DAVID Y. !GE EXECUTIVE CHAMBERS

GOVERNOR HONOLULU

July 5, 2019 GOV. MSG. NO. I ! S:J

The Honorable Ronald D. Kouchi, The Honorable Scott K. Saiki,

President Speaker and Members of the

and Members of the Senate House of Representatives

Thirtieth State Legislature Thirtieth State Legislature

State Capitol, Room 409 State Capitol, Room 431

Honolulu, Hawai'i 96813 Honolulu, Hawai'i 96813

Dear President Kouchi, Speaker Saiki, and Members of the Legislature:

This is to inform you that on July 5, 2019, the following bill was signed into law:

HB665 HD2 SD1 CD1 RELATING TO THE ELECTRONIC

PRESCRIPTION ACCOUNTABILITY SYSTEM.

ACT 251 (19)

Sincerely,

DAVID Y. IGE

Governor, State of Hawai'i

Approved by me Governor ORIGINAL

on------------ JUL O52019 ACT 251 665

HousE OF REPRESENTATIVES H.B. NO. H.D.2

THIRTIETH LEGISLATURE, 2019

STATE OF HAWAII S.D.1

C.D.1

HOUSE OF REPRESENTATIVES	H.B. NO.	665
THIRTIETH LEGISLATURE, 2019
STATE OF HAWAII

A BILL FOR AN ACT

RELATING TO THE ELECTRONIC PRESCRIPTION ACCOUNTABILITY SYSTEM.

relating to the electronic prescription accountability system.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE O:F HAWAIi:

1 OF HAWAII:

SECTION 1. The legislature finds that Act 153, Session

2 Laws of Hawaii 2018, requires all prescribers of controlled

3 substances to query the electronic prescription accountability

4 system, prior to issuing a prescription for certain controlled

5 substances, to reduce the risk of abuse of or addiction to a

6 controlled substance. The electronic prescription

7 accountability system, also known as the prescription drug

8 monitoring program, is a useful tool for health care providers

9 when determining which controlled substances a patient has been

10 prescribed.

11 The legislature notes that although prescribers have taken

12 steps to implement this law, some concerns have been raised

13 about the applicability of the law to certain patient

14 populations. The legislature believesfurther finds that the law should not

15 apply in inpatient settings, where a patient is in a hospital or

16 nursing home and is directly administered a prescription under

17 the supervision of a health care provider. The law should also

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1 not apply to initial prescriptions for patients being treated

2 for post-operative pain with a limited three-day supply, which

3 is consistent with a 2016 recommendation on acute pain

4 management by the federal Centers for Disease Control and

5 Prevention. An exemption for hospice patients is also

6 appropriate to reduce barriers to this end-of-life choice. By

7 definition, a patient electing hospice typically has only six

8 months or less to live. Therefore, requiring a health care

9 provider to consult the electronic prescription accountability

10 system under these circumstances may cause a delay in the

11 provision of appropriate care to the patient.

12 The legislature additionally finds that existing law requires prescribing health care providers to adopt and maintain informed consent policies for opioid therapy patients. Providers have since adopted these policies; however, concerns have been raised about requiring a patient to complete the informed consent process in certain situations, such as where the patient is in intensive care, is being monitored, or otherwise lacks the capacity to provide consent.

The purpose of this Act is to specify:

(1) Specify that a health care

13 provider shall not be required to consult the electronic

14 prescription accountability system when a patient is in an

15 inpatient setting, in post-operative care, or has a terminal

16 disease and is receiving or in hospice or other palliative care.

17 ; and

(2) Clarify that an informed consent agreement is not required for patients whose prescription will be directly administered under the supervision of a health care provider.

SECTION 2. Section 329-38.2 Hawaii Revised Statutes, is

18 amended by amending subsection (b) to read as follows:

19 "(b) No prescriber shall prescribe a schedule II, III, or

20 IV controlled substance without first requesting, receiving, and

21 considering records of the ultimate user from the state

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1 electronic prescription accountability system as needed to

2 reduce the risk of abuse of or addiction to a controlled

3 substance, as needed to avoid harmful drug interactions, or as

4 otherwise medically necessary; provided that this subsection

5 shall not apply to[~)[:] any prescription:

6 (1) [Any prescription for] For a supply of three days or

7 less that is made in an emergency situation, by an

8 emergency medical provider, or in an emergency room;

9 [aae:]

10 [~~and~~]

(2) [Any prescription written] That will be administered

11 directly to a patient under the supervision of a

12 health care provider licensed to practice within the

13 State; provided that a medically-indicated query of

14 the electronic prescription accountability system is

15 made when the patient is initially admitted for

16 inpatient care at a hospital;

17 l.l2_ That is an initial prescription for a patient being

18 treated for post-operative pain; provided that the

19 prescription is limited to a three-day supply with no

20 refills;

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1 ill State;

(3) For a patient with a terminal disease receiving

2 hospice care; or other types of palliative care; provided

3 that for purposes of this paragraph, "terminal

4 disease" means an incurable and irreversible disease

5 that will, within reasonable medical judgment, produce

6 death within six months; or

7 .i22_ Prescribed

(4) Written while the state electronic prescription

8 accountability system is nonfunctional."

9 SECTION 3. Section 329-38.5, Hawaii Revised Statutes, is amended by amending subsection (c) to read as follows:

"(c) For the purposes of this section, "qualifying opioid therapy patient" means:

(1) A patient requiring opioid treatment for more than three months;

(2) A patient who is prescribed benzodiazepines and opioids together; or

(3) A patient who is prescribed a dose of opioids that exceeds ninety morphine equivalent doses.

This term shall not apply to an individual who is receiving treatment at a hospital under the supervision of a licensed health care provider and who lacks capacity as defined in section 327E-2."

SECTION 4. Statutory material to be repealed is bracketed

10 and stricken. New statutory material is underscored.

11 SECTION 45. This Act shall take effect on July 1, 2019.

APPROVED this O5 day of JUL , 2019

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HB No. 665, HD 2, SD 1, CD 1

THE HOUSE OF REPRESENTATIVES OF THE STATE OF HAWAII

Date: April 30, 2019

Honolulu, Hawaii

We hereby certify that the above-referenced Bill on this day passed Final Reading in the

House of Representatives of the Thirtieth Legislature of the State of Hawaii, Regular Session of

2019.

Scott K. Saiki

Speaker

House of Representatives

Brian L. Takeshita

Chief Clerk

House of Representatives

H.B. No. 665, H.D. 2, S.D. 1, C.D. 1

THE SENATE OF THE STATE OF HAWAl'I

Date: April 30, 2019

Honolulu, Hawaii 96813

We hereby certify that the foregoing Bill this day passed Final Reading in the

Senate of the Thirtieth Legislature of the State of Hawai'i, Regular Session of 2019.

~/Ir-~

President of the Senate

Clerk of the Senateupon its approval.

INTRODUCED BY:	_____________________________