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: Yes (Temporarily until 12/31/25)

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:  Yes
  • 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.

Last updated 02/13/2024

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.  Except as provided through an interactive telecommunication system, standard telephone contacts, facsimile transmissions, or e-mail text, in combination or alone, do not constitute telehealth services.

SOURCE: HI Revised Statutes § 431:10A-116.3(g); 432D-23.5(g); & 432:1-601.5(g). Amended by HB 907 (Will be repealed after December 31, 2025).  (Accessed Feb. 2024).

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 Feb. 2024).

Last updated 02/13/2024

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 in-person 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). Amended by HB 907 (Will be repealed December 31, 2025).(Accessed Feb. 2024).


PAYMENT PARITY

Reimbursement for services provided through telehealth via an interactive telecommunication system shall be equivalent to reimbursement for the same services provided via in-person contact between a health care provider and patient; provided that reimbursement for two-way, real-time audio-only communication technology for purpose of diagnosis, evaluation, or treatment of a mental health disorder to a patient in the patient’s home shall be equivalent to eighty per cent of the reimbursement for the same services provided via in-person contact between a health care provider and a patient. To be reimbursed for telehealth via an interactive telecommunications system using two-way, real-time audio-only communication technology in accordance with this subsection, the health care provider shall first conduct an in-person visit or a telehealth visit that is not audio-only, within six months prior to the initial audio-only visit, or within twelve months prior to any subsequent audio-only visit. The telehealth visit required prior to the initial or subsequent audio-only visit in this subsection shall not be provided using audio-only communication. Nothing in this section shall require the heath care provider to be physically present with the patient at an originating site unless a health care provider at a distant site deem sit necessary.

SOURCE: HI Revised Statutes § 431:10A-116.3(c); 432D-23.5(c); & 432:1-601.5 (c). Amended by HB 907. (Will be repealed December 31, 2025). (Accessed Feb. 2024).

Unless otherwise provided by law, reimbursement for behavioral health services provided through telehealth via an interactive telecommunications system shall be equivalent to reimbursement for the same services provided via in-person contact between a health care provider and a patient; provided that reimbursement for two-way, real-time audio-only communication technology for purposes of diagnosis, evaluation, or treatment of a mental health disorder to a patient in the patient’s home shall be equivalent to eighty percent of the reimbursement for the same services provided via in-person contact between a health care provider and a patient. To be reimbursed for telehealth via an interactive telecommunications system using two-way, real-time audio-only communication technology in accordance with this subsection, the health care provider shall first conduct an in-person visit or a telehealth visit that is not audio-only, within six months prior to the initial audio-only visit, or within twelve months prior to any subsequent audio-only visit. The telehealth visit required prior to the initial or subsequent audio-only visit in this subsection shall not be provided using audio-only communication.

SOURCE:  HI Revised Statutes 453-1.3(h).  Amended by HB 907 (Will be repealed December 31, 2025).(Accessed Feb. 2024).

Last updated 02/13/2024

Requirements

Insurance plans, health maintenance organizations and mutual benefit society plans cannot require in-person 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. Amended by HB 907 (Will be repealed December 31, 2025).  (Accessed Feb. 2024).

Network Adequacy

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 Feb. 2024).

Last updated 02/02/2024

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. Except as provided through an interactive telecommunications system, standard telephone contacts, facsimile transmissions, or e-mail text, in combination or alone, do not constitute telehealth services.”

SOURCE: HI Revised Statutes § 346-59.1(g). (Accessed Feb. 2024).

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 Feb. 2024).

Audio-visual real-time telehealth – Multimedia communications equipment that includes, at a minimum, audio and video equipment permitting two-way, real-time interactive communication between the patient and distant site physician or practitioner.

SOURCE:  HI Dept of Human Services, Med-QUEST, Memo No. QI-2338/FFS 23-22, CCS-2311. (Accessed Feb. 2024).

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. 108 (Jan. 2023) (Accessed Feb. 2024).

Last updated 02/12/2024

Email, Phone & Fax

Recently Passed Legislation – Effective until December 31, 2025.

Med-QUEST Division (MQD) supports the medically appropriate use of interactive telecommunications system using two-way, real-time audio-only communication technology (audio-only) to increase access to healthcare and promote continuity of care. MQD will continue to reimburse select healthcare services delivered through audio-only communication technology after the Federal PHE expires. The following guidance is in effect until December 31, 2025, which aligns with the amended Hawaii Revised Statute 346-59.1 as amended by 2023 Hawaii legislative session Act 107 (HB 907).

