State Overview: Hawaii

Prior authorization requirements are up to the discretion of the state Medicaid program or insurance company.

Hawaii credentials one type of addiction counselor. A Certified Substance Abuse Counselor requires a high school diploma, 270 hours of relevant education and 6,000 hours of experience. A higher-level degree can substitute the number of hours (i.e. a person with a bachelor's degree needs 2,000 hours). Hawaii Admin. Rules §11-177.1 and Hawaii Department of Health, Alcohol and Drug Abuse Division

A licensed mental health counselor may provide professional counseling services to individuals, families, or groups. Services may include the assessment, diagnosis, and treatment of, and counseling for, mental and emotional disorders, substance abuse and conduct disorders defined in the approved diagnostic and statistical manual for mental disorders. Hawaii Rev. Stat. §453D-1

The certification standards and procedures for peer specialists are developed and administered by the state's Adult Mental Health Division Office of Consumer Affairs. The standards include requirements for peer specialist qualifications, core competencies, training and examination, renewal, revocation and supervision.

Full independent practice and prescriptive authority.

CNMs provide independent management of women's health care, focusing particularly on pregnancy, childbirth, the postpartum period, care of the newborn, and the family planning and gynecological needs of women and practice in accordance with the standards for the practice of nurse midwifery of the American College of Nurse Midwives, unless otherwise indicated by the board.

If meeting all requirements of the board, CNMs have prescriptive authority to prescribe including Schedules II-V controlled substances. Hawaii Admin. Rules §16-89

Full independent practice and prescriptive authority.

NPs may practice independently from physicians and practice under licensure authority of the State Board of Nursing. Hawaii Admin. Rules §16-89-2

NPs are authorized to independently prescribe prescription drugs and Schedules II-V controlled substances. Medical devices may be prescribed if within the NP's specialty. Hawaii Admin. Rules §16-89-122

Any health care provider, including NPs, who is licensed, certified or otherwise authorized by law to provide health care, may sign POLST forms. Hawaii Rev. Stat. §327K-2

NPs are recognized in state policy as primary care providers. A health insurance company may recognize a participating NP as a primary care provider if a patient's insurance policy requires the selection of a primary care provider. Hawaii Rev. Stat. §431:10A-125

Full independent practice and prescriptive authority.

Advanced practice registered nurses, including CRNAs, are considered independent practitioners and shall practice within standards established or recognized by the nursing board and be guided by the authorized scope of practice. Hawaii Admin. Rules §16-89-81

The board may grant prescriptive authority, set requirements and determine exclusionary formulary for qualified APRNs. CRNAs may prescribe and administer over-the-counter drugs, legend drugs and controlled substances. Hawaii Rev. Stat. §457-8.6(a)

Optometrists may only examine, diagnose and treat conditions of the visual system. Hawaii Rev. Stat. §459‑1

Optometrists may only administer an epinephrine autoinjector for treatment of anaphylaxis. Hawaii Rev. Stat. §459‑7.4

Optometrists may not prescribe controlled substances. Hawaii Rev. Stat. §459‑7.4

A licensed dental hygienist may perform preventive dental sealant screenings and apply preventive dental sealants on individuals who may or may not yet be patients of record, have not been previously examined by a licensed dentist, or do not have a treatment plan prescribed by a licensed dentist, when under the general supervision of a licensed dentist in a school-based oral health program. Haw. Rev. Stat. § 447-3

Statute does not identify dental therapists as an oral health provider.

Hawaii does not explicitly allow for the practice of teledentistry.

Hawaii codified the amendments to the PREP Act that authorize pharmacists administer vaccines to persons three years of age or older. The federal PREP Act allows pharmacists to administer the COVID-19 vaccine through the duration of the public health emergency. (HB 2553, 2024).

Hawaii does not allow pharmacists to modify prescriptions.

A written protocol for hormonal contraception drug therapy must be approved by the Board of Pharmacy. Hawaii Rev. Stat. §461

Hawaii does not allow pharmacists to prescribe tobacco cessation aids.

Supervision by a physician required for practice and prescriptive authority.

The board shall establish the degree of supervision required by the supervising physician, osteopathic physician, or group of physicians when a PA performs a service within the practice of medicine.

PA means a person who is registered under this chapter to administer, prescribe, or dispense a controlled substance under the authority and supervision of a physician. Hawaii Rev. Stat. § 453-5.3(f)

Statute limits the number of PAs a physician may supervise.

The supervising physician or osteopathic physician shall supervise no more than four PAs at any one time. Hawaii Rev. Stat. § 16-85-49(a)(7)

Chart co-signatures are required by statute to practice or prescribe as a PA.

Each PA and supervising physician, osteopathic physician, or group of physicians shall establish written guidelines for the review of medical records as appropriate to the specific practice.

The supervising physician, osteopathic physician, or group of physicians shall review medical records as required by this subsection; provided that:

1. When supervising a PA with less than one year of practice experience, the supervising physician, osteopathic physician, or group of physicians shall:
   1. For the first six months of supervision, review 50% of the medical records within 30 days of the patient visit;
   2. For the next six months of supervision, review 25% of the medical records within 30 days of the patient visit;
2. When supervising a PA with more than one year of practice experience as a licensed physician assistant, the supervising physician, osteopathic physician, or group of physicians shall:
   1. Establish a process for the regular review of a sample of medical records of patients seen by the PA, including a sample of controlled substance records, if available;
   2. For at least 30 minutes each month, perform an audit and review of the medical record.

Hawaii Rev. Stat. § 453-5.3(g)

Statute allows adaptable proximity.

The direction and control shall not be construed in every case to require the personal presence of the supervising and controlling physician or osteopathic physician. Hawaii Rev. Stat. § 453-2(b)(5)

The supervising physician determines of PA's scope of practice in a written document developed on-site. Hawaii Admin. Rules §16-85-49.1