Hawaii 2025 Regular Session

Hawaii House Bill HB615 Compare Versions

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1	1	HOUSE OF REPRESENTATIVES H.B. NO. 615 THIRTY-THIRD LEGISLATURE, 2025 STATE OF HAWAII A BILL FOR AN ACT relating to health care. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
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3	3	HOUSE OF REPRESENTATIVES H.B. NO. 615
4	4	THIRTY-THIRD LEGISLATURE, 2025
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13	13	THIRTY-THIRD LEGISLATURE, 2025
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31	31	A BILL FOR AN ACT
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37	37	relating to health care.
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43	43	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
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47	47	SECTION 1. The Act shall be known and may be cited as the Health Care Access Protection Act. SECTION 2. Chapter 583A, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows: "§583A- Laws contrary to the public policy of this State. A law of another state that authorizes a state agency to remove a child from a parent or guardian based on the parent or guardian allowing the child to receive gender-affirming health care services shall be against the public policy of this State and shall not be enforced or applied in a case pending in a court in this State." SECTION 3. Chapter 323J, Hawaii Revised Statutes, is amended to read as follows: "[[]CHAPTER 323J[]] REPRODUCTIVE HEALTH CARE SERVICES AND GENDER-AFFIRMING HEALTH CARE SERVICES [[]§323J-1[]] Definitions. As used in this chapter, unless the context otherwise requires: "Gender-affirming health care services" includes: (1) Medically necessary health care that respects the gender identity of the patient, as experienced and defined by the patient, and may include the following interventions to: (A) Suppress the development of endogenous secondary sex characteristics; (B) Align the patient's appearance or physical body with the patient's gender identity; or (C) Alleviate symptoms of clinically significant distress resulting from gender dysphoria, as defined in the Diagnostic and Statistical Manual of Mental Disorders; or (2) Mental health care or behavioral health care that respects the gender identity of the patient, as experienced and defined by the patient, and may include developmentally appropriate exploration and integration of identity, reduction of distress, adaptive coping, or strategies to increase family acceptance. "Person" includes an individual, partnership, joint venture, corporation, association, business, trust, or any organized group of persons or legal entity, or any combination thereof. "Reproductive health care services" includes all medical, surgical, pharmaceutical, counseling, or referral services relating to the human reproductive system, including but not limited to services relating to pregnancy, contraception, or the termination of a pregnancy. [[]§323J-2[]] Disclosures prohibited. (a) Except as provided in rules 504, 504.1, and 505.5 of the Hawaii rules of evidence and subsection (b) or as authorized under the Health Insurance Portability and Accountability Act of 1996, P.L. 104-191, as amended, and any federal regulations promulgated thereunder, in any civil action or any proceeding preliminary thereto or in any probate, legislative, or administrative proceeding, no covered entity[, as defined in title 45 Code of Federal Regulations section 160.103, or as the same as may be from time to time amended or modified,] shall disclose: (1) Any communication made to the covered entity, or any information obtained by the covered entity from a patient or the conservator, guardian, or other authorized legal representative of a patient relating to reproductive health care services or gender-affirming health care services that are [permitted] lawful under the laws of [the] this State; or (2) Any information obtained by personal examination of a patient relating to reproductive health care services or gender-affirming health care services that are [permitted] lawful under the laws of [the] this State, unless the patient or that patient's conservator, guardian, or other authorized legal representative explicitly consents to the disclosure in writing in the form of a release of protected health information compliant with the federal Health Insurance Portability and Accountability Act of 1996, P.L. 104-191, as amended[.], and any federal regulations promulgated thereunder. A covered entity shall inform the patient or the patient's conservator, guardian, or other authorized legal representative of the patient's right to withhold the written consent. (b) Written consent of the patient or the patient's conservator, guardian, or other authorized legal representative shall not be required for the disclosure of the communication or information[:] described under subsection (a): (1) If the [records relate] communication or information relates to a patient who is a plaintiff in a complaint pending before a court of competent jurisdiction alleging health care negligence and a request for [records] the communication or information has been served on a named defendant in that litigation; (2) If the [records are] communication or information is requested by a licensing authority, as defined in section 436B-2, and the request is made in connection with an investigation of a complaint to the licensing authority and the [records are] communication or information is related to the complaint, unless the complaint is made solely on the basis that the licensee, acting within the licensee's scope of practice, provided reproductive health care services or gender-affirming health care services that are lawful [in] under the laws of this State; (3) To the director of health [for records of a patient of a covered entity in connection with an investigation of a complaint,] if the [records are related] communication or information relates to the investigation of a complaint; or (4) If child abuse, abuse of an individual who is sixty years of age or older, abuse of an individual who is physically disabled or incompetent, or abuse of an individual with an intellectual disability is known or in good faith suspected[.]; provided that reproductive health care services or gender-affirming health care services that are lawful under the laws of this State shall not alone constitute abuse. (c) Nothing in this section shall be construed to impede the lawful sharing of medical records as permitted by state or federal law or the rules of the court, except in the case of a subpoena or warrant issued by a court, government agency, or legislative body of another state commanding the production, copying, or inspection of medical records relating to reproductive health care services[.] or gender-affirming health care services that are lawful under the laws of this State. (d) As used in this section: "Communication or information" does not include uses and disclosures that covered entities are not required to be in an accounting of disclosures pursuant to title 45 Code of Federal Regulations section 164.528. "Covered entity" has the same meaning as in title 45 Code of Federal Regulations section 160.103, or as the same may be from time to time amended or modified. [[]§323J-3[]] Subpoenas; when allowed. Notwithstanding sections 624-27 and 624D-3 or any other law to the contrary, no court or clerk of a court shall order the issuance of a subpoena requested by an officer, appointed according to the laws or usages of another state or government, or by any court of the United States or of another state or government, in connection with an out-of-state or interstate investigation or proceeding relating to reproductive health care services [legally performed in the] or gender-affirming health care services that are lawful under the laws of this State. [[]§323J-4[]] Agencies prohibited from providing information or expending resources. (a) No agency, as defined in section 92F-3, or employee, appointee, officer, official, or any other person acting on behalf of an agency shall provide any nonpublic information or expend or use time, money, facilities, property, equipment, personnel, or other resources in furtherance of any out-of-state or interstate investigation or proceeding seeking to impose civil or criminal liability upon a person or entity for: (1) [The provision, seeking,] Seeking, receiving, paying for, [receipt of,] or inquiring about reproductive health care services [that are legal in the] or gender-affirming health care services that are lawful under the laws of this State; [or] (2) Providing or responding to an inquiry about reproductive health care services or gender-affirming health care services that are lawful under the laws of this State; [(2)] (3) Assisting [any person or entity providing, seeking, receiving, paying for, or responding to an inquiry about reproductive health care services that are legal in the State.] or aiding or abetting in any of the conduct described in paragraph (1) or (2); or (4) Attempting or intending to engage in or providing material support for (or any other theory of vicarious, attempt, joint, several, or conspiracy liability derived therefrom) conduct described in paragraphs (1) to (3). (b) This section shall not apply to any investigation or proceeding where the conduct subject to potential liability under the investigation or proceeding would be subject to liability under the laws of this State if committed in this State. [[]§323J-5[]] Prohibition on state action. The State shall not penalize, prosecute, or otherwise take adverse action against an individual based on the individual's actual, potential, perceived, or alleged pregnancy or gender-affirming health care outcomes. The State shall not penalize, prosecute, or otherwise take adverse action against a person for aiding or assisting [a]: (1) A pregnant individual accessing reproductive health care services [in accordance with] that are lawful under the laws of [the] this State and with the pregnant individual's voluntary consent[.]; or (2) An individual accessing gender-affirming health care services that are lawful under the laws of this State and with the individual's voluntary consent. [[]§323J-6[]] Denial of demands for surrender. Notwithstanding any provision of chapter 832 to the contrary, the governor shall deny any demand made by the executive authority of any state for the surrender of any person charged with a crime under the laws of that state when the alleged crime involves [the provision or receipt of,]: (1) Seeking, receiving, paying for, or [assistance with,] inquiring about reproductive health care services[,] or gender-affirming health care services; (2) Providing or responding to an inquiry about reproductive health care services or gender-affirming health care services; (3) Assisting or aiding or abetting in any of the conduct described in paragraph (1) or (2); or (4) Attempting or intending to engage in or providing material support for (or any other theory of vicarious, attempt, joint, several, or conspiracy liability derived therefrom) conduct described in paragraphs (1) to (3), unless the acts forming the basis of the prosecution would also constitute a criminal offense in this State. This section shall not apply to demands made under Article IV, section 2, of the United States Constitution. [[]§323J-7[]] Laws contrary to the public policy of this State. (a) A law of another state authorizing a civil action or criminal prosecution based on any of the following [is] shall be declared to be contrary to the public policy of this State: (1) [Receiving, seeking, or] Seeking, receiving, paying for, or inquiring about reproductive health care services[;] or gender-affirming health care services that are lawful under the laws of this State; (2) Providing or responding to an inquiry about reproductive health care services[;] or gender-affirming health care services that are lawful under the laws of this State; (3) [Engaging in conduct that assists or aids or abets the provision or receipt of reproductive health care services;] Assisting or aiding or abetting in any of the conduct described in paragraph (1) or (2); or (4) Attempting or intending to engage in or providing material support for (or any other theory of vicarious, attempt, joint, several or conspiracy liability derived therefrom) conduct described in paragraphs (1) to (3)[, in accordance with the laws of this State]. (b) No law described in subsection (a) shall be applied to a case or controversy heard in the courts of this State." SECTION 4. Section 451J-11, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows: "(a) The department shall deny, revoke, condition, or suspend a license granted pursuant to this chapter on the following grounds: (1) Conviction by a court of competent jurisdiction of a crime [which] that the department has determined, by rules adopted pursuant to chapter 91, to be of a nature that renders the person convicted unfit to practice marriage and family therapy[;], except when the conviction was based on the provision or assistance in receipt or provision of gender-affirming health care services, as defined in section 323J-1, so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State; (2) Failing to report in writing to the director any disciplinary decision related to the provision of mental health services issued against the licensee or the applicant in any jurisdiction within thirty days of the disciplinary decision, or within thirty days of licensure; (3) Violation of recognized ethical standards for marriage and family therapists or licensed marriage and family therapists as set by the association; (4) Fraud or misrepresentation in obtaining or renewing a license, including making a false certification of compliance with the continuing education requirement set forth in section 451J-10; (5) Revocation, suspension, or other disciplinary action by any state or federal agency against a licensee or applicant for any reason provided under this section[;], except when the revocation, suspension, or other disciplinary action was based on the provision or assistance in receipt or provision of gender-affirming health care services, as defined in section 323J-1, so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State; or (6) Other just and sufficient cause that renders a person unfit to practice marriage and family therapy." SECTION 5. Section 451J-12, Hawaii Revised Statutes, is amended to read as follows: "[[]§451J-12[]] Confidentiality and privileged communications. No person licensed as a marriage and family therapist, nor any of the person's employees or associates, shall be required to disclose any information that the person may have acquired in rendering marriage and family therapy services except in the following circumstances: (1) As required by law; (2) To prevent a clear and immediate danger to a person or persons; (3) In the course of a civil, criminal, or disciplinary action arising from the therapy where the therapist is a defendant[;], except when the