| 47 | | - | SECTION 1. The legislature finds that the coronavirus disease 2019 pandemic has placed severe restrictions on in-person gatherings and meetings. The emergency proclamation issued by the governor on December 16, 2020, suspended the application of certain laws that excluded the use of standard telephone contacts from the definition of "telehealth" to enable doctors and patients to minimize in‑person meetings while ensuring access to medical care. The use of standard telephone contacts for telehealth benefits in underserved and low-income communities where cellular data plans and broadband services needed for video calls, traditionally the hallmark of telehealth services, are not feasible options for many residents. Moreover, standard telephone contacts have been used by medical professionals for decades to provide necessary access to primary care where a patient is home-bound or otherwise unable to access face-to-face care. The legislature further finds that the Centers for Medicare and Medicaid Services recently made permanent coverage changes to include audio-only (telephone) services used in the treatment of mental health and substance abuse issues in certain circumstances, which will allow federally qualified health centers and rural health clinics to use telehealth to care for patients in their own homes. Consistent provisions for managed care plans and commercial health care plans are warranted to ensure pay parity for telephonic and telehealth services in these circumstances. Accordingly, the purpose of this Act is to allow for the use of standard telephone contacts for telehealth purposes, consistent with the recent rule changes in the 2022 Medicare Physician Fee Schedule. 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" means multimedia communications equipment that includes, at a minimum, audio and video equipment permitting two-way, real-time interactive communications between the patient and distant site physician or practitioner; provided that, for services furnished for purposes of diagnosis, evaluation, or treatment of a mental health disorder to a patient in their home, interactive telecommunications may include two-way, real-time audio-only communication technology if the distant site physician or practitioner is technically capable of using an interactive telecommunications system but the patient is not capable of, or does not consent to, the use of video technology; provided further that the term shall have the same meaning as the term is defined 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 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 not constitute a telehealth service [for the purposes of this section]." 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. 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" means multimedia communications equipment that includes, at a minimum, audio and video equipment permitting two-way, real-time interactive communications between the patient and distant site physician or practitioner; provided that, for services furnished for purposes of diagnosis, evaluation, or treatment of a mental health disorder to a patient in their home, interactive telecommunications may include two-way, real-time audio-only communication technology if the distant site physician or practitioner is technically capable of using an interactive telecommunications system but the patient is not capable of, or does not consent to, the use of video technology; provided further that the term shall have the same meaning as the term is defined 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, 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 not constitute a telehealth service [for the purposes of this chapter]." SECTION 4. Section 432:1-601.5, 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. 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: "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" means multimedia communications equipment that includes, at a minimum, audio and video equipment permitting two-way, real-time interactive communications between the patient and distant site physician or practitioner; provided that, for services furnished for purposes of diagnosis, evaluation, or treatment of a mental health disorder to a patient in their home, interactive telecommunications may include two-way, real-time audio-only communication technology if the distant site physician or practitioner is technically capable of using an interactive telecommunications system but the patient is not capable of, or does not consent to, the use of video technology; provided further that the term shall have the same meaning as the term is defined 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, 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 in this section, 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]." SECTION 5. Section 432D-23.5, 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. 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" means multimedia communications equipment that includes, at a minimum, audio and video equipment permitting two-way, real-time interactive communications between the patient and distant site physician or practitioner; provided that, for services furnished for purposes of diagnosis, evaluation, or treatment of a mental health disorder to a patient in their home, interactive telecommunications may include two-way, real-time audio-only communication technology if the distant site physician or practitioner is technically capable of using an interactive telecommunications system but the patient is not capable of, or does not consent to, the use of video technology; provided further that the term shall have the same meaning as the term is defined 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, 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 in this section, 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]." SECTION 6. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored. SECTION 7. This Act shall take effect on January 1, 2050, and shall be repealed on July 1, 2027; provided that 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 before the effective date of this Act. |
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| 47 | + | SECTION 1. The legislature finds that the coronavirus disease 2019 pandemic has placed severe restrictions on in-person gatherings and meetings. The emergency proclamation issued by the governor on December 16, 2020, suspended the application of certain laws that excluded the use of standard telephone contacts from the definition of "telehealth" to enable doctors and patients to minimize in‑person meetings while ensuring access to medical care. The use of standard telephone contacts for telehealth benefits in underserved and low-income communities where cellular data plans and broadband services needed for video calls, traditionally the hallmark of telehealth services, are not feasible options for many residents. Moreover, standard telephone contacts have been used by medical professionals for decades to provide necessary access to primary care where a patient is home-bound or otherwise unable to access face-to-face care. The legislature further finds that allowing standard telephone contact for the purpose of telehealth is endorsed by the Hawaii primary care association. The purpose of this Act is to allow for the use of standard telephone contact for telehealth purposes. 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] Facsimile transmissions[,] or e-mail text, in combination or by itself, does not constitute a telehealth service for the purposes of this section." 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] Facsimile transmissions[,] or e-mail text, in combination or by itself, does not constitute a telehealth service for the purposes of this chapter." 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] Facsimile transmissions[,] or e-mail text, in combination or by itself, does not constitute a telehealth service for the purposes of this chapter." 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] Facsimile transmissions[,] or e-mail text, in combination or by itself, does not constitute a telehealth service for the purposes of this chapter." SECTION 6. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored. SECTION 7. This Act shall take effect on January 1, 2050. |
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