Last updated 02/28/2021
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 Feb. 2021).
Dentistry
“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. 77 (Jan. 2021) & MedQuest Memo, Reimbursement for Procedures Related to FFS Teledentistry Services, No. 19-01, Mar. 13, 2019 & Med-QUEST Memo 20-03. (Accessed Feb. 2021).
Last updated 02/28/2021
Live Video
POLICY
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(b). (Accessed Feb. 2021).
Hawaii Medicaid 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 17-1737-51.1(c). (Accessed Feb. 2021).
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: HI Department of Human Services. Med-QUEST Division. Memo 17-01A. & Medicaid.gov. Hawaii, SPA 16-0004. Approval Letter. & HI Department of Human Services. Med-QUEST Division. Attachment A. (Accessed Feb. 2021).
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. 79 (Jan. 2021). (Accessed Feb. 2021).
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 Feb. 2021).
Federally Qualified Health Centers
Eligible services will be consistent with Memo QI-1702A and FFS 19-01. See memo for specific billing scenarios.
SOURCE: Med-QUEST Memo 20-03 (Mar. 16, 2020), (Accessed Feb. 2021).
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. 77 (Jan. 2021) & MedQuest Memo, Reimbursement for Procedures Related to FFS Teledentistry Services, No. 19-01, Mar. 13, 2019. (Accessed Feb. 2021).
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: HI Med-QUEST Medicaid Provider Manual: Federally Qualified Health Centers, pg. 2 (March 2016) & Med-QUEST Memo 20-03 (Mar. 16, 2020), (Accessed Feb. 2021)
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). – Law passed & state plan amendment accepted prohibiting this limitation, however the prohibiting language is still present in regulation (Accessed Feb. 2021).
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 Feb. 2021)
Guidance for Federally Qualified Health Centers:
Services must be provided at a HRSA approved site or satellite.
The spoke (originating site) is the location where the patient is located whether accompanied or not by a helath care provider through telehealth. The originating site includes a patient’s residence.
SOURCE: HI Med-QUEST Memo 20-03. (Accessed Feb. 2021).
Approved state plan amendment authorizes HI Medicaid to remove geographic and originating site requirements.
SOURCE: HI State Plan Amendment 16-0004, (Accessed Feb. 2021)
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 Feb. 2021). – Law passed & 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 Feb. 2021).
Federally Qualified Health Centers:
Services must be provided at a HRSA approved site or satellite.
SOURCE: HI Med-QUEST Memo 20-03. (Accessed Feb. 2021).
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 (Jan. 2021).
FACILITY/TRANSMISSION FEE
No Reference Found
Last updated 02/28/2021
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, they should also be reimbursing for store-and-forward and remote patient monitoring, however CCHP has yet to find any documentation from Hawaii Medicaid that they are reimbursing for these modalities.
Last updated 02/28/2021
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 Feb. 2021).
CONDITIONS
No Reference Found
PROVIDER LIMITATIONS
No Reference Found
OTHER RESTRICTIONS
No Reference Found
Last updated 02/28/2021
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 Feb. 2021).
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) – Law passed & state plan amendment accepted prohibiting this limitation, however the prohibiting language is still present in regulation. (Accessed Feb. 2021).
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. 77 (Jan. 2021).
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 Feb. 2021).
GEOGRAPHIC LIMITS
No Reference Found
TRANSMISSION FEE
No Reference Found
