Hawaii

Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

At A Glance
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MEDICAID REIMBURSEMENT

  • Live Video: Yes
  • Store-and-Forward: Yes
  • Remote Patient Monitoring: Yes* (CMS RPM Codes)
  • Audio Only: No

PRIVATE PAYER LAW

  • Law Exists: Yes
  • Payment Parity: Yes

PROFESSIONAL REQUIREMENTS

  • Licensure Compacts: None
  • Consent Requirements: No

FQHCs

  • Originating sites explicitly allowed for Live Video:  Yes
  • Distant sites explicitly allowed for Live Video: Yes
  • Store and forward explicitly reimbursed:  No
  • Audio-only explicitly reimbursed:  No
  • Allowed to collect PPS rate for telehealth:  Yes

STATE RESOURCES

  1. Medicaid Program: Hawaii Medicaid (Med-QUEST)
  2. Administrator: Hawaii Dept. of Human Services
  3. Regional Telehealth Resource Center: Pacific Basin Telehealth Resource Center
Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

COVID-19

Last updated 10/29/2022

Audio Only Delivery

Medicaid: Memo on Telephonic Services and Qualified non-physician Health Care Professionals

STATUS: State PHE ended, unclear if still active

Medicaid: Memo on Telehealth Guidance With Procedure Codes

STATUS: State PHE ended, unclear if still active

Medicaid: COVID-19 Pandemic Action Plan for QI Health Plans

STATUS: Active, until the last day of the final month of the PHE (Some elements may be overridden by QI-2107A).

Medicaid: Memo QI-2038: Telehealth and Telephonic E&M & Terminating Pregnancy

STATUS: Active until 30 days after the end of the PHE

Medicaid: Memo QI-2036: Telehealth Guidance During the PHE Related to EPSDT Visits

STATUS: State PHE ended, unclear if still active

Medicaid: FFS Memo 20-08: Teledentistry and Telephonic Guidance During Public Health Emergency in Response to COVID-19

STATUS: State PHE ended, unclear if still active

Office of the Governor: Twenty-First Proclamation Related To The Covid-19 Emergency (See p.24 for audio-only provision)

STATUS: Expired

Medicaid: Memo QI-2120 -“FFS 2109”: Continued Coverage of Audio-Only Visits Through Federal Public Health Emergency (PHE)

STATUS: Active “through the end of the federal PHE.”

Medicaid: Memo QI-2123 – Covid-19 Pandemic Action Plan for QI Health Plans – Part VII

STATUS: Expired Oct. 1, 2021. Further guidance is supposed to be provided.

Last updated 10/29/2022

Cross State Licensing

Department of Commerce and Consumer Affairs: State Provides Guidance for Dental Profession During COVID-19

STATUS: State PHE ended, unclear if still active

Last updated 10/29/2022

Easing Consent Requirements

Memo QI-2036: Telehealth Guidance During the PHE Related to EPSDT Visits

STATUS: State PHE ended, unclear if still active

Last updated 10/29/2022

Easing Prescribing Requirements

No reference found.

Last updated 10/29/2022

Miscellaneous

Office of the Governor: Emergency Proclamation Related to COVID-19 (Omicron Variant), Amendment – Emergency Proclamation Related to COVID-19 (Omnicron Variant)

STATUS: Expired Mar 25, 2022.

 

Last updated 10/29/2022

Originating Site

No reference found.

Last updated 10/29/2022

Private Payer

Medicaid: COVID-19 Pandemic Action Plan for QI Health Plans

STATUS: Active, until the last day of the final month of the PHE (Some elements may be overridden by QI-2107A).

Department of Insurance:  COVID-19 FAQs (includes telehealth question)

STATUS: State PHE ended, unclear if still active

Last updated 10/29/2022

Provider Type

Medicaid: Memo on Telephonic Services and Qualified non-physician Health Care Professionals

STATUS: State PHE ended, unclear if still active

Medicaid: COVID-19 Pandemic Action Plan for QI Health Plans

STATUS: Active, until the last day of the final month of the PHE (Some elements may be overridden by QI-2107)

Memo QI-2036: Telehealth Guidance During the PHE Related to EPSDT Visits

STATUS: Active

Last updated 10/29/2022

Service Expansion

Medicaid: Memo on Telephonic Services and Qualified non-physician Health Care Professionals