civil, criminal, or disciplinary action by another state or federal agency is based on the provision or assistance in receipt or provision of gender-affirming health care services, as defined in section 323J-1, so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State; (4) In a criminal proceeding where the client is a defendant and the use of the privilege would violate the defendant's right to a compulsory process of the right to present testimony and witnesses in the defendant's own behalf; (5) In accordance with the terms of a client's previously written waiver of the privilege; or (6) Where more than one person in a family jointly receives therapy and each [family member] person who is legally competent executes a written waiver[; in]. In that instance, a therapist may disclose information received from any [family member] person in accordance with the terms of [the] that person's waiver." SECTION 6. Section 453-8, Hawaii Revised Statutes, is amended by amending subsections (a), (b), and (c) to read as follows: "(a) In addition to any other actions authorized by law, any license to practice medicine and surgery may be revoked, limited, or suspended by the board at any time in a proceeding before the board, or may be denied, for any cause authorized by law, including but not limited to the following: (1) Procuring, or aiding or abetting in procuring, an abortion that is unlawful under the laws of this State or that would be unlawful under the laws of this State if performed within this State; (2) Employing any person to solicit patients for one's self; (3) Engaging in false, fraudulent, or deceptive advertising, including but not limited to: (A) Making excessive claims of expertise in one or more medical specialty fields; (B) Assuring a permanent cure for an incurable disease; or (C) Making any untruthful and improbable statement in advertising one's medical or surgical practice or business; (4) Being habituated to the excessive use of drugs or alcohol; or being addicted to, dependent on, or a habitual user of a narcotic, barbiturate, amphetamine, hallucinogen, or other drug having similar effects; (5) Practicing medicine while the ability to practice is impaired by alcohol, drugs, physical disability, or mental instability; (6) Procuring a license through fraud, misrepresentation, or deceit, or knowingly permitting an unlicensed person to perform activities requiring a license; (7) Professional misconduct, hazardous negligence causing bodily injury to another, or manifest incapacity in the practice of medicine or surgery; (8) Incompetence or multiple instances of negligence, including but not limited to the consistent use of medical service, which is inappropriate or unnecessary; (9) Conduct or practice contrary to recognized standards of ethics of the medical profession as adopted by the Hawaii Medical Association, the American Medical Association, the Hawaii Association of Osteopathic Physicians and Surgeons, or the American Osteopathic Association; (10) Violation of the conditions or limitations upon which a limited or temporary license is issued; (11) Revocation, suspension, or other disciplinary action by another state or federal agency of a license, certificate, or medical privilege, except when the revocation, suspension, or other disciplinary action was based on the provision or assistance in receipt or provision of [medical,]: (A) Medical, surgical, pharmaceutical, counseling, or referral services relating to the human reproductive system, including but not limited to services relating to pregnancy, contraception, or the termination of a pregnancy[,]; or (B) Gender-affirming health care services, as defined in section 323J-1, so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State; (12) Conviction, whether by nolo contendere or otherwise, of a penal offense substantially related to the qualifications, functions, or duties of a physician or osteopathic physician, notwithstanding any statutory provision to the contrary, except when the conviction was based on the provision or assistance in receipt or provision of [medical,]: (A) Medical, surgical, pharmaceutical, counseling, or referral services relating to the human reproductive system, including but not limited to services relating to pregnancy, contraception, or the termination of a pregnancy[,]; or (B) Gender-affirming health care services, as defined in section 323J-1, so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State; (13) Violation of chapter 329, the uniform controlled substances act, or any rule adopted thereunder except as provided in section 329-122; (14) Failure to report to the board, in writing, any disciplinary decision issued against the licensee or the applicant in another jurisdiction within thirty days after the disciplinary decision is issued; or (15) Submitting to or filing with the board any notice, statement, or other document required under this chapter[, which] that is false or untrue or contains any material misstatement or omission of fact. (b) If disciplinary action related to the practice of medicine has been taken against the applicant by another state or federal agency, or if the applicant reveals a physical or mental condition that would constitute a violation under this section, then the board may impose one or more of the following requirements as a condition for licensure: (1) Physical and mental evaluation of the applicant by a licensed physician or osteopathic physician approved by the board; (2) Probation, including conditions of probation as requiring observation of the licensee by an appropriate group or society of licensed physicians, osteopathic physicians, or surgeons; (3) Limitation of the license by restricting the fields of practice in which the licensee may engage; (4) Further education or training or proof of performance competency; and (5) Limitation of the medical practice of the licensee in any reasonable manner to assure the safety and welfare of the consuming public; provided that the board shall not impose as a condition for licensure any of the requirements pursuant to this subsection if the disciplinary action related to the practice of medicine taken against the applicant was based on the provision or assistance in receipt or provision of medical, surgical, pharmaceutical, counseling, or referral services relating to the human reproductive system, including but not limited to services relating to pregnancy, contraception, or the termination of a pregnancy, or the provision or assistance in receipt or provision of gender-affirming health care services, as defined in section 323J-1, so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State. (c) Notwithstanding any other law to the contrary, the board may deny a license to any applicant who has been disciplined by another state or federal agency, except on the basis of discipline for the provision or assistance in receipt or provision of medical, surgical, pharmaceutical, counseling, or referral services relating to the human reproductive system, including but not limited to services relating to pregnancy, contraception, or the termination of a pregnancy, or the provision or assistance in receipt or provision of gender-affirming health care services, as defined in section 323J-1, so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State. Any final order of discipline taken pursuant to this subsection shall be a matter of public record." SECTION 7. Section 453-8.6, Hawaii Revised Statutes, is amended as follows: 1. By amending subsection (a) to read: "(a) Upon receipt of evidence of revocation, suspension, or other disciplinary action against a licensee by another state or federal agency, the board may issue an order imposing disciplinary action upon the licensee on the following conditions: (1) The board shall serve the licensee with a proposed order imposing disciplinary action as required by chapter 91; (2) The licensee shall have the right to request a hearing pursuant to chapter 91 to show cause why the action described in the proposed order should not be imposed; (3) Any request for a hearing shall be made in writing and filed with the board within twenty days after mailing of the proposed order to the licensee; and (4) If the licensee does not submit a written request for a hearing within twenty days after mailing of the proposed order, the board may issue a final order imposing the disciplinary action described in the proposed order; provided that the board shall not issue an order imposing disciplinary action upon the licensee if the revocation, suspension, or other disciplinary action against a licensee by another state was based on the provision or assistance in receipt or provision of medical, surgical, pharmaceutical, counseling, or referral services relating to the human reproductive system, including but not limited to services relating to pregnancy, contraception, or the termination of a pregnancy, or the provision or assistance in receipt or provision of gender-affirming health care services, as defined in section 323J-1, so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State." 2. By amending subsection (c) to read: "(c) A licensee against whom the board has issued a proposed order under this section shall be prohibited from practicing in this State until the board issues a final order if: (1) The licensee was the subject of disciplinary action by another state, except where the disciplinary action against the licensee by another state was based on the provision or assistance in receipt or provision of [medical,]: (A) Medical, surgical, pharmaceutical, counseling, or referral services relating to the human reproductive system, including but not limited to services relating to pregnancy, contraception, or the termination of a pregnancy[,]; or (B) Gender-affirming health care services, as defined in section 323J-1, so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State; and (2) The disciplinary action by another state prohibits the licensee from practicing in that state." SECTION 8. Section 453D-12, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows: "(a) In addition to any other acts or conditions provided by law, the director may refuse to renew, reinstate, or restore, and may deny, revoke, suspend, or condition in any manner, any license for any one or more of the following acts or conditions on the part of a licensee or license applicant: (1) Failing to meet or maintain the conditions and requirements necessary to qualify for the granting of a license; (2) Engaging in false, fraudulent, or deceptive advertising, or making untruthful or improbable statements; (3) Being addicted to, dependent on, or a habitual user of a narcotic, barbiturate, amphetamine, hallucinogen, opium, cocaine, or other drugs or derivatives of a similar nature; (4) Practicing the licensed profession while impaired by alcohol, drugs, physical disability, or mental instability; (5) Procuring a license through fraud, misrepresentation, or deceit; (6) Aiding and abetting an unlicensed person to directly or indirectly perform activities requiring a license; (7) Professional misconduct, incompetence, gross negligence, or manifest incapacity, in the practice of the licensed profession; (8) Engaging in conduct or practice contrary to recognized standards of ethics for the licensed profession; (9) Violating any condition or limitation upon which a conditional or temporary license was issued; (10) Engaging in business under a past or present license issued pursuant to the licensing laws, in a manner causing injury to one or more members of the public; (11) Failing to comply with, observe, or adhere to any law in a manner [such] that the director deems the applicant or holder to be an unfit or improper person to hold a license; (12) Having had a license revoked or suspended, or having been the subject of other disciplinary action, by another state or a federal agency for any reason provided by the licensing laws or this section[;], except when the revocation, suspension, or other disciplinary action was based on the provision or assistance in receipt or provision of gender-affirming health care services, as defined in section 323J-1, so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State; (13) Having been convicted of a crime, whether by nolo contendere or otherwise, directly related to the qualifications, functions, or duties of the licensed profession[;], except when the conviction was based on the provision or assistance in receipt or provision of gender-affirming health care services, as defined in section 323J-1, so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State; (14) Failing to report in writing to the director any disciplinary decision issued against the licensee or applicant in another jurisdiction within thirty days of the disciplinary decision; (15) Employing, utilizing, or attempting to employ or utilize, at any time, any person not licensed under the licensing laws where licensure is required; or (16) Violating this chapter, chapter 436B, or any rule or order of the director." SECTION 9. Section 453D-13, Hawaii Revised Statutes, is amended to read as follows: "[[]§453D-13[]] Confidentiality and privileged communications. No person licensed as a mental health counselor, nor any of the person's employees or associates, shall be required to disclose any information that the person may have acquired in rendering mental health counseling services, except in the following circumstances: (1) As required by law; (2) To prevent a clear and imminent danger to a person or persons; (3) In accordance with the terms of a previously written waiver of the privilege where the waiver is executed by the client or by the client's legally recognized representative; (4) Where more than one person jointly receives counseling and each person who is legally competent executes a written waiver. In that instance, a mental health counselor may disclose information from any person in accordance with that person's waiver; or (5) In the course of a disciplinary action or pursuant to a duly authorized subpoena issued by the department[.], except when the disciplinary action by another federal or state agency is based on the provision or assistance in receipt or provision of gender-affirming health care services, as defined in section 323J-1, so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State." SECTION 10. Section 457-12, Hawaii Revised Statutes, is amended by amending subsections (a) and (b) to read as follows: "(a) In addition to any other actions authorized by law, the board shall have the power to deny, revoke, limit, or suspend any license to practice nursing as a registered nurse or as a licensed practical nurse applied for or issued by the board in accordance with this chapter, and to fine or to otherwise discipline a licensee for any cause authorized by law, including but not limited to the following: (1) Fraud or deceit in procuring or attempting to procure a license to practice nursing as a registered nurse or as a licensed practical nurse; (2) Gross immorality; (3) Unfitness or incompetence by reason of negligence, habits, or other