HB2558

SECTION 1. The legislature finds that Hawaii has been the leader in telehealth adoption with the passing of Act 226, session laws of Hawaii 2016, which included provisions for telehealth designed to enhance health care access and outcomes. This provision brought Hawaii's telehealth landscape into alignment with federal standards regarding- security, privacy, liability, coverage, requirements, and Medicaid reimbursement. Notwithstanding, the need for further telehealth regulation is underscored by the State's current physician shortage which stands at five hundred and forty-three equivalent physicians. This issue is exacerbated on the neighbor islands which carry their own geographic limitations and barriers to care.

Despite the State's recent adoption of the Interstate Medical Licensure Compact, the scope of telehealth services is still limited. Stringent medical licensing requirements dramatically limit the mobility of care for certain residents to Hawaii-licensed providers alone. Additionally, the burdensome regulatory environment precludes situations where residents battling cancer and other serious medical conditions gain access to services critical to the next step of their treatment plan. Furthermore, a 2022 study reported that Medicare beneficiaries used out-of-state telemedicine at higher rates for specialty care, especially cancer care, which amounted to 9.8 per cent of all out-of-state telemedicine visits, followed by hematology and neurological diseases. The lack of telehealth provisions allowing consultations and treatment from out-of-state providers forces cancer patients and those needing specialty care to foot all travel costs to the continental mainland, sometimes ranging in the tens of thousands of dollars.

According to a 2024 study conducted by the Pacific Basin Telehealth Resource Center at the University of Hawaii, the adoptions of telehealth in Hawaii increased from only two per cent in 2014 to 20.5 per cent in 2019. This confirms that in the wake of the great demand for telehealth services in the State, more reform is needed to increase its use and effectiveness. Telemedicine intervention has proven comparable to or better than in-person control groups. This ideal scenario was once adopted with Governor Ige's emergency proclamation in 2020, which expanded telehealth services and relaxed regulatory barriers for out-of-state physicians to practice safely in the State. This provision sunset only six months later.

Therefore, the purpose of this Act is to expand telehealth services to residents by providing temporary licensure to providers who perform certain medical treatments out-of-state via telehealth.

SECTION 2. Section 453-2, Hawaii Revised Statutes, is amended to read as follows:

"§453-2 License required; exceptions. (a) Except as otherwise provided by law, no person shall practice medicine or surgery in the State, either gratuitously or for pay, or offer to practice medicine or surgery in the State, or advertise or announce one's self, either publicly or privately, as prepared or qualified to practice medicine or surgery in the State, or append the letters "Dr.", "M.D.", or "D.O." to one's name with the intent to imply that the person is a practitioner of medicine or surgery, without having a valid unrevoked license or a limited and temporary license obtained from the Hawaii medical board.

(b) Nothing herein shall:

(1) Apply to so-called Christian Scientists; provided that the Christian Scientists practice the religious tenets of their church without pretending a knowledge of medicine or surgery;

(2) Prohibit service in the case of emergency or the domestic administration of family remedies;

(3) Apply to any commissioned medical officer in the United States armed forces or public health service engaged in the discharge of one's official duty, including a commissioned medical officer employed by the United States Department of Defense, while providing direct telehealth support or services to neighbor island beneficiaries within a Hawaii National Guard armory on the island of Kauai, Hawaii, Molokai, or Maui; provided that the commissioned medical officer employed by the United States Department of Defense is credentialed by Tripler Army Medical Center;

(4) Apply to any practitioner of medicine and surgery from another state when in actual consultation, including in-person, mail, electronic, telephonic, fiber-optic, or other telehealth consultation with a licensed physician or osteopathic physician of this State, if the physician or osteopathic physician from another state at the time of consultation is licensed to practice in the state in which the physician or osteopathic physician resides; provided that:

(A) The physician or osteopathic physician from another state shall not open an office, or appoint a place to meet patients in this State, or receive calls within the limits of the State for the provision of care for a patient who is located in this State;

(B) The licensed physician or osteopathic physician of this State retains control and remains responsible for the provision of care for the patient who is located in this State; and

(5) Prohibit services rendered by any person licensed under part II of this chapter to provide emergency medical services, or any physician assistant, when the services are rendered under the direction and control of a physician or osteopathic physician licensed in this State except for final refraction resulting in a prescription for spectacles, contact lenses, or visual training as performed by an oculist or optometrist duly licensed by the State. The direction and control shall not be construed in every case to require the personal presence of the supervising and controlling physician or osteopathic physician. Any physician or osteopathic physician who employs or directs a person licensed under part II of this chapter to provide emergency medical services, or a physician assistant, shall retain full professional and personal responsibility for any act that constitutes the practice of medicine when performed by the licensed person or physician assistant;

(6) Prohibit automated external defibrillation by:

(A) Any first responder personnel certified by the department of health to provide automated external defibrillation when it is rendered under the medical oversight of a physician or osteopathic physician licensed in this State; or

(B) Any person acting in accordance with section 663-1.5(e); or

(7) Prohibit a radiologist duly licensed to practice medicine and provide radiology services in another state from using telehealth while located in this State to provide radiology services to a patient who is located in the state in which the radiologist is licensed. For the purposes of this paragraph:

"Distant site" means the location of the radiologist 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 radiologist through telehealth, including but not limited to a radiologist's or health care provider's office, hospital, health care facility, a patient's home, and other non-medical environments such as school-based health centers, university-based health centers, or the work location of a patient.