STATUS: State PHE ended, unclear if still active

Medicaid: Memo on Telehealth Guidance With Procedure Codes

STATUS: State PHE ended, unclear if still active

Medicaid: Memo on Telehealth Guidance FAQs for FQHCs

STATUS: State PHE ended, unclear if still active

Medicaid Memo: QI-2038: Telehealth and Telephonic E&M & Terminating Pregnancy

STATUS: Active until 30 days after end of PHE

Medicaid Memo QI-2036: Telehealth Guidance During the PHE Related to EPSDT Visits

STATUS: State PHE ended, unclear if still active

Medicaid Memo QI-2020: Coverage of Services for Autism Spectrum Disorder via Telehealth

STATUS: State PHE ended, unclear if still active

Medicaid 1915(c) Waiver: Appendix K Extension – Home and Community Based Services for People with Intellectual and Developmental Disabilities

STATUS: Active, extends current waiver until 6 months after the conclusion of the PHE

Medicaid 1915(c) Waiver: Appendix K –Home and Community Based Services for People with Intellectual and Developmental Disabilities

STATUS: Active, extended until 6 months after the conclusion of the PHE

Medicaid: Memo QI-2105 – Community Integration Services (Cis) Implementation Guidelines: Overview, Member Eligibility, Service Delivery, Coordination, & Reimbursement

STATUS: Active

 

Private Payer

Last updated 10/29/2022

Definition

“Telehealth” means the use of telecommunications 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 chapter.”

SOURCE: HI Revised Statutes § 431:10A-116.3(g); 432D-23.5(g); & 432:1-601.5(g). (Accessed Oct. 2022).

Applies to network adequacy:  

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 § 431:26-101. (Accessed Oct. 2022).

Last updated 10/29/2022

Parity

SERVICE PARITY

No accident and health or sickness insurance plan/health maintenance organization, mutual benefit society plan that is issued, amended, or renewed shall require face-to-face contact between a health care provider and a patient as a prerequisite for payment for services appropriately provided through telehealth in accordance with generally accepted health care practices and standards prevailing in the applicable professional community at the time the services were provided. Coverage may be subject to all the terms and conditions of the plan agreed upon among the enrollee or subscriber, the insurer and the health care provider.

SOURCE: HI Revised Statutes § 431:10A-116.3(b); 432D-23.5(b); & 432:1-601.5(b). (Accessed Oct. 2022).

PAYMENT PARITY

Reimbursement for services provided through telehealth must be equivalent to reimbursement for the same services provided via face-to-face contact between a health care provider and patient.

SOURCE: HI Revised Statutes § 431:10A-116.3(c); 432D-23.5(c); & 432:1-601.5 (c). (Accessed Oct. 2022).

Last updated 10/29/2022

Requirements

Insurance plans, health maintenance organizations and mutual benefit society plans cannot require face-to-face contact between a health provider and a patient as a prerequisite for payment for services appropriately provided through telehealth.

All insurers must provide to current and prospective insureds a written disclosure of covered benefits associated with telehealth services, including information on copayments, deductibles, or coinsurance requirements under a policy, contract, plan, or agreement. The information provided must be current, understandable, and available prior to the issuance of a policy, contract, plan, or agreement and upon request thereafter

SOURCE: HI Revised Statutes § 431:10A-116.3; 432D-23.5; & 432:1-601.5. (Accessed Oct. 2022).

Health benefit plans must maintain a network sufficient in numbers and appropriate types of providers to assure that all covered benefits will be accessible without unreasonable travel or delay. Plans may use telehealth as a service delivery system option for ensuring network adequacy.

SOURCE: HI Revised Statutes § 431:26-103. (Accessed Oct. 2022).

Medicaid

Last updated 10/29/2022

Consent Requirements

No reference found.

Last updated 10/29/2022

Definitions

“Telehealth” means the use of telecommunications 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 § 346-59.1(g). (Accessed Oct. 2022).

Telehealth services is the use of communication equipment to link health care practitioners and patients in different locations. It may be used in place of a face-to-face, “hands on” encounter for consultation, office visits, individual psychotherapy and pharmacologic management. For purposes of this section, the term “patient” refers to individuals eligible for medical assistance.

SOURCE: Code of HI Rules 17-1737-51.1(a). (Accessed Oct. 2022).

