Eligible Distant Site

Distant/Hub Site:

The location of the enrolled Hawai‘i Medicaid provider delivering Medicaid eligible services through telehealth. The U.S. Department of Health and Human Services, Office for Civil Rights, expects health care providers will implement HIPAA safeguards and conduct telehealth in private settings, such as a doctor in a clinic or office connecting to a patient who is at home or at another clinic.

Eligible providers are health care providers who are eligible to bill Hawai‘i Medicaid, practicing within their scope, and delivering services which can be appropriately and effectively administered through the telehealth modality.

If a provider does not have the capacity to provide in-person services, they must, for each appointment, inform the patient and document in the patient’s record that the following information was provided: The patient has a right to receive in-person services if they prefer; they (the provider) are incapable of providing in-person services; and they (the provider) must inform the patient that their QI managed care organization (MCO) can assist with finding a provider who can furnish in-person services.

If prescribing controlled substances, the provider must be located in the State of Hawai‘i. Refer to Hawai‘i Revised Statute §346-53.64 (5) for the list of providers who may provide PPS service

EXCEPTION: FQHC BEHAVIORAL HEALTH PROVIDERS LOCATED AT A NON-FQHC SITE within the United States and the United States’ territories with provision of relevant wrap-around services: PPS reimbursement continues subject to approval of Med-QUEST Division’s State Plan Amendment, currently under review by the Centers for Medicare and Medicaid Services (CMS).

WRAP-AROUND SERVICES: FQHCs must ensure the provision of relevant wrap-around non-billable services. Efforts shall be made to ensure that patients receive relevant wrap-around services, and this may mean delivering care to the patient’s location as one way to ensure services are received. Wrap-around non-billable services may or may not occur on the same day as services provided through telehealth modality and the eligible FQHC provider delivering services through the telehealth modality must provide clear instructions to the patient and document in the patient’s record how and when the wrap-around non-billable services will be provided. Wrap-around non-billable services must be documented in the patient’s medical record.

ELIGIBLE SERVICES: Services provided by telehealth must be appropriate for the telehealth modality, clinically appropriate for the patient, rendered in conformance with the full description of the procedure code, and performed by a health care provider eligible to bill Hawai‘i Medicaid.

See Attachment C for guidance.

SOURCE: Med-QUEST Memo QI-2527/FFS-25-12/CCS-2509 (Dec. 8, 2025).  (Accessed Feb 2026).

Distant site means the location of the health care provider delivering services through telehealth at the time the services are provided.

SOURCE: HI Revised Statues Section 346-59.1(g). (Accessed Feb. 2026).

Teledentistry

Clinics that qualify for FQHC Prospective Payment System (PPS) reimbursement may submit telehealth claims using PPS reimbursement, as long as both the patient and dentist were each physically located at separate eligible FQHC/RHC sites during the encounter and the diagnosis. (Form 5b service sites registered with Med-QUEST as a Medicaid location and issued a HRSA Notice of Award identifying the specific service location address). Refer to Provider Memo QI-2338/ FFS 23-22. The first lines of these claims should be D9999 or D0140.

Claims for patients that were located at “public health settings” not federally registered as a FQHC or RHC service site are not eligible for PPS reimbursement.

SOURCE: HI Med-QUEST Medicaid Provider Manual Dental Benefits (May 2025), p. 40.  (Accessed Feb. 2026).