House Standing Committee on Consumer Protection & Commerce

Good afternoon, everyone. We are convening the Committee on Consumer Protection and Commerce. It is Thursday, April 2, 2026, about 02:03PM in Conference Room 329. Vice Chair.

Thank you. Just a quick reminder that we have a two minute time limit for testimony just to make sure that we stay on track for our agenda. I have a timer here, and when it goes off, I will politely ask you to wrap up your comments. First up on the agenda is SB 874 SD2 HD1relating to veterinary medicine.

Requires veterinarians to provide a written prescription upon the request of a client for any animal patient of a client with whom the veterinarian has established an existing veterinarian client patient relationship to be filled at the pharmacy of the client's choosing.

Allows pharmacies licensed in the state to dispense medications prescribed by veterinarians. First up is DCCA Board of Veterinary Medicine in support. Sorry. Hello.

My name is Kristy Fogelman. I am the Executive Officer of the Veterinary Medicine Board.

Thank you. Fine Humane Society in support on Zoom. Not present. Winston Welch, individual in support on Zoom. Not present.

Anyone else in person or online who'd like to testify on this measure? Seeing none, members any questions? Okay. Seeing none, moving on to SB 847 SD two HD1 relating to psychologists.

Establishes a three year pilot program in the county of Kauai to allow qualified psychologists under the supervision of a super supervising psychiatrist limited authority to prescribe psychotropic medications to patients between the ages of 18 and 65 years under the care of the psychologist.

Requires the board of psychology to adopt rules and requires the state health planning and development agency to report to the legislature. First step is the state health planning and development agency in support.

Hi. Chair, Vice Chair, Members. We do support this. We have you know, it's a challenging issue and a controversial one to to a lot of people that we've been moving forward on.

We'd like to have we're certainly gonna set this up with advisers if we do this from from the boards don't wanna actually be implement editors of this kind of thing of of medical board and psychology board, but they would they would definitely be advisers to look on the outside.

We bring in physicians and psychologists and others who are experts in the field, who do have someone else where to make us go. We think that there's definitely a psychiatrist who's willing to participate on the island Of Kauai,

but we'd have to locate some people that had the right training or do or go through the training before the pilot could begin. Any questions, I'll be here for that. Thank you.

Thank you. DCCA Board of Psychology in support.

Thank you. Chair, Vice Chair, Members of the committee. My name is Christopher Fernandez, Executive Officer to the Board of Psychology. I'm here to stand on the board's testimony, strongly supporting this measure.

So from the last hearing where health took our amendments, the board met with the association at its meeting last Monday on the twenty third. And in that meeting, it discussed concerns about the the viability of the bill.

So at that time, the board accepted the request to support the SD two version. So that's why you're seeing the testimony you're seeing before you.

However, I can't state that the board is is fine with either version that is currently the current version right now or the SD two version if that means the bill continues to move forward. So we have if there's any questions, I'm here and available. Thank you.

Thank you. Department of Health offering comments.

Chair, Vice Chair, distinguished committee Members. My name is James or Jim Dillon. I'm a psychiatrist at the Kauai Branch Medical Director in the Department of Health, mental health program.

Department of Health recommends that any pilot program authorizing prescriptive authority for psychologists have certain features that we wanna emphasize.

First, it should be limited in scope, a circumscribed formulary of relatively low risk drugs that are used for disorders, such as depression and anxiety, medications such as SSRIs, and that be limited to those providing in person as distinct from telehealth services.

We recommend that we require the credentialing body, the board of psychology, to have one member that is a psychiatrist holding an active medical license and board certified by the American Board of Psychiatry and Neurology.

Third, we recommend that you require the state health planning and development agency to work with the Hawaii Medical Board to develop clear standards and define measurable outcomes to evaluate the utility and safety of program.

Finally, we recommend that you require the authorization, to prescribe to be provisional, until satisfactory completion of the period of supervision by a psychiatrist is completed.

That's particularly important because unlike any paramedical professions, this one licenses or authorizes prescribing with no prior clinical supervision in the prescribing process based on didactic. Happy to answer any questions.

Thank you.

We'll call you up if after everyone's testified if we have questions. Thank you. Sorry? We'll call you back up if we have any questions, but we can have it if everyone testify first.

Hawaii Mental Health Coalition in support.

Aloha. I'm Melissa Pavlicek, and with me today is Dr. Alex Lipton. I wanted to be available for questions, but he is our, a practicing psychologist who is chairing our coalition's efforts to advocate for this bill.

Good afternoon. The shortage of psychiatrists on Kauai is 60% of what is needed for adults and 62% for children and adolescents according to last year's University of Hawaii physician workforce report.

The average wait time statewide to see a psychiatrist or advanced practice students with prescriptive authority is three point two months according to a recent survey of a 111 psychologists done by my organization.

In human terms, we're talking about people with acute psychosis, anxiety, severe depression, which can lead to suicide, incarceration, unemployment, and the breakup of families due to lack of access to care. For decades, psychiatrists have not been able to fill the gap through workforce development projects.

While telehealth allows for geographic flexibility, it does not increase the number of available prescribers. There are available psychologists with sufficient training to successfully implement the pilot program project.

We should be focused on the very real danger of untreated mental illness rather than the imaginary harm claimed by the opposition. Decades of experience in the US military, the federal Indian health and the Indian health service have shown no significant difference

in harmful effects between psychologists and psychiatrists. Prescribing psychologists have more coursework in psychopharmacology than primary care physicians who prescribe more mental health medications in this country than psychiatrists.

Kauai can now join seven states and Guam in granting prescriptive authority to psychologists. After twenty years in Louisiana and New Mexico, suicide rates declined by five to seven percent. Please pass, SB1847 very modest proposal, which has the potential to save lives. Thank you.

