| 1 | 1 | | HOUSE OF REPRESENTATIVES H.B. NO. 1708 THIRTY-FIRST LEGISLATURE, 2022 STATE OF HAWAII A BILL FOR AN ACT relating to access to behavioral health services. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII: |
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| 3 | 3 | | HOUSE OF REPRESENTATIVES H.B. NO. 1708 |
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| 4 | 4 | | THIRTY-FIRST LEGISLATURE, 2022 |
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| 5 | 5 | | STATE OF HAWAII |
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| 6 | 6 | | |
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| 7 | 7 | | HOUSE OF REPRESENTATIVES |
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| 9 | 9 | | H.B. NO. |
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| 11 | 11 | | 1708 |
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| 13 | 13 | | THIRTY-FIRST LEGISLATURE, 2022 |
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| 17 | 17 | | STATE OF HAWAII |
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| 31 | 31 | | A BILL FOR AN ACT |
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| 37 | 37 | | relating to access to behavioral health services. |
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| 43 | 43 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII: |
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| 47 | 47 | | SECTION 1. The legislature finds that emergency governmental proclamations to restrict and manage in-person gatherings and meetings during the coronavirus disease 2019 (COVID-19) pandemic have suspended certain laws that exclude the use of standard telephone contacts from the definition of "telehealth" to enable health care providers and patients to minimize in-person meetings while also ensure access to care. The availability of insurance reimbursement for telehealth provided through standard telephone contacts has greatly increased access to care for vulnerable populations, including the elderly, low-income, medically- and socially-complex patients, and those in rural areas who do not have the broadband capabilities, electronic equipment, financial means, transportation options, or technological proficiency to operate sophisticated digital video conferencing software. Allowing standard telephone contacts to qualify as "telehealth" also avoids problems with devices, internet, sufficient bandwidth, power and battery charging capabilities, and digital literacy. The legislature further finds that the prolonged nature of the public health emergency created by COVID-19 and its attendant personal, familial, work, social, and economic disruptions have created chronic and unprecedented emotional distress, anxiety, and mental conditions for all of Hawaii's communities. The demand for mental health services has never been so high. Research has found standard telephone contacts to be an effective, viable means for providing timely mental health services to patients. Talk therapy and other audio-only treatment modalities do not require physical examinations or medical prescriptions. As recently noted by the Hawaii department of human services in testimony submitted in support of a similar measure (which was broadly and enthusiastically supported by the medical community with the exception of the health insurance companies), "telephone calls have been shown to be clinically effective for some services such as behavioral health." Moreover, standard telephone contacts for telehealth purposes is endorsed nationally by the American Psychological Association. Therefore, the purpose of this Act is to allow for the use and reimbursement of standard telephone contacts for telehealth purposes by mental health professionals. SECTION 2. Section 346-59.1, Hawaii Revised Statutes, is amended by amending subsection (g) to read as follows: "(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. "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 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 telephone contacts, facsimile transmissions, or e-mail text, in combination or by itself, does not constitute a telehealth service for the purposes of this section[.], except for behavioral health services pursuant to section 453-1.3(h)." SECTION 3. Section 431:10A-116.3, Hawaii Revised Statutes, is amended by amending subsection (g) to read as follows: "(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. "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 telephone contacts, facsimile transmissions, or e-mail text, in combination or by itself, does not constitute a telehealth service for the purposes of this chapter[.], except for behavioral health services pursuant to section 453-1.3(h)." SECTION 4. Section 432:1-601.5, Hawaii Revised Statutes, is amended by amending subsection (g) to read as follows: "(g) For the purposes of this section: "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. "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 telephone contacts, facsimile transmissions, or e-mail text, in combination or by itself, does not constitute a telehealth service for the purposes of this chapter[.], except for behavioral health services pursuant to section 453-1.3(h)." SECTION 5. Section 432D-23.5, Hawaii Revised Statutes, is amended by amending subsection (g) to read as follows: "(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. "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 telephone contacts, facsimile transmissions, or e-mail text, in combination or by itself, does not constitute a telehealth service for the purposes of this chapter[.], except for behavioral health services pursuant to section 453-1.3(h)." SECTION 6. Section 453-1.3, Hawaii Revised Statutes, is amended by amending subsection (h) to read as follows: "(h) Reimbursement for behavioral health services provided through telehealth, including standard telephone contacts, shall be equivalent to reimbursement for the same services provided via face-to-face contact between a health care provider and a patient." SECTION 7. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored. SECTION 8. This Act shall take effect upon its approval. INTRODUCED BY: _____________________________ |
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| 48 | 48 | | |