Dentistry & Federally Qualified Health Centers

“Telehealth” means the use of telecommunication services to transmit patient health information for interpretation and diagnosis while a patient is at an originating site and the health care provider is at a distant site. It is an enabling technology intended to facilitate access for patients who would otherwise not receive services without the provider being physically present. “Teledentistry” is a form of telehealth.

SOURCE: HI Med-QUEST Medicaid Provider Manual: Dental, pg. 80 & MedQuest Memo, Reimbursement for Procedures Related to FFS Teledentistry Services, No. 19-01, Mar. 13, 2019 & Med-QUEST Memo 20-03. (Accessed Oct. 2022).

Last updated 10/29/2022

Email, Phone & Fax

No Reimbursement for:

  • Telephone
  • Facsimile machine
  • Electronic mail

SOURCE: Code of HI Rules 17-1737.-51.1(c) p. 69 (Accessed Oct. 2022).

Last updated 10/29/2022

Live Video

POLICY

The State’s Medicaid managed care and fee-for-service programs shall not deny coverage for any service provided through telehealth that would be covered if the service were provided through in-person consultation between a patient and a health care provider. Hawaii Medicaid is required under statute to reimburse telehealth equivalent to reimbursement for the same services provided via face-to-face contact.

SOURCE: HI Revised Statutes § 346-59.1 (a & b). (Accessed Oct. 2022). 

Interactive audio and video telecommunication systems must be used. Interactive telecommunications systems must be multi-media communications that, at a minimum, include audio and video equipment, permitting real-time consultation among the patient, consulting practitioner, and referring practitioner. Telephones, facsimile machines, and electronic mail systems do not meet the requirements of interactive telecommunications system. As a condition of payment the patient must be present and participating in the telehealth visit.

SOURCE: Code of HI Rules 17-1737-51.1(c). (Accessed Oct. 2022).

Hawaii’s State Plan Amendment for telehealth services was approved. Approval is retroactive to January 1, 2017. Hawaii state telehealth law 346-59.1 continues to be in effect and adhered to by QI health plans and Medicaid fee-for-service providers

SOURCE: HI Department of Human Servies, Med-QUEST Division, Quest Integration (QI) Health Plans Memo QI-2139/FF2 21-15.  (Accessed Oct. 2022).

ELIGIBLE SERVICES/SPECIALTIES

GT, GQ or 95 modifiers must be used.  See Attachment A for full list of CPT codes that are “prime candidates” for telehealth services.  Distant site providers should use the 02 Place of Service Code.  Codes listed in Attachment A are considered prime candidates for telehealth reimbursement.

SOURCE: QI-2139 Tele-Health Law (Act 226, SLH 2016) Implementation/FFS-21-15 (Replaces QI-1702A/FFS-1701A) (Accessed Oct. 2022).

Dentistry

Eligible codes for reimbursement are listed in Attachment A.  All claims for services provided through telehealth technology must be identified by the applicable teledentistry CDT code D9995 or D9996.

CDT code D9999 must be used to identify the claim for PPS payment by FQHCs and RHCs.

SOURCE: HI Med-QUEST Medicaid Provider Manual: Dental, pg. 82 (Jan. 2021)., HI Department of Human Services.  Med-QUEST Division.  Attachment A., HI MedQUEST Division, CTR 19-01 Reimbursement for Procedures Related to FQHC Teledentistry Services. (Accessed Oct. 2022).

Applied Behavioral Analysis & Autism Spectrum Disorder

Applied behavioral analysis services (including family adaptive behavior treatment guidance) can be provided through telehealth.  MedQuest provides some areas of consideration when approving ABA services through telehealth (see memo).

SOURCE: HI Med-QUEST Memo QI-2028 (Jul. 21, 2020) & QI-2020 (Jun. 17, 2020), (Accessed Oct. 2022).

Federally Qualified Health Centers

Eligible services will be consistent with Memo QI-1702A and FFS 19-01.  See memo for specific billing scenarios.  Memo QI- 2139/FFS 21-15 replaces Memo QI-1702A.

SOURCE: Med-QUEST Memo 20-03 (Mar. 16, 2020), QI-2139 Tele-Health Law (Act 226, SLH 2016) Implementation (Replaces QI-1702A), (Accessed Oct. 2022).