Hawai’i Revised Statute (HRS) 346-59.1 amended during the 2023 Hawai’i legislative session (Act 107 (HB 907)) updated definitions and reimbursements:

HRS 346-59.1 as amended specifically states: (b) Reimbursement for services provided through telehealth via an interactive telecommunications system shall be equivalent to reimbursement for the same services provided via in-person contact between a health care provider and a patient; provided that reimbursement for the diagnosis, evaluation, or treatment of a mental health disorder delivered through an interactive telecommunications system using two-way, real-time audio-only communication technology shall meet the requirements of title 42 Code of Federal Regulations section 410.78.

SOURCE:  HI Med-Quest Memo No: QI-2338, CCS-2311, FFS 23-22 (Nov 17, 2023).  (Accessed Feb. 2024).

Newly Amended Statute, Will be Repealed Dec. 31, 2025

Reimbursement for services provided through telehealth via an interactive telecommunications system shall be equivalent to reimbursement for the same services provided via in-person contact between a health care provider and a patient; provided that reimbursement for the diagnosis, evaluation, or treatment of a mental health disorder delivered through an interactive telecommunications system using two-way, real-time audio-only communication technology shall meet the requirements of title 42 Code of Federal Regulations section 410.78.  Nothing in this section shall require a health care provider to be physically present with the patient at an originating site unless a health care provider at the distant site deems it necessary.

Except as provided through an interactive telecommunications system, standard telephone contacts, facsimile transmissions, or e-mail text, in combination or alone, do not constitute telehealth services.

SOURCE: HI Revised Statute, Sec. 346-59.1 as amended by HB 907HD 2/SD 2 (Accessed Feb. 2024).

Audio-only real-time communication technology (Audio-only) – For services furnished for purposes of diagnosis, evaluation, or treatment of a mental health disorder to a patient in their home, interactive telecommunications may include two-way, real-time audio-only communication technology if the distant site physician or practitioner is technically capable to use an interactive telecommunications system as defined in the previous sentence, but the patient is not capable of, or does not consent to, the use of video technology.

SOURCE:  HI Dept of Human Services, Med-QUEST, Memo No. QIk-2338/FFS 23-22, CCS-2311. (Accessed Feb. 2024).

No Reimbursement for:

  • Telephone
  • Facsimile machine
  • Electronic mail

SOURCE: Code of HI Rules 17-1737.-51.1(c) p. 69 (Accessed Feb. 2024).  (NOTE:  Temporarily suspended by HI Dept of Human Services, Med-QUEST, Memo No. QIk-2338/FFS 23-22, CCS-2311.) (Accessed Feb. 2024).

Conditions for reimbursement of interactive telecommunications system using two-way, realtime audio-only communication technology for purposes of diagnosis, evaluation, or treatment of a mental health disorder to a patient includes the following:

The provider must have the capacity to furnish two-way, audio-video telehealth services;

Audio-only mode must be the preference of the patient;

The patient’s medical record must document the reason for the patient’s preference for audio-only mode (examples: broadband access is unsatisfactory, audio-visual technology is not available or is available and the patient does not know how or does not wish to use the technology); and

In-person visit requirements with the provider furnishing a service by use of interactive telecommunications system using two-way, real-time audio-only communication technology for purposes of diagnosis, evaluation, or treatment of a mental health disorder to a patient includes:

  • An in-person visit must occur six months prior to the initial audio-only service furnished;
  • After the initial 6 month in-person visit, a minimum of one medically necessary service must be furnished in-person within 12 months and every twelve months thereafter if services continue to be furnished by interactive telecommunications system. If no medically necessary service is required within 12 months of the previous in-person visit, the next medically necessary service must be furnished inperson. The patient’s medical record must document the reason why an in-person visit was not furnished within that particular 12-month period.
  • The provider furnishing the medically necessary service may be the same provider who furnished services through interactive telecommunications system or may be a provider of the same specialty or subspeciality in the same group practice.

Limitation: A clinical psychologist and a clinical social worker may bill and receive payment for individual psychotherapy via a telecommunications system but may not seek payment for medical evaluation and management services.

