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HB557
HOUSE OF REPRESENTATIVES
H.B. NO.
557
THIRTY-THIRD LEGISLATURE, 2025
STATE OF HAWAII
A BILL FOR AN ACT
relating
to telehealth
.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
����
SECTION
1
.
�
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 in-person contact between a
health care provider and a patient[
; provided that reimbursement for the
diagnosis, evaluation, or treatment of a mental health disorder delivered
through an interactive telecommunications system using two-way, real-time
audio-only communication technology shall meet the requirements of title 42
Code of Federal Regulations section 410.78.
�
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).
]
means multimedia
communications equipment that includes, at a minimum, audio and video equipment
permitting two-way, real-time interactive telecommunications between the
patient and distant site physician or practitioner.
�
"Interactive telecommunications system"
may also include two‑way, real-time, audio-only communication technology
for any telehealth service furnished to a patient in the patient's home 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 that verification of
the patient's lack of video capability or consent shall be appended to any
claim for telehealth services furnished using two-way, real‑time,
audio-only communications technology.
����
"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 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.
�
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
2
.
�
Section
431:2-211, Hawaii Revised Statutes, is amended to read as follows:
����
"
�431:2-211
�
Annual report.
�
The commissioner, as early each year as
accurate preparation enables, shall prepare and submit to the legislature a
report [
which
]
that
shall contain:
����
(1)
�
The condition of
all insurers authorized to do business in this State during the preceding year[
.
]
;
����
(2)
�
A summary of
abuses and deficiencies in benefit payments, the complaints made to the
commissioner and their disposition, and the extent of compliance and noncompliance
by each insurer with the provisions of this code[
.
]
;
����
(3)
�
A summary of
the telehealth claims reimbursed during the preceding year, pursuant to
Act
����
, Session Laws of Hawaii 2025;
and
���
[
(3)
�
Such
]
(4)
Any
additional information and comments relative to insurance activities
in this State [
as
]
that
the commissioner deems proper."
����
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 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
]
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.
�
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).
]
means multimedia
communications equipment that includes, at a minimum, audio and video equipment
permitting two-way, real-time interactive telecommunications between the
patient and distant site physician or practitioner.
�
"Interactive telecommunications
system" may also include two‑way, real-time, audio-only
communication technology for any telehealth service furnished to a patient in
the patient's home 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
that verification of the patient's lack of video capability or consent shall be
appended to any claim for telehealth services furnished using two-way, real‑time,
audio-only communications technology.
����
"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.
�
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
.
�
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 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
]
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.
�
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" [
has the same meaning as the term is defined in title 42 Code
of Federal Regulations section 410.78(a).
]
means multimedia
communications equipment that includes, at a minimum, audio and video equipment
permitting two‑way, real-time interactive telecommunications between the
patient and distant site physician or practitioner.
�
"Interactive telecommunications
system" may also include two‑way, real-time, audio-only
communication technology for any telehealth service furnished to a patient in
the patient's home 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
that verification of the patient's lack of video capability or consent shall be
appended to any claim for telehealth services furnished using two-way, real‑time,
audio-only communications technology.
����
"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.
�
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
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 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
]
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.
�
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).
]
means multimedia
communications equipment that includes, at a minimum, audio and video equipment
permitting two-way, real-time interactive telecommunications between the
patient and distant site physician or practitioner.
�
"Interactive telecommunications
system" may also include two‑way, real-time, audio-only
communication technology for any telehealth service furnished to a patient in
the patient's home 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
that verification of the patient's lack of video capability or consent shall be
appended to any claim for telehealth services furnished using two-way, real‑time,
audio-only communications technology.
����
"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.
�
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
6
.
�
Section
453-1.3, Hawaii Revised Statutes, is amended as follows:
����
1.
��
By amending
subsection (h) to read:
����
"(h)
�
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
]
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.
]"
����
2.
��
By amending
subsection (j) to read:
����
"(j)
�
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).
]
means multimedia
communications equipment that includes, at a minimum, audio and video equipment
permitting two‑way, real-time interactive telecommunications between the
patient and distant site physician or practitioner.
�
"Interactive telecommunications
system" may also include two‑way, real-time, audio-only
communication technology for any telehealth service furnished to a patient in
the patient's home 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
that verification of the patient's lack of video capability or consent shall be
appended to any claim for telehealth services furnished using two-way, real‑time,
audio-only communications technology.
����
"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 7.
�
Beginning with the regular session of 2026
and each regular session thereafter, the insurance commissioner's annual report
to the legislature shall include the total number of claims reimbursed in the
previous calendar year for:
����
(1)
�
Telehealth
services;
����
(2)
�
Telehealth
services related to mental health;
����
(3)
�
Audio-only
telehealth services related to mental health;
����
(4)
�
Telehealth
services not related to mental health; and
����
(5)
�
Audio-only
telehealth services not related to mental health.
����
SECTION 8.
�
Act 107, Session Laws of Hawaii 2023, is
amended by amending section 8 to read as follows:
����
"SECTION 8.
�
This Act shall take effect upon its approval[
;
provided that on December 31, 2025, this Act shall be repealed and sections
346-59.1, 431:10A-116.3, 432:1-601.5, 432D-23.5, and 453‑1.3, Hawaii
Revised Statutes, shall be reenacted in the form in which they read on the day
prior to the effective date of this Act
]."
����
SECTION 9.
�
This Act does not affect rights and duties
that matured, penalties that were incurred, and proceedings that were begun
before its effective date.
����
SECTION 10.
�
Statutory material to be repealed is
bracketed and stricken.
�
New statutory
material is underscored.
����
SECTION 11.
�
This Act shall take effect upon its approval.
INTRODUCED BY:
_____________________________
Report Title:
Telehealth;
Audio-Only; Medicare; Insurance Reimbursement
Description:
Updates
the State's laws on telehealth services to conform with federal Medicare
regulations.
�
Requires the Insurance
Commissioner to report to the Legislature on reimbursements claimed in the
previous year for certain telehealth services.
�
Repeals the sunset date of Act 107, Session Laws of Hawaii 2023.
The summary description
of legislation appearing on this page is for informational purposes only and is
not legislation or evidence of legislative intent.