RELATING TO PSYCHOLOGISTS.

HB2169

HOUSE OF REPRESENTATIVES

H.B. NO.

2169

THIRTY-THIRD LEGISLATURE, 2026

STATE OF HAWAII

A BILL FOR AN ACT

relating
to PSYCHOLOGISTS
.

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

����
SECTION 1.
�
The legislature
finds that the State needs more mental health professionals having prescriptive
authority to provide its 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, where shortages of
psychiatrists reach as high as seventy-five per cent.
�
These shortages are leaving significant
mental health needs unmet.

����
The legislature further
finds that the State currently authorizes prescription privileges for advanced
practice registered nurses, optometrists, dentists, podiatrists, and physician
assistants, based on demonstration of specific training, education, and
practical competency.
�
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 granted prescriptive
authority for advanced trained psychologists.
�

The United States Department
of Defense and the 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:

����
"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 defined in section 329-1.

����
"Forensically
encumbered" means a person who has been detained by a state 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 state
court, or is involved in mental health court or a jail diversion program.

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

����
"Opiate"
has the same meaning as defined 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.

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�
465-
�
Administration.
�
(a)
�

The board shall prescribe forms and fees for the application for and
renewal of prescriptive authority privilege by psychologists 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, including rules that:

����
(1)
�
Establish
the grounds for denial, suspension, or revocation of prescriptive authority
privilege, including provisions for suspension or revocation of a license to
practice psychology upon suspension or revocation of prescriptive authority
privilege; provided that rules governing actions of denial, suspension, or
revocation of prescriptive authority privilege shall be in accordance with this
chapter; and

����
(2)
�
Require
a prescribing psychologist to collaborate with the patient's primary health
care provider.

����
(e)
�
The board shall maintain current records on each
prescribing psychologist in the State, including the psychologist's federal Drug
Enforcement Administration registration numbers, if applicable.

����
(f)
�
The board shall provide to the board of
pharmacy an annual list of prescribing psychologists that contains the
information agreed upon between the board and the board of pharmacy.
�
The board shall promptly provide the board of
pharmacy with the names of any psychologists who are added to or deleted from
the list of prescribing psychologists.

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

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�
465-
�
Prescriptive authority privilege;
requirements.
�
Beginning on July 1,
2027, the board shall accept applications for prescriptive authority privilege
under this part.
�
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

���������
(C)
�
Any successor organization;

����
(3)
�
A current license in good standing to
practice psychology in the State;

����
(4)
�
Malpractice insurance sufficient to
satisfy the rules adopted by the board, that will cover the applicant as a
prescribing psychologist; and

����
(5)
�
Completion of all other requirements,
as determined by rules adopted by the board pursuant to chapter 91, for
obtaining prescriptive authority privilege.

����
(b)
�
The board shall grant prescriptive authority
privilege if it finds that the applicant has met all of the requirements of
subsection (a).

����
(c)
�
Any psychologist who no longer meets the
requirements of subsection (a) shall immediately relinquish their prescriptive
authority privilege.

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�
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 prescribing
psychologists to determine compliance with the continuing education required by
subsection (b).
�
The board shall provide
written notice of an audit to each randomly selected prescribing psychologist.
�
Within ninety days of notification, the prescribing
psychologist shall provide the board with documentation verifying compliance
with the continuing education requirement established by subsection (b).

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

����
(1)
�
Has been licensed or otherwise
authorized 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 forces;

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

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

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�
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 prescribe or administer any
medication; or to communicate, represent, or imply in any manner, including
through the use of any sign, card, or device, 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:

����
(1)
�
Date of issuance;

����
(2)
�
Original signature of the prescribing
psychologist;

����
(3)
�
N
ame and business address of the
prescribing psychologist;

����
(4)
�
Name, strength, dosage form, quantity, route
of administration, and specific instructions for use of the psychotropic
medication prescribed;

����
(5)
�
Name and address of the patient for
whom the prescription is issued;

����
(6)
�
Room number or other information
identifying the location of the patient, if the patient is receiving care 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

���������
(C)
�
After providing notification to all
other health care providers who are treating the patient; 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 privilege to any other person.

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�
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.

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�
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."

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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" includes 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;

����
(3)
�
A
licensed midwife practicing as a certified midwife registered under section
329-32 to prescribe and administer controlled substances in the course of
professional practice in this State; [
and
]

����
(4)
�
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

���
[
(4)
]

(5)
�
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."

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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
]

hand-printed
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
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 prescriptions issued by the psychologist:

���������
(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 psychologist; and

���������
(C)
�
The signature of the psychologist.
"

����
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 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,
psychologist,
or
veterinarian by whom the prescription is written; and

����
(5)
�
[
Such
]

The
directions as may be stated on the prescription.

����
(c)
�

No person shall alter, deface, or remove any label affixed to a package,
bottle, or other container in which a drug is sold or dispensed, except for the
purpose of replacing the label with the person's own lawful authorized
label."

����
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 psychologist with prescriptive authority privilege 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
2027, on the authorization of
prescriptive authority privilege to 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 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 sum 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, 2026.

INTRODUCED BY:

_____________________________

Report Title:

Board of
Psychology; Clinical Psychologists; Prescriptive Authority Privilege; Report;
Appropriation

Description:

Authorizes
and appropriates moneys for the Board of Psychology to grant prescriptive
authority privilege to clinical psychologists who meet specific education,
training, and registration requirements.
�

Requires the Board of Psychology to accept applications for prescriptive
authority privilege beginning 7/1/2027.
�

Requires reports to the Legislature.

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