causes; (4) Habitual intemperance, addiction to, or dependency on alcohol or other habit-forming substances; (5) Mental incompetence; (6) Unprofessional conduct as defined by the board in accordance with its own rules; (7) Wilful or repeated violation of any of the provisions of this chapter or any rule adopted by the board; (8) Revocation, suspension, limitation, or other disciplinary action by another state of a nursing license, except when the revocation, suspension, limitation, or other disciplinary action by another state was based on the provision or assistance in receipt or provision of [medical,]: (A) Medical, surgical, pharmaceutical, counseling, or referral services relating to the human reproductive system, including but not limited to services relating to pregnancy, contraception, or the termination of a pregnancy[,]; or (B) Gender-affirming health care services, as defined in section 323J-1, so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State; (9) Conviction, whether by nolo contendere or otherwise, of a penal offense substantially related to the qualifications, functions, or duties of a nurse, notwithstanding any statutory provision to the contrary, except when the conviction was based on the provision or assistance in receipt or provision of [medical,]: (A) Medical, surgical, pharmaceutical, counseling, or referral services relating to the human reproductive system, including but not limited to services relating to pregnancy, contraception, or the termination of a pregnancy[,]; or (B) Gender-affirming health care services, as defined in section 323J-1, so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State; (10) Failure to report to the board any disciplinary action taken against the licensee in another jurisdiction within thirty days after the disciplinary action becomes final; (11) Submitting to or filing with the board any notice, statement, or other document required under this chapter[, which] that is false or untrue or contains any material misstatement of fact, including a false attestation of compliance with continuing competency requirements; or (12) Violation of the conditions or limitations upon which any license is issued. (b) Notwithstanding any other law to the contrary, the board may deny a license to any applicant who has been disciplined by another state, except on the basis of discipline by another state for the provision or assistance in receipt or provision of [medical,]: (1) Medical, surgical, pharmaceutical, counseling, or referral services relating to the human reproductive system, including but not limited to services relating to pregnancy, contraception, or the termination of a pregnancy[,]; or (2) Gender-affirming health care services, as defined in section 323J-1, so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State. Any final order entered pursuant to this subsection shall be a matter of public record." SECTION 11. Section 457-12.5, Hawaii Revised Statutes, is amended as follows: 1. By amending subsection (a) to read: "(a) Upon receipt of evidence of revocation, suspension, or other disciplinary action against a licensee in another state, the board may issue an order imposing disciplinary action upon the licensee on the following conditions: (1) The board shall serve the licensee with a proposed order imposing disciplinary action as required by chapter 91; (2) The licensee shall have the right to request a hearing pursuant to chapter 91 to show cause why the action described in the proposed order should not be imposed; (3) Any request for a hearing shall be made in writing and filed with the board within twenty days after mailing of the proposed order to the licensee; and (4) If the licensee does not submit a written request for a hearing within twenty days after mailing of the proposed order, the board shall issue a final order imposing the disciplinary action described in the proposed order; provided that the board shall not issue an order imposing disciplinary action upon the licensee if the revocation, suspension, or other disciplinary action against a licensee by another state was based on the provision or assistance in receipt or provision of medical, surgical, pharmaceutical, counseling, or referral services relating to the human reproductive system, including but not limited to services relating to pregnancy, contraception, or the termination of a pregnancy, or the provision or assistance in receipt or provision of gender-affirming health care services, as defined in section 323J-1, so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State." 2. By amending subsection (c) to read: "(c) A licensee against whom the board has issued a proposed order under this section shall be prohibited from practicing in this State until the board issues a final order if: (1) The licensee was the subject of disciplinary action by another state, except where the disciplinary action against the licensee by another state was based on the provision or assistance in receipt or provision of [medical,]: (A) Medical, surgical, pharmaceutical, counseling, or referral services relating to the human reproductive system, including but not limited to services relating to pregnancy, contraception, or the termination of a pregnancy[,]; or (B) Gender-affirming health care services, as defined in section 323J-1, so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State; and (2) The disciplinary action in the other state prohibits the licensee from practicing in that state." SECTION 12. Section 461-21.5, Hawaii Revised Statutes, is amended as follows: 1. By amending subsection (a) to read: "(a) Upon receipt of evidence of revocation, suspension, or other disciplinary action against a licensee by another state or federal agency, the board may issue an order imposing disciplinary action upon the licensee on the following conditions: (1) The board shall serve the licensee with a proposed order imposing disciplinary action as required by chapter 91; (2) The licensee shall have the right to request a hearing pursuant to chapter 91 to show cause why the action described in the proposed order should not be imposed; (3) Any request for a hearing shall be made in writing and filed with the board within twenty days after mailing of the proposed order to the licensee; and (4) If the licensee does not submit a written request for a hearing within twenty days after mailing of the proposed order, the board shall issue a final order imposing the disciplinary action described in the proposed order; provided that the board shall not issue an order imposing disciplinary action upon the licensee if the revocation, suspension, or other disciplinary action against a licensee by another state was based on the provision or assistance in receipt or provision of medical, surgical, pharmaceutical, counseling, or referral services relating to the human reproductive system, including but not limited to services relating to pregnancy, contraception, or the termination of a pregnancy, or the provision or assistance in receipt or provision of gender-affirming health care services, as defined in section 323J-1, so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State." 2. By amending subsection (c) to read: "(c) A licensee against whom the board has issued a proposed order under this section shall be prohibited from practicing in this State until the board issues a final order if: (1) The licensee was the subject of disciplinary action by another state, except where the disciplinary action against the licensee by another state was based on the provision or assistance in receipt or provision of [medical,]: (A) Medical, surgical, pharmaceutical, counseling, or referral services relating to the human reproductive system, including but not limited to services relating to pregnancy, contraception, or the termination of a pregnancy[,]; or (B) Gender-affirming health care services, as defined in section 323J-1, so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State; and (2) The disciplinary action by another state prohibits the licensee from practicing in that state." SECTION 13. Section 465-13, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows: "(a) In addition to any other actions authorized by law, the board shall refuse to grant a license to any applicant and may revoke or suspend any license, or may place a license or [may] put a license holder on conditional probation, for any cause authorized by law, including but not limited to the following: (1) Professional misconduct, gross carelessness, manifest incapacity, or incompetency in the practice of psychology; (2) Violation of this chapter by the applicant within one year of the application, or violation of this chapter by a license holder any time the license is valid; (3) Any unethical practice of psychology as defined by the board in accordance with its own rules; (4) Fraud or deception in applying for or procuring a license to practice psychology as defined in section 465-1; (5) Conviction of a crime substantially related to the qualifications, functions, or duties of psychologists[;], except when the conviction was based on the provision or assistance in receipt or provision of gender-affirming health care services, as defined in section 323J-1, so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State; (6) Wilful unauthorized communication of information received in professional confidence; (7) The suspension, revocation, or imposition of probationary conditions by another state of a license or certificate to practice psychology issued by that state if the act for which the disciplinary action was taken constitutes a violation of this chapter; (8) The commission of any dishonest, corrupt, or fraudulent act or any act of sexual abuse, or sexual relations with a client, or sexual misconduct that is substantially related to the qualifications, functions, or duties of a psychologist; (9) Harassment, intimidation, or abuse, sexual or otherwise, of a client or patient; (10) Exercising undue influence in the manner as to exploit the client, patient, student, or supervisee for financial or other personal advantage to the practitioner or a third party; (11) Conviction of fraud in filing medicaid claims or conviction of fraud in filing claims to any third party payor, for which a copy of the record of conviction, certified by the clerk of the court entering the conviction, shall be conclusive evidence; (12) Aiding or abetting any unlicensed person to engage in the practice of psychology; (13) Repeated acts of excessive treatment or use of diagnostic procedures as determined by the standard of the local community of licensees; (14) Inability to practice psychology with reasonable skill and safety to patients or clients by reason of illness, inebriation, or excessive use of any substance, or as a result of any mental or physical condition; (15) Conviction of any crime or offense that reflects the inability of the practitioner to practice psychology with due regard for the health and safety of clients or patients; (16) Use of untruthful or deceptive or improbable statements concerning the licensee's qualifications or the effects or results of proposed treatment; (17) Functioning outside of the licensee's professional competence established by education, training, and experience; (18) Refusal to comply with any written order of the board; (19) Making any fraudulent or untrue statement to the board, including a false certification of compliance with the continuing education requirement of section 465-11; or (20) Violation of a board rule." SECTION 14. Section 583A-102, Hawaii Revised Statutes, is amended by adding a new definition to be appropriately inserted and to read as follows: ""Gender-affirming health care services" has the same meaning as in section 323J-1." SECTION 15. Section 583A-201, Hawaii Revised Statutes, is amended to read as follows: "[[]§583A-201[]] Initial child-custody jurisdiction. (a) Except as otherwise provided in section 583A-204, a court of this State [has] shall have jurisdiction to make an initial child-custody determination only if: (1) This State is the home state of the child on the date of the commencement of the proceeding, or was the home state of the child within six months before the commencement of the proceeding and the child is absent from this State but a parent or person acting as a parent continues to live in this State; (2) A court of another state does not have jurisdiction under paragraph (1), or a court of the home state of the child has declined to exercise jurisdiction on the ground that this State is the more appropriate forum under section 583A-207 or 583A-208, and: (A) The child and the child's parents, or the child and at least one parent or a person acting as a parent, have a significant connection with this State other than mere physical presence; and (B) Substantial evidence is available in this State concerning the child's care, protection, training, and personal relationships; (3) All courts having jurisdiction under paragraph (1) or (2) have declined to exercise jurisdiction on the ground that a court of this State is the more appropriate forum to determine the custody of the child under section 583A-207 or 583A-208; or (4) No court of any other state would have jurisdiction under the criteria specified in paragraph (1), (2), or (3). (b) Subsection (a) shall be the exclusive jurisdictional basis for making a child-custody determination by a court of this State. (c) Physical presence of, or personal jurisdiction over, a party or [a] child shall not be necessary or sufficient to make a child-custody determination. (d) The presence of a child in this State for the purpose of obtaining gender-affirming health care services shall be sufficient to meet the requirements of subsection (a)(2)." SECTION 16. Section 583A-204, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows: "(a) A court of this State [has] shall have temporary emergency jurisdiction if the child is present in this State and the child has been abandoned or it is necessary in an emergency to protect the child because [the]: (1) The child, or a sibling or parent of the child, is subjected to or threatened with mistreatment or abuse[.]; or (2) The child has been unable to obtain gender-affirming health care services." SECTION 17. Section 583A-207, Hawaii Revised Statutes, is amended to read as follows: "[[]§583A-207[]] Inconvenient forum. (a) A court of this State [which] that has jurisdiction under this chapter to make a child-custody determination may decline to exercise its jurisdiction at any time if it determines that it is an inconvenient forum under the circumstances and that a court of another state is a more appropriate forum. The issue of inconvenient forum may be raised upon the motion of a party, the court's own motion, or request of another court. (b) Before determining whether it is an inconvenient forum, a court of this State shall consider whether it is appropriate for a court of another state to exercise jurisdiction. For this purpose, the court shall allow the parties to submit information and shall consider all relevant