House Healthcare committee approves bill creating prescribing specialty for doctoral psychologists

The House Healthcare committee on March 14 approved H237 as amended to create a prescribing specialty for doctoral-level psychologists, setting training, clinical-rotation and supervision requirements and limiting the scope of prescriptive authority. The committee approved the bill on a 10-0-1 vote.

Katie McLennan, Office of Legislative Counsel, presented the amendments and described the key changes, including new definitions and limits on who may serve as a collaborating practitioner. "Prescriptive authority means the authority to prescribe or discontinue prescription drugs solely for the purpose of diagnosing, treating, or managing a condition recognized in the DSM," McLennan said, and she noted the amendment also cross-references an existing definition of "drug."

The amended bill defines a "collaborating practitioner" as a physician licensed to practice medicine with a specialty in psychiatry. It requires that a psychologist seeking the new prescribing specialty hold a current doctoral-level psychology license and complete designated postdoctoral training in psychopharmacology. The draft specifies minimum clinical-rotation experience: not less than 14 months total across at least nine practice settings, which McLennan listed to include psychiatry, pediatrics, geriatrics, family medicine, internal medicine, emergency medicine, obstetrics and gynecology, surgery and one elective.

The amendment also takes several procedural and safety steps. It gives the relevant board rulemaking authority to adopt rules necessary to implement the specialty, including rules "that regulate prescribing psychologists licensees pursuant to section 3019 of this title, including the settings of clinical rotations and prescriptive authority, including designation of conditions and drugs excluded from that authority, as well as requirements for the prescribing of particular drugs," McLennan said. The amendment further states that prescriptive authority excludes the authority to dispense, administer or distribute prescription drugs and (as presented in the amendment) excludes prescribing or discontinuing prescription drugs for patients who are under 18 years of age, over 80 years of age, or who are pregnant.

Committee members raised questions about the meaning of "specialty in psychiatry" and whether that label should be tied to board certification. A committee member suggested an alternative phrasing that would identify a collaborating psychiatrist as "a physician certified in psychiatry by the American Board of Medical Specialties." McLennan and other participants discussed that physicians listing a specialty generally must be board certified in that specialty.

Debate also touched on how the supervisory relationship would work in cases the prescribing psychologist cannot or should not manage alone (for example, when a patient is pregnant or reaches an age threshold). McLennan and others said the amendment requires a collaborating agreement with a psychiatrist; under that arrangement the psychiatrist could assume prescribing responsibility when clinically appropriate.

On a procedural motion, the committee accepted the amendments (draft 1.3) and then voted to approve H237 as amended. The roll call recorded "yes" votes from Representative Gina; Representative Cordes; Representative Critchlow; Representative DeMar; Representative Goldman; Representative Potson; Representative Powers; Representative Burbanko; Representative McFonge; and Representative Black. The committee recorded the measure as passing by a vote of 10-0-1. Representative McFawn of Barrymoreland was designated as the bill reporter.

The amended bill now proceeds from the House Healthcare committee with committee approval; the text as approved instructs the board to write rules and leaves some implementation details (such as specific excluded drugs and certification exam standards) to rulemaking.