Thank you. Hawaii Medical Association in opposition on Zoom.

Aloha, Chair Matayoshi, Vice Chair and Committee members. Doctor Elizabeth Ignacio, Maui, physician and Chair, Hawaii Medical Association Public Policy. HMA is opposed. We stand on our written testimony.

HMA respectfully asks that should this measure go forward, please add ongoing collaborative review on a biannual or annual basis by a multidisciplinary advisory committee on behavioral health providers.

This group could be convened under SHPTO or the Department of Health and include representatives from psychiatry, psychiatric mental health nurse practitioners, and psychology, as well as Hawaii Medical Board and Hawaii Board of Psychology.

That review should include adverse event tracking, patient outcomes, and evaluation of escalation protocols for safe and effective care of Kauai patients. Thank you, Chair, for your fortitude and the engagement on this complex, important issue. Mahalo.

HMA is available for questions, Chair.

Thank you. Hawaii Psychological Association in support on Zoom. Hawaii Psychological Association.

That's me. Aloha. Hi. I'm Judy Steinman. I am the Chair of the Hawaii Psychological Association, RXP committee, and I am also the past program coordinator for the University of Hawaii, MSCP program, clinical psychopharmacology program with the Daniel K.

Inouye School of Pharmacy, and also a past director of the Alliant MSCP program. I've been an educator in this field for about fifteen years. I do wanna stand by the testimony that was submitted in strong support by HPA.

I also would like to comment on Doctor. Ignacio's recommendation that we have a special panel to review adverse events, to review suicide rates, and to review drug drug interactions, whatever it is that there is a concern about.

We produce students and graduates who practice in a very safe and effective manner. If you look at our testimony, you'll see that there's a reference to the trust, which is the insurance underwriter for us, for all prescribing psychologists around the country.

And they have maintained a very minimum fee because we are very safe and effective.

I would like to point out that we have been doing extensive research on those issues, And doctor Phil Hughes, who is not here today, but he has submitted with written testimony, speaks to the fact that we do show fewer adverse events with our patients, about twenty percent.

We have fewer incidents of polypharmacy, and we, you know, practice in a safe and effective way.

The need on Kauai, but the need on Hawaii Island where I lived for seventeen years, and Maui. I we all know what the needs are on Maui. We want to help. We want to be part of the solution, and I believe that, that we can we can make a difference. Mahalo.

Thank you. HK Blaise Dobrinen, individual in opposition.

Aloha, Chair and Members. I'm doctor Blaise Dobrinen, a psychiatrist. I stand on my private testimony and also the testimony of Hawaii Psychiatric Medical Association.

If I may, I also want to begin by acknowledging testimony I've read by people who've lost someone dear. I too have lost someone and that pain is real.

We all wanna address it. I know in my case, we wanted to do it urgently, and I went to medical school as a second career. But today, we're not talking about whether death is tragic. We're talking about whether this is the safest solution for people on Kauai. I'm not just a doctor.

I'm the granddaughter of Japanese immigrants who worked on Kauai and Oahu. I have family on both islands. Grandma Slaichou always said, no matter how little we have, we give our very best to others. All I'm asking is, is this the very best that we can offer?

Or there's a doctor named Anthony Guerrero who works for the department of psychiatry, who works with the Department of Health, who's been quietly serving the island of Kauai every year since the Covid pandemic.

I asked him yesterday, why don't we know about your work? But like most of us, he doesn't brag and he doesn't broadcast what he does. Every year, he takes over more psychiatrists. Every year, he's having more residents train, and he has a plan to address the problems on Kauai. I really respect your decision.

I know it's not easy, and I just humbly request that you do whatever you feel is best for all of us. Thank you.

Thank you. Cecilia Tuluage, individual in support.

Hi. I'm on Zoom. I was gonna be in person, but I it's hard for me to get there because I live in Colorado. So I hope that you'll accept my testimony online. So I'm Dr. Gay.

I'm a clinical psychologist currently practicing in Colorado on an inpatient psychiatric unit. I'm originally from American Samoa and lived in Hawaii both as a child and later as an adult. So access to mental health care in island communities is very personal to me.

I strongly support SB847. I chose to practice in Colorado partly because psychologists here can pursue prescriptive authority after advanced training in clinical psychopharmacology.

I personally completed three and a half years of advanced training psychopharmacology to prepare for this role. So if people tell you, oh, you just gotta take a weekend seminar and now you can prescribe prescribe meds, no, that's not true.

Three and a half years, and my instructors consisted of MDs and NPs, a pharmacist, and even a biochemist. So the faculty, they were very well trained, and we were very well trained in it.

Hawaii currently does not offer that pathway even though many communities face shortages of providers who can prescribe psychiatric medications.

The proposed three year pilot program in Kauai is a thoughtful and responsible step forward, Allowing properly trained psychologists to prescribe reduces the burden on medical providers while ensuring medication management is handled by Clinicians who specialize in

diagnosing and monitoring mental health conditions. Simply put, prescribing psychology improves continuity of care. It reduces the delays between providers and helps patients receive treatment faster.

For these reasons, I respectfully urge you to support SB 847. Thank you for the opportunity.

Thank you. Okay. Kathleen McNamara, individual in support on Zoom.

Kathleen?

Not unmuting, but she isn't.

Kathleen, you're unmuted if you're trying to talk. Maybe you're

I'm sorry. I'm having difficulty getting the access to the video.

Hear you. Yep. Go ahead. Oh. There you are.

We can hear you now.

Found it.

