Hawaii State Telehealth Laws and Reimbursement Policies

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Information Provided ByCenter for Connected Health Policy

© Public Health Institute/ Center for
Connected Health Policy 2019: http://cchpca.org

Hawaii Quest

Hawaii
Medicaid Program: Hawaii Quest

Program Administrator: Hawaii Dept. of Human Services

Regional Telehealth Resource Center:

Pacific Basin Telehealth Resource Center
Telehealth Research Institute, John A. Burns School of Medicine

651 Ilalo Street
Honolulu, HI 96813
(808) 692-1090 www.pbtrc.org

STATE LAW/REGULATIONS MEDICAID PROGRAM

Definition of telemedicine/telehealth

“Telehealth” means the use of telecommunications No reference found.

services, as defined in section 269 1, to encompass
four modalities: store and forward technologies, remote
monitoring, live consultation, and mobile health; and
which shall include but not be limited to real-time video
conferencing-based communication, secure interactive
and non interactive web-based communication, and
secure asynchronous information exchange, to transmit
patient medical information, including diagnostic-quality
digital images and laboratory results for medical
interpretation and diagnosis, for the purpose of
delivering enhanced health care services and
information while a patient is at an originating site and
the health care provider is at a distant site. Standard
telephone contacts, facsimile transmissions, or e-mail
text, in combination or by itself, does not constitute a
telehealth service for the purposes of this section.”

Source: HI Revised Statutes Ch. 346, § 671, 457-2, 453-1.3, §

431:10A-116.3, 466J-6 & 453-2 (SB 2395).

Telehealth means health care services provided through

telecommunications technology by a health care
professional who is at a location other than where the
covered person is located.

Source: HI Revised Statutes Ch. 431.

Live Video Reimbursement

Hawaii Medicaid and private payers are required to cover telehealth services (which includes live video) equivalent to reimbursement for the same services provided in-person.

Source: HI Revised Statutes § 346 & 431:10A-116.3 (SB 2395 – 2016).

(See Medicaid column & “Private Payers” Section)

Hawaii Quest will reimburse for live video, as long as it “includes audio and video equipment, permitting real-time consultation among the patient, consulting practitioner and referring practitioner.”

Source: Code of HI Rules 17-1737.

GT, GQ or 95 modifier must be use. See Attachment A for full list of CPT codes that are “prime candidates” for telehealth services.

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

Source: HI Department of Human Services. Med-QUEST Division.
Memo, May 2, 2017. (Accessed Oct. 2017).

Store and Forward Reimbursement

Hawaii Medicaid and private payers are required to Hawaii Quest requires the patient to be “present and
cover appropriate telehealth services (which includes participating in the telehealth visit” therefore excluding
store and forward) equivalent to reimbursement for the store and forward from reimbursement.
same services provided in-person. Source: Code of HI Rules 17-1737.

Source: HI Revised Statutes § 346 & 431:10A-116.3 (SB 2395 – Telemedicine-based retinal imaging and interpretation is
2016).
(also see Medicaid column) not a covered service for PPS reimbursement.
Source: Med-QUEST Provider Manual. Ch. 21: Federally Qualified

Health Centers. Mar. 2016. (Accessed Aug. 2016).

Remote Patient Monitoring Reimbursement

Hawaii Medicaid and private payers are required to No reference found.

cover appropriate telehealth services (which includes
remote patient monitoring) equivalent to reimbursement
for the same services provided in-person.
Source: HI Revised Statutes § 346 & 431:10A-116.3 (SB 2395 –
2016).

Email/Phone/FAX

No reimbursement for email. No reimbursement for email.
No reimbursement for telephone. No reimbursement for telephone.
No reimbursement for FAX. No reimbursement for FAX.
Source: HI Revised Statutes § 431:10A-116.3. Source: Code of HI Rules 17-1737 (2012).
(also see Medicaid column) Behavioral Health Services
Telephone services may not be billed to Medicaid as an
office visit.
Source: Medicaid Provider Manual. Ch. 15 Behavioral Health
Services. Oct. 18, 2002. (Accessed Mar. 2016).

Online Prescribing

Prescribing providers must have a provider-patient No reference found.
relationship prior to e-prescribing. This includes:
A face-to-face history and physical exam;
A diagnosis and therapeutic plan;
Discussion of diagnosis or treatment with the
patient;
Availability of appropriate follow-up care.
Source: HI Revised Statutes § 329-1 (2012).
Treatment recommendations made via telemedicine are
appropriate for traditional physician-patient settings that
do not include a face-to-face visit, but in which
prescribing is appropriate, including on-call telephone
encounters and encounters for which a follow-up visit is

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

arranged.

Issuing a prescription based solely on an online

questionnaire is prohibited.

A physician-patient relationship may be established via

telehealth if the patient is referred to the telehealth
provider by another health care provider who has
conducted an in-person consultation and has provided
all pertinent patient information to the telehealth
provider.

Source: HI Revised Statutes § 453-1.3.

Consent

No reference found. No reference found.

Location

(see Medicaid column) Eligible originating sites:
The office of a physician or practitioner;
Hospitals;
Critical Access Hospitals;
Rural Health Clinics;
Federally Qualified Health Centers;
Federal telehealth demonstration project sites.
In addition, originating sites must be located in one of
the following:
A federally designated Rural Health
Professional Shortage Area;
A county outside of a Metropolitan Statistical
Area;
An entity that participates in a federal
telemedicine demonstration project.
Source: Code of HI Rules 17-1737. – Law passed & state plan
amendment accepted prohibiting this limitation, however still the
prohibiting language is still present in regulation.
Approved state plan amendment authorizes HI Medicaid
to remove geographic and originating site requirements.
Source: HI State Plan Amendment 16-0004 & Med-QUEST Memo
17-01A.

Cross-State Licensing

Out-of-state radiologists may provide services in Hawaii. No reference found.
Source: HI Revised Statutes § 453-2(b) (6).
Commissioned medical officers or psychologists
employed by the US Department of Defense and
credentialed by Tripler Army Medical Center are exempt
from licensing requirements when providing services to

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

neighbor island beneficiaries within a Hawaii national
guard armory.
Source: HI Revised Statutes Sec. 453-2(3).

Private Payers

Hawaii requires coverage of telehealth services No reference found.
equivalent to reimbursement for the same services
provided via-face-to-face contact.
Source: HI Revised Statutes § 431:10A-116.3.

Site/Transmission Fee

No reference found. No reference found.

Miscellaneous

Professional liability insurance for health care providers Act 226 includes both telemedicine and teledentistry
must provide malpractice coverage for telehealth services, and does not add any new services to those
equivalent to coverage for the same services provided presently available to Medicaid recipients.
via face-to-face contact. The SPA was approved March 15, 2017. Providers are

Source: HI Revised Statutes §671 (SB 2395 – 2016). to use the 95, GT or GQ modifier with all CPT or
HCPCS codes.
Source: Medicaid.gov. Hawaii, SPA 16-0004. Approval Letter.

Comments: In July 2011, Hawaii began implementing a mobile medical van telehealth pilot project, staffed by primary care providers, for consults with other health care providers.

HI Revised Statutes, Div. 1, Title 20, Ch. 346 Note (2012).

Hawaii and Alaska are the only two states with Medicare coverage of store and forward services.

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