Hawaii's Governor issued eight Emergency Proclamations relating to COVID-19 between March 4 and May 18. The Governor also issued five Executive Orders and "Rules Relating to COVID-19" during this time. These issuances contain a number of directives that directly affect health care providers. Below is a summary of these directives which impact the provision of health care services in Hawaii:

The following laws applicable to health care providers have been suspended or modified:

• Laws regulating purchases made by state and county agencies providing health and human services have been suspended effective March 4 (Suspended law: HRS § 103F).

• Out-of-state physicians, osteopathic physicians, physician assistants, respiratory therapists, occupational therapists, physical therapists, speech pathologists, audiologists, radiographers, radiation specialists, nuclear medicine technologists, LPNs, RNs, and APRNs may practice without a Hawaii license, so long as (1) they have a current and active license in another jurisdiction; (2) they have never had their license suspended or revoked; and (3) they are hired by a state or county agency or facility, or by a hospital, clinic, nursing home, hospice, pharmacy, or clinical laboratory. Effective March 16; updated May 5 (Suspended laws: HRS §§ 453, 457, 457G, 461J, 466, 466J, and 468E; Hawaii Administrative Rules §§ 11-44,16-85, 16-89, 16-93, and 16-100). But see "Mandatory Quarantine" below.

• Provisions related to prevention, control, treatment of, and advancing knowledge about communicable diseases are suspended to the limited extent if they conflict with any of the Proclamations or the Executive Order, effective March 23 (Suspended law: provisions of HRS § 325 to the extent any conflict arises).

• Physicians practicing telehealth may issue prescriptions for controlled substances, effective March 23 (Suspended law: HRS § 329-41(a)(8); all other provisions of HRS § 329 continue to be in effect).

• Physicians may practice telehealth without an in-person consultation or a prior existing physician-patient relationship. This also applies to out-of-state physicians, osteopathic physicians, and physician assistants. Effective March 29 (Suspended law: HRS § 453-1.3).

• Out-of-state physicians and nurses may dispense controlled substances without registering, so long as they have a current and active license in another jurisdiction. Effective March 29 (Suspended laws: HRS §§ 329-32(a), 329-33(a), 329-38.2, and 329-101(b)).

• Registered medical users of cannabis whose registration cards expire in March and April, and May will have their cards extended for ninety days. Effective March 23, revised effective April 26 (Suspended law: HRS §§ 329-121 through 131 only to the extent necessary to extend expiration dates).

• Hand sanitizer and surface disinfectants are excluded from definitions of “liquor” and “intoxicating liquor.” Hospitals and medical clinics may purchase hand sanitizer and surface disinfectants from class 1 liquor licensees without a county alcohol purchase permit. Effective April 26, 2020 (Suspended laws: HRS § 281-1 and 281-37).

• A facsimile, photograph, or scan of a written prescription may be given to a pharmacist within 15 days of an emergency oral prescription. Effective April 26 (Suspended laws: HRS § 329-38(a)(1)(C) and related administrative rules, in accordance with the DEA’s COVID-19 guidance concerning the issuance of oral schedule II prescriptions dated March 27, 2020).

• Opioid treatment programs may dispense take-home doses of medication offsite without obtaining a separate state registration, and may dispense up to 28 doses of methadone. Effective April 26 (Suspended laws: HRS § 329-32(e) in accordance with the United States Drug Enforcement Administration’s COVID-19 policy concerning DEA narcotic treatment programs dated April 7, 2020, and HRS § 329-40(b)(7) in accordance with the United States Substance Abuse and Mental Health Services Administration’s Opioid Treatment Program Guidance, updated on March 19, 2020).

• Nursing and pharmacy graduates who have recently graduated within 180 days may practice under the supervision of a registered practitioner and with the endorsement of their employer. Effective April 26 (Suspended laws: HRS §§ 457 and 461; related Hawaii Administrative Rules).

• All external reviews of health insurance determinations are suspended and will be rescheduled, and all deadlines, including appellate deadlines, will be extended by the Insurance Commissioner. Effective April 26 (Suspended law: HRS § 432E, Part IV).

The following laws or rules applicable to health care providers have been invoked:

• Prices cannot be increased on food, water, ice, medical supplies, medical protective measures, medications, vitamins, personal hygiene products, hand sanitizer, alcohol, hydrogen peroxide, cleaning supplies, and all other commodities to sanitize or clean persons or objects, as well as items to help the population to stay well, prevent illness, or recover from illness (HRS § 127A-30). This applies to wholesale and retail prices, effective March 4.

• The Governor has directed all state agencies and officers to extend services, materials, and facilities as may be required (HRS § 127A-12(b), effective March 4.

• Owners of "critical infrastructure" (as identified by Dept. of Homeland Cybersecurity & Infrastructure Security Agency) must provide for the protection of their premises and key resources (HRS § 127A-12(b)(13). County emergency management directors have additional discretion to identify additional critical infrastructure to be protected and safeguarded. Emergency services, Healthcare, and Public Health are "critical infrastructure." Effective March 16.

• COVID-19 (SARS-CoV-2) has been added to the list of communicable diseases Hawaii health care providers are required to report to the Department of Health (HRS § 325-2; HRS § 91-3(b); Hawaii Administrative Rules 11-156). Failure to comply is a misdemeanor punishible by up to 12 months of imprisonment and a $5,000 fine. Effective March 16 through September 16, 2020.

• Mandatory Quarantine: All persons entering Hawaii must self-quarantine for 14 days or the duration of the stay in Hawaii, whichever is shorter. Costs to be borne by the quarantined person. Failure to comply is a misdemeanor. The mandatory quarantine does not apply to health care workers traveling inter-island for work, so long as they wear appropriate protective gear and follow social distancing requirements. Effective March 23 2020 (Rules Relating to COVID-19, Sections 2-4).

• The stay-at-home order of March 23 exempts healthcare services and facilities; sellers of food and medicine; food, beverage, and cannabis production; agriculture; charitable and social services; manufacture, distribution, and supply chain for critical products and industries; and outdoor exercise activities, effective March 23.

• Health care facilities, health care professionals, and health care volunteers who in good faith comply completely with all state and federal orders regarding the COVID-19 emergency shall be immune from civil liability for any death of or injury to persons and for property damage alleged to have been caused by any act or omission while they were engaged in the course of rendering assistance to the State by providing services, assistance, or support in response to the COVID-19 outbreak, unless it is established that such death of or injury to persons, or property damage was caused by wilful misconduct, gross negligence, or recklessness. Effective April 16 through the pendency of the Emergency Proclamations.

All laws suspended or invoked aboveremain in effect for the emergency proclamation or when sooner terminated by separate proclamation, unless otherwise indicated. The above information is current as of June 7, 2020.