Community Integration Services (CIS)-Supportive Housing Services

CIS services may be rendered via telehealth as appropriate, as long as the required face-to-face interaction requirements are met (See Section 16, Service Settings for more information). Services rendered via telehealth shall be billed with the additional and appropriate telehealth modifiers, and applicable POS codes, as outline in memorandum QI-1702A (NOTE: QI-1702A has been replaced with QI-2139/FFS-21-15). Services may also be rendered via an approved telehealth modality, if determined by the health plan to be appropriate and effective and agreed to by the member.

SOURCE: Med-QUEST Memo QI-2105 (April 1, 2021). (Accessed Oct. 2022).

Induced/Intentional Termination of Pregnancy (ITOP) Evaluation & Management Services

Telehealth (audio-visual modality) may be used for evaluation and management services performed prior to the date of the medical ITOP. Codes in the range of 99201-99215 with modifiers 95, GQ, or GT are allowed.

SOURCE: Med-QUEST Memo FFS 2105 (May 7, 2021). (Accessed Oct. 2022).

QUEST Integration Health Plans & Community Case Management Agencies

Assessments and re-assessments may be conducted using telehealth and telecommunications technology only if an in-person interaction is not an option and should only be used on an exception basis. In-person interactions with members using appropriate safety precautions is the current expectation. Where possible, members at greatest risk and need should be prioritized to receive in-person interactions before members at lower risk and need.

The health plan must document the reason for conducting an interaction using a technology option.

SOURCE: Memo QI-2107A (April 29, 2021). (Accessed Oct. 2022).

ELIGIBLE PROVIDERS

Dentistry

Dental providers who are eligible to bill Hawaii Medicaid are also eligible to bill for telehealth for specific services (see Dental Manual Attachment A for details).  The criteria for eligible dental providers are the same regardless whether or not telehealth is utilized (e.g., DDS or DMD).

SOURCE: HI Med-QUEST Medicaid Provider Manual: Dental, pg. 80, 85 (Jan. 2021) & MedQuest Memo, Reimbursement for Procedures Related to FFS Teledentistry Services, No. 19-01, Mar. 13, 2019. (Accessed Oct. 2022).

Federally Qualified Health Centers

Providers who are eligible to bill for Hawaii Medicaid services are also eligible to bill for telehealth. Please refer to Hawaii Provider Manual Chapter 21 (21.2.1) for a list of eligible providers.

SOURCE: Med-QUEST Memo 20-03 (Mar. 16, 2020), & HI Med-QUEST Medicaid Provider Manual: Federally Qualified Health Centers, Chapter 21 (21.2.1),pg. 2 (March 2016). (Accessed Oct. 2022)

ELIGIBLE SITES

Eligible originating sites listed in the Administrative Rules:

  • The office of a physician or practitioner;
  • Hospitals;
  • Critical Access Hospitals;
  • Rural Health Clinics;
  • Federally Qualified Health Centers;
  • Federal telehealth demonstration project sites.

SOURCE: Code of HI Rules 17-1737-51.1(d), p. 70  – Law passed & state plan amendment accepted prohibiting this limitation, however the prohibiting language is still present in regulation (Accessed Oct. 2022).

In statute, these locations are also included:

  • A patient’s home;
  • Other non-medical environments such as school-based health centers, university-based health centers, or the work location of a patient.

SOURCE: HI Revised Statutes § 346-59.1. (Accessed Oct. 2022).

Approved state plan amendment authorizes HI Medicaid to remove geographic and originating site requirements.

SOURCE: HI State Plan Amendment 16-0004. (Accessed Oct. 2022). 

Federally Qualified Health Centers:

The criteria for sites eligible to receive PPS payment is the same regardless whether or not tele-health is utilized. The services must be provided at an HRSA approved site or satellite. 5C (Other Activiteis/Locations) sites are not eligible to receive PPS reimbursement in Hawaii and therefore are not eligible to receive PPS for tele-health services.

The spoke (originating site) is the location where the patient is located whether accompanied or not by a health care provider through telehealth.  The originating site includes a patient’s residence.

SOURCE: HI Med-QUEST Memo 20-03. (Accessed Oct. 2022).

GEOGRAPHIC LIMITS

Telehealth services may only be provided to patients if they are presented from an originating site located in either:

  • 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.-51.1. (Accessed Oct. 2022). – Law passed (HI Statute Section 346-59.1(c) & state plan amendment accepted prohibiting this limitation, however 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. (Accessed Oct. 2022). 