factors, including: (1) Whether domestic violence has occurred and is likely to continue in the future and which state could best protect the parties and the child; (2) The length of time the child has resided outside this State; (3) The distance between the court in this State and the court in the state that would assume jurisdiction; (4) The relative financial circumstances of the parties; (5) Any agreement of the parties as to which state should assume jurisdiction; (6) The nature and location of the evidence required to resolve the pending litigation, including testimony of the child; (7) The ability of the court of each state to decide the issue expeditiously and the procedures necessary to present the evidence; (8) The familiarity of the court of each state with the facts and issues in the pending litigation; and (9) The physical and psychological health of the parties. (c) If a court of this State determines that it is an inconvenient forum and that a court of another state is a more appropriate forum, it shall stay the proceedings upon condition that a child-custody proceeding be promptly commenced in another designated state and may impose any other condition the court considers just and proper. (d) A court of this State may decline to exercise its jurisdiction under this chapter if a child-custody determination is incidental to an action for divorce or another proceeding, while still retaining jurisdiction over the divorce or other proceeding. (e) In a case where the provision of gender-affirming health care services to the child is at issue, a court of this State shall not determine that it is an inconvenient forum where the law or policy of the other state that may take jurisdiction limits the ability of a parent to obtain gender-affirming health care services for the child." SECTION 18. Section 583A-208, Hawaii Revised Statutes, is amended to read as follows: "[[]§583A-208[]] Jurisdiction declined by reason of conduct. (a) Except as otherwise provided in section 583A-204, if a court of this State has jurisdiction under this chapter because a person seeking to invoke its jurisdiction has engaged in unjustifiable conduct, the court shall decline to exercise its jurisdiction unless: (1) The parents and all persons acting as parents have acquiesced in the exercise of jurisdiction; (2) A court of the state otherwise having jurisdiction under sections 583A-201 to 583A-203 determines that this State is a more appropriate forum under section 583A-207; or (3) No court of any other state would have jurisdiction under the criteria specified in sections 583A-201 to 583A-203. (b) If a court of this State declines to exercise its jurisdiction pursuant to subsection (a), it may fashion an appropriate remedy to ensure the safety of the child and prevent a repetition of the unjustifiable conduct, including staying the proceeding until a child-custody proceeding is commenced in a court having jurisdiction under sections 583A-201 to 583A-203. (c) If a court dismisses a petition or stays a proceeding because it declines to exercise its jurisdiction pursuant to subsection (a), it may assess against the party seeking to invoke its jurisdiction necessary and reasonable expenses including costs, communication expenses, attorney's fees, investigative fees, expenses for witnesses, travel expenses, and child care during the course of the proceedings, unless the party from whom fees are sought is a protective parent fleeing abuse, or the assessment would be clearly inappropriate. The court [may] shall not assess fees, costs, or expenses against this State unless authorized by law other than this chapter. (d) In making a determination under this section, a court shall not consider as a factor weighing against the petitioner any taking of the child, or retention of the child after a visit or other temporary relinquishment of physical custody, from the person who has legal custody if there is evidence that the taking or retention of the child was for the purposes of obtaining gender-affirming health care services for the child and the law or policy of the other state limits the ability of a parent to obtain gender-affirming health care services for the child." SECTION 19. Section 636C-9, Hawaii Revised Statutes, is amended to read as follows: "[[]§636C-9[]] Enforcement of foreign penal civil actions relating to protected reproductive health care services[.] or protected gender-affirming health care services. (a) No judgment or other order arising from a foreign penal civil action or other penal law banning, restricting, burdening, punishing, penalizing, or otherwise interfering with the provision of protected reproductive health care services or protected gender-affirming health care services shall be enforced in this State. (b) As used in this section: "Foreign penal civil action" means an action authorized by the law of a state, or of any municipality or other governmental entity within a state, other than this State, the essential character and effect of which is to punish an offense against the public justice of that state, municipality, or other governmental entity. "Gender-affirming health care services" has the same meaning as in section 323J-1. "Protected gender-affirming health care services" means gender-affirming health care services that are protected under the Hawaii State Constitution or are otherwise lawful under the laws of this State or that would be constitutionally protected or otherwise lawful if performed within this State. "Protected reproductive health care services" means medical, surgical, pharmaceutical, counseling, or referral services relating to the human reproductive system, including but not limited to services relating to pregnancy, contraception, or termination of a pregnancy, that are protected under the Hawaii State Constitution or otherwise lawful under the laws of this State or that would be constitutionally protected or otherwise lawful if performed within this State." SECTION 20. Section 836-2, Hawaii Revised Statutes, is amended to read as follows: "§836-2 Summoning witness in this State to testify in another state. (a) If a judge of a court of record in any state [which] that by its laws has made provision for commanding persons within that state to attend and testify in this State certifies under the seal of that court that there is a criminal prosecution pending in that court, or that a grand jury investigation has commenced or is about to commence, that a person in this State is a material witness in the prosecution or grand jury investigation, and that the person's presence will be required for a specified number of days, upon presentation of the certificate to any judge of a court of record in this State in the judicial district in which the person is, the judge shall fix a time and place for a hearing, and shall make an order directing the witness to appear at a time and place certain for the hearing. (b) If at a hearing the judge determines that the witness is material and necessary, that it will not cause undue hardship to the witness to be compelled to attend and testify in the prosecution or a grand jury investigation in the other state, and that the laws of the state in which the prosecution is pending, or grand jury investigation has commenced or is about to commence, and of any other state through which the witness may be required to pass by ordinary course of travel, will give to the witness protection from arrest and the service of civil and criminal process, the judge shall issue a summons, with a copy of the certificate attached, directing the witness to attend and testify in the court where the prosecution is pending, or where a grand jury investigation has commenced or is about to commence at a time and place specified in the summons[, except]; provided that no judge shall issue a summons in a case where prosecution is pending, or where a grand jury investigation has commenced or is about to commence, for a criminal violation of a law of another state involving [the provision,]: (1) Seeking, receiving, paying for, [receipt of, or assistance with] or inquiring about reproductive health care services [as defined in section 323J-1] or gender-affirming health care services; (2) Providing or responding to an inquiry about reproductive health care services or gender-affirming health care services; (3) Assisting or aiding or abetting in any of the conduct described in paragraph (1) or (2); or (4) Attempting or intending to engage in or providing material support for (or any other theory of vicarious, attempt, joint, several, or conspiracy liability derived therefrom) conduct described in paragraphs (1) to (3), unless the acts forming the basis of the prosecution or investigation would also constitute an offense in this State. In any hearing, the certificate shall be prima facie evidence of all the facts stated therein. (c) If the certificate recommends that the witness be taken into immediate custody and delivered to an officer of the requesting state to assure the witness' attendance in the requesting state, the judge may, in lieu of notification of the hearing, direct that the witness be forthwith brought before the judge for the hearing; and the judge at the hearing being satisfied of the desirability of the custody and delivery, for which determination the certificate shall be prima facie proof of the desirability may, in lieu of issuing subpoena or summons, order that the witness be forthwith taken into custody and delivered to an officer of the requesting state. (d) If the witness, who is summoned pursuant to this section, after being paid or tendered by some properly authorized person a sum equivalent to the cost of round-trip air fare to the place where the prosecution is pending and $30 for each day, that the witness is required to travel and attend as a witness, fails without good cause to attend and testify as directed in the summons, the witness shall be punished in the manner provided for the punishment of any witness who disobeys a summons issued from a court of record in this State. (e) As used in this section, "gender-affirming health care services" and "reproductive health care services" have the same meanings as in section 323J-1." SECTION 21. If any provision of this Act, or the application thereof to any person or circumstance, is held invalid, the invalidity does not affect other provisions or applications of the Act that can be given effect without the invalid provision or application, and to this end the provisions of this Act are severable. SECTION 22. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored. SECTION 23. This Act shall take effect upon its approval; provided that the amendments made to section 451J-12, Hawaii Revised Statutes, by section 5 of this Act and section 453D-13, Hawaii Revised Statutes, by section 9 of this Act shall not be repealed when the amendments made to those sections by sections 9 and 18, respectively, of Act 93, Session Laws of Hawaii 2024, take effect on July 1, 2026. INTRODUCED BY: _____________________________
48	48
49	49	SECTION 1. The Act shall be known and may be cited as the Health Care Access Protection Act.
50	50
51	51	SECTION 2. Chapter 583A, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:
52	52
53	53	"§583A- Laws contrary to the public policy of this State. A law of another state that authorizes a state agency to remove a child from a parent or guardian based on the parent or guardian allowing the child to receive gender-affirming health care services shall be against the public policy of this State and shall not be enforced or applied in a case pending in a court in this State."
54	54
55	55	SECTION 3. Chapter 323J, Hawaii Revised Statutes, is amended to read as follows:
56	56
57	57	"[[]CHAPTER 323J[]]
58	58
59	59	REPRODUCTIVE HEALTH CARE SERVICES AND GENDER-AFFIRMING HEALTH CARE SERVICES
60	60
61	61	[[]§323J-1[]] Definitions. As used in this chapter, unless the context otherwise requires:
62	62
63	63	"Gender-affirming health care services" includes:
64	64
65	65	(1) Medically necessary health care that respects the gender identity of the patient, as experienced and defined by the patient, and may include the following interventions to:
66	66
67	67	(A) Suppress the development of endogenous secondary sex characteristics;
68	68
69	69	(B) Align the patient's appearance or physical body with the patient's gender identity; or
70	70
71	71	(C) Alleviate symptoms of clinically significant distress resulting from gender dysphoria, as defined in the Diagnostic and Statistical Manual of Mental Disorders; or
72	72
73	73	(2) Mental health care or behavioral health care that respects the gender identity of the patient, as experienced and defined by the patient, and may include developmentally appropriate exploration and integration of identity, reduction of distress, adaptive coping, or strategies to increase family acceptance.
74	74
75	75	"Person" includes an individual, partnership, joint venture, corporation, association, business, trust, or any organized group of persons or legal entity, or any combination thereof.
76	76
77	77	"Reproductive health care services" includes all medical, surgical, pharmaceutical, counseling, or referral services relating to the human reproductive system, including but not limited to services relating to pregnancy, contraception, or the termination of a pregnancy.
78	78
79	79	[[]§323J-2[]] Disclosures prohibited. (a) Except as provided in rules 504, 504.1, and 505.5 of the Hawaii rules of evidence and subsection (b) or as authorized under the Health Insurance Portability and Accountability Act of 1996, P.L. 104-191, as amended, and any federal regulations promulgated thereunder, in any civil action or any proceeding preliminary thereto or in any probate, legislative, or administrative proceeding, no covered entity[, as defined in title 45 Code of Federal Regulations section 160.103, or as the same as may be from time to time amended or modified,] shall disclose:
80	80
81	81	(1) Any communication made to the covered entity, or any information obtained by the covered entity from a patient or the conservator, guardian, or other authorized legal representative of a patient relating to reproductive health care services or gender-affirming health care services that are [permitted] lawful under the laws of [the] this State; or
82	82
83	83	(2) Any information obtained by personal examination of a patient relating to reproductive health care services or gender-affirming health care services that are [permitted] lawful under the laws of [the] this State,
84	84
85	85	unless the patient or that patient's conservator, guardian, or other authorized legal representative explicitly consents to the disclosure in writing in the form of a release of protected health information compliant with the federal Health Insurance Portability and Accountability Act of 1996, P.L. 104-191, as amended[.], and any federal regulations promulgated thereunder. A covered entity shall inform the patient or the patient's conservator, guardian, or other authorized legal representative of the patient's right to withhold the written consent.
