in accordance with the laws of this State
if it occurred within this State; and

����
(2)
�
The disciplinary
action in the other state prohibits the licensee from practicing in that
state."

����
SECTION
11
.
�
Section
461-21.5, Hawaii Revised Statutes, is amended as follows:

����
1.
�

By amending subsection (a) to read:

����
"
(a)
�
Upon receipt of evidence of
revocation, suspension, or other disciplinary action against a licensee by
another state or federal agency, the board may issue an order imposing
disciplinary action upon the licensee on the following conditions:

����
(1)
�
The board shall serve the licensee with
a proposed order imposing disciplinary action as required by chapter 91;

����
(2)
�
The licensee shall have the right to
request a hearing pursuant to chapter 91 to show cause why the action described
in the proposed order should not be imposed;

����
(3)
�
Any request for a hearing shall be made
in writing and filed with the board within twenty days after mailing of the
proposed order to the licensee; and

����
(4)
�
If the licensee does not submit a
written request for a hearing within twenty days after mailing of the proposed
order, the board shall issue a final order imposing the disciplinary action
described in the proposed order;

provided

that the board shall not issue an order imposing disciplinary action
upon the licensee if the revocation, suspension, or other disciplinary action
against a licensee by another state was based on the provision or assistance in
receipt or provision of medical, surgical, pharmaceutical, counseling, or
referral services relating to the human reproductive system, including but not
limited to services relating to pregnancy, contraception, or the termination of
a pregnancy,
or the provision or assistance in receipt or provision of
gender-affirming health care services, as defined in section 323J-1,
so
long as the provision or assistance in receipt or provision of the services was
in accordance with the laws of this State or would have been in accordance with
the laws of this State if it occurred within this State."

����
2.
�

By amending subsection (c) to read:

����
"
(c)
�

A licensee against whom the board has issued a proposed order under this
section shall be prohibited from practicing in this State until the board
issues a final order if:

����
(1)
�
The licensee was the subject of
disciplinary action by another state, except where the disciplinary action
against the licensee by another state was based on the provision or assistance
in receipt or provision of [
medical,
]
:

���������
(A)
�
Medical,
surgical, pharmaceutical, counseling,
or referral services relating to the human reproductive system, including but
not limited to services relating to pregnancy, contraception, or the
termination of a pregnancy[
,
]
; or

���������
(B)
�
Gender-affirming health care services,
as defined in section 323J-1,

���������
so long as the provision or assistance
in receipt or provision of the services was in accordance with the laws of this
State or would have been in accordance with the laws of this State if it
occurred within this State; and

����
(2)
�
The disciplinary action by another
state prohibits the licensee from practicing in that state.
"

����
SECTION
12
.
�
Section
465-13, Hawaii Revised Statutes, is amended by amending subsection (a) to read
as follows:

����
"(a)
�
In addition to any other actions authorized
by law, the board shall refuse to grant a license to any applicant and may
revoke or suspend any license, or may place a license or [
may
] put a
license holder on conditional probation, for any cause authorized by law,
including but not limited to the following:

����
(1)
�
Professional
misconduct, gross carelessness, manifest incapacity, or incompetency in the
practice of psychology;

����
(2)
�
Violation of this
chapter by the applicant within one year of the application, or violation of
this chapter by a license holder any time the license is valid;

����
(3)
�
Any unethical
practice of psychology as defined by the board in accordance with its own
rules;

����
(4)
�
Fraud or deception
in applying for or procuring a license to practice psychology as defined in
section 465-1;

����
(5)
�
Conviction of a
crime substantially related to the qualifications, functions, or duties of
psychologists[
;
]
, except when the conviction was based on the
provision or assistance in receipt or provision of gender-affirming health care
services, as defined in section 323J-1, so long as the provision or assistance
in receipt or provision of the services was in accordance with the laws of this
State or would have been in accordance with the laws of this State if it
occurred within this State;

����
(6)
�
Wilful
unauthorized communication of information received in professional confidence;