Thank you. I apologize. I am doctor Kathleen McNamara. I am a licensed psychologist in Hawaii, and I live on Maui, and I also practice on Maui. I have served as the, staff psychologist and chief psychologist at the Veterans Administration Pacific Island Health Care System for 28 years, retired in 2017.

I also have an independent practice, which is also here on Maui. And I provide that information by way of a comment I'd really like to share, which is with the VA and with my private practice, I actually was able to practice on every island except Niahao.

And, therefore, I became very aware of the critical need for increased access to mental health services and, actually, even some improvements in mental health services.

And I am very supportive of this particular bill, including the fact that it is on Kauai. Although I do admit that I am ever hopeful that what will happen is that the benefits that the project will show will be able to be extended to other neighbor islands, including my own here on Maui.

As a psychologist in particular, I appreciate the opportunity for this pilot project to demonstrate that allowing and authorizing psychologists to prescribe will really minimize and possibly even eliminate a lot of the delays in mental health services that occur now,

and particularly for neighbor islands. Neighbor islands residents anyway have so many barriers across so many areas, but mental health is definitely an area where that's very critical.

And so, again, with this pilot project, my hope is that because of these studies that will be part of the outcome, that the benefits by authorizing psychologists to include medication in their practice will definitely, minimize again or eliminate the delays in accessing really

comprehensive care where the patient becomes the center as always for the treatment. And as the center for that treatment that they are allowed to stay with their trusted provider who can now integrate medication when needed into their treatment plan.

So, again, I am very supportive of this legislation, and I do hope that, the committee will be supportive and and be favorable in the vote.

Thank you very much for this opportunity to testify. Aloha.

Thank you. Sarah Thompson, individual in support on Zoom.

Hi. Can you hear me?

Yes. We can hear you.

Okay. Good afternoon, Chair, Vice Chair, and committee Members. My name is Dr. Sarah Thompson, and I've been a licensed psychologist working for a nonprofit agency for over thirteen years.

I'm here today representing my personal opinions and, that have been shaped by my own personal experiences. I would like to just take a few minutes of your time to highlight, some key points from my submitted testimony, and reasons for my strong support of SB 847.

One of my most defining moments of my career thus far, and the primary motivator for enrolling in Psychopharm Fellowship myself was during the New York City Covid mission. I witnessed firsthand the devastating lack of mental health prescribers.

Many primary care physicians that I treated were overwhelmed and sidelined by burnout, sleep deprivation, and anxiety, leaving the private citizens without care. In such crises, therapy alone is often insufficient and even something as simple as a sleep aid could have made a significant difference.

This experience inspired me to address these dangerous shortages and bring solutions back home to Hawaii.

The path to becoming a prescribing psychologist is rigorous And in respect of your time, I'm not gonna go through a detailed curriculum right now, but I'd happy to share that with you, if requested.

I do wanna assure you that our education and training is not only highly competitive, but not, if not more stringent as compared to other disciplines in mental health care who are currently prescribing psychotropic medications.

Currently, I'm working through my own supervised hours under two board certified psychiatrists and physical exam evaluations under a board certified family medicine physician who have all been extremely supportive.

After three years of continued supervision, I'll finally be able to prescribe independently in 2028, hopefully in Hawaii. Nationally, the number of psychiatrists compared to psychologists available for patient care is one to four.

Now imagine the impact on access to care if even one of those four psychologists with the added education and training were granted prescriptive authority.

States that have already passed similar legislations, as you know and heard already, reported improved access to care, particularly in underserved areas, reduced suicide rates, and have demonstrated an excellent safety record.

This bill is not a cure all, but it is a critical step forward. It does not force a choice between safety or access. We all agree both are essential. Instead, it offers a structured and super supervised solution to reduce suffering in communities that currently are lacking this opportunity.

Please afford prescribing psychologists with the opportunity to demonstrate our worth as we most certainly have done and already in other states. And for all these reasons, please vote yes on SB 847. Thank you for your time and consideration.

Thank you. Joe Velasquez, individual in support.

Hi there, Chair and Vice Chair and committee members. I'm Dr. Joe Velasquez. I'm a licensed clinical prescribing psych neuropsychologist practicing in New Mexico. I'm an owner operator of a large group practice in New Mexico.

Currently, the prescribing psychology group practice, we have over a dozen prescribing psychologists in the pipeline, so at various levels of licensing. So we opened our doors in this is our tenth year, as a matter of fact. December 2016 is when we opened.

And and I'm gonna give you a little bit of information about, you know, what the road is like for us here in New Mexico and then what which is very similar to to the various states that have the law and just kind of the numbers that we've been able to, accomplish in serving the needs of the people.

So all prescribers must be doctoral level licensed psychologists completing four hundred and fifty hours of classroom education. So and they earn then we earn our postdoctoral masters master of science in clinical psychopharmacology.

And successfully, we need to pass the ABPP examination offered by the American Psychological Association. Once that happens, then we have let me see. We have residency hours, which takes six months to thirty months.

And depending on what state you're in, you're being supervised sometimes by psychiatrist, sometimes by physiatrist, sometimes by NPs, DNP's, various mental health professionals and or related professionals.

After we complete the residency component, then we move into a two year supervised fellowship.

And we have two folks at residency level in the practice here, two two people at the fellowship level, and we have eight folks that are independently licensed.

In a study that we did that we published about a year ago, we with with doctor Philip Hughes, we have served about 6,500 individuals for a total of about 70,000, sessions of service.

51% of the population served by this prescribing psychology group practice received Medicaid, while 49% carried commercial or federal insurance with a small percentage paying for services out of pocket.

I'm a strong supporter of SB eight four seven legislation permitting prescribing psychologists to practice in your state. This law will increase the number of mental health experts in your state to better meet the needs of the people of Hawaii. Thank you so much. Thank you.

