Last updated 06/03/2024
Email, Phone & Fax
Recently Passed Legislation – Effective until December 31, 2025.
Med-QUEST Division (MQD) supports the medically appropriate use of interactive telecommunications system using two-way, real-time audio-only communication technology (audio-only) to increase access to healthcare and promote continuity of care. MQD will continue to reimburse select healthcare services delivered through audio-only communication technology after the Federal PHE expires. The following guidance is in effect until December 31, 2025, which aligns with the amended Hawaii Revised Statute 346-59.1 as amended by 2023 Hawaii legislative session Act 107 (HB 907).
Hawai’i Revised Statute (HRS) 346-59.1 amended during the 2023 Hawai’i legislative session (Act 107 (HB 907)) updated definitions and reimbursements:
HRS 346-59.1 as amended specifically states: (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.
SOURCE: HI Med-Quest Memo No: QI-2338, CCS-2311, FFS 23-22 (Nov 17, 2023). (Accessed Jun. 2024).
Newly Amended Statute, Will be Repealed Dec. 31, 2025
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.
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.
SOURCE: HI Revised Statute, Sec. 346-59.1 as amended by HB 907HD 2/SD 2 (Accessed Jun. 2024).
Audio-only real-time communication technology (Audio-only) – 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 to use an interactive telecommunications system as defined in the previous sentence, but the patient is not capable of, or does not consent to, the use of video technology.
SOURCE: HI Dept of Human Services, Med-QUEST, Memo No. QIk-2338/FFS 23-22, CCS-2311. (Accessed Jun. 2024).
No Reimbursement for:
- Telephone
- Facsimile machine
- Electronic mail
SOURCE: Code of HI Rules 17-1737.-51.1(c) p. 69 (Accessed Feb. 2024). (NOTE: Temporarily suspended by HI Dept of Human Services, Med-QUEST, Memo No. QIk-2338/FFS 23-22, CCS-2311.) (Accessed Jun. 2024).
Conditions for reimbursement of interactive telecommunications system using two-way, realtime audio-only communication technology for purposes of diagnosis, evaluation, or treatment of a mental health disorder to a patient includes the following:
The provider must have the capacity to furnish two-way, audio-video telehealth services;
Audio-only mode must be the preference of the patient;
The patient’s medical record must document the reason for the patient’s preference for audio-only mode (examples: broadband access is unsatisfactory, audio-visual technology is not available or is available and the patient does not know how or does not wish to use the technology); and
In-person visit requirements with the provider furnishing a service by use of interactive telecommunications system using two-way, real-time audio-only communication technology for purposes of diagnosis, evaluation, or treatment of a mental health disorder to a patient includes:
- An in-person visit must occur six months prior to the initial audio-only service furnished;
- After the initial 6 month in-person visit, a minimum of one medically necessary service must be furnished in-person within 12 months and every twelve months thereafter if services continue to be furnished by interactive telecommunications system. If no medically necessary service is required within 12 months of the previous in-person visit, the next medically necessary service must be furnished inperson. The patient’s medical record must document the reason why an in-person visit was not furnished within that particular 12-month period.
- The provider furnishing the medically necessary service may be the same provider who furnished services through interactive telecommunications system or may be a provider of the same specialty or subspeciality in the same group practice.
Limitation: A clinical psychologist and a clinical social worker may bill and receive payment for individual psychotherapy via a telecommunications system but may not seek payment for medical evaluation and management services.
Modifier “FQ-service furnished using audio-only communication technology” must be used when billing for services furnished by real-time audio-only communication technology. U
For FQHCs:
FQHCs must ensure the provision of relevant wrap-around non-billable services. Efforts shall be made to ensure that patients receive relevant wrap around non-billable services, and this may mean delivering care to the patient’s location as one way to ensure services are received. Wrap-around non-billable services may or may not occur on the same day as services provided through telehealth modality and the eligible FQHC provider delivering services through the telehealth modality must provide clear instructions to the patient on how and when the wrap-around non-billable services will be provided. Wrap-around non-billable services must be documented in the patient’s medical record.
See Appendix B for more information including coding guidelines and codes.
SOURCE: HI Med-Quest Memo No: QI-2338, CCS-2311, FFS 23-22 (Nov 17, 2023). (Accessed Jun. 2024).
Direct Acting Antiviral (DAA) Medications for Treatment of Chronic Hepatitis C Infection
For on-treatment monitoring, an in-person or telehealth/phone visit may be scheduled, if needed, for patient support, assessment of symptoms, and/or new medications.