86	86
87	87	(b) Written consent of the patient or the patient's conservator, guardian, or other authorized legal representative shall not be required for the disclosure of the communication or information[:] described under subsection (a):
88	88
89	89	(1) If the [records relate] communication or information relates to a patient who is a plaintiff in a complaint pending before a court of competent jurisdiction alleging health care negligence and a request for [records] the communication or information has been served on a named defendant in that litigation;
90	90
91	91	(2) If the [records are] communication or information is requested by a licensing authority, as defined in section 436B-2, and the request is made in connection with an investigation of a complaint to the licensing authority and the [records are] communication or information is related to the complaint, unless the complaint is made solely on the basis that the licensee, acting within the licensee's scope of practice, provided reproductive health care services or gender-affirming health care services that are lawful [in] under the laws of this State;
92	92
93	93	(3) To the director of health [for records of a patient of a covered entity in connection with an investigation of a complaint,] if the [records are related] communication or information relates to the investigation of a complaint; or
94	94
95	95	(4) If child abuse, abuse of an individual who is sixty years of age or older, abuse of an individual who is physically disabled or incompetent, or abuse of an individual with an intellectual disability is known or in good faith suspected[.]; provided that reproductive health care services or gender-affirming health care services that are lawful under the laws of this State shall not alone constitute abuse.
96	96
97	97	(c) Nothing in this section shall be construed to impede the lawful sharing of medical records as permitted by state or federal law or the rules of the court, except in the case of a subpoena or warrant issued by a court, government agency, or legislative body of another state commanding the production, copying, or inspection of medical records relating to reproductive health care services[.] or gender-affirming health care services that are lawful under the laws of this State.
98	98
99	99	(d) As used in this section:
100	100
101	101	"Communication or information" does not include uses and disclosures that covered entities are not required to be in an accounting of disclosures pursuant to title 45 Code of Federal Regulations section 164.528.
102	102
103	103	"Covered entity" has the same meaning as in title 45 Code of Federal Regulations section 160.103, or as the same may be from time to time amended or modified.
104	104
105	105	[[]§323J-3[]] Subpoenas; when allowed. Notwithstanding sections 624-27 and 624D-3 or any other law to the contrary, no court or clerk of a court shall order the issuance of a subpoena requested by an officer, appointed according to the laws or usages of another state or government, or by any court of the United States or of another state or government, in connection with an out-of-state or interstate investigation or proceeding relating to reproductive health care services [legally performed in the] or gender-affirming health care services that are lawful under the laws of this State.
106	106
107	107	[[]§323J-4[]] Agencies prohibited from providing information or expending resources. (a) No agency, as defined in section 92F-3, or employee, appointee, officer, official, or any other person acting on behalf of an agency shall provide any nonpublic information or expend or use time, money, facilities, property, equipment, personnel, or other resources in furtherance of any out-of-state or interstate investigation or proceeding seeking to impose civil or criminal liability upon a person or entity for:
108	108
109	109	(1) [The provision, seeking,] Seeking, receiving, paying for, [receipt of,] or inquiring about reproductive health care services [that are legal in the] or gender-affirming health care services that are lawful under the laws of this State; [or]
110	110
111	111	(2) Providing or responding to an inquiry about reproductive health care services or gender-affirming health care services that are lawful under the laws of this State;
112	112
113	113	[(2)] (3) Assisting [any person or entity providing, seeking, receiving, paying for, or responding to an inquiry about reproductive health care services that are legal in the State.] or aiding or abetting in any of the conduct described in paragraph (1) or (2); or
114	114
115	115	(4) Attempting or intending to engage in or providing material support for (or any other theory of vicarious, attempt, joint, several, or conspiracy liability derived therefrom) conduct described in paragraphs (1) to (3).
116	116
117	117	(b) This section shall not apply to any investigation or proceeding where the conduct subject to potential liability under the investigation or proceeding would be subject to liability under the laws of this State if committed in this State.
118	118
119	119	[[]§323J-5[]] Prohibition on state action. The State shall not penalize, prosecute, or otherwise take adverse action against an individual based on the individual's actual, potential, perceived, or alleged pregnancy or gender-affirming health care outcomes. The State shall not penalize, prosecute, or otherwise take adverse action against a person for aiding or assisting [a]:
120	120
121	121	(1) A pregnant individual accessing reproductive health care services [in accordance with] that are lawful under the laws of [the] this State and with the pregnant individual's voluntary consent[.]; or
122	122
123	123	(2) An individual accessing gender-affirming health care services that are lawful under the laws of this State and with the individual's voluntary consent.
124	124
125	125	[[]§323J-6[]] Denial of demands for surrender. Notwithstanding any provision of chapter 832 to the contrary, the governor shall deny any demand made by the executive authority of any state for the surrender of any person charged with a crime under the laws of that state when the alleged crime involves [the provision or receipt of,]:
126	126
127	127	(1) Seeking, receiving, paying for, or [assistance with,] inquiring about reproductive health care services[,] or gender-affirming health care services;
128	128
129	129	(2) Providing or responding to an inquiry about reproductive health care services or gender-affirming health care services;
130	130
131	131	(3) Assisting or aiding or abetting in any of the conduct described in paragraph (1) or (2); or
132	132
133	133	(4) Attempting or intending to engage in or providing material support for (or any other theory of vicarious, attempt, joint, several, or conspiracy liability derived therefrom) conduct described in paragraphs (1) to (3),
134	134
135	135	unless the acts forming the basis of the prosecution would also constitute a criminal offense in this State. This section shall not apply to demands made under Article IV, section 2, of the United States Constitution.
136	136
137	137	[[]§323J-7[]] Laws contrary to the public policy of this State. (a) A law of another state authorizing a civil action or criminal prosecution based on any of the following [is] shall be declared to be contrary to the public policy of this State:
138	138
139	139	(1) [Receiving, seeking, or] Seeking, receiving, paying for, or inquiring about reproductive health care services[;] or gender-affirming health care services that are lawful under the laws of this State;
140	140
141	141	(2) Providing or responding to an inquiry about reproductive health care services[;] or gender-affirming health care services that are lawful under the laws of this State;
142	142
143	143	(3) [Engaging in conduct that assists or aids or abets the provision or receipt of reproductive health care services;] Assisting or aiding or abetting in any of the conduct described in paragraph (1) or (2); or
144	144
145	145	(4) Attempting or intending to engage in or providing material support for (or any other theory of vicarious, attempt, joint, several or conspiracy liability derived therefrom) conduct described in paragraphs (1) to (3)[,
146	146
147	147	in accordance with the laws of this State].
148	148
149	149	(b) No law described in subsection (a) shall be applied to a case or controversy heard in the courts of this State."
150	150
151	151	SECTION 4. Section 451J-11, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:
152	152
153	153	"(a) The department shall deny, revoke, condition, or suspend a license granted pursuant to this chapter on the following grounds:
154	154
155	155	(1) Conviction by a court of competent jurisdiction of a crime [which] that the department has determined, by rules adopted pursuant to chapter 91, to be of a nature that renders the person convicted unfit to practice marriage and family therapy[;], except when the conviction was based on the provision or assistance in receipt or provision of gender-affirming health care services, as defined in section 323J-1, so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State;
156	156
157	157	(2) Failing to report in writing to the director any disciplinary decision related to the provision of mental health services issued against the licensee or the applicant in any jurisdiction within thirty days of the disciplinary decision, or within thirty days of licensure;
158	158
159	159	(3) Violation of recognized ethical standards for marriage and family therapists or licensed marriage and family therapists as set by the association;
160	160
161	161	(4) Fraud or misrepresentation in obtaining or renewing a license, including making a false certification of compliance with the continuing education requirement set forth in section 451J-10;
162	162
163	163	(5) Revocation, suspension, or other disciplinary action by any state or federal agency against a licensee or applicant for any reason provided under this section[;], except when the revocation, suspension, or other disciplinary action was based on the provision or assistance in receipt or provision of gender-affirming health care services, as defined in section 323J-1, so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State; or
164	164
165	165	(6) Other just and sufficient cause that renders a person unfit to practice marriage and family therapy."
166	166
167	167	SECTION 5. Section 451J-12, Hawaii Revised Statutes, is amended to read as follows:
168	168
169	169	"[[]§451J-12[]] Confidentiality and privileged communications. No person licensed as a marriage and family therapist, nor any of the person's employees or associates, shall be required to disclose any information that the person may have acquired in rendering marriage and family therapy services except in the following circumstances:
170	170
171	171	(1) As required by law;
172	172
173	173	(2) To prevent a clear and immediate danger to a person or persons;
174	174
175	175	(3) In the course of a civil, criminal, or disciplinary action arising from the therapy where the therapist is a defendant[;], except when the civil, criminal, or disciplinary action by another state or federal agency is based on the provision or assistance in receipt or provision of gender-affirming health care services, as defined in section 323J-1, so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State;
176	176
177	177	(4) In a criminal proceeding where the client is a defendant and the use of the privilege would violate the defendant's right to a compulsory process of the right to present testimony and witnesses in the defendant's own behalf;
178	178
179	179	(5) In accordance with the terms of a client's previously written waiver of the privilege; or
180	180
181	181	(6) Where more than one person in a family jointly receives therapy and each [family member] person who is legally competent executes a written waiver[; in]. In that instance, a therapist may disclose information received from any [family member] person in accordance with the terms of [the] that person's waiver."