Teledentistry

The criteria for eligible dental sites are the same regardless whether or not telehealth is utilized.

SOURCE: HI Med-QUEST Medicaid Provider Manual: Dental, pg. 77 (Oct. 2022).

Federally Qualified Health Centers:

Services must be provided at an HRSA approved site or satellite.

The spoke (originating site) is the location where the patient is located whether accompanied or not by a health care provider through telehealth.  The originating site includes a patient’s residence.

SOURCE: HI Med-QUEST Memo 20-03. (Accessed Oct. 2022).

FACILITY/TRANSMISSION FEE

For FQHCs

When a spoke or originating site is solely used to facilitate tele-health, payment for the facilitation shall not exceed the published Medicare rate for transmission services for spoke sites.

SOURCE: HI Dept. of Human Services, Med-QUEST Division, Memo No. QI-2007/FFS 20-03. (Accessed Oct. 2022).

Last updated 10/29/2022

Miscellaneous

Recently Passed Legislation (6/2022)

SB 2624 requires the establishment of a telehealth and rural health care pilot projects.

SOURCE: SB 2624 (2022 Session). (Accessed Oct. 2022).

Last updated 10/29/2022

Out of State Providers

No reference found.

Last updated 10/29/2022

Overview

Hawaii Medicaid (Med-QUEST) reimburses for live video.  Although their statute prohibits HI Medicaid from placing any restrictions on originating sites, regulations creating restrictions on the types or originating site eligible for reimbursement and their geographic location still exist in Hawaii Rules.  HI indicated in a memo that a state plan amendment was approved that allows for the changes in Hawaii Medicaid policy based on the statutory requirements, but it did not provide any specifics on removing the originating site or geographic restrictions currently present in HI rules.

Additionally, according to Hawaii’s statutory definition of telehealth and limited documentation from Hawaii Medicaid, they appear to be reimbursing for store-and-forward and remote patient monitoring in certain circumstances.

Last updated 10/29/2022

Remote Patient Monitoring

POLICY

Hawaii Medicaid is required to cover appropriate telehealth services (which includes store-and-forward and remote patient monitoring) equivalent to reimbursement for the same services provided in-person.

SOURCE: HI Revised Statutes § 346-59.1.  (Accessed Oct. 2022).

Several remote monitoring codes in “Attachment A” are listed as “prime candidates” for telehealth services.

SOURCE: HI Med-Quest Division Memo QI-2139/FFS 21-15 (December 29, 2021).  (Accessed Oct. 2022).

CONDITIONS

No Reference Found

PROVIDER LIMITATIONS

No Reference Found

OTHER RESTRICTIONS

No Reference Found

Last updated 10/29/2022

Store and Forward

POLICY

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

SOURCE: HI Revised Statutes § 346-59.1 & 431:10A-116.3. (Accessed Oct. 2022).

To properly identify telehealth services, one of the following modifiers (95, GQ or GT) must always be used when billing with CPT or HCPCS code for telehealth services.

SOURCE: HI Med-QUEST Memo No. QI-2139/FFS 21-15 (Replaces QI-1702A/FFS-1701A) (Accessed Oct. 2022).

Hawaii Medicaid requires, as a condition of payment, the patient to be present and participating in the telehealth visit.

SOURCE: Code of HI Rules 17-1737.-51.1(c) p. 70 – Law passed & state plan amendment accepted prohibiting this limitation, however the prohibiting language is still present in regulation. (Accessed Oct. 2022).

Teledentistry

D9996 (teledentistry-asynchronous; information stored and forwarded to dentist for subsequent review) can be used to identify eligible telehealth delivered services.

SOURCE: HI Med-QUEST Medicaid Provider Manual: Dental, pg. 81 (Jan 2021) (Accessed Oct. 2022).

ELIGIBLE SERVICES/SPECIALTIES

Federally Qualified Health Centers

Telemedicine-based retinal imaging and interpretation is not a covered service for PPS reimbursement. A face-to-face encounter with a member by an ophthalmologist or optometrist is eligible for PPS reimbursement, regardless of whether retinal imaging or interpretation is a component of the services provided.

SOURCE: Med-QUEST Provider Manual.  Ch. 21: Federally Qualified Health Centers. Mar. 2016, p. 4.  (Accessed Oct. 2022).