"Radiologist" means a doctor of medicine or a doctor of osteopathy certified in radiology by the American Board of Radiology or the American Board of Osteopathy.

"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.

(8) Prohibit a physician licensed to practice medicine in another state, and in good standing, from establishing a physician-patient relationship via telehealth and providing telemedicine services to a patient who is located in the state, provided that:

(A) The telemedicine service is a service the individual is licensed to perform under the nonresident health care license of the state, district, or territory that issued the nonresident health care license;

(B) The telemedicine service is not available in the state due to a physician shortage or lack of reasonable access;

(D) Performing the telemedicine service would not otherwise violate state law.

For the purposes of this paragraph:

"Nonresident health care license" means a health care license issued by another state, district, or territory of the United States.

"Telemedicine service" means the same as "telehealth" defined by section 453-1.3, including:

(1) Clinical care;

(2) Health education;

(3) Health administration;

(4) Facilitation of self-managed care and caregiver support; and

(5) Remote patient monitoring occurring incidentally to general supervision.

(c) Nothing in this chapter shall prohibit healing practices by traditional Hawaiian healers engaged in traditional Native Hawaiian healing practices, both as recognized and certified as such by any kupuna council convened by Papa Ola Lokahi. No person or organization involved with the selection of kupuna council members, the convening of a kupuna council, or the certification process of healers under this subsection shall be sued or held liable for any cause of action that may arise out of their participation in the selection, convening, or certification process. Nothing in this chapter shall limit, alter, or otherwise adversely affect any rights of practice of traditional Native Hawaiian healing pursuant to the Constitution of the State of Hawaii."

SECTION 3. Section 453-1.3, Hawaii Revised Statutes, is amended to read as follows:

"§453-1.3 Practice of telehealth. (a) Subject to section 453-2(b), nothing in this section shall preclude any physician acting within the scope of the physician's license to practice from practicing telehealth as defined in this section.

(b) Telehealth services shall include a documented patient evaluation, including history and a discussion of physical symptoms adequate to establish a diagnosis and to identify underlying conditions or contraindications to the treatment recommended or provided.

(c) [Repeal and reenactment on December 31, 2027. L 2025, c 217, §1.] Treatment recommendations made via telehealth, including issuing a prescription via electronic means, shall be held to the same standards of appropriate practice as those in traditional physician-patient settings that do not include an in-person visit but in which prescribing is appropriate, including on-call telephone encounters and encounters for which a follow-up visit is arranged. Issuing a prescription based solely on an online questionnaire is not treatment for the purposes of this section and does not constitute an acceptable standard of care. For the purposes of prescribing opiates, a physician-patient relationship shall only be established after an in-person consultation between the prescribing physician and the patient; provided that a patient who has been seen in person by a health care provider in the same medical group as the prescribing provider authorized pursuant to section 329-33, may be prescribed an opiate prescription for a three-day supply or less via telehealth.

(d) All medical reports resulting from telehealth services are part of a patient's health record and shall be made available to the patient. Patient medical records shall be maintained in compliance with all applicable state and federal requirements including privacy requirements.

(e) A physician-patient relationship may be established via a telehealth interaction; provided that the physician has a license to practice medicine in the State[.], except as provided in 453-2(b)(8).

(f) Once a physician-patient relationship is established, a patient or physician licensed in this State may use telehealth for any authorized purpose, including consultation with a medical provider licensed in another state, authorized by this section or as otherwise provided by law.

(g) The physician-patient relationship prerequisite under this section shall not apply to telehealth consultations for emergency department services.

(h) [Repeal and reenactment on December 31, 2027. L 2025, c 217, §1.] Unless otherwise provided by law, reimbursement for behavioral health 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.

(i) Services provided by telehealth pursuant to this chapter shall be consistent with all federal and state privacy, security, and confidentiality laws.

(j) [Repeal and reenactment on December 31, 2027. L 2025, c 217, §1.] For the purposes of this section:

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

"Interactive telecommunications system" has the same meaning as the term is defined in title 42 Code of Federal Regulations section 410.78(a).

"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 physician through telehealth, including but not limited to a physician's office, hospital, health care facility, a patient's home, and other non-medical environments such as school-based health centers, university-based health centers, or the work location of a patient.

"Telehealth" means the use of telecommunications 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 purposes of: delivering enhanced health care services and information while a patient is at an originating site and the physician is at a distant site; establishing a physician-patient relationship; evaluating a patient; or treating a patient. 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."

SECTION 4. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 5. This Act shall take effect upon its approval.

INTRODUCED BY:	_____________________________

HOUSE OF REPRESENTATIVES	H.B. NO.	2558
THIRTY-THIRD LEGISLATURE, 2026
STATE OF HAWAII