182	182
183	183	SECTION 6. Section 453-8, Hawaii Revised Statutes, is amended by amending subsections (a), (b), and (c) to read as follows:
184	184
185	185	"(a) In addition to any other actions authorized by law, any license to practice medicine and surgery may be revoked, limited, or suspended by the board at any time in a proceeding before the board, or may be denied, for any cause authorized by law, including but not limited to the following:
186	186
187	187	(1) Procuring, or aiding or abetting in procuring, an abortion that is unlawful under the laws of this State or that would be unlawful under the laws of this State if performed within this State;
188	188
189	189	(2) Employing any person to solicit patients for one's self;
190	190
191	191	(3) Engaging in false, fraudulent, or deceptive advertising, including but not limited to:
192	192
193	193	(A) Making excessive claims of expertise in one or more medical specialty fields;
194	194
195	195	(B) Assuring a permanent cure for an incurable disease; or
196	196
197	197	(C) Making any untruthful and improbable statement in advertising one's medical or surgical practice or business;
198	198
199	199	(4) Being habituated to the excessive use of drugs or alcohol; or being addicted to, dependent on, or a habitual user of a narcotic, barbiturate, amphetamine, hallucinogen, or other drug having similar effects;
200	200
201	201	(5) Practicing medicine while the ability to practice is impaired by alcohol, drugs, physical disability, or mental instability;
202	202
203	203	(6) Procuring a license through fraud, misrepresentation, or deceit, or knowingly permitting an unlicensed person to perform activities requiring a license;
204	204
205	205	(7) Professional misconduct, hazardous negligence causing bodily injury to another, or manifest incapacity in the practice of medicine or surgery;
206	206
207	207	(8) Incompetence or multiple instances of negligence, including but not limited to the consistent use of medical service, which is inappropriate or unnecessary;
208	208
209	209	(9) Conduct or practice contrary to recognized standards of ethics of the medical profession as adopted by the Hawaii Medical Association, the American Medical Association, the Hawaii Association of Osteopathic Physicians and Surgeons, or the American Osteopathic Association;
210	210
211	211	(10) Violation of the conditions or limitations upon which a limited or temporary license is issued;
212	212
213	213	(11) Revocation, suspension, or other disciplinary action by another state or federal agency of a license, certificate, or medical privilege, except when the revocation, suspension, or other disciplinary action was based on the provision or assistance in receipt or provision of [medical,]:
214	214
215	215	(A) Medical, surgical, pharmaceutical, counseling, or referral services relating to the human reproductive system, including but not limited to services relating to pregnancy, contraception, or the termination of a pregnancy[,]; or
216	216
217	217	(B) Gender-affirming health care services, as defined in section 323J-1,
218	218
219	219	so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State;
220	220
221	221	(12) Conviction, whether by nolo contendere or otherwise, of a penal offense substantially related to the qualifications, functions, or duties of a physician or osteopathic physician, notwithstanding any statutory provision to the contrary, except when the conviction was based on the provision or assistance in receipt or provision of [medical,]:
222	222
223	223	(A) Medical, surgical, pharmaceutical, counseling, or referral services relating to the human reproductive system, including but not limited to services relating to pregnancy, contraception, or the termination of a pregnancy[,]; or
224	224
225	225	(B) Gender-affirming health care services, as defined in section 323J-1,
226	226
227	227	so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State;
228	228
229	229	(13) Violation of chapter 329, the uniform controlled substances act, or any rule adopted thereunder except as provided in section 329-122;
230	230
231	231	(14) Failure to report to the board, in writing, any disciplinary decision issued against the licensee or the applicant in another jurisdiction within thirty days after the disciplinary decision is issued; or
232	232
233	233	(15) Submitting to or filing with the board any notice, statement, or other document required under this chapter[, which] that is false or untrue or contains any material misstatement or omission of fact.
234	234
235	235	(b) If disciplinary action related to the practice of medicine has been taken against the applicant by another state or federal agency, or if the applicant reveals a physical or mental condition that would constitute a violation under this section, then the board may impose one or more of the following requirements as a condition for licensure:
236	236
237	237	(1) Physical and mental evaluation of the applicant by a licensed physician or osteopathic physician approved by the board;
238	238
239	239	(2) Probation, including conditions of probation as requiring observation of the licensee by an appropriate group or society of licensed physicians, osteopathic physicians, or surgeons;
240	240
241	241	(3) Limitation of the license by restricting the fields of practice in which the licensee may engage;
242	242
243	243	(4) Further education or training or proof of performance competency; and
244	244
245	245	(5) Limitation of the medical practice of the licensee in any reasonable manner to assure the safety and welfare of the consuming public;
246	246
247	247	provided that the board shall not impose as a condition for licensure any of the requirements pursuant to this subsection if the disciplinary action related to the practice of medicine taken against the applicant was based on the provision or assistance in receipt or provision of medical, surgical, pharmaceutical, counseling, or referral services relating to the human reproductive system, including but not limited to services relating to pregnancy, contraception, or the termination of a pregnancy, or the provision or assistance in receipt or provision of gender-affirming health care services, as defined in section 323J-1, so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State.
248	248
249	249	(c) Notwithstanding any other law to the contrary, the board may deny a license to any applicant who has been disciplined by another state or federal agency, except on the basis of discipline for the provision or assistance in receipt or provision of medical, surgical, pharmaceutical, counseling, or referral services relating to the human reproductive system, including but not limited to services relating to pregnancy, contraception, or the termination of a pregnancy, or the provision or assistance in receipt or provision of gender-affirming health care services, as defined in section 323J-1, so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State. Any final order of discipline taken pursuant to this subsection shall be a matter of public record."
250	250
251	251	SECTION 7. Section 453-8.6, Hawaii Revised Statutes, is amended as follows:
252	252
253	253	1. By amending subsection (a) to read:
254	254
255	255	"(a) Upon receipt of evidence of revocation, suspension, or other disciplinary action against a licensee by another state or federal agency, the board may issue an order imposing disciplinary action upon the licensee on the following conditions:
256	256
257	257	(1) The board shall serve the licensee with a proposed order imposing disciplinary action as required by chapter 91;
258	258
259	259	(2) The licensee shall have the right to request a hearing pursuant to chapter 91 to show cause why the action described in the proposed order should not be imposed;
260	260
261	261	(3) Any request for a hearing shall be made in writing and filed with the board within twenty days after mailing of the proposed order to the licensee; and
262	262
263	263	(4) If the licensee does not submit a written request for a hearing within twenty days after mailing of the proposed order, the board may issue a final order imposing the disciplinary action described in the proposed order;
264	264
265	265	provided that the board shall not issue an order imposing disciplinary action upon the licensee if the revocation, suspension, or other disciplinary action against a licensee by another state was based on the provision or assistance in receipt or provision of medical, surgical, pharmaceutical, counseling, or referral services relating to the human reproductive system, including but not limited to services relating to pregnancy, contraception, or the termination of a pregnancy, or the provision or assistance in receipt or provision of gender-affirming health care services, as defined in section 323J-1, so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State."
266	266
267	267	2. By amending subsection (c) to read:
268	268
269	269	"(c) A licensee against whom the board has issued a proposed order under this section shall be prohibited from practicing in this State until the board issues a final order if:
270	270
271	271	(1) The licensee was the subject of disciplinary action by another state, except where the disciplinary action against the licensee by another state was based on the provision or assistance in receipt or provision of [medical,]:
272	272
273	273	(A) Medical, surgical, pharmaceutical, counseling, or referral services relating to the human reproductive system, including but not limited to services relating to pregnancy, contraception, or the termination of a pregnancy[,]; or
274	274
275	275	(B) Gender-affirming health care services, as defined in section 323J-1,
276	276
277	277	so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State; and
278	278
279	279	(2) The disciplinary action by another state prohibits the licensee from practicing in that state."
280	280
281	281	SECTION 8. Section 453D-12, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:
282	282
283	283	"(a) In addition to any other acts or conditions provided by law, the director may refuse to renew, reinstate, or restore, and may deny, revoke, suspend, or condition in any manner, any license for any one or more of the following acts or conditions on the part of a licensee or license applicant:
284	284
285	285	(1) Failing to meet or maintain the conditions and requirements necessary to qualify for the granting of a license;
286	286
287	287	(2) Engaging in false, fraudulent, or deceptive advertising, or making untruthful or improbable statements;
288	288
289	289	(3) Being addicted to, dependent on, or a habitual user of a narcotic, barbiturate, amphetamine, hallucinogen, opium, cocaine, or other drugs or derivatives of a similar nature;
290	290
291	291	(4) Practicing the licensed profession while impaired by alcohol, drugs, physical disability, or mental instability;
292	292
293	293	(5) Procuring a license through fraud, misrepresentation, or deceit;
294	294
295	295	(6) Aiding and abetting an unlicensed person to directly or indirectly perform activities requiring a license;
296	296
297	297	(7) Professional misconduct, incompetence, gross negligence, or manifest incapacity, in the practice of the licensed profession;
298	298
299	299	(8) Engaging in conduct or practice contrary to recognized standards of ethics for the licensed profession;
300	300
301	301	(9) Violating any condition or limitation upon which a conditional or temporary license was issued;
302	302
303	303	(10) Engaging in business under a past or present license issued pursuant to the licensing laws, in a manner causing injury to one or more members of the public;
304	304
305	305	(11) Failing to comply with, observe, or adhere to any law in a manner [such] that the director deems the applicant or holder to be an unfit or improper person to hold a license;
306	306
307	307	(12) Having had a license revoked or suspended, or having been the subject of other disciplinary action, by another state or a federal agency for any reason provided by the licensing laws or this section[;], except when the revocation, suspension, or other disciplinary action was based on the provision or assistance in receipt or provision of gender-affirming health care services, as defined in section 323J-1, so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State;
308	308
309	309	(13) Having been convicted of a crime, whether by nolo contendere or otherwise, directly related to the qualifications, functions, or duties of the licensed profession[;], except when the conviction was based on the provision or assistance in receipt or provision of gender-affirming health care services, as defined in section 323J-1, so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State;
310	310
311	311	(14) Failing to report in writing to the director any disciplinary decision issued against the licensee or applicant in another jurisdiction within thirty days of the disciplinary decision;
312	312
313	313	(15) Employing, utilizing, or attempting to employ or utilize, at any time, any person not licensed under the licensing laws where licensure is required; or
314	314
315	315	(16) Violating this chapter, chapter 436B, or any rule or order of the director."
316	316
317	317	SECTION 9. Section 453D-13, Hawaii Revised Statutes, is amended to read as follows:
318	318
319	319	"[[]§453D-13[]] Confidentiality and privileged communications. No person licensed as a mental health counselor, nor any of the person's employees or associates, shall be required to disclose any information that the person may have acquired in rendering mental health counseling services, except in the following circumstances:
320	320
321	321	(1) As required by law;
322	322
323	323	(2) To prevent a clear and imminent danger to a person or persons;
324	324
325	325	(3) In accordance with the terms of a previously written waiver of the privilege where the waiver is executed by the client or by the client's legally recognized representative;
326	326
327	327	(4) Where more than one person jointly receives counseling and each person who is legally competent executes a written waiver. In that instance, a mental health counselor may disclose information from any person in accordance with that person's waiver; or
328	328
329	329	(5) In the course of a disciplinary action or pursuant to a duly authorized subpoena issued by the department[.], except when the disciplinary action by another federal or state agency is based on the provision or assistance in receipt or provision of gender-affirming health care services, as defined in section 323J-1, so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State."
330	330
331	331	SECTION 10. Section 457-12, Hawaii Revised Statutes, is amended by amending subsections (a) and (b) to read as follows:
332	332
333	333	"(a) In addition to any other actions authorized by law, the board shall have the power to deny, revoke, limit, or suspend any license to practice nursing as a registered nurse or as a licensed practical nurse applied for or issued by the board in accordance with this chapter, and to fine or to otherwise discipline a licensee for any cause authorized by law, including but not limited to the following:
334	334
335	335	(1) Fraud or deceit in procuring or attempting to procure a license to practice nursing as a registered nurse or as a licensed practical nurse;
336	336
337	337	(2) Gross immorality;
338	338
339	339	(3) Unfitness or incompetence by reason of negligence, habits, or other causes;
340	340
341	341	(4) Habitual intemperance, addiction to, or dependency on alcohol or other habit-forming substances;
342	342
343	343	(5) Mental incompetence;
344	344
345	345	(6) Unprofessional conduct as defined by the board in accordance with its own rules;
346	346
347	347	(7) Wilful or repeated violation of any of the provisions of this chapter or any rule adopted by the board;
348	348
349	349	(8) Revocation, suspension, limitation, or other disciplinary action by another state of a nursing license, except when the revocation, suspension, limitation, or other disciplinary action by another state was based on the provision or assistance in receipt or provision of [medical,]:
350	350
351	351	(A) Medical, surgical, pharmaceutical, counseling, or referral services relating to the human reproductive system, including but not limited to services relating to pregnancy, contraception, or the termination of a pregnancy[,]; or
352	352
353	353	(B) Gender-affirming health care services, as defined in section 323J-1,
354	354
355	355	so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State;
356	356
357	357	(9) Conviction, whether by nolo contendere or otherwise, of a penal offense substantially related to the qualifications, functions, or duties of a nurse, notwithstanding any statutory provision to the contrary, except when the conviction was based on the provision or assistance in receipt or provision of [medical,]:
358	358
359	359	(A) Medical, surgical, pharmaceutical, counseling, or referral services relating to the human reproductive system, including but not limited to services relating to pregnancy, contraception, or the termination of a pregnancy[,]; or
360	360
361	361	(B) Gender-affirming health care services, as defined in section 323J-1,
362	362
363	363	so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State;
364	364
365	365	(10) Failure to report to the board any disciplinary action taken against the licensee in another jurisdiction within thirty days after the disciplinary action becomes final;
366	366
367	367	(11) Submitting to or filing with the board any notice, statement, or other document required under this chapter[, which] that is false or untrue or contains any material misstatement of fact, including a false attestation of compliance with continuing competency requirements; or
368	368
369	369	(12) Violation of the conditions or limitations upon which any license is issued.