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| 49 | 49 | | SECTION 1. The legislature finds that emergency governmental proclamations to restrict and manage in-person gatherings and meetings during the coronavirus disease 2019 (COVID-19) pandemic have suspended certain laws that exclude the use of standard telephone contacts from the definition of "telehealth" to enable health care providers and patients to minimize in-person meetings while also ensure access to care. |
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| 50 | 50 | | |
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| 51 | 51 | | The availability of insurance reimbursement for telehealth provided through standard telephone contacts has greatly increased access to care for vulnerable populations, including the elderly, low-income, medically- and socially-complex patients, and those in rural areas who do not have the broadband capabilities, electronic equipment, financial means, transportation options, or technological proficiency to operate sophisticated digital video conferencing software. Allowing standard telephone contacts to qualify as "telehealth" also avoids problems with devices, internet, sufficient bandwidth, power and battery charging capabilities, and digital literacy. |
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| 52 | 52 | | |
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| 53 | 53 | | The legislature further finds that the prolonged nature of the public health emergency created by COVID-19 and its attendant personal, familial, work, social, and economic disruptions have created chronic and unprecedented emotional distress, anxiety, and mental conditions for all of Hawaii's communities. The demand for mental health services has never been so high. |
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| 54 | 54 | | |
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| 55 | 55 | | Research has found standard telephone contacts to be an effective, viable means for providing timely mental health services to patients. Talk therapy and other audio-only treatment modalities do not require physical examinations or medical prescriptions. As recently noted by the Hawaii department of human services in testimony submitted in support of a similar measure (which was broadly and enthusiastically supported by the medical community with the exception of the health insurance companies), "telephone calls have been shown to be clinically effective for some services such as behavioral health." Moreover, standard telephone contacts for telehealth purposes is endorsed nationally by the American Psychological Association. |
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| 56 | 56 | | |
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| 57 | 57 | | Therefore, the purpose of this Act is to allow for the use and reimbursement of standard telephone contacts for telehealth purposes by mental health professionals. |
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| 58 | 58 | | |
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| 59 | 59 | | SECTION 2. Section 346-59.1, Hawaii Revised Statutes, is amended by amending subsection (g) to read as follows: |
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| 60 | 60 | | |
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| 61 | 61 | | "(g) For the purposes of this section: |
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| 62 | 62 | | |
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| 63 | 63 | | "Distant site" means the location of the health care provider delivering services through telehealth at the time the services are provided. |
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| 64 | 64 | | |
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| 65 | 65 | | "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. |
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| 66 | 66 | | |
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| 67 | 67 | | "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 environments such as school-based health centers, university-based health centers, or the work location of a patient. |
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| 68 | 68 | | |
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| 69 | 69 | | "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 telephone contacts, facsimile transmissions, or e-mail text, in combination or by itself, does not constitute a telehealth service for the purposes of this section[.], except for behavioral health services pursuant to section 453-1.3(h)." |
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| 70 | 70 | | |
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| 71 | 71 | | SECTION 3. Section 431:10A-116.3, Hawaii Revised Statutes, is amended by amending subsection (g) to read as follows: |
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| 72 | 72 | | |
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| 73 | 73 | | "(g) For the purposes of this section: |
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| 74 | 74 | | |
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| 75 | 75 | | "Distant site" means the location of the health care provider delivering services through telehealth at the time the services are provided. |
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| 76 | 76 | | |
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| 77 | 77 | | "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. |
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| 78 | 78 | | |
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| 79 | 79 | | "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. |
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| 80 | 80 | | |
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| 81 | 81 | | "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 telephone contacts, facsimile transmissions, or e-mail text, in combination or by itself, does not constitute a telehealth service for the purposes of this chapter[.], except for behavioral health services pursuant to section 453-1.3(h)." |
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| 82 | 82 | | |
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| 83 | 83 | | SECTION 4. Section 432:1-601.5, Hawaii Revised Statutes, is amended by amending subsection (g) to read as follows: |
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| 84 | 84 | | |