Modifier “FQ-service furnished using audio-only communication technology” must be used when billing for servicesfurnished by real-time audio-only communication technology. U

For FQHCs:

FQHCs must ensure the provision of relevant wrap-around non-billable services. Efforts shall be made to ensure that patients receive relevant wrap around non-billable 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 on 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.

See Appendix B for more information including coding guidelines and codes.

SOURCE:  HI Med-Quest Memo No: QI-2338, CCS-2311, FFS 23-22 (Nov 17, 2023).  (Accessed Feb. 2024).

Direct Acting Antiviral (DAA) Medications for Treatment of Chronic Hepatitis C Infection

For on-treatment monitoring, an in-person or telehealth/phone visit may be scheduled, if needed, for patient support, assessment of symptoms, and/or new medications.

SOURCE: HI Med-Quest Memo No. QI-2227/FFS 22-08 (December 30, 2022). (Accessed Feb. 2024).

Last updated 02/12/2024

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.

(Repeal and reenactment on December 31, 2025) Reimbursement for services provided through telehealth via an interactive telecommunications system shall be equivalent to reimbursement for the same services provided via in-person contact between a health care provider and a patient; provided that reimbursement for the diagnosis, evaluation, or treatment of a mental health disorder delivered through an interactive telecommunications system using two-way, real-time audio-only communication technology shall meet the requirements of title 42 Code of Federal Regulations section 410.78.  Nothing in this section shall require a health care provider to be physically present with the patient at an originating site unless a health care provider at the distant site deems it necessary.

SOURCE: HI Revised Statutes § 346-59.1 (a & b).  Amended by HB 907 HD2 SD 2 (Repeal date of December 31, 2025).  (Accessed Feb. 2024).

Reimbursement for services provided through telehealth via an interactive telecommunications system shall be equivalent to reimbursement for the same services provided via in-person contact between a health care provider and a patient; provided that reimbursement for two-way, real-time audio-only communication technology for purposes of diagnosis, evaluation, or treatment of a mental health disorder to a patient in the patient’s home shall be equivalent to eighty per cent of the reimbursement for the same services provided via in-person contact between a health care provider and a patient.

To be reimbursed for telehealth via an interactive telecommunications system using two-way, real-time audio-only communication technology in accordance with this subsection, the health care provider shall first conduct an in-person visit or a telehealth visit that is not audio only, within six months prior to the initial audio-only visit, or within twelve months prior to any subsequent audio-only visit.  The telehealth visit required prior to the initial or subsequent audio-only visit in this subsection shall not be provided using audio-only communication.  Nothing in this section shall require a health care provider to be physically present with the patient at an originating site unless a health care provider at the distant site deems it necessary.

SOURCE: HI Revised Statutes § 431:10A-116.3(c).  Amended by HB 907 HD2 SD 2 (Repeal date of December 31, 2025).  (Accessed Feb. 2024).

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 Feb. 2024). (NOTE: Recent legislation not yet reflected in Rules)

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 telehealth.

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. Services provided shall be consistent with all federal and state privacy, security, and confidentiality laws.

SOURCE:  HI Dept of Human Services, Med-QUEST, Memo No. QIk-2338/FFS 23-22, CCS-2311. (Accessed Feb. 2024).

As noted in the Overview, due to the Maui fires, a public health emergency (PHE) was declared on August 8, 2023. Certain waivers were put into place for telehealth policies.  See Med-Quest Memo QI-2335A for more information.


ELIGIBLE SERVICES/SPECIALTIES

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. Services provided shall be consistent with all federal and state privacy, security, and confidentiality laws.  See Attachment A in memo for list of suggested codes for live video.

SOURCE:  HI Dept of Human Services, Med-QUEST, Memo No. QI-2338/FFS 23-22, CCS-2311. (Accessed Feb. 2024).

Dentistry

The eligible codes for reimbursement will remain consistent with Memo QI-1702A (see Attachment A) with the addition of code D0145. All eligible codes are subject to the processing policies as defined in Chapter 14 of the Medicaid Dental Provider Manual.

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. 108 (Jan. 2023). CTR 19-01 Reimbursement for Procedures Related to FQHC Teledentistry Services (Under FFS-1901). HI Dept of Human Services, Med-QUEST, Memo No. QI-2338/FFS 23-22, CCS-2311. (Accessed Feb. 2024).

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). Memo QI 2301/FFS 23-01 Updates policy.

SOURCE: QI-2020 (Jun. 17, 2020), HI Med-Quest memo QI-2301/FFS 23-01.(January 13, 2023) (Accessed Feb. 2024).