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found

Professional Requirements

Last updated 10/29/2022

Consent Requirements

No Reference Found

Last updated 10/29/2022

Cross State Licensing

Recently Signed Legislation (6/2022)

SB 2798 temporarily allows out-of-state veterinarians to practice in the state. The board may issue a 30-day courtesy permit to a veterinarian licensed in another state. The permit may be renewed once in any twelve-month period provided that the permit shall not exceed sixty days total days in a twelve-month period.

SOURCE: SB 2798 (2022 Session). (Accessed Oct. 2022).

A licensed out-of-state practitioner of medicine or surgery can utilize telehealth to consult with a Hawaii licensed physician or osteopathic physician as long as they don’t open an office or meet with patients in the state; the HI licensed provider retains control of the patient; and the laws and rules relating to contagious diseases are not violated.

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 neighbor island beneficiaries within a Hawaii national guard armory.

SOURCE: HI Revised Statutes Sec. 453-2(3-4). (Accessed Oct. 2022).

Licensed out-of-state radiologists located in Hawaii, may provide services via telemedicine to patients located in another state that the radiologist is licensed to practice in.

SOURCE: HI Revised Statutes § 453-2(b) (7). (Accessed Oct. 2022).

Last updated 10/29/2022

Definitions

“Telehealth” means the use of telecommunications 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 physician is at a distant site; establishing a physician-patient relationship; evaluating a patient; or treating a patient.

SOURCE: HI Revised Statutes Ch. 453-1.3. (Accessed Oct. 2022).

“Telehealth” means the use of telecommunications, as that term is 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 radiologist is at a distant site.  Standard telephone contacts, facsimile transmissions, or e-mail texts, in combination or by themselves, do not constitute a telehealth service for the purposes of this paragraph.

SOURCE: HI Revised Statutes Sec. 453-2.  HI Revised Statutes Sec. 466J-6 (8). (Accessed Oct. 2022).

Nursing

“Telehealth” means the use of telecommunications as that term is 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, to support long-distance clinical health care while a patient is at an originating site and the nurse is at a distant site, patient and professional health-related education, public health and health administration, to the extent that it relates to nursing.

SOURCE: HI Revised Statutes Sec. 457-2(a). (Accessed Oct. 2022).

Last updated 10/29/2022

Licensure Compacts

No Reference Found

Last updated 10/29/2022

Miscellaneous

Professional liability insurance for health care providers must provide malpractice coverage for telehealth equivalent to coverage for the same services provided via face-to-face contact.

SOURCE: HI Revised Statutes §671-7 (a). (Accessed Oct. 2022).

Last updated 10/29/2022

Online Prescribing

Prescribing providers must have a provider-patient relationship prior to prescribing. This includes:

  • A face-to-face history and appropriate physical exam to make a diagnosis and therapeutic plan;
  • Discussion of diagnosis or treatment with the patient; including the benefits of other treatment options; and
  • Ensure the availability of appropriate follow-up care.

SOURCE: HI Revised Statutes § 329-1. (Accessed Oct. 2022)

Treatment recommendations made via telehealth, including issuing a prescription via electronic means, shall be held to the same standards of practice as traditional 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 not treatment for the purposes of this section and does not constitute an acceptable standard of care.

A physician-patient relationship may be established via a telehealth interaction; provided that the physician has a license to practice medicine in the State.  Once a physician-patient relationship is established, a patient or physician licensed in this State may use telehealth for any authorized purpose, including consultation with a medical provider licensed in another state, authorized by this section or as otherwise provided by law.

For the purposes of prescribing opiates or medical cannabis, a physician-patient relationship shall only be established after an in-person consultation between the prescribing physician and the patient.

SOURCE: HI Revised Statutes § 453-1.3. (Accessed Oct. 2022).

For purposes of prescribing medical cannabis, a bona fide physician-patient relationship may be established via telehealth, and a nurse-patient relationship can be established via telehealth; provided that treatment recommendations that certify a patient for the medical use of cannabis via telehealth shall be allowed only after an initial in-person consultation between the certifying physician or advanced practice registered nurse and the patient.

SOURCE: HI Revised Statutes § 329-126. (Accessed Oct. 2022).