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| 85 | 85 | | "(g) For the purposes of this section: |
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| 86 | 86 | | |
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| 87 | 87 | | "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. |
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| 88 | 88 | | |
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| 89 | 89 | | "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. |
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| 90 | 90 | | |
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| 91 | 91 | | "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 telephone contacts, facsimile transmissions, or e-mail text, in combination or by itself, does not constitute a telehealth service for the purposes of this chapter[.], except for behavioral health services pursuant to section 453-1.3(h)." |
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| 92 | 92 | | |
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| 93 | 93 | | SECTION 5. Section 432D-23.5, Hawaii Revised Statutes, is amended by amending subsection (g) to read as follows: |
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| 94 | 94 | | |
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| 95 | 95 | | "(g) For the purposes of this section: |
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| 96 | 96 | | |
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| 97 | 97 | | "Distant site" means the location of the health care provider delivering services through telehealth at the time the services are provided. |
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| 98 | 98 | | |
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| 99 | 99 | | "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. |
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| 100 | 100 | | |
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| 101 | 101 | | "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. |
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| 102 | 102 | | |
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| 103 | 103 | | "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 telephone contacts, facsimile transmissions, or e-mail text, in combination or by itself, does not constitute a telehealth service for the purposes of this chapter[.], except for behavioral health services pursuant to section 453-1.3(h)." |
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| 104 | 104 | | |
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| 105 | 105 | | SECTION 6. Section 453-1.3, Hawaii Revised Statutes, is amended by amending subsection (h) to read as follows: |
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| 106 | 106 | | |
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| 107 | 107 | | "(h) Reimbursement for behavioral health services provided through telehealth, including standard telephone contacts, shall be equivalent to reimbursement for the same services provided via face-to-face contact between a health care provider and a patient." |
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| 108 | 108 | | |
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| 109 | 109 | | SECTION 7. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored. |
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| 110 | 110 | | |
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| 111 | 111 | | SECTION 8. This Act shall take effect upon its approval. |
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| 112 | 112 | | |
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| 113 | 113 | | |
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| 114 | 114 | | |
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| 115 | 115 | | INTRODUCED BY: _____________________________ |
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| 116 | 116 | | |
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| 117 | 117 | | INTRODUCED BY: |
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| 118 | 118 | | |
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| 119 | 119 | | _____________________________ |
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| 120 | 120 | | |
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| 133 | 133 | | Report Title: Telehealth; Behavioral Health Services; Standard Telephone Contacts; Insurance Description: Allows for standard telephone contacts for telehealth purposes related to behavior health services. The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent. |
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| 135 | 135 | | |
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| 136 | 136 | | |
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| 137 | 137 | | |
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| 138 | 138 | | |
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| 139 | 139 | | Report Title: |
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| 140 | 140 | | |
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| 141 | 141 | | Telehealth; Behavioral Health Services; Standard Telephone Contacts; Insurance |
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| 142 | 142 | | |
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| 143 | 143 | | |
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| 144 | 144 | | |
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| 145 | 145 | | Description: |
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| 146 | 146 | | |
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| 147 | 147 | | Allows for standard telephone contacts for telehealth purposes related to behavior health services. |
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| 148 | 148 | | |
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| 149 | 149 | | |
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| 150 | 150 | | |
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| 151 | 151 | | |
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| 152 | 152 | | |
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| 153 | 153 | | |
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| 154 | 154 | | |
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| 155 | 155 | | The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent. |
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