Is there anyone else in person around Zoom who would like to testify on this measure? Seeing none, Members, any questions?

So I have a question. Is there a clinical psychologist here who's practicing now as a psychologist?

Semi retired. I'm not Okay. So I am a, like.

Thank you. Under our current laws, when you are treating a patient who who you recognize they could benefit from prescript pharmaceutical prescription, how do you how do they get the how do they get the drug now?

They have to be referred to a psychiatrist or an advanced practice nurse with prescriptive authority.

And is there a shortage of the latter?

To my knowledge, yes.

And so you're saying if we go this route, there'll be an increased access. People will be able to get more timely help.

Yes. There'll be more of a client.

Okay. One of my concerns is that if we go this route, then the amount of psychologists versus the amount of psychiatrists and and young people going to school for if they have to choose between psychiatry and psychology. Would this perpetuate the shortage of psychiatrists?

Because I don't follow why it might perpetuate the shortage of psychiatrists. Psychologists are already doing psychotherapy with the NHS. And as part of that time when they're doing psychotherapy, they can also be doing the medication management.

So that would provide some efficiency. They wouldn't have to also then go see a psychiatrist. So that would presumably free up the psychiatrist time to see another patient. I don't follow why it might.

It just see it just seems like

sense is that it seems to increase. Excellent.

No. That medical students would choose or, I mean, there might be a more of a it would lead more students who are interested in providing a healing help to the community to go into psychology rather than psychiatry. But either way.

I can't speak for medical students making a decision.

Given the model that is being proposed, who would be liable for malpractice if something should go wrong under the model that's being proposed in this bill. Would it go to the psychiatrist who's providing supervision be liable, or would it be psychologist who's being.

All the professionals would have to have responsibility and be covered by malpractice insurance for the part of the care that they're responsible for.

So a supervising psychiatrist has certain responsibilities and also for his his or her supervision of the psychologist as well as the psychologist has their own malpractice insurance for their responsibility. Or if they're if they were caused harm, then their insurance would have to cover it.

If the prescribed the supervising psychiatrist caused harm by a lack of supervision or misdirecting the medication, their insurance would have to cover it.

This isn't anything different than we have, and I think we're currently in the process of implementing a lot for associate licensure for marriage and family therapists and other professionals through DCCA right now

and thinking through some of these malpractice insurance questions, but they're very similar to I'm an attorney, for example, in a law firm.

My legal malpractice insurance has to cover the acts of my paralegal, my associates, etcetera. But for the attorneys who work for our partner, they also have malpractice insurance. So whatever to the extent that they're responsible for it, their insurance would have to cover. Okay.

I have a question for SHPDA.

Thank you.

I was wondering if you could address some of the concerns and testimony that the majority of patients at federally qualified health centers are Medicaid enrollees, but it's not an it's not clear whether drugs prescribed by psychologists under this bill would be reimbursable under Medicaid.

We have to consider that in the pilot, and we have to work that out with CMS and with the Federal Government. I so I think that's to be determined in the pilot. But I think that all lines of business insurance business should should conceivably be willing to reimburse this.

You know, I strongly believe in the team practice approach. I kinda lament the fact that medicine splintering off into various independent practice practitioners. Whereas, together as a team of people, this is how we work as physicians.

We don't, you know, family doctors don't do any other surgery and so forth. We definitely build up teams. And I think the best very the very best care is provided by team practices.

In primary care, that's physicians, advanced practice nurses, PAs, social workers, pharmacists, all working together. That's the aspiration of the head grant. I've strongly testified that I think this model can work if psychiatrists and psychologists are working in partnership.

I realized that many of the psychologists advocating here want to go toward an independent practice group. But I think if we would stay together in a team practice model, not only would we minimize the malpractice risks for the psychologist,

but I think the whole model would be would be better. I was kind of enthused by the psychiatrist who is willing to take this project on in Kauai because his vision is to have a psychologist, a family physician or clinician or advanced practice nurse, and a social worker in different

in three different areas of state that he would supervise and closely watch and be available for the problem the process. Creating, I think, a really interesting care model innovation model that would be spectacular.

But I can't say that that at the end of it that this wouldn't lead to, you know, fragmented independent practice or it would lead to more keen practice. But I I think in the context of this this pilot project, I think it's it can be done very safely.

So, Jack, we we reached out to DHS. We got a couple of mildly squirrely responses from them about Medicaid reimbursement. The long and short of it is I think that the answer is no.

That Medicaid is not going to be reimbursing for prescriptions written by psychologists even if they're under the supervision of a psychiatrist. Does that change the efficacy of the program at all?

I think, you know I mean, I think that's Medicaid is taking a a a cautious stance in this in terms of whether their interpretation meets the law at the time. But I'm sure that in other states, the Medicaid program is probably covering these services, but I don't know the answer to that.

If they refuse, would the program necessarily would the pilot program necessarily fail?

I don't think it would fail. I think there's still there'll be some commercial patients who will who opt for this program, and there would be but this program has a limit of 65, so Medicare patients would not be participating.

Okay. I I would like more information on this, and we'll get to the Zoom in a second. Did you have something to add?

Yes.

I'll come the microphones will hear you from back there.

So I'm not sure when you had time to read all the testimony, but we have several psychiatrists from Illinois who submitted testimony saying that in the fifteen years since psychologists have been authorized to prescribe in Illinois, only, wait, only a dozen or so have signed up.

None of them can work at FQHCs. None of them can work at hospitals because Medicare and Medicaid do not reimburse.

To be clear, in order for reimbursement to happen, our state DHS would have to make a provision, but it would also have to work hand in hand with the federal government CMS. And the federal CMS system has not allowed reimbursements for prescribing psychologists.