Federally Qualified Health Centers

Providers who are eligible to bill for Hawaii Medicaid services are also eligible providers who can bill for telehealth.  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.  See Attachment C in QI-2338/FFS 23-22, CCS-2311.

SOURCE: Med-QUEST Memo 20-07 (Mar. 16, 2020), QI-2139 Tele-Health Law (Act 226, SLH 2016) Implementation (Replaces QI-1702A) HI Dept of Human Services, Med-QUEST, Memo No. QI-2338/FFS 23-22, CCS-2311. (Accessed Feb. 2024).

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 was replaced with QI-2338/FFS 23-22/CCS 2311). 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 Feb. 2024).

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 Feb. 2024).

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 Feb. 2024).

Chronic Hepatitis C Infection

An in-person or telehealth/phone visit may be scheduled, if needed, for patient support, assessment of symptoms, and/or new medications.

SOURCE:  HI Med-Quest Memo QI-2227/FFS 22-08 (December 30, 2022). (Accessed Feb. 2024).


ELIGIBLE PROVIDERS

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 telehealth.

SOURCE:  HI Dept of Human Services, Med-QUEST, Memo No. QI-2338/FFS 23-22, CCS-2311. (Accessed Feb. 2024).

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. 108-109 (Jan. 2023) & MedQuest Memo, Reimbursement for Procedures Related to Teledentistry Services, FFS No. 19-01, Mar. 13, 2019. (Accessed Feb. 2024).

Federally Qualified Health Centers

Providers who are eligible to bill for Hawaii Medicaid services are also eligible to bill for telehealth. Refer to HRS §346-53.64 (5) for the list of providers who may provide PPS services. See Attachment C in QI-2338/FFS 23-22, CCS-2311.

SOURCE: Med-QUEST FFS Memo 20-03 (Mar. 16, 2020), HI Med-QUEST Medicaid Provider Manual: Federally Qualified Health Centers, Chapter 21 (21.2.1),pg. 2 , HI Dept of Human Services, Med-QUEST, Memo No. QI-2338/FFS 23-22, CCS-2311. (Accessed Feb. 2024).


ELIGIBLE SITES

All providers prescribing controlled substances must be located in the State of Hawai’i. Until December 31, 2024, Federally Qualified Health Center (FQHC) behavioral health providers may be located at a non-HRSA approved site or satellite within the United States and the United States’ territories. If the FQHC provider is prescribing controlled substances, they must be located in the State of Hawai’i.

Originating/Spoke Site – 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 nonmedical environments such as schoolbased health centers, university-based health centers, or the work location of the patient. The originating site includes a patient’s residence. The U.S. Department of Health and Human Services Office for Civil Rights expects that patients should not receive telehealth services in public or semi-public settings, absent patient consent or exigent circumstances.

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.

Non-FQHC Providers 

With one exception, the provider must be located within the United States and the United States’ territories is eligible to be a distant site for delivery and payment purposes. Exception: If prescribing controlled substances, the provider must be located in the State of Hawai’i.

FQHC Providers

With exceptions, the FQHC provider must be located at their contracted FQHC’s HRSA approved site or satellite.

Exceptions:

  • Until December 31, 2024, FQHC behavioral health providers may be located at a non-HRSA approved site or satellite within the United States and the United States’ territories.
  • If prescribing controlled substances, the provider must be located in the State of Hawai’i.

SOURCE:  HI Dept of Human Services, Med-QUEST, Memo No. QI-2338/FFS 23-22, CCS-2311. (Accessed Feb. 2024).

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 Feb. 2024).

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. 2024).

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

SOURCE: HI State Plan Amendment 16-0004. (Accessed Feb. 2024). 

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 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 (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 FFS Memo 20-03. (Accessed Feb. 2024).


GEOGRAPHIC LIMITS

All providers prescribing controlled substances must be located in the State of Hawai’i. Until December 31, 2024, Federally Qualified Health Center (FQHC) behavioral health providers may be located at a non-HRSA approved site or satellite within the United States and the United States’ territories. If the FQHC provider is prescribing controlled substances, they must be located in the State of Hawai’i.

Originating/Spoke Site – 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 nonmedical environments such as schoolbased health centers, university-based health centers, or the work location of the patient. The originating site includes a patient’s residence. The U.S. Department of Health and Human Services Office for Civil Rights expects that patients should not receive telehealth services in public or semi-public settings, absent patient consent or exigent circumstances.