Last updated 10/29/2022

Professional Boards Standards

No Reference Found

Federally Qualified Health Center (FQHC)

Last updated 10/29/2022

Definition of a Visit

FQHC encounters are face-to-face contacts between a patient and an FQHC covered professional for preventive and/or medically necessary services and include the FQHC facility costs, and all services, and supplies associated with the FQHC covered professional’s services. FQHC encounters also include services and/or supplies that are commonly furnished in a practitioner’s office, without charge, included in the FQHC’s facility costs, and/or furnished as incidental although an integral part of professional services.

Contacts with one or more health care professionals whether more than one is/are qualified (PPS reimbursable) or a combination of qualified and unqualified (not PPS reimbursable) and multiple contacts with the same qualified health care professional that take place on the same day and at a single location constitute a single encounter. Medicaid will only pay for one encounter per day, except as described in 21.4.1.1.

Billable FQHC encounters are face-to-face contacts between a patient and a FQHC covered professional. They include preventive services and medically necessary services such as lab services, diagnostic services such as EKGs, x-ray services (including ultrasounds), dental services, medical services, EPSDT services, family planning services, and prenatal services. Billable FQHC encounters for recipients in the fee-for-service Medicaid program are submitted to MQD for payment through its Fiscal Agent. Billable encounters for recipients in a QI plan are submitted to the plan in which the patient is enrolled.

Non-billable FQHC encounters are: (1) non-face-to-face contacts between a patient and FQHC covered health care professional; (2) face-to-face contacts between a patient and FQHC covered health care professional for non-FQHC covered services; and (3) face-to-face contacts between a patient and a FQHC non-covered professional such as a physical therapist, dental hygienist, and/or audiologist Health screening services in a clinic or community health fair setting such as weight check only or blood pressure check only are not eligible for FQHC PPS reimbursement.

SOURCE: HI Medicaid Provider Manual (FQHC) (March 2016), p. 9-10. (Accessed Oct. 2022).

Last updated 10/29/2022

Eligible Distant Site

Providers who are eligible to bill for Hawaii Medicaid services are also eligible providers who can bill for tele-health.  Refer to Hawaii Provider Manual Chapter 21 FQHCs for list of providers who may provide PPS services.

SOURCE: MedQUEST Memo QI-2007/FFS 20-03 (March 16, 2020). (Accessed Oct. 2022).

Last updated 10/29/2022

Eligible Originating Site

Originating site means the location where the patient is located, whether accompanied or not by a health care provider, at the time services are provided by a health care provider through telehealth, including but not limited to a health care provider’s office, hospital, critical access hospital, rural health clinic, federally qualified health center, a patient’s home, and other non-medical environments such as school-based health centers, university-based health centers, or the work location of the patient.

SOURCE: HI Revised Statues Section 671-7(c). (Accessed Oct. 2022).

The criteria for sites eligible to receive PPS payment is the same regardless whether or not tele-health is utilized. The services must be provided at a HRSA approved site or satellite. 5C (Other Activities/Locations) sites are not eligible to receive PPS reimbursement in Hawaii and therefore are not eligible to receive PPS for tele-health services.

The spoke site (originating site) is the location where the patient is located whether accompanied or not by a health care provider through tele-health. The originating site includes a patient’s residence.

The hub (distant site) is the location of the Medicaid eligible health care provider that delivers Medicaid eligible services through tele-health.

SOURCE: MedQUEST Memo QI-2007/FFS 20-03 (March 16, 2020). (Accessed Oct. 2022).

Last updated 10/29/2022

Facility Fee

When a spoke or originating site is solely used to facilitate tele-health, payment for the facilitation shall not exceed the published Medicare rate for transmission services for spoke sites.

SOURCE: MedQUEST Memo QI-2007/FFS 20-03 (March 16, 2020). (Accessed Oct 2022).

Last updated 10/29/2022

Home Eligible

PPS will be paid as follows:

When the patient is at the spoke/originating site, that is a FQHC (or their residence), and the provider of FQHC services is at the hub/distant site where the service is performed, which is also a FQHC, the hub/distant site will be paid PPS.

SOURCE: MedQUEST Memo QI-2007/FFS 20-03 (March 16, 2020). (Accessed Oct. 2022)

Originating site means the location where the patient is located, whether accompanied or not by a health care provider, at the time services are provided by a health care provider through telehealth, including but not limited to a health care provider’s office, hospital, critical access hospital, rural health clinic, federally qualified health center, a patient’s home, and other non-medical environments such as school-based health centers, university-based health centers, or the work location of the patient.