Now in military systems, the psychologists work for the federal government, so that's a completely different pay system. But if you're looking at trying to increase care on the island of Kauai, FQHCs will not be able to reimburse.

So the care responsibility will go to sliding b to our patients or to the FQHCs themselves whom we all know are facing consequence downward consequences from the one big beautiful build. So bottom line, in Illinois, it has an improved rural access.

The only psychologists who are now prescribing are in urban areas, and they accept cash because Medicare and Medicaid are not accepting, and they're not able to help the born underserved populations. Thank you.

I know there are other states that have as well. Let's hear from Zoom. Go ahead.

Aloha. I'm gonna defer to Dr. Velasquez in a minute, but most of that is not true. Unfortunately, for the Illinois bill, when it was passed, they did have a provision that they're not allowed to to get reimbursed by Medicaid.

However, in all the other states, that is not the case. There is a testimony that has been submitted by Doctor.

Elizabeth Lonning, who is the president of or PEP president of the Society for Prescribing Psychology. And there's specific ways that we can put into the language where we will be able to be reimbursed by Medicaid. I'm gonna defer to Dr. Velanchez to speak from her direct experience.

Before we do that, you you suggested that specific language needs to be included in this bill in order to allow that reimbursement. Is it currently in this bill?

It has not been added in. Okay. We did not add it in, but it can be.

Whose testimony did you say suggested the language to be added in.?

It's a Dr. Elizabeth Lonning, l o n n i n g. I believe that was submitted from the last hearing.

But I can get that to you. Absolutely.

Okay. And she didn't testify in this hearing, though? That might be the one

She didn't she didn't testify live, but she has written testimony.

Okay. We might have to refer to the previous.

If you don't have it, we'll get it to you.

But Dr. Velasquez is the person who who bills Medicaid all the time. So let's say I have her speak.

Okay.

Okay. Sure. She's here.+

Hello, Chair, Vice Chair, and committee Members. So, yeah, couple of things I wanna address. First of all, to address the questions that you've asked. Malpractice insurance for us, prescribed psychologists in New Mexico.

When we go from clinical psychology or counseling psychology over to prescribing psychology, our malpractice insurance goes up about $100 for the year.

And that is because our, the incidence of malpractice is so very low for psychologists and continues to be low, as prescribers and you can reference Dr. Phillips Hughes' work in regards to that.

The existing model for FQH, there is a model that already exists for FQHCs to be reimbursed for Medicaid and for prescribing psychologists and for Medicaid services. FQHCs are paid. For example, $400 per contact individual.

Whether that person spends thirty minutes or one hour or two hours with a particular provider, then they would in the FQHCs here, they would get they would bill for $400 for to the federal government or under this particular funding. And then and then that so that more than covers.

I guess it's what I'm saying is it more than covers. In regards to Medicaid, creating Medicaid reimbursement pathways for CMS or commercial, our legislature here would tell you the the CMS and insurance companies in the state of New Mexico, they are required to do what the legislature requires them to do.

So the it's the lawmakers that then establish the laws for the state, for your state of Hawaii as to who that if there's gonna be insurance companies that come in to provide make available insurance to the Hawaii to the people of Kauai,

then they will be they will have to reimburse equivalent to or or equivalent to nurse practitioners, for example. Equivalent to the way you you reimburse nurse practitioners. Thank you.

And as far as we.

We looked at plotting's testimony from last time. There there is no suggested language in there. Does anyone here or online have honestly, we if that language is so essential, we may need to push decision making a little bit so we can figure that part out.

I don't want to pass a bill where the Medicaid reimbursement is not available, especially in this pilot situation. But does anyone have any further knowledge about what language would need to be added to the bill in order to effectuate this?

So the the gentleman, the Senate the Senator who has sponsored several bills regarding prescribing psychology in New Mexico would have the language for you. That so

Okay. Why don't you email?

I'm happy to.

Yeah. Why don't you email email my office, and I can distribute it to through the committee. But we .

You got it.

I do need that. And, you know, but works in New Mexico. I don't know. Oh, it's federal, so it's probably a little better. Okay.

Yeah. Maybe send him a bill too and and see what he see what he thinks where exactly it should be put to. But we'll take it into consideration. Thank you.

Okay. Very good. To you as well.

Jack, do you have any thought on that? Or do do you know anything about that?

Okay. I'll try to figure it out. Did you have any more questions? Okay. Jack, I do have a couple questions for you.

I don't.

So HMA suggested doing a group to track, I guess, for lack of a better term, the the results of this, any kind of mistakes made or or not made just to have some data? I mean, what what do you I was gonna have you shift to to be there.

I have no objection to that at all.

Okay. I makes I'm honestly, it makes sense to me. Would this data not be tracked without this?

I think we would certainly you know, we would definitely wanna have that kind of advisory group to to look at this in the planning process to make sure that it's done safely and effectively, it proceeds. So no objection whatsoever to that. Okay.

You you may or may not be the right person to ask about this. So if you're not, you know, we'll we'll defer to someone else. But the current bill requires a master's in psychotropic something. Pharmacology. Pharmacology.

The does that master's degree require the kind of study for interactions between drugs and things like that that the doctors are worried about, or or does it not come from.

I assume it would include that kind of interactive pharmacology in terms of what's prescribed. You know, clearly, there's a there's a big difference in the training between psychologists and psychiatrists and their but I think the pharmacology program, if it's focused on a limited formulary.

It could be very comprehensive and it could look at the most common kinds of interactions with with other medications even though those medications aren't psychotropic medications.

Because some of the drug interactions are are concerning and it gets psychiatrists in trouble in their prescribing have to do with, you know, somebody's on chemotherapy or on cardiovascular drugs which somehow have some interaction that's untoward.