370	370
371	371	(b) Notwithstanding any other law to the contrary, the board may deny a license to any applicant who has been disciplined by another state, except on the basis of discipline by another state for the provision or assistance in receipt or provision of [medical,]:
372	372
373	373	(1) Medical, surgical, pharmaceutical, counseling, or referral services relating to the human reproductive system, including but not limited to services relating to pregnancy, contraception, or the termination of a pregnancy[,]; or
374	374
375	375	(2) Gender-affirming health care services, as defined in section 323J-1,
376	376
377	377	so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State. Any final order entered pursuant to this subsection shall be a matter of public record."
378	378
379	379	SECTION 11. Section 457-12.5, Hawaii Revised Statutes, is amended as follows:
380	380
381	381	1. By amending subsection (a) to read:
382	382
383	383	"(a) Upon receipt of evidence of revocation, suspension, or other disciplinary action against a licensee in another state, the board may issue an order imposing disciplinary action upon the licensee on the following conditions:
384	384
385	385	(1) The board shall serve the licensee with a proposed order imposing disciplinary action as required by chapter 91;
386	386
387	387	(2) The licensee shall have the right to request a hearing pursuant to chapter 91 to show cause why the action described in the proposed order should not be imposed;
388	388
389	389	(3) Any request for a hearing shall be made in writing and filed with the board within twenty days after mailing of the proposed order to the licensee; and
390	390
391	391	(4) If the licensee does not submit a written request for a hearing within twenty days after mailing of the proposed order, the board shall issue a final order imposing the disciplinary action described in the proposed order;
392	392
393	393	provided that the board shall not issue an order imposing disciplinary action upon the licensee if the revocation, suspension, or other disciplinary action against a licensee by another state was based on the provision or assistance in receipt or provision of medical, surgical, pharmaceutical, counseling, or referral services relating to the human reproductive system, including but not limited to services relating to pregnancy, contraception, or the termination of a pregnancy, or the provision or assistance in receipt or provision of gender-affirming health care services, as defined in section 323J-1, so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State."
394	394
395	395	2. By amending subsection (c) to read:
396	396
397	397	"(c) A licensee against whom the board has issued a proposed order under this section shall be prohibited from practicing in this State until the board issues a final order if:
398	398
399	399	(1) The licensee was the subject of disciplinary action by another state, except where the disciplinary action against the licensee by another state was based on the provision or assistance in receipt or provision of [medical,]:
400	400
401	401	(A) Medical, surgical, pharmaceutical, counseling, or referral services relating to the human reproductive system, including but not limited to services relating to pregnancy, contraception, or the termination of a pregnancy[,]; or
402	402
403	403	(B) Gender-affirming health care services, as defined in section 323J-1,
404	404
405	405	so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State; and
406	406
407	407	(2) The disciplinary action in the other state prohibits the licensee from practicing in that state."
408	408
409	409	SECTION 12. Section 461-21.5, Hawaii Revised Statutes, is amended as follows:
410	410
411	411	1. By amending subsection (a) to read:
412	412
413	413	"(a) Upon receipt of evidence of revocation, suspension, or other disciplinary action against a licensee by another state or federal agency, the board may issue an order imposing disciplinary action upon the licensee on the following conditions:
414	414
415	415	(1) The board shall serve the licensee with a proposed order imposing disciplinary action as required by chapter 91;
416	416
417	417	(2) The licensee shall have the right to request a hearing pursuant to chapter 91 to show cause why the action described in the proposed order should not be imposed;
418	418
419	419	(3) Any request for a hearing shall be made in writing and filed with the board within twenty days after mailing of the proposed order to the licensee; and
420	420
421	421	(4) If the licensee does not submit a written request for a hearing within twenty days after mailing of the proposed order, the board shall issue a final order imposing the disciplinary action described in the proposed order;
422	422
423	423	provided that the board shall not issue an order imposing disciplinary action upon the licensee if the revocation, suspension, or other disciplinary action against a licensee by another state was based on the provision or assistance in receipt or provision of medical, surgical, pharmaceutical, counseling, or referral services relating to the human reproductive system, including but not limited to services relating to pregnancy, contraception, or the termination of a pregnancy, or the provision or assistance in receipt or provision of gender-affirming health care services, as defined in section 323J-1, so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State."
424	424
425	425	2. By amending subsection (c) to read:
426	426
427	427	"(c) A licensee against whom the board has issued a proposed order under this section shall be prohibited from practicing in this State until the board issues a final order if:
428	428
429	429	(1) The licensee was the subject of disciplinary action by another state, except where the disciplinary action against the licensee by another state was based on the provision or assistance in receipt or provision of [medical,]:
430	430
431	431	(A) Medical, surgical, pharmaceutical, counseling, or referral services relating to the human reproductive system, including but not limited to services relating to pregnancy, contraception, or the termination of a pregnancy[,]; or
432	432
433	433	(B) Gender-affirming health care services, as defined in section 323J-1,
434	434
435	435	so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State; and
436	436
437	437	(2) The disciplinary action by another state prohibits the licensee from practicing in that state."
438	438
439	439	SECTION 13. Section 465-13, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:
440	440
441	441	"(a) In addition to any other actions authorized by law, the board shall refuse to grant a license to any applicant and may revoke or suspend any license, or may place a license or [may] put a license holder on conditional probation, for any cause authorized by law, including but not limited to the following:
442	442
443	443	(1) Professional misconduct, gross carelessness, manifest incapacity, or incompetency in the practice of psychology;
444	444
445	445	(2) Violation of this chapter by the applicant within one year of the application, or violation of this chapter by a license holder any time the license is valid;
446	446
447	447	(3) Any unethical practice of psychology as defined by the board in accordance with its own rules;
448	448
449	449	(4) Fraud or deception in applying for or procuring a license to practice psychology as defined in section 465-1;
450	450
451	451	(5) Conviction of a crime substantially related to the qualifications, functions, or duties of psychologists[;], except when the conviction was based on the provision or assistance in receipt or provision of gender-affirming health care services, as defined in section 323J-1, so long as the provision or assistance in receipt or provision of the services was in accordance with the laws of this State or would have been in accordance with the laws of this State if it occurred within this State;
452	452
453	453	(6) Wilful unauthorized communication of information received in professional confidence;
454	454
455	455	(7) The suspension, revocation, or imposition of probationary conditions by another state of a license or certificate to practice psychology issued by that state if the act for which the disciplinary action was taken constitutes a violation of this chapter;
456	456
457	457	(8) The commission of any dishonest, corrupt, or fraudulent act or any act of sexual abuse, or sexual relations with a client, or sexual misconduct that is substantially related to the qualifications, functions, or duties of a psychologist;
458	458
459	459	(9) Harassment, intimidation, or abuse, sexual or otherwise, of a client or patient;
460	460
461	461	(10) Exercising undue influence in the manner as to exploit the client, patient, student, or supervisee for financial or other personal advantage to the practitioner or a third party;
462	462
463	463	(11) Conviction of fraud in filing medicaid claims or conviction of fraud in filing claims to any third party payor, for which a copy of the record of conviction, certified by the clerk of the court entering the conviction, shall be conclusive evidence;
464	464
465	465	(12) Aiding or abetting any unlicensed person to engage in the practice of psychology;
466	466
467	467	(13) Repeated acts of excessive treatment or use of diagnostic procedures as determined by the standard of the local community of licensees;
468	468
469	469	(14) Inability to practice psychology with reasonable skill and safety to patients or clients by reason of illness, inebriation, or excessive use of any substance, or as a result of any mental or physical condition;
470	470
471	471	(15) Conviction of any crime or offense that reflects the inability of the practitioner to practice psychology with due regard for the health and safety of clients or patients;
472	472
473	473	(16) Use of untruthful or deceptive or improbable statements concerning the licensee's qualifications or the effects or results of proposed treatment;
474	474
475	475	(17) Functioning outside of the licensee's professional competence established by education, training, and experience;
476	476
477	477	(18) Refusal to comply with any written order of the board;
478	478
479	479	(19) Making any fraudulent or untrue statement to the board, including a false certification of compliance with the continuing education requirement of section 465-11; or
480	480
481	481	(20) Violation of a board rule."
482	482
483	483	SECTION 14. Section 583A-102, Hawaii Revised Statutes, is amended by adding a new definition to be appropriately inserted and to read as follows:
484	484
485	485	""Gender-affirming health care services" has the same meaning as in section 323J-1."
486	486
487	487	SECTION 15. Section 583A-201, Hawaii Revised Statutes, is amended to read as follows:
488	488
489	489	"[[]§583A-201[]] Initial child-custody jurisdiction. (a) Except as otherwise provided in section 583A-204, a court of this State [has] shall have jurisdiction to make an initial child-custody determination only if:
490	490
491	491	(1) This State is the home state of the child on the date of the commencement of the proceeding, or was the home state of the child within six months before the commencement of the proceeding and the child is absent from this State but a parent or person acting as a parent continues to live in this State;
492	492
493	493	(2) A court of another state does not have jurisdiction under paragraph (1), or a court of the home state of the child has declined to exercise jurisdiction on the ground that this State is the more appropriate forum under section 583A-207 or 583A-208, and:
494	494
495	495	(A) The child and the child's parents, or the child and at least one parent or a person acting as a parent, have a significant connection with this State other than mere physical presence; and
496	496
497	497	(B) Substantial evidence is available in this State concerning the child's care, protection, training, and personal relationships;
498	498
499	499	(3) All courts having jurisdiction under paragraph (1) or (2) have declined to exercise jurisdiction on the ground that a court of this State is the more appropriate forum to determine the custody of the child under section 583A-207 or 583A-208; or
500	500
501	501	(4) No court of any other state would have jurisdiction under the criteria specified in paragraph (1), (2), or (3).
502	502
503	503	(b) Subsection (a) shall be the exclusive jurisdictional basis for making a child-custody determination by a court of this State.
504	504
505	505	(c) Physical presence of, or personal jurisdiction over, a party or [a] child shall not be necessary or sufficient to make a child-custody determination.
506	506
507	507	(d) The presence of a child in this State for the purpose of obtaining gender-affirming health care services shall be sufficient to meet the requirements of subsection (a)(2)."