����
(7)
�
The suspension,
revocation, or imposition of probationary conditions by another state of a
license or certificate to practice psychology issued by that state if the act
for which the disciplinary action was taken constitutes a violation of this
chapter;

����
(8)
�
The commission of
any dishonest, corrupt, or fraudulent act or any act of sexual abuse, or sexual
relations with a client, or sexual misconduct that is substantially related to
the qualifications, functions, or duties of a psychologist;

����
(9)
�
Harassment,
intimidation, or abuse, sexual or otherwise, of a client or patient;

���
(10)
�
Exercising undue
influence in the manner as to exploit the client, patient, student, or
supervisee for financial or other personal advantage to the practitioner or a
third party;

���
(11)
�
Conviction of
fraud in filing medicaid claims or conviction of fraud in filing claims to any
third party payor, for which a copy of the record of conviction, certified by
the clerk of the court entering the conviction, shall be conclusive evidence;

���
(12)
�
Aiding or abetting
any unlicensed person to engage in the practice of psychology;

���
(13)
�
Repeated acts of
excessive treatment or use of diagnostic procedures as determined by the
standard of the local community of licensees;

���
(14)
�
Inability to
practice psychology with reasonable skill and safety to patients or clients by
reason of illness, inebriation, or excessive use of any substance, or as a
result of any mental or physical condition;

���
(15)
�
Conviction of any
crime or offense that reflects the inability of the practitioner to practice
psychology with due regard for the health and safety of clients or patients;

���
(16)
�
Use of untruthful
or deceptive or improbable statements concerning the licensee's qualifications
or the effects or results of proposed treatment;

���
(17)
�
Functioning
outside of the licensee's professional competence established by education,
training, and experience;

���
(18)
�
Refusal to comply
with any written order of the board;

���
(19)
�
Making any
fraudulent or untrue statement to the board, including a false certification of
compliance with the continuing education requirement of section 465-11; or

���
(20)
�
Violation of a
board rule."

����
SECTION
13
.
�
Section
636C-9, Hawaii Revised Statutes, is amended to read as follows:

����
"
[
[
]
�636C-9[
]
]

�
Enforcement of foreign penal civil actions
relating to protected reproductive health care services[
.
]
or
protected gender-affirming health care services.
�
(a)
�
No
judgment or other order arising from a foreign penal civil action or other
penal law banning, restricting, burdening, punishing, penalizing, or otherwise
interfering with the provision of protected reproductive health care services
or
protected gender-affirming health care services
shall be enforced in this
State.

����
(b)
�

As used in this section:

����
"Foreign penal civil
action" means an action authorized by the law of a state, or of any
municipality or other governmental entity within a state, other than this
State, the essential character and effect of which is to punish an offense
against the public justice of that state, municipality, or other governmental
entity.

����
"Gender-affirming health
care services" has the same meaning as in section 323J-1.

����
"Protected gender-affirming
health care services" means gender-affirming health care services that are
protected under the Hawaii State Constitution or are otherwise lawful under the
laws of this State or that would be constitutionally protected or otherwise
lawful if performed within this State.

����
"Protected reproductive health
care services" means medical, surgical, pharmaceutical, counseling, or
referral services relating to the human reproductive system, including but not
limited to services relating to pregnancy, contraception, or termination of a
pregnancy, that are protected under the Hawaii State Constitution or otherwise
lawful under the laws of this State or that would be constitutionally protected
or otherwise lawful if performed within this State."

����
SECTION
14
.
�
Section 836-2,
Hawaii Revised Statutes, is amended to read as follows:

����
"
�836-2
�
Summoning witness in this
State to testify in another state.
�
(a)
�
If a judge of a court of record in any state
[
which
]
that
by its laws has made provision for commanding
persons within that state to attend and testify in this State certifies under
the seal of that court that there is a criminal prosecution pending in that
court, or that a grand jury investigation has commenced or is about to
commence, that a person in this State is a material witness in the prosecution
or grand jury investigation, and that the person's presence will be required
for a specified number of days, upon presentation of the certificate to any
judge of a court of record in this State in the judicial district in which the
person is, the judge shall fix a time and place for a hearing, and shall make
an order directing the witness to appear at a time and place certain for the
hearing.