It wasn't expected. Nothing to do with the psychotropic medication.

And I think that's the concern of the doctors is that even if you have a narrower band of prescriptive authority for psychologists that they can prescribe these things, but there are so many other drugs out there that may interact with them that they can't have or I'm assuming

they're not gonna most of them are not gonna have that general knowledge of all of the other drugs. So you can prescribe this drug, and you may know how it interacts with other drugs in the spectrum, and maybe some of the common ones outside of it as well.

But the danger, I think, that they're trying to point out is whether that is well, I guess that's why they're gonna be supervised by psychiatrists.

And and you really touched on what I think is the the ultimate best model would be, which is just a a team practice where the psych psychiatrist is available to talk about those complex interactions with patients that may have, you know, a bunch of comorbidities.

That just gonna be less stress for the psychologist and better for the patient and just better care.

Okay. That's fair. In your testimony, you also suggested that we expand it to Wilcox and Samuel Mahalona Memorial Hospital as well.

There's some testimony that under the current version of the bill, there are no psychologists that have that master's degree necessary to be able to take the test and to participate in this program. My fear is that there's there aren't gonna be you know, it's a three year pilot program.

It's just limited in scope or at least in timing. If someone has to go get a one or two year master's program, that's gonna eat up all the time before they can even participate in this program.

So by expanding it to those two other sites, would that eliminate that problem? Are there psychologists available that can do this?

No Chair .Not to my knowledge. I think that however, there's a very real possibility a psychologist with that kind of training would come to Kauai.

And I think that that's the the anticipation is that there will be those who've had pharmacologic training that would meet that would would come to Kauai in part of the project.

And that that those people could be recruited, or that somebody would go through the year long program, which is gonna take a year or so to launch out and get to get started, get organized, plan, that somebody could enter that training and be available in a year and a half or so.

Do you know how many people how many psychologists on in Hawaii right now have the master's degree? None. Okay. What year program you said?

I don't you know, that's all to be defined as well, and I I would really wanna work with the board of psychiatry over the the medical board and the and the board of psychology to define what that education training should be.

Okay. But what So

that's all part of the plans for this project that would be Do

we do we kick the program out a year to let you guys set up before the three years start to tick? Otherwise, it seems sort of like we're we're shorting ourselves with the data that we want. But, Melissa, did you have something to add?

I just wanted to say that we've been hearing from psychologists, even those on Kauai, that some of them have some training towards receiving a master. So they may not be credentialed yet, but they might not be from a cold start.

So, you know, giving it some time before starting or recognizing that there are either people who would be able to get you know, Kauai psychologists might have the qualification here in Oahu who would be willing to live or practice in Kauai or what or Kauai psychologists already have some training.

Okay. Doctor, do you mind if I have to yell to come up here?

Thank you, Jenny. So if the bill does move forward, we would ask that the psychologist actually live on the island of Hawaii. One of the concerns of our Illinois colleagues is that most of the psychologists who got prescriptive authority are doing it by telehealth. And, you know

I'm not sure about living on Kauai, but maybe they could find it. I mean, we're not that far away.

Well, I'm just saying to physically be, otherwise, we're opening the door to an Illinois psychologist or someone doing telehealth. And if that's the case, we psychiatrists who are actually flying over there, like Tony Guerrero and his team, are actually already filling that need. And then to the I

I mean, because it's a pilot program just for Kauai, Jack, could they even do this on a telehealth? I mean, is telehealth available in this program?

I wouldn't personally recommend that there be this be an in person process for for the pilot project. So I would I would strongly expect that that language. Yep. I

would recommend adding language.

Okay. So you'd be okay with adding language for more of an in person, no telehealth?

But my expectation was this would be if it's gonna be supervision and it's gonna be a learning process that there actually be a physical connection between the psychiatrist and the psychologist.

Okay.

And that that was my expectation of what what was anticipated for the bio.

Okay. To the point of drug drug interactions, there's no question that the masters of psychopharmacology provides training. The difference is that a doctor has 15,000 hours of clinical training.

And you've heard the psychologist themselves say that they have will have 400 hours. So that's not less than .

There's gonna be less than partners.

Percentable, but that's why.

That's why there's gonna be supervision. Thank you.

Yes.Thank you.

I think I can answer a number of the questions that were raised. Sorry. I don't wanna overemcode.

Sure. I'll I'll give you I'll give you one minute. Go ahead.

Okay. So in the training, we not only cover psychopharmacology, but our students have multiple classes that cover physiology, pathophysiology, biochemistry, pharmacology, general pharmacology, as well as the multiple psychopharmacology courses.

Our students have to know all the medications that are used for hypertension.

I Sorry. Sorry? I just wanna make sure I'm clear that when you say our students, you mean the students here that would also be taking that course would have all those courses required as well?

All of this all of the programs around the country k. That have MSCP programs that have been designated by APA. We have certain requirements, and the requirements include that we have medical training. So we do know how the kidney works. We do know how the heart works.

Plus, we know all the medications used for those conditions and how those drugs are going to interact with the drugs that a psychologist might prescribe. We train our students to do medication reconciliation before they ever prescribe a medication. So they're fully aware of comorbid conditions.

The thought that we would allow people to prescribe that don't have that training is frightening to me. So we understand that. Include all of that.

Honestly, it seems like the doctors are acknowledging that as well. It's just less training. Did you just do that? Please go ahead.

Just a couple of points. I I think that the three prescribing psychologists have made one of them for me. They describe very robust training programs, years of fellowship. This is not that at all. There's no fellowship.

There's supervision by a psychiatrist after a master's degree. That's it. So that's why we recommend a very circumscribed authority. If we had so robust a program as the three have described, we might see it differently. But this one is very limited.