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.

Non-FQHC Providers 

With one exception, the provider must be located within the United States and the United States’ territories is eligible to be a distant site for delivery and payment purposes. Exception: If prescribing controlled substances, the provider must be located in the State of Hawai’i.

FQHC Providers

With exceptions, the FQHC provider must be located at their contracted FQHC’s HRSA approved site or satellite.

Exceptions:

  • Until December 31, 2024, FQHC behavioral health providers may be located at a non-HRSA approved site or satellite within the United States and the United States’ territories.
  • If prescribing controlled substances, the provider must be located in the State of Hawai’i.

SOURCE:  HI Dept of Human Services, Med-QUEST, Memo No. QI-2338/FFS 23-22, CCS-2311. (Accessed Feb. 2024).

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. 2024). – 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 Feb. 2024). 

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. 108 (Jan. 2023) (Accessed Feb. 2024).


FACILITY/TRANSMISSION FEE

No reference found.

Last updated 02/12/2024

Miscellaneous

Health Plan Network Adequacy

Rules for classifying/counting providers:

Providers who offer telehealth-based services may be included under the following circumstances:

  • The key role of telehealth in the context of a provider network adequacy analysis is to close network gaps, as opposed to infection control or alternative options for communication, although these are key advantages in other contexts. Therefore, telehealth may be used in this report predominantly to close gaps or enhance the provider network.
  • Telehealth shall only be used to close network gaps for the provider types/types of services only for services that canbe rendered via telehealth.
  • Rules for classifying/counting providers also apply to telehealth providers with some key distinctions.
  • Telehealth may be used to close gaps on neighbor islands, or in rural areas on Oahu. Therefore, a given provider in an urban area on one island willing to provide telehealth services in an urban area on another island may be included twice even within a given provider group. However, if the provider is located on the same island, the provider may only be counted twice if they are located in an urban area, but additionally providing services via telehealth to members in a rural part of the island (and vice versa).
  • In all these instances, the statewide metrics must deduplicate providers within a single provider group.
  • For the purposes of this report, a given provider may only serve via telehealth on a single second island than the one on which they reside. In other words, a given provider may not be used to close network gaps on more than two islands for the purposes of this report even if they in theory can provide telehealth services statewide, to proxy a consideration for a given provider’s capacity. If the provider is located outside Hawaii, they may only serve a single island via telehealth.

If a provider is available to a member via telehealth, the member driving time to the provider shall be zero minutes, unless the member’s telehealth claims typically include an origination site that is non-residential. In these cases, the driving time shall be based on the distance from the member’s residence to the origination site.

“Aggregate Metrics – Physical Network” shall be based on all providers in the network, based on their physical location, and not including their capacity to provide telehealth-basedservices.

SOURCE: Department of Human Services, Med-QUEST Division Health Plan Manual (Oct 1, 2023), p. 170-171, 175, 178.  (Accessed Feb. 2024).

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

SOURCE: SB 2624 (2022 Session). (Accessed Feb. 2024).

Last updated 02/12/2024

Out of State Providers

All providers prescribing controlled substances must be located in the State of Hawai’i

SOURCE: Med-QUEST Memo QI-2338/FFS 23-22/CCS-2311.  (Accessed Feb. 2024).

Last updated 02/13/2024

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.  Recently passed legislation indicates that Hawaii Medicaid will cover some audio-only delivered services until December 31, 2025.

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.

Note that in August 2023 a public health emergency (PHE) was declared in Hawaii for the Maui fires.  In response to the PHE, Hawaii has enacted several waivers that impact the Medicaid population and utilize telehealth.  See Hawaii Med-Quest Memo QI-2335A for more details. These waivers will last until the end of the PHE, though Medicaid does have the ability to extend them.

Last updated 02/12/2024

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. 2024).

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

SOURCE: HI Med-Quest Division Memo QI-2338/FFS23-22/CCS-2311.  (Accessed Feb. 2024).


CONDITIONS

No Reference Found


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

No Reference Found

Last updated 02/12/2024

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. 2024).

Always use one of the following when billing:  95, GQ or GT).

SOURCE: HI Med-QUEST Memo No. QI-2338/FFS 23-22/CCS-2311 (Replaces QI-2306/QI-2138, QI-2007,FFS 23-04, FFS-21015, FFS20-03, CCS-2302) (Accessed Feb. 2024).

