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Telehealth laws and licensure requirements for the State of Hawaiʻi
Hawaiʻi has one of the most progressive telehealth laws in the nation. Hawaiʻi Revised Statute Act 226 (16): Relating to Telehealth was signed into law by Governor David Ige in 2016. HRS Act 226(16) applies to Medicaid and private insurers.
Some key components to this law include:
However, currently the definition of telehealth in Act 266 (16) does not include audio-only or telephonic delivery of care.
This is a comprehensive summary of Act 226 (16) (PDF):
Hawaiʻi Revised Statute Act 226 (16): Relating to Telehealth was signed into law by Governor David Ige in 2016. Read the full text of the law.
See telehealth legislation and regulation in Hawaiʻi for the current legislative session.
CCHCP tracks Hawaiʻi’s telehealth policies by: COVID-19, Medicaid, Private Payer, and Professional Requirements.
The temporary PHE telehealth waivers in most part would require a change in law in order to become permanent. The Consolidated Appropriations Act (CAA) of 2021 included provisions for permanent changes for tele-behavioral mental health. The CAA was enacted in 2020 with $908 Billion of relief funds and $1.4 Trillion for fiscal year 2021. It will come into effect at the end of the Federal PHE. Here is a summary of the telehealth components of CAA 2021:
The CAA 2021 also established a new Rural Emergency Hospital (REH) designation.
CCHCP tracks Medicare telehealth policies by: definitions, live video, store-and-forward, remote patient monitoring, email, phone & fax, consent requirements, out of state providers, and miscellaneous.
Read a summary of the major impacts on federal telehealth policy on Medicare in the 2022 CAA.
There have been many temporary policy waivers at the state and federal level during the PHE to assist in wider access to care via telehealth.
There were many policy waivers for Medicare that temporarily lifted restrictions such as the patient and provide location, provider type, services and delivery mechanism including lack of enforcement by the Office for Civil Rights for use of non-HIPAA guideline compliant platforms. With the exception of Behavioral Mental Health, most of these waivers remain temporary until the end of the PHE. It remains to be determined what policies will become permanent.
Fortunately, Act 226 (16) enacted prior to the PHE was less prohibitive than federal policies. The Act enabled patients to be located at home with no geographic restrictions, no limits on provider and service type and modality. A major issue during the pandemic has been digital equity and literacy issues, meaning that patients may not have adequate access to broadband, technologies or know-how to use video conferencing for telehealth visits. Thus, the need for audio-only (standard telephone contacts) telehealth consultations increased during the pandemic. Act 226(16) does not include audio-only as a means of providing telehealth services. Governor Ige’s Emergency Proclamations (EP) have suspended the sections of law that did not include audio-only as a means of telehealth. Specifically the EPs suspended Sections 346-59.1, 431:10A-116.3, 432:1-601.5, and 432D-23.5, HRS, coverage for telehealth, to the extent that the definitions of “telehealth” in each section shall exclude the use of standard telephone contacts.
The 21st proclamation related to the COVID-19 emergency (PDF) also waived the license requirement for marriage and family therapists licensed in their state, but not licensed in Hawaiʻi, who have pre-established relationships with a patient or client currently residing in the State of Hawaiʻi, to engage in telehealth practices with these patients. This shall not authorize out-of-state mental health professionals who are not licensed in Hawaiʻi to solicit or establish new relationships with clients or patients located in Hawaiʻi.
Billing for telehealth services can be complex and confusing due to the ongoing guideline and policy changes during the COVID-19 pandemic. PBTRC has developed a guide to provide guidance on billing, documentation requirements, cost share for various payers, and software solutions.
The Center for Medicare and Medicaid Services (CMS) released their final Physician Fee Schedule (PFS) for CY 2022. The PFS are the policies that the agency will be implementing for Medicare beginning on January 1, 2022, unless otherwise noted.
A comprehensive guidance on billing and reimbursement, such as specific codes, documentation requirements and specific payer requirements.
The Pacific Basin Telehealth Resource Center (PBTRC) is an affiliation of the 14 Telehealth Resource Centers funded individually through cooperative agreements from the Health Resources & Services Administration, Office for the Advancement of Telehealth. This website was made possible by grant GA5RH37468 and 1 U1UTH42529‐01‐00 from the Office for the Advancement of Telehealth/Health Resources and Services Administration/HRSA.