Second, most prescribing psychologists don't live in rural areas. They don't go to rural areas. They they serve them. But eventually, that would happen here because it's hard to drive that to a rural area, from Oahu. It it the, sorry.

So after we solve the shortage by having a contract with the University of Hawaii, right, by clinic. We have two psychiatrists, three psychiatrists actually who telehealth in.

That's worked very nicely. I was kinda taking advantage of those opportunities, but I don't I think the shortage can be resolved in other ways. There are about 300 prescribing psychologists nationally after thirty years of this.

It's not gonna likely be a large number. And the number they have no longer be doing regular psychology. We need psychologists. We really do. We love psychologists, but we have a great shortage of those as well.

Thank you. Oh, a question. Yeah.

Oh, you mentioned in your testimony, I think you just mentioned it now, a circumscribed formulary. Yes. Are you advocating for limiting it more than the current language?

The the formula well, I probably need some discretion to be specific, but we we we I guess we picture psychologists treating patients whom they're seeing with common disorders like depression and anxiety, things that would perhaps be handled by a FQHC doc otherwise.

And this supports their their treatment with therapy and makes perfect sense. But we don't want we're not recommending that they use very much more toxic drugs like antipsychotics or the drug that they treat children using stimulants.

That's that's kind of we could be more specific about a formula if you wish. But

Okay. Thank you. Yep. That's all. Thank you.

Thank you very much.

Any one else have questions on this. Okay. That's good. Okay.

Alright. Moving on to the final measure, SB 83 SD two HD two relating to hotels. Requires hotel keepers to provide an adequate notice of service disruptions to third party vendors and guests under certain conditions. First up is the DCCA Office of Consumer Protection and Support.

Good afternoon, Chair, Vice Chair, and Members. Mana Moriarty. I'm the Executive Director of the Office of Consumer Protection. I just wanna express appreciation for the prior committee's amendments.

And I wanna go through those quickly because to me, they represent an an under an under focused on part of this bill. In particular, the prohibition on hotels collecting a fee or penalty from a guest who walked into a situation.

They didn't know a lockout was going on or a work stoppage, and they encountered it when they got there, and then they terminated their reservation where they wanted to. I mean, that is a diminished guest experience. It is not what they bargained for.

So it it really does, I think, if you ask the average person, shock the conscience that a hotel would attempt to extract fees in that particular situation, which in all likelihood was not contemplated in the agreement they entered into in the first place.

The damages provision that was inserted is for treble damages. There there may be a lot of Hoo about that, but let's let's be let's focus in. What does that actually mean? Three times the amount of the sum charged in excess of what was entitled to. We're not talking actually huge amounts of damages here.

So it really beggars belief that we would try to get rid of a damages provision or a legal consequence, especially in the context of extracting fees from somebody who didn't know the situation they were walking into. We've talked about informational asymmetry, and I apologize for the late testimony.

That's a mouthful, but in the labor stoppage context, in the work stoppage context, the hotels know what is coming down the road before the guests do and to allow them to exercise their advantage of knowledge to the disadvantage of the consumer really is contrary to our consumer protection mission here.

I wanna focus on those. I hope you'll agree that the that we should keep in the waiver language, and we have ex the the non waiver language.

We have asked, and the private previous committee inserted a provision there saying that any attempt to waive the guest's right to receive notice is void as a matter of public policy.

I'm happy to talk more about that and what that would actually look like in the case of a guest actually filing a complaint in arbitration or filing a complaint in the courts. I'm happy to leave it with that. Thank you.

Thank you.

I'll say for the record that we support the passage of this.

Unite Here local five.

Ben Sedoski with Unite Here Local five. Very supportive of SB 83, and we appreciate the amendments that were made in the HD2 version of the bill.

You know, I I think, ultimately, this is a bill about consumer protection, and we're hoping to end up with something that will provide robust protections to consumers in the event that their services are disrupted one way or the other.

So in doing that, you know, we think it's absolutely crucial that there be remedies for guests, that they're able to be able to cancel, get their money back, and to be able to do it in a way that is really reasonable where they're not, you know, sort of put through a bunch of hoops or a bunch of cases to try

to just to try to get we think, you know, it's it's, of course, crucial for there to be penalties for hotels that fail to notify their guests. Otherwise, the legislation doesn't really have any teeth. It doesn't really do much if hotels can easily just ignore it.

And, you know, we would push for the definition of service disruption to be expanded. We think that in order for it to be real protection for consumers, it should include not just what's in there now, but, additionally, some of the things that we've had in there initially were construction work as well as if the

electricity were out, utilities out, things like that. That would all, you know, significantly impact the guest experience.

And and then I would just say on I know that there has come up the question of notification timing, when and how far in advance should guests be notified and, you know, how how likely does a service disruption have to be for guests to to to have that right, for hotels to have to do that.

And, you know, I think, you know, we acknowledge that hotels don't always know when service disruptions such as strikes will occur. Like, nonunion hotels, for instance, could go on strike at any time. But in many cases, hotels do know. You know, I think as the DCCA mentioned, there's sort of informational asymmetry.

So the hotels often do know a lot about what's going on, so we would ask that there'd be something that's reasonable and balanced in a way that doesn't just put all the risk back onto the consumer.

And yeah. I mean, I think, you know, just 11 other thought on the on the remedies for guests. You know, I do think that there's the impact of a service disruption isn't only about the unavailability of services, but also, like, for instance, you know, again, if there's a strike having to cross a picket line.

If there are utilities out, there's, you know, other side effects of that too that impact more than just the ability to have your room clean. Right?

So, you know, we'd ask that you look at all of those things. But we really appreciate you this committee taking up this bill. We appreciate you looking at it, and we are in support of this message. Thank you.