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 Feb. 2024).

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. 108 (Jan 2023) (Accessed Feb. 2024).


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. 2024).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 02/13/2024

Cross State Licensing

The board may issue a courtesy permit to an individual licensed to engage in the practice of veterinary medicine in another jurisdiction.  A courtesy permit issued pursuant to this section shall be valid for a period of thirty days and may be renewed once in any twelve-month period; provided that any courtesy permit issued and renewed pursuant to this section shall not exceed sixty total days in any twelve-month period; provided further that a courtesy permittee’s request for more than two courtesy permits within a two-year period shall constitute prima facie evidence that the courtesy permittee is engaged in the active practice of veterinary medicine in the State and a license issued under section 471-9 shall be required.

SOURCE: HI Revised Statutes Sec. 471-9.5(a) (Section effective July 1, 2024) (Accessed Feb. 2024).

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 Feb. 2024).

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 Feb. 2024).

Last updated 02/13/2024

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.  Except as provided through an interactive telecommunications system, standard telephone contacts, facsimile transmissions, or e-mail text, in combination or alone, do not constitute telehealth services.

SOURCE: HI Revised Statutes Ch. 453-1.3.  Amended by HB 907 (To be repealed December 31, 2025).  (Accessed Feb. 2024).

“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 Feb. 2024).

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 Feb. 2024).

Last updated 02/13/2024

Licensure Compacts

No Reference Found

Last updated 02/13/2024

Miscellaneous

Unless otherwise provided by law, reimbursement for behavioral health services provided through telehealth via an interactive telecommunications system shall be equivalent to reimbursement for the same services provided via ink-person contact between a health care provider and a patient; provided that reimbursement for two-way, real-time audio-only communication technology for purposes of diagnosis, evaluation, or treatment of a mental health disorder to a patient in the patient’s home shall be equivalent to eighty percent of the reimbursement for the same services provided via in-person contact between a health care provider and a patient. To be reimbursed for telehealth via an interactive telecommunications system using two-way, real-time audio-only communication technology in accordance with this subsection, the health care provider shall first conduct an in-person visit or a telehealth visit that is not audio-only, within six months prior to the initial audio-only visit, or within twelve months prior to any subsequent audio-only visit. The telehealth visit required prior to the initial or subsequent audio-only visit in this subsection shall not be provided using audio-only communication.

SOURCE:  HI Revised Statutes 453-1.3(h).  Amended by HB 907 (To be repealed December 31, 2025).(Accessed Feb. 2024).

Malpractice Insurance

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 Feb. 2024).

Network Adequacy

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 Feb. 2024).

Last updated 02/13/2024

Online Prescribing

Medicaid

All providers prescribing controlled substances must be located in the State of Hawai’i.

Until December 31, 2024, Federally Qualified Health Center (FQHC) behavioral health providers may be located at a non-HRSA approved site or satellite within the United States and the United States’ territories. If the FQHC provider is prescribing controlled substances, they must be located in the State of Hawai’i.

SOURCE:  HI Med-QUEST Memo QI-2338/FFS 23-22/CCS-2311. (Accessed Feb. 2024).

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 Feb. 2024)

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 in-person 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.  Amended by HB 907 (To be repealed December 31, 2025). (Accessed Feb. 2024).

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 Feb. 2024).

Last updated 02/13/2024

Professional Boards Standards

No Reference Found

Last updated 02/13/2024

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 Feb. 2024).

Last updated 02/13/2024

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.

If a provider does not have the capacity to provide in-person services, they must inform the patient that: the patient has the 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 MCO can assist with finding a provider who can provide in-person services.

With exceptions, the FQHC provider must be located at their contracted FQHC’s HRSA approved site or satellite.

Exceptions:

  • Until December 31, 2024, FQHC behavioral health providers may be located at a non-HRSA approved site or satellite within the United States and the United States’ territories.
  • If prescribing controlled substances, the provider must be located in the State of Hawai’i.

SOURCE: Med-QUEST Memo QI-2338/FFS 23-22/CCS-2311.  (Accessed Feb. 2024).

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. 2024).

Last updated 02/13/2024

Eligible Originating Site

Until December 31, 2024, Federally Qualified Health Center (FQHC) behavioral health providers may be located at a non-HRSA approved site or satellite within the United States and the United States’ territories. If the FQHC provider is prescribing controlled substances, they must be located in the State of Hawai’i.