SOURCE: HI Revised Statues Section 346-59.1(g). (Accessed Oct. 2022).

Last updated 10/29/2022

Modalities Allowed

Live Video

FQHCs may provide services via telehealth. Hawaii Medicaid refers FQHCs to the telehealth memo (MedQUEST Memo QI-2139/FFS 21-15) for the program regarding eligible codes.

SOURCE: HI Medicaid Provider Manual (FQHC) (March 2016), p. 8-9. (Accessed Oct. 2022).

Store and Forward

Telemedicine-based retinal imaging and interpretation is not a covered service for PPS reimbursement. It should be billed with the code and modifier 92014 SE and billed on the CMS 1500 form or electronically in CMS 1500 format. A face-to-face encounter with a member by an ophthalmologist or optometrist is eligible for PPS reimbursement, regardless of whether retinal imaging or interpretation is a component of the services provided.

SOURCE: HI Medicaid Provider Manual (FQHC) (March 2016), p. 4. (Accessed Oct. 2022).

Remote Patient Monitoring

No reference for FQHCs found.

Audio-Only

Hawaii Medicaid does not reimburse for audio-only.

Last updated 10/29/2022

Patient-Provider Relationship

No reference found.

Last updated 10/29/2022

PPS Rate

PPS will be paid as follows:

  • When the patient is at the spoke/originating site, that is a FQHC (or their residence), and the provider of FQHC services is at the hub/distant site where the service is performed, which is also a FQHC, the hub/distant site will be paid PPS.
  • When the patient is at the spoke/originating site that is not a FQHC (and not their residence) and the provider of services is at the hub/distant where the service is performed, which is a FQHC, the hub/Distant site will be paid FFS.
  • If PPS eligible services are performed at a FQHC spoke/originating site and services are provided by a Medicaid provider contracted by the FQHC at a non-FQHC site, the spoke/originating site gets PPS and shall compensate the contracted provider for the services that were performed.
  • When a spoke or originating site is solely used to facilitate tele-health, payment for the facilitation shall not exceed the published Medicare rate for transmission services for spoke sites.

SOURCE: MedQUEST Memo QI-2007/FFS 20-03 (March 16, 2020). (Accessed Oct. 2022).

Dentistry:

Eligible codes for reimbursement are listed in Attachment A.  All claims for services provided through telehealth technology must be identified by the applicable teledentistry CDT code D9995 or D9996.

CDT code D9999 must be used to identify the claim for PPS payment by FQHCs and RHCs.

SOURCE: HI Med-QUEST Medicaid Provider Manual: Dental, pg. 82 (Jan. 2021)., HI Department of Human Services.  Med-QUEST Division.  Attachment A., HI MedQUEST Division, CTR 19-01 Reimbursement for Procedures Related to FQHC Teledentistry Services. (Accessed Oct. 2022).

 

Last updated 10/29/2022

Same Day Encounters

Federally Qualified Health Centers (FQHCs) are paid a PPS all-inclusive rate for all services performed by the FQHC covered health care professionals (as defined in section 21.2.1) for each encounter with a Medicaid client per day. Contacts with one or more health care professionals and multiple contacts with the same health care professional that take place on the same day and at a single location shall constitute a single encounter unless:

I.  After the first encounter, the patient suffers illness or injury requiring additional diagnosis or treatment.

  • Two (2) encounters are payable when the first encounter is for treatment of an acute and/or chronic condition such as cough/ fever and/or hypertension and patient returns to the FQHC with an acute injury such laceration of the forearm, sprained ankle, etc. or
  • One (1) medical encounter is payable when the first encounter is for treatment of cough and fever and the second encounter is for a pelvic and breast exam for cancer screening.
  • One (1) medical encounter is payable when one (1) encounter is a face-to-face visit with a MD/DO and other encounter(s) is/are face-to-face visit(s) with an OD, DPM, or non-behavioral health APRN for the same, related, or unrelated condition(s).

II.  The patient makes visits for different types of services, specifically, dental or behavioral health. Medicaid shall pay for a maximum of one visit per day for each of these services in addition to one medical visit.

SOURCE: HI Medicaid Provider Manual (FQHC) (March 2016), p. 8-9. (Accessed Oct. 2022).