Thank you. Kohala Coast Resort Association in opposition on Zoom.

Aloha. Can you hear me okay? We're having some weather in the Hamakua District, so I wanted to make certain you can hear me just fine. Aloha. I'm Stephanie Donahoe.

I'm the Administrative Director of the Kohala Coast Resort Association, And I want to emphasize some things from my written testimony. You know, in an ideal world, there would never be a service disruption.

But unfortunately, for hotels and for other businesses, there are times when things are not able to function the way that we would like them to. And in as many cases as possible, our goal is always to make it right. But what right looks like isn't always a form of payment.

In many cases, for a lot of the people who visit our properties, they're coming for a limited period of time. Returning a fee to them is not going to make it right. They want to have their time here valued. So we find alternatives that can hopefully make that customer feel comfortable with the situation.

When you're talking about service disruptions as varied as construction or an elevator not functioning or a rodent issue, some of those service disruptions are going to require that we have representatives come from other islands to help.

For example, if it's an elevator not working, we're going to need to have a repairman who's going to come from Oahu to the neighbor islands. This bill also really doesn't take into consideration how hoteliers receive information on the guests that they're coming.

The notification to third party vendors, we may not have all of the contact information to do an advanced notification until those guests check-in at our property. We might not have a way to notify them directly.

If you've attended past conferences, for example, you know, the Hawaii State Association of Counties conferences or a state legislative conference, we work with a meeting planner or a meeting organizer for Room Blocks, but we don't have the contact information for all of those guests until they arrive on-site.

So some of that advanced notification, that's a very difficult thing to operationalize. The challenge with this bill, I think, is that it puts together a wide variety of service disruptions into the same bill, acting as if they are the same that can all be treated the same way.

While we always wanna make it right, we don't believe that that's the case. It can't always all be treated the same way. We don't interact with our guests at the same level.

And so we're asking you to please defer this measure and have further discussions on how to handle consumer protections. This bill also, we believe, unfairly looks at hotels when there are many other public facing organizations that have service disruptions with large economic challenges

that are put into place as well. The Department of Consumer Affairs will say people work very hard and they come out here to take a vacation. Well, people also work very, very hard to schedule time away when they need a surgery.

And a labor dispute at a hospital also has an economic impact, but this isn't addressing that.

It's only addressing hotels. So we would ask you to defer this measure and break out the service disruption so that they can be handled individually as is needed. Thank you so much, and I'll be here if you have any questions.

Thank you. Is there anyone else in person or on Zoom who would like to testify on this measure? Seeing none, Members, any questions?

I guess not. Oh, hearing no questions. We'll recess.

Alright. We're convening for decision making.

First up, we've got SB874 SD2 HD1 relating to veterinary medicine. Chair's recommendation sorry. Also, I know my o m is listening. This is really small. Maybe we could, like, up the up the font for next time.

That'd be nice. It's getting old. Right? Okay. So for SP874ST2 h D one related to veterinary medicine, chair's recommendation is to add a requirement that the notice in subsection b must be provided directly to the client at the time the prescription is prescribed or recommended, but not more than once per office visit.

Members, any comments? Vice chair for the vote.

Voting on SB874 SD2 HD1, Chair's recommendation is to pass with amendments. [Roll call]. Chair, your recommendation is adopted.

K. Thank you, members. Moving on to SB847 SD2 HD1relating to psychologists. It is the intent of this committee to pass this bill at a later date, but I think we need to get some more information on, especially the Medicaid language needed to allow Medicaid reimbursements. That's a very important part of this bill that I do not wanna leave out, but we'll be discussing it later.

We'll be deferring this for decision making for an agenda next week that will be noticed properly. So defer for now, but we'll be back. Last on the agenda, SD 83 SD2 HD2 relating to hotels. Chair's recommendation is we've got a a bunch of them here. So we'll be putting back in the notification for major construction, something that would qualify for compensation, specifically for planned major construction like renovations rather than emergency major construction as the result of some weather disaster.

On page four, lines 11 through 18, which is the rodent slice and bed bug section, we'll be deleting this per the request by Local five. We will be adding a provision requiring hotels and to reimburse guests for the value of any lost services or amenities caused by a service disruption, which will be capped at the value of their room of your complete reimbursement determination by the hotels.

This is in lieu of the provision requiring hotels to allow guests to terminate their reservations due to a service disruption. So that provision will be those provisions will be deleted. Amending so that the service labor union strike will occur upon a valid notice of an authorized strike to the hotel.

On page two, subsection a will be replacing language for notice of a service disruption that may occur with language that if a service disruption is recently anticipated, notice of the guest must be given within twenty four hours of receiving notice of the anticipated service disruption four or five days prior to the anticipated service disruption, whichever is less. Deleting the notice requirement for hotels on platforms and mediums on page two, lines 14 through 17.

And on page two, line 12, changing the notice requirement to prospective guests who have entered into a reservation booking their agreement. Deleting on page three line 11 that references subsection subsection a accordingly since we're deleting the other one too. Alright.

Members, any comments?

So let's see if a union, they anticipate taking a strike vote in five days, and all past strike folks led to a strike. Would that count as anticipated service disruption, which would trigger the hotel?

No. That would not. I I mean, we discussed it with the with all of you and and local five as well. If they're going to take a vote, great. Okay.

Okay. Thank you.

Yep. Any other comments?

But it's not until the the vote is the strike is actually authorized by the union of that this thing will kick in.

Okay, vice chair for the vote.

Voting on SB 83, SD2, HD2, chair's recommendation is to pass with amendments. Any reservations? Any no's? Chair, your recommendation is adopted.

Good. Thank you, members. We're adjourned.