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 nonmedical environments such as schoolbased health centers, university-based health centers, or the work location of the patient. The originating site includes a patient’s residence. The U.S. Department of Health and Human Services Office for Civil Rights expects that patients should not receive telehealth services in public or semi-public settings, absent patient consent or exigent circumstances.

SOURCE: Med-QUEST Memo QI-2338/FFS 23-22/CCS-2311.  (Accessed Feb. 2024).

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 Feb. 2024).

Last updated 02/13/2024

Facility Fee

No reference found.

Last updated 02/13/2024

Home Eligible

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 nonmedical environments such as schoolbased health centers, university-based health centers, or the work location of the patient. The originating site includes a patient’s residence. The U.S. Department of Health and Human Services Office for Civil Rights expects that patients should not receive telehealth services in public or semi-public settings, absent patient consent or exigent circumstances.

SOURCE: Med-QUEST Memo QI-2338/FFS- 23-22/CCS-2311. (Accessed Feb. 2024).

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 Feb. 2024).

Last updated 02/13/2024

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 Feb. 2024).

Until December 31, 2024, FQHC behavioral health providers may be located at a non-HRSA approved site or satellite within the United States and the United States’ territories.

  • If the FQHC behavioral health provider does not have the capacity to provide in-person services, they must inform the patient that: the patient has the 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 MCO can assist with finding a provider who can provide in-person services.
  • If prescribing controlled substances, the provider must be located in the State of Hawai’i.

FQHCs must ensure the provision of relevant wrap-around non-billable services. Efforts shall be made to ensure that patients receive relevant wrap-around non-billable 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 on 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.

See Memo QI-2338/FFS 23-22/CCS-2311 for codes.

SOURCE: HI Med-QUEST Memo QI-2338/FFS 23-22/CCS-2311.  (Accessed Feb. 2024).


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 Feb. 2024).


Remote Patient Monitoring

No reference for FQHCs found.


Audio-Only

In the latest Med-QUEST memo, FQHCs are mentioned in the Audio-Only policy section:

FQHCs must ensure the provision of relevant wrap-around non-billable services. Efforts shall be made to ensure that patients receive relevant wrap-around non-billable 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 on 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.

See Memo QI-2338/FFS 23-22/CCS-2311 for codes.

SOURCE: HI Med-QUEST Memo QI-2338/FFS 23-22/CCS-2311.  (Accessed Feb. 2024).

Last updated 02/13/2024

Patient-Provider Relationship

No reference found.

Last updated 02/13/2024

PPS Rate

The criteria for sites eligible to receive PPS payment is the same for services furnished in-person and by telehealth modality. Services provided through telehealth which are eligible for PPS payment must be for services that are approved within the scope of the specific FQHC’s PPS reimbursement rate. The services must be provided at the FQHC’s HRSA approved site or satellite.

With exceptions, the FQHC provider must be located at their contracted FQHC’s HRSA approved site or satellite. Exceptions:

Until December 31, 2024, FQHC behavioral health providers may be located at a non-HRSA approved site or satellite within the United States and the United States’ territories.

  • If the FQHC behavioral health provider does not have the capacity to provide in-person services, they must inform the patient that: the patient has the 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 MCO can assist with finding a provider who can provide in-person services.
  • If prescribing controlled substances, the provider must be located in the State of Hawai’i.

FQHCs must ensure the provision of relevant wrap-around non-billable services. Efforts shall be made to ensure that patients receive relevant wrap-around non-billable 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 on 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.

SOURCE: Med-QUEST Memo QI-2338/FFS 23-22/CCS-2311.  (Accessed Feb. 2024).

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. 108 (Jan. 2023)., HI Department of Human Services.  Med-QUEST Division.  Attachment A., HI MedQUEST Division, FFS 19-01 Reimbursement for Procedures Related to FQHC Teledentistry Services. (Accessed Feb. 2024).

 

Last updated 02/13/2024

Same Day Encounters

FQHCs must ensure the provision of relevant wrap-around non-billable services. Efforts shall be made to ensure that patients receive relevant wrap-around non-billable 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 on 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.

See Memo QI-2338/FFS 23-22/CCS-2311 for codes.

SOURCE: HI Med-QUEST Memo QI-2338/FFS 23-22/CCS-2311.  (Accessed Feb. 2024).

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 Feb. 2024).