Hawaiʻi Policies and Regulations
Telehealth laws and licensure requirements for the State of Hawaiʻi
Hawaiʻi Telehealth Laws
Hawaiʻi has one of the most progressive telehealth laws in the nation. Hawaiʻi Revised Statute Act 226 (16): Relating to Telehealth was signed into law by Governor David Ige in 2016. HRS Act 226(16) applies to Medicaid and private insurers.
Some key components to this law include:
- Parity for telehealth service and payment in comparison to in person services
- Malpractice coverage for telehealth
- Lifts restrictions on originating site requirements including patient or provider location; meaning providers can get paid for delivering services to a patient who is in his/her home
- Broad definition of telehealth including:
- store/forward
- remote monitoring
- live consultation & mHealth
However, currently the definition of telehealth in Act 266 (16) does not include audio-only or telephonic delivery of care.
Summary of Act 226
This is a comprehensive summary of Act 226 (16) (PDF):
- Requires the State’s Medicaid Managed Care and Fee-for-Service programs to cover services provided through telehealth;
- Specifies that any telehealth services provided shall be consistent with all federal and state privacy, security, and confidentiality laws;
- Specifies medical professional liability insurance policy requirements with regard to telehealth coverage;
- Clarifies that reimbursement for services provided through telehealth shall be equivalent to reimbursement for the same services provided via face-to-face contact between a health care provider and a patient;
- Requires written disclosure of coverages and benefits associated with telehealth services;
- Ensures that telehealth encompasses store and forward technologies, remote monitoring, live consultation, and mobile health;
- Ensures that telehealth is covered when originating in a patient’s home and other non-medical environments;
- Clarifies requirements for physicians and out-of-state physicians to establish a physician-patient relationship via telehealth;
- Ensures that reimbursement requirements for telehealth services apply to all health benefits plans under chapter 87A, Hawaiʻi Revised Statutes; and
- Makes other conforming amendments related to telehealth for clarity.
Resources For Hawaiʻi Telehealth Laws
HRS Act 226 (16)
Hawaiʻi Revised Statute Act 226 (16): Relating to Telehealth was signed into law by Governor David Ige in 2016. Read the full text of the law.
Hawaiʻi Pending Legislation and Regulation
See telehealth legislation and regulation in Hawaiʻi for the current legislative session.
Current Hawaiʻi State Laws & Policies
CCHCP tracks Hawaiʻi’s telehealth policies by: COVID-19, Medicaid, Private Payer, and Professional Requirements.
US Federal Telehealth Laws and Policies
The temporary PHE telehealth waivers in most part would require a change in law in order to become permanent. The Consolidated Appropriations Act (CAA) of 2021 included provisions for permanent changes for tele-behavioral mental health. The CAA was enacted in 2020 with $908 Billion of relief funds and $1.4 Trillion for fiscal year 2021. It will come into effect at the end of the Federal PHE. Here is a summary of the telehealth components of CAA 2021:
Mental Health Services via Telehealth (Medicare)
- Geographic restrictions are lifted – telehealth can be used for diagnosis, treatment or evaluation of mental health disorders
- This was made permanent in law via CAA 2021
- However, patients must have an in-person relationship with a provider, one in-person visit within 6-months prior to the telehealth consult and a follow-up visit within 12-months
- The PHE waivers take precedence over the CAA provisions, once the PHE ends these telehealth related laws will go into effect.
Rural Emergency Hospital Designation
The CAA 2021 also established a new Rural Emergency Hospital (REH) designation.
- New eligible site designation for Critical Access Hospitals (CAH) or other rural hospitals with fewer than 50 beds
- Emergency / Outpatient Services amd a wider diversity of services
- REH are eligible originating sites (patients can be there for telehealth services)
- However, eligible provider and service type according to CMS rules still apply
- And HRSA definition of “rural” still applies
Resources For US Federal Telehealth Laws
Medicare Policies
CCHCP tracks Medicare telehealth policies by: definitions, live video, store-and-forward, remote patient monitoring, email, phone & fax, consent requirements, out of state providers, and miscellaneous.
Telehealth Policy Impacts in the Consolidated Appropriations Act (CAA)
Read a summary of the major impacts on federal telehealth policy on Medicare in the 2022 CAA.
Public Health Emergency (PHE) Status and Waivers Due to COVID-19 Pandemic
There have been many temporary policy waivers at the state and federal level during the PHE to assist in wider access to care via telehealth.
Federal
There were many policy waivers for Medicare that temporarily lifted restrictions such as the patient and provide location, provider type, services and delivery mechanism including lack of enforcement by the Office for Civil Rights for use of non-HIPAA guideline compliant platforms. With the exception of Behavioral Mental Health, most of these waivers remain temporary until the end of the PHE. It remains to be determined what policies will become permanent.
State of Hawaiʻi
Fortunately, Act 226 (16) enacted prior to the PHE was less prohibitive than federal policies. The Act enabled patients to be located at home with no geographic restrictions, no limits on provider and service type and modality. A major issue during the pandemic has been digital equity and literacy issues, meaning that patients may not have adequate access to broadband, technologies or know-how to use video conferencing for telehealth visits. Thus, the need for audio-only (standard telephone contacts) telehealth consultations increased during the pandemic. Act 226(16) does not include audio-only as a means of providing telehealth services. Governor Ige’s Emergency Proclamations (EP) have suspended the sections of law that did not include audio-only as a means of telehealth. Specifically the EPs suspended Sections 346-59.1, 431:10A-116.3, 432:1-601.5, and 432D-23.5, HRS, coverage for telehealth, to the extent that the definitions of “telehealth” in each section shall exclude the use of standard telephone contacts.
The 21st proclamation related to the COVID-19 emergency (PDF) also waived the license requirement for marriage and family therapists licensed in their state, but not licensed in Hawaiʻi, who have pre-established relationships with a patient or client currently residing in the State of Hawaiʻi, to engage in telehealth practices with these patients. This shall not authorize out-of-state mental health professionals who are not licensed in Hawaiʻi to solicit or establish new relationships with clients or patients located in Hawaiʻi.
Billing and Reimbursement
Billing for telehealth services can be complex and confusing due to the ongoing guideline and policy changes during the COVID-19 pandemic. PBTRC has developed a guide to provide guidance on billing, documentation requirements, cost share for various payers, and software solutions.
Physician Fee Schedule
The Center for Medicare and Medicaid Services (CMS) released their final Physician Fee Schedule (PFS) for CY 2022. The PFS are the policies that the agency will be implementing for Medicare beginning on January 1, 2022, unless otherwise noted.
Telehealth Virtual Visit Reimbursement Guide
A comprehensive guidance on billing and reimbursement, such as specific codes, documentation requirements and specific payer requirements.