STAND. COM. REP. NO. 573

Honolulu, Hawaii

RE: S.B. No. 1038

S.D. 1

Honorable Ronald D. Kouchi

President of the Senate

Thirty-Second State Legislature

Regular Session of 2023

State of Hawaii

Sir:

Your Committee on Health and Human Services, to which was referred S.B. No. 1038 entitled:

"A BILL FOR AN ACT RELATING TO TELEHEALTH,"

begs leave to report as follows:

The purpose and intent of this measure is to:

(1) Clarify reimbursement for telehealth services via an

"interactive telecommunications system";

(2) Define "interactive telecommunications system"; and

(3) Clarify that interactive telecommunications may include audio-only communication for services related to diagnosis, evaluation, or treatment of a mental health disorder, under certain circumstances.

Your Committee received testimony in support of this measure from the University of Hawai‘i System; Hawaiian Islands Association for Marriage and Family Therapy; Hawai‘i Primary Care Association; National Association of Social Workers - Hawai‘i; Hawai‘i Psychological Association; AARP Hawai‘i; Elemental Guidance, LLC; Hawaii Substance Abuse Coalition; Hawaii Medical Association; Hawai‘i Parkinson Association; American Cancer Society Cancer Action Network; Hawaii Disability Rights Center; Hawai‘i Pacific Health; Alzheimer's Association; Kapolei Chamber of Commerce; AlohaCare; and twenty-seven individuals. Your Committee received testimony in opposition to this measure from the Hawaii Counseling and Education Center, Inc. Your Committee received comments on this measure from the Department of Human Services, Department of Commerce and Consumer Affairs, and Hawaii Medical Service Association.

Your Committee finds that many residents in underserved and low-income communities where cellular data plans and broadband are inaccessible are unable to utilize telehealth services that require internet connectivity. The Centers for Medicare and Medicaid Services authorizes coverage of audio-only services used in the treatment of mental health and substance abuse, under certain circumstances, allowing federally qualified health centers and rural health clinics to use telehealth to care for patients in patients' homes. This measure authorizes the use of standard telephone contacts for telehealth purposes in certain circumstances to ensure coverage parity across managed care plans and commercial health care plans.

Your Committee notes the concerns raised by Hawaii Medical Service Association that care provided via audio-only interactive telecommunications has not been proven to be as effective as care provided in person or via telehealth. Therefore, reimbursement for audio-only visits should not equal that of face-to-face visits. Further, behavioral health providers obtain valuable insights through face-to-face interactions. Requirements similar to those of the Centers for Medicare and Medicaid Services, which specify periodic in-person visits, are necessary. Additionally, the Centers for Medicare and Medicaid Services' temporary telehealth provisions are scheduled to end on December 31, 2024. A corresponding sunset date to this measure would allow time to study the efficacy and value of audio-only visits for behavioral health. Therefore, should your Committee on Commerce and Consumer Protection choose to deliberate on this measure, your Committee respectfully requests that it considers examining these concerns.

Accordingly, your Committee has amended this measure by:

(1) Clarifying that the definition of "interactive telecommunications system" is consistent with that used by the Centers for Medicare and Medicaid Services, as the term is defined in title 42 Code of Federal Regulations section 410.78(a), as amended, relating to telehealth services; and

(2) Inserting an effective date of December 31, 2050, to encourage further discussion.

As affirmed by the record of votes of the members of your Committee on Health and Human Services that is attached to this report, your Committee is in accord with the intent and purpose of S.B. No. 1038, as amended herein, and recommends that it pass Second Reading in the form attached hereto as S.B. No. 1038, S.D. 1, and be referred to your Committee on Commerce and Consumer Protection.

Respectfully submitted on behalf of the members of the Committee on Health and Human Services,

________________________________

JOY A. SAN BUENAVENTURA, Chair