Last updated 11/20/2023
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). As amended by HB907 HD2 SD2 (which has a repeal date of December 31, 2025) (Accessed Nov. 2023).
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 Nov. 2023).
Audio-visual real-time telehealth – Multimedia communications equipment that includes, at a minimum, audio and video equipment permitting twoway, 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 Nov. 2023).
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 Nov. 2023).
Last updated 11/22/2023
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 Nov. 2023).
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 Nov. 2023).
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 Nov. 2023).
No Reimbursement for:
- Telephone
- Facsimile machine
- Electronic mail
SOURCE: Code of HI Rules 17-1737.-51.1(c) p. 69 (Accessed Jun. 2023). (NOTE: Temporarily suspended by HI Dept of Human Services, Med-QUEST, Memo No. QIk-2338/FFS 23-22, CCS-2311.) (Accessed Nov. 2023).
Conditionsfor 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 Nov. 2023).
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 Nov. 2023).
Last updated 11/20/2023
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.
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.
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 § 346-59.1 (a & b). Amended by HB 907 HD2 SD 2 (Repeal date of December 31, 2025). (Accessed Nov. 2023).
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 Nov. 2023). (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 Nov. 2023).
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 Nov. 2023).
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 Nov. 2023).
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 Nov. 2023).
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 Nov. 2023).
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 Nov. 2023).
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 Nov. 2023).
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 Nov. 2023).
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 Nov. 2023).
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 Nov. 2023).
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 Nov. 2023).
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 Nov. 2023).
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 Nov. 2023).
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 Nov. 2023).
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 No. 2023).
Approved state plan amendment authorizes HI Medicaid to remove geographic and originating site requirements.
SOURCE: HI State Plan Amendment 16-0004. (Accessed Nov. 2023).
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 Nov. 2023).
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 Nov. 2023).
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 Jan. 2023). – 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 Nov. 2023).
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 Nov. 2023).
FACILITY/TRANSMISSION FEE
No reference found.