HB2558 HD2

SECTION 1. The legislature finds that Hawaii has been the leader in telehealth adoption with the passage 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. However, 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 United States, 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 adopted once in 2020 via a governor's emergency proclamation, which expanded telehealth services and relaxed regulatory barriers for out-of-state physicians to practice safely in the State. However, this provision sunset only six months later.

Therefore, the purpose of this Act is to expand access to telehealth services by authorizing residents to establish a physician-patient relationship with out-of-state providers via telehealth under certain circumstances.

SECTION 2. Section 453-1.3, Hawaii Revised Statutes, is amended by amending subsection (e) to read as follows:

"(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[.] or is an out-of-state physician who is authorized to provide telehealth services pursuant to section 453-2(b)(8)."

SECTION 3. Section 453-2, Hawaii Revised Statutes, is amended by amending subsection (b) to read as follows:

"(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~~] electronic mail texts, in combination or by themselves, do not constitute a telehealth service for the purposes of this paragraph[.]; or

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

(A) The out-of-state physician was referred by a physician licensed under this chapter;

(B) The telehealth service is a service the out-of-state physician is licensed to perform by the state, district, or territory in which the out-of-state physician resides;

(D) At the time the telehealth service is performed, the patient is located in this State;

(E) If the out-of-state physician is not a holder of an expedited license under the Interstate Medical Licensure Compact, the orders of the out-of-state physician for prescriptions and procedures to be dispensed or performed in the State shall be approved by a physician licensed under this chapter;

(F) The out-of-state physician shall, no later than three days before the initial consultation with a patient located within the State, report to the Hawaii medical board all disciplinary actions taken against the out-of-state physician in other jurisdictions;

(G) The out-of-state physician performing the telehealth services shall be considered to be under the jurisdiction of the Hawaii medical board and may be subject to appropriate disciplinary actions for acts prohibited under section 453-8; and

(H) The exemption under this paragraph shall only apply to the initial consultation that establishes the physician-patient relationship between the out-of-state physician and patient.

For purposes of this paragraph, "telehealth" has the same meaning as in section 453-1.5."

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

SECTION 5. This Act shall take effect on July 1, 3000.

HOUSE OF REPRESENTATIVES	H.B. NO.	2558
THIRTY-THIRD LEGISLATURE, 2026		H.D. 2
STATE OF HAWAII