����
(b)
�

If at a hearing the judge determines that the witness is material
and necessary, that it will not cause undue hardship to the witness to be
compelled to attend and testify in the prosecution or a grand jury
investigation in the other state, and that the laws of the state in which the
prosecution is pending, or grand jury investigation has commenced or is about
to commence, and of any other state through which the witness may be required
to pass by ordinary course of travel, will give to the witness protection from
arrest and the service of civil and criminal process, the judge shall issue a
summons, with a copy of the certificate attached, directing the witness to
attend and testify in the court where the prosecution is pending, or where a
grand jury investigation has commenced or is about to commence at a time and
place specified in the summons[
, except
]
; provided
that no judge
shall issue a summons in a case where prosecution is pending, or where a grand
jury investigation has commenced or is about to commence for a criminal
violation of a law of another state involving [
the provision,
]
:

����
(1)
�
Seeking,
receiving,
paying for, [
receipt of, or assistance with
]
or
inquiring about
reproductive health care services [
as defined in section
323J-1
]
or gender-affirming health care services;

����
(2)
�
Providing or
responding to an inquiry about reproductive health care services or
gender-affirming health care services;

����
(3)
�
Assisting or
aiding or abetting in any of the conduct described in paragraph (1) or (2); or

����
(4)
�
Attempting or
intending to engage in or providing material support for (or any other theory
of vicarious, attempt, joint, several, or conspiracy liability derived
therefrom) conduct described in paragraphs (1) to (3),

unless the acts forming the basis of the prosecution
or investigation would also constitute an offense in this State.
�
In any hearing, the certificate shall be
prima facie evidence of all the facts stated therein.

����
(c)
�

If the certificate recommends that the witness be taken into
immediate custody and delivered to an officer of the requesting state to assure
the witness' attendance in the requesting state, the judge may, in lieu of
notification of the hearing, direct that the witness be forthwith brought
before the judge for the hearing; and the judge at the hearing being satisfied
of the desirability of the custody and delivery, for which determination the
certificate shall be prima facie proof of the desirability may, in lieu of
issuing subpoena or summons, order that the witness be forthwith taken into
custody and delivered to an officer of the requesting state.

����
(d)
�

If the witness, who is summoned pursuant to this section, after
being paid or tendered by some properly authorized person a sum equivalent to
the cost of round-trip air fare to the place where the prosecution is pending
and $30 for each day, that the witness is required to travel and attend as a
witness, fails without good cause to attend and testify as directed in the
summons, the witness shall be punished in the manner provided for the
punishment of any witness who disobeys a summons issued from a court of record
in this State.

����
(e)
�
As used in this section:

����
"Gender-affirming health
care services" has the same meaning as in section 323J-1.

����
"Reproductive health care
services" has the same meaning as in section 323J-1.
"

����
SECTION 15.
�
If any provision of this Act, or the
application thereof to any person or circumstance, is held invalid, the
invalidity does not affect other provisions or applications of the Act that can
be given effect without the invalid provision or application, and to this end
the provisions of this Act are severable.

����
SECTION 16.
�
Statutory material to be repealed is
bracketed and stricken.
�
New statutory
material is underscored.

����
SECTION
17
.
�
This Act shall
take effect on July 1, 2026.

INTRODUCED BY:

_____________________________

Report Title:

Gender-Affirming
Health Care Services; Reproductive Health Care Services; Protections; Abusive
Litigation; Medical Malpractice Insurance; Health Carriers; Protected Health
Information; Covered Entities

Description:

Expands
the protections established under Act 2, SLH 2023, to include gender-affirming
health care services, including clarifying permitted disclosures of protected
health information to address changes in federal regulations.
�
Establishes protections against abusive
litigation.
�
Prohibits medical
malpractice insurers and health carriers from taking certain adverse actions
against health care providers solely on the basis that the health care provider
provides lawful reproductive health care services or gender-affirming care
services.

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