HAWAII

MASTER MEDICAID TELEHEALTH LAWS
WITH THE HELP FROM GD

Summary

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.

 

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 Mar. 2019).

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 Mar. 2019)

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.” Z/P>

Source: Code of HI Rules 17-1737-51.1(c). (Accessed Mar. 2019).
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 Mar. 2019).
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 Mar. 2019).

In statute, these locations are also included
• A patient’s home;
• Other non-medical environments.

Source: HI Revised Statutes § 346-59.1. (Accessed Mar. 2019).

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

Source: HI State Plan Amendment 16-0004 & Med-QUEST Memo 17-01A. (Accessed Mar. 2019).
Geographic Limits

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 Mar. 2019)

 

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 Mar. 2019).

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 Mar. 2019).

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 Mar. 2019).
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 Mar.2019).
Email / Phone / Fax

No Reimbursement for: • Telephone • Facsimile machine • Electronic mail

 

Source: Code of HI Rules 17-1737.-51.1(c) (Accessed Mar. 2019).
Miscellaneous

Hawaii and Alaska are the only two states with Medicare coverage of store-and-forward services.

 

Source: 42 USC 1395m(m)(1).

Private Payer Laws

Requirements

Insurance 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 servicesd.

 

Source: HI Revised Statutes § 431:10A-116.3. (Accessed Mar. 2019).
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 § 431:10A-116.3(g). (Accessed Mar. 2019).

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 Mar. 2019).

Parity

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). (Accessed Mar. 2019).
Service Parity

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). (Accessed Mar. 2019).

Professional Regulation /
Health & Safety

Definitions

“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. (Accessed Mar. 2019).
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 Mar. 2019).
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;
• Ensure the availability of appropriate follow-up care

 

Source: HI Revised Statutes § 329-1. (Accessed Mar. 2019).

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.
Issuing a prescription based solely on an online questionnaire is prohibited.
A physician-patient relationship may be established via telehealth if the patient is referred to the telehealth provider by another health care provider who has conducted an in-person consultation and has provided all pertinent patient information to the telehealth provider.
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 Mar. 2019).

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.
Issuing a prescription based solely on an online questionnaire is prohibited.
A physician-patient relationship may be established via telehealth if the patient is referred to the telehealth provider by another health care provider who has conducted an in-person consultation and has provided all pertinent patient information to the telehealth provider.
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 Mar. 2019).

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 (HB 2729 – 2018). (Accessed Mar. 2019).

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

Source: HI Revised Statutes § 453-2(b(7)). (Accessed: Mar. 2019).
Cross-State Licensing

A licensed out-of-state practitioner of medicine or surgery can utilize telemedicine 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 Mar. 2019).

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

Source: HI Revised Statutes § 453-2(b(7)). (Accessed: Mar. 2019).

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