SB1038 SD2

SECTION 1. The legislature 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 legislature further finds that medical professionals have used standard telephone contacts for decades to provide necessary access to primary care when a patient is homebound or otherwise unable to access face-to-face care. The Centers for Medicare and Medicaid Services continues to authorize coverage of audio-only (telephone) services used in the treatment of mental health and substance abuse in certain circumstances, allowing federally qualified health centers and rural health clinics to use telehealth to care for patients in patients' homes. Consistent provisions for managed care plans and commercial health care plans are warranted to ensure pay parity for telephonic and telehealth services.

Accordingly, the purpose of this Act is to temporarily allow for the reimbursement for services provided through an interactive telecommunication system and two-way, real-time audio-only communications for telehealth purposes, consistent with the 2023 Medicare Physician Fee Schedule and impose certain reimbursement limits and conditions for private insurers.

SECTION 2. Section 346-59.1, Hawaii Revised Statutes, is amended as follows:

1. By amending subsection (b) to read:

"(b) Reimbursement for services provided through telehealth via an interactive telecommunications system shall be equivalent to reimbursement for the same services provided via face-to-face contact between a health care provider and a patient. 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."

2. By amending subsection (g) to read:

"(g) For the purposes of this section:

"Distant site" means the location of the health care provider delivering services through telehealth at the time the services are provided.

"Health care provider" means a provider of services, as defined in title 42 United States Code section 1395x(u), a provider of medical and other health services, as defined in title 42 United States Code section 1395x(s), other practitioners licensed by the State and working within their scope of practice, and any other person or organization who furnishes, bills, or is paid for health care in the normal course of business, including but not limited to primary care providers, mental health providers, oral health providers, physicians and osteopathic physicians licensed under chapter 453, advanced practice registered nurses licensed under chapter 457, psychologists licensed under chapter 465, and dentists licensed under chapter 448.

"Interactive telecommunications system" has the same meaning as the term is defined in title 42 Code of Federal Regulations section 410.78(a), as amended; provided that, as used in the definition of "interactive telecommunications system", "two-way, real-time audio-only communication" is subject to the same meaning and conditions as in title 42 Code of Federal Regulations section 410.78, as amended.

"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~~] nonmedical environments such as school-based health centers, university-based health centers, or the work location of a patient.

"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~~] Except as otherwise provided in this section, standard telephone contacts, facsimile transmissions, or e-mail text, in combination or [~~by itself, does~~] alone, do not constitute [a] telehealth [~~service for the purposes of this section.~~] services."

SECTION 3. Section 431:10A-116.3, Hawaii Revised Statutes, is amended as follows:

1. By amending subsection (c) to read:

"(c) Reimbursement for services provided through telehealth via an interactive telecommunications system shall be equivalent to reimbursement for the same services provided via face-to-face 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 their home shall be equivalent to eighty per cent of the reimbursement for the same services provided via face-to-face contact between a health care provider and a patient; provided further that the health care provider has conducted an in-person or telehealth visit with the patient no longer than six months prior to the audio-only service and at least twelve months prior to any subsequent audio-only visit. 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."

2. By amending subsection (g) to read:

"(g) For the purposes of this section:

"Distant site" means the location of the health care provider delivering services through telehealth at the time the services are provided.

"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, health care facility, a patient's home, and other nonmedical environments such as school-based health centers, university-based health centers, or the work location of a patient.

"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~~] Except as otherwise provided for in this section, standard telephone contacts, facsimile transmissions, or e-mail text, in combination or [~~by itself, does~~] alone, do not constitute [a] telehealth [~~service for the purposes of this chapter.~~] services."

SECTION 4. Section 432:1-601.5, Hawaii Revised Statutes, is amended as follows:

1. By amending subsection (c) to read:

2. By amending subsection (g) to read:

"(g) For the purposes of this section:

"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, health care facility, a patient's home, and other nonmedical environments such as school-based health centers, university-based health centers, or the work location of a patient.

SECTION 5. Section 432D-23.5, Hawaii Revised Statutes, is amended as follows:

1. By amending subsection (c) to read:

2. By amending subsection (g) to read:

"(g) For the purposes of this section:

"Distant site" means the location of the health care provider delivering services through telehealth at the time the services are provided.

"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, health care facility, a patient's home, and other nonmedical environments such as school-based health centers, university-based health centers, or the work location of a patient.

SECTION 6. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 7. This Act shall take effect on December 31, 2050; provided that on December 31, 2025, this Act shall be repealed and sections 346-59.1, 431:10A-116.3, 432:1-601.5, and 432D-23.5, Hawaii Revised Statutes, shall be reenacted in the form in which they read on the day prior to the effective date of this Act.

THE SENATE	S.B. NO.	1038
THIRTY-SECOND LEGISLATURE, 2023		S.D. 2
STATE OF HAWAII