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                                                                                 Center for Connected Health Policy

           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

            According to state insurance law, “Telehealth means the  No reference found.
            use of telecommunications services, including but not
            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 to parties separated by
            distance. Standard telephone contacts, facsimile
            transmissions, or email text, in combination or by itself,
            does not constitute a telehealth service for the purposes
            of this chapter.”

            Source: HI Revised Statutes § 431:10A-116.3 (2012).

            According to state business law, “Telehealth means the
            use of electronic information and telecommunication
            technologies to support long-distance clinical health
            care, patient and professional health-related education,
            public health and health administration, to the extent that
            it relates to nursing.”

            Source: HI Revised Statutes § 457-2 (2012).

            Recently Passed Law
            Telehealth means the use of telecommunications, as
            that term is defined in section 269-2, including but not
            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
            establishing a physician-patient relationship, evaluating
            a patient, or treating a patient.



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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            Source: HI Revised Statutes § 453-1.3 (SB 2469).

            "Telehealth" means the use of telecommunications, as
            that term is defined in section 269-1, including but not
            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 to parties separated by
            distance.  Standard telephone contacts, facsimile
            transmissions, or email texts, in combination or by
            themselves, do not constitute a telehealth service for the
            purposes of this paragraph.

            Source: HI Revised Statutes § 466J-6 & 453-2 (SB 2469).

            Live Video Reimbursement
            Hawaii requires coverage of telehealth services     Hawaii Quest will reimburse for live video, as long as it
            equivalent to reimbursement for the same services   “includes audio and video equipment, permitting real-
            provided via-face-to-face contact.                  time consultation among the patient, consulting
                                                                practitioner and referring practitioner.”
            The patient must be accompanied by a treating health
            care provider at the time telehealth services are   Source: Code of HI Rules 17-1737 (2012).
            provided (except in the case of behavioral health
            services).

            Source: HI Revised Statutes § 431:10A-116.3 (2012).

            (See Medicaid column & “Private Payers” Section)

            Store and Forward Reimbursement
            Based upon the definition of “telehealth” (which includes  Hawaii Quest requires the patient to be “present and
            secure asynchronous information exchange) in the state  participating in the telehealth visit” therefore excluding
            insurance law, store and forward may be covered.   store and forward from reimbursement.

            Source: HI Revised Statutes § 431:10A-116.3 (2012).   Source: Code of HI Rules 17-1737 (2012).

            (also see Medicaid column)

            Remote Patient Monitoring Reimbursement
            No reference found.                                No reference found.

            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 (2012).   Source: Code of HI Rules 17-1737 (2012).

            (also see Medicaid column)
            Online Prescribing

            Prescribing providers must have a provider-patient   No reference found.

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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            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
            arranged.

            Issuing a prescription based solely on an online
            questionnaire is prohibited.

            Source: HI Revised Statutes § 453-1.3.

            Consent
            No reference found.                                No reference found.

            Location
            (see Medicaid column)                              Eligible originating sites:

                                                                   •   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 (2012).
            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


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                                                                                 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 (2012).
            Site/Transmission Fee

            No reference found.                                No reference found.
            Miscellaneous



           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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