508	508
509	509	SECTION 16. Section 583A-204, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:
510	510
511	511	"(a) A court of this State [has] shall have temporary emergency jurisdiction if the child is present in this State and the child has been abandoned or it is necessary in an emergency to protect the child because [the]:
512	512
513	513	(1) The child, or a sibling or parent of the child, is subjected to or threatened with mistreatment or abuse[.]; or
514	514
515	515	(2) The child has been unable to obtain gender-affirming health care services."
516	516
517	517	SECTION 17. Section 583A-207, Hawaii Revised Statutes, is amended to read as follows:
518	518
519	519	"[[]§583A-207[]] Inconvenient forum. (a) A court of this State [which] that has jurisdiction under this chapter to make a child-custody determination may decline to exercise its jurisdiction at any time if it determines that it is an inconvenient forum under the circumstances and that a court of another state is a more appropriate forum. The issue of inconvenient forum may be raised upon the motion of a party, the court's own motion, or request of another court.
520	520
521	521	(b) Before determining whether it is an inconvenient forum, a court of this State shall consider whether it is appropriate for a court of another state to exercise jurisdiction. For this purpose, the court shall allow the parties to submit information and shall consider all relevant factors, including:
522	522
523	523	(1) Whether domestic violence has occurred and is likely to continue in the future and which state could best protect the parties and the child;
524	524
525	525	(2) The length of time the child has resided outside this State;
526	526
527	527	(3) The distance between the court in this State and the court in the state that would assume jurisdiction;
528	528
529	529	(4) The relative financial circumstances of the parties;
530	530
531	531	(5) Any agreement of the parties as to which state should assume jurisdiction;
532	532
533	533	(6) The nature and location of the evidence required to resolve the pending litigation, including testimony of the child;
534	534
535	535	(7) The ability of the court of each state to decide the issue expeditiously and the procedures necessary to present the evidence;
536	536
537	537	(8) The familiarity of the court of each state with the facts and issues in the pending litigation; and
538	538
539	539	(9) The physical and psychological health of the parties.
540	540
541	541	(c) If a court of this State determines that it is an inconvenient forum and that a court of another state is a more appropriate forum, it shall stay the proceedings upon condition that a child-custody proceeding be promptly commenced in another designated state and may impose any other condition the court considers just and proper.
542	542
543	543	(d) A court of this State may decline to exercise its jurisdiction under this chapter if a child-custody determination is incidental to an action for divorce or another proceeding, while still retaining jurisdiction over the divorce or other proceeding.
544	544
545	545	(e) In a case where the provision of gender-affirming health care services to the child is at issue, a court of this State shall not determine that it is an inconvenient forum where the law or policy of the other state that may take jurisdiction limits the ability of a parent to obtain gender-affirming health care services for the child."
546	546
547	547	SECTION 18. Section 583A-208, Hawaii Revised Statutes, is amended to read as follows:
548	548
549	549	"[[]§583A-208[]] Jurisdiction declined by reason of conduct. (a) Except as otherwise provided in section 583A-204, if a court of this State has jurisdiction under this chapter because a person seeking to invoke its jurisdiction has engaged in unjustifiable conduct, the court shall decline to exercise its jurisdiction unless:
550	550
551	551	(1) The parents and all persons acting as parents have acquiesced in the exercise of jurisdiction;
552	552
553	553	(2) A court of the state otherwise having jurisdiction under sections 583A-201 to 583A-203 determines that this State is a more appropriate forum under section 583A-207; or
554	554
555	555	(3) No court of any other state would have jurisdiction under the criteria specified in sections 583A-201 to 583A-203.
556	556
557	557	(b) If a court of this State declines to exercise its jurisdiction pursuant to subsection (a), it may fashion an appropriate remedy to ensure the safety of the child and prevent a repetition of the unjustifiable conduct, including staying the proceeding until a child-custody proceeding is commenced in a court having jurisdiction under sections 583A-201 to 583A-203.
558	558
559	559	(c) If a court dismisses a petition or stays a proceeding because it declines to exercise its jurisdiction pursuant to subsection (a), it may assess against the party seeking to invoke its jurisdiction necessary and reasonable expenses including costs, communication expenses, attorney's fees, investigative fees, expenses for witnesses, travel expenses, and child care during the course of the proceedings, unless the party from whom fees are sought is a protective parent fleeing abuse, or the assessment would be clearly inappropriate. The court [may] shall not assess fees, costs, or expenses against this State unless authorized by law other than this chapter.
560	560
561	561	(d) In making a determination under this section, a court shall not consider as a factor weighing against the petitioner any taking of the child, or retention of the child after a visit or other temporary relinquishment of physical custody, from the person who has legal custody if there is evidence that the taking or retention of the child was for the purposes of obtaining gender-affirming health care services for the child and the law or policy of the other state limits the ability of a parent to obtain gender-affirming health care services for the child."
562	562
563	563	SECTION 19. Section 636C-9, Hawaii Revised Statutes, is amended to read as follows:
564	564
565	565	"[[]§636C-9[]] Enforcement of foreign penal civil actions relating to protected reproductive health care services[.] or protected gender-affirming health care services. (a) No judgment or other order arising from a foreign penal civil action or other penal law banning, restricting, burdening, punishing, penalizing, or otherwise interfering with the provision of protected reproductive health care services or protected gender-affirming health care services shall be enforced in this State.
566	566
567	567	(b) As used in this section:
568	568
569	569	"Foreign penal civil action" means an action authorized by the law of a state, or of any municipality or other governmental entity within a state, other than this State, the essential character and effect of which is to punish an offense against the public justice of that state, municipality, or other governmental entity.
570	570
571	571	"Gender-affirming health care services" has the same meaning as in section 323J-1.
572	572
573	573	"Protected gender-affirming health care services" means gender-affirming health care services that are protected under the Hawaii State Constitution or are otherwise lawful under the laws of this State or that would be constitutionally protected or otherwise lawful if performed within this State.
574	574
575	575	"Protected reproductive health care services" means medical, surgical, pharmaceutical, counseling, or referral services relating to the human reproductive system, including but not limited to services relating to pregnancy, contraception, or termination of a pregnancy, that are protected under the Hawaii State Constitution or otherwise lawful under the laws of this State or that would be constitutionally protected or otherwise lawful if performed within this State."
576	576
577	577	SECTION 20. Section 836-2, Hawaii Revised Statutes, is amended to read as follows:
578	578
579	579	"§836-2 Summoning witness in this State to testify in another state. (a) If a judge of a court of record in any state [which] that by its laws has made provision for commanding persons within that state to attend and testify in this State certifies under the seal of that court that there is a criminal prosecution pending in that court, or that a grand jury investigation has commenced or is about to commence, that a person in this State is a material witness in the prosecution or grand jury investigation, and that the person's presence will be required for a specified number of days, upon presentation of the certificate to any judge of a court of record in this State in the judicial district in which the person is, the judge shall fix a time and place for a hearing, and shall make an order directing the witness to appear at a time and place certain for the hearing.
580	580
581	581	(b) If at a hearing the judge determines that the witness is material and necessary, that it will not cause undue hardship to the witness to be compelled to attend and testify in the prosecution or a grand jury investigation in the other state, and that the laws of the state in which the prosecution is pending, or grand jury investigation has commenced or is about to commence, and of any other state through which the witness may be required to pass by ordinary course of travel, will give to the witness protection from arrest and the service of civil and criminal process, the judge shall issue a summons, with a copy of the certificate attached, directing the witness to attend and testify in the court where the prosecution is pending, or where a grand jury investigation has commenced or is about to commence at a time and place specified in the summons[, except]; provided that no judge shall issue a summons in a case where prosecution is pending, or where a grand jury investigation has commenced or is about to commence, for a criminal violation of a law of another state involving [the provision,]:
582	582
583	583	(1) Seeking, receiving, paying for, [receipt of, or assistance with] or inquiring about reproductive health care services [as defined in section 323J-1] or gender-affirming health care services;
584	584
585	585	(2) Providing or responding to an inquiry about reproductive health care services or gender-affirming health care services;
586	586
587	587	(3) Assisting or aiding or abetting in any of the conduct described in paragraph (1) or (2); or
588	588
589	589	(4) Attempting or intending to engage in or providing material support for (or any other theory of vicarious, attempt, joint, several, or conspiracy liability derived therefrom) conduct described in paragraphs (1) to (3),
590	590
591	591	unless the acts forming the basis of the prosecution or investigation would also constitute an offense in this State. In any hearing, the certificate shall be prima facie evidence of all the facts stated therein.
592	592
593	593	(c) If the certificate recommends that the witness be taken into immediate custody and delivered to an officer of the requesting state to assure the witness' attendance in the requesting state, the judge may, in lieu of notification of the hearing, direct that the witness be forthwith brought before the judge for the hearing; and the judge at the hearing being satisfied of the desirability of the custody and delivery, for which determination the certificate shall be prima facie proof of the desirability may, in lieu of issuing subpoena or summons, order that the witness be forthwith taken into custody and delivered to an officer of the requesting state.
594	594
595	595	(d) If the witness, who is summoned pursuant to this section, after being paid or tendered by some properly authorized person a sum equivalent to the cost of round-trip air fare to the place where the prosecution is pending and $30 for each day, that the witness is required to travel and attend as a witness, fails without good cause to attend and testify as directed in the summons, the witness shall be punished in the manner provided for the punishment of any witness who disobeys a summons issued from a court of record in this State.
596	596
597	597	(e) As used in this section, "gender-affirming health care services" and "reproductive health care services" have the same meanings as in section 323J-1."
598	598
599	599	SECTION 21. If any provision of this Act, or the application thereof to any person or circumstance, is held invalid, the invalidity does not affect other provisions or applications of the Act that can be given effect without the invalid provision or application, and to this end the provisions of this Act are severable.
600	600
601	601	SECTION 22. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
602	602
603	603	SECTION 23. This Act shall take effect upon its approval; provided that the amendments made to section 451J-12, Hawaii Revised Statutes, by section 5 of this Act and section 453D-13, Hawaii Revised Statutes, by section 9 of this Act shall not be repealed when the amendments made to those sections by sections 9 and 18, respectively, of Act 93, Session Laws of Hawaii 2024, take effect on July 1, 2026.
604	604
605	605
606	606
607	607	INTRODUCED BY: _____________________________
608	608
609	609	INTRODUCED BY:
610	610
611	611	_____________________________
612	612
613	613	Report Title: Gender-Affirming Health Care Services; Protections; Child Custody Description: Expands the protections established under Act 2, SLH 2023, to include gender-affirming health care services. Clarifies jurisdiction under the Uniform Child-Custody Jurisdiction and Enforcement Act for cases involving children who obtain gender-affirming health care services. The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.
614	614
615	615
616	616
617	617
618	618
619	619	Report Title:
620	620
621	621	Gender-Affirming Health Care Services; Protections; Child Custody
622	622
623	623
624	624
625	625	Description:
626	626
627	627	Expands the protections established under Act 2, SLH 2023, to include gender-affirming health care services. Clarifies jurisdiction under the Uniform Child-Custody Jurisdiction and Enforcement Act for cases involving children who obtain gender-affirming health care services.
628	628
629	629
630	630
631	631
632	632
633	633
634	634
635	635	The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.