SOURCE: HI Med-Quest Memo No. QI-2227/FFS 22-08 (December 30, 2022). (Accessed Jun. 2024).
Telephone services, including consultation, medical advice, and course of treatment (including long distance calls), are not recognized as a valid medical service(s) and may not be claimed as a Medicaid service.
SOURCE: HI Med-Quest Provider Manual, Ch. 2: Provider Requirements, Revised Apr. 2010, pg. 16, (Accessed Jun. 2024).
Medical/Surgical Services
Telephone calls, including long-distance calls, are not covered and cannot be billed to the Medicaid Program or to the patient.
SOURCE: HI Med-Quest Provider Manual, Ch. 6: Medical/Surgical Services, Revised Jan. 2011, pg. 34, (Accessed Jun. 2024).
Behavioral Health Services
Telephone Consultation. Telephone services, including long distance calls, are not recognized as valid medical services and may not be billed to Medicaid as an office visit.
SOURCE: HI Med-Quest Provider Manual, Ch. 15: Behavioral Health Services, Revised Oct. 18, 2002, pg. 3, (Accessed Jun. 2024).
Last updated 06/03/2024
Live Video
POLICY
The State’s Medicaid managed care and fee-for-service programs shall not deny coverage for any service provided through telehealth that would be covered if the service were provided through in-person consultation between a patient and a health care provider.
(Repeal and reenactment on December 31, 2025) 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.
SOURCE: HI Revised Statutes § 346-59.1 (a & b). Amended by HB 907 HD2 SD 2 (Repeal date of December 31, 2025). (Accessed Jun. 2024).
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 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.
SOURCE: HI Revised Statutes § 431:10A-116.3(c). Amended by HB 907 HD2 SD 2 (Repeal date of December 31, 2025). (Accessed Jun 2024).
Interactive audio and video telecommunication systems must be used. Interactive telecommunications systems must be multi-media communications that, at a minimum, include audio and video equipment, permitting real-time consultation among the patient, consulting practitioner, and referring practitioner. Telephones, facsimile machines, and electronic mail systems do not meet the requirements of interactive telecommunications system. As a condition of payment the patient must be present and participating in the telehealth visit.
SOURCE: Code of HI Rules 17-1737-51.1(c). (Accessed Jun. 2024). (NOTE: Recent legislation not yet reflected in Rules)
Eligible providers are health care providers who are eligible to bill Hawai’i Medicaid; practicing within their scope; and delivering services which can be appropriately and effectively administered through telehealth.
Services provided by telehealth must be appropriate for the telehealth modality, clinically appropriate for the patient, rendered in conformance with the full description of the procedure code, and performed by a health care provider eligible to bill Hawai’i Medicaid. Services provided shall be consistent with all federal and state privacy, security, and confidentiality laws.
SOURCE: HI Dept of Human Services, Med-QUEST, Memo No. QIk-2338/FFS 23-22, CCS-2311. (Accessed Jun. 2024).
As noted in the Overview, due to the Maui fires, a public health emergency (PHE) was declared on August 8, 2023. Certain waivers were put into place for telehealth policies. See Med-Quest Memo QI-2335A for more information.
ELIGIBLE SERVICES/SPECIALTIES
Services provided by telehealth must be appropriate for the telehealth modality, clinically appropriate for the patient, rendered in conformance with the full description of the procedure code, and performed by a health care provider eligible to bill Hawai’i Medicaid. Services provided shall be consistent with all federal and state privacy, security, and confidentiality laws. See Attachment A in memo for list of suggested codes for live video.
SOURCE: HI Dept of Human Services, Med-QUEST, Memo No. QI-2338/FFS 23-22, CCS-2311. (Accessed Jun. 2024).
Dentistry
The eligible codes for reimbursement will remain consistent with Memo QI-1702A (see Attachment A) with the addition of code D0145. All eligible codes are subject to the processing policies as defined in Chapter 14 of the Medicaid Dental Provider Manual. See Manual also for codes.
CDT code D9999 must be used to identify the claim for PPS payment by FQHCs and RHCs.
While the reimbursement for radiographic services is traditionally based on the date that the radiograph is read by the dentist providing the diagnosis, to minimize confusion that may potentially arise with asynchronous technology, the following protocol will be used when filing claims:
- Only one claim submission is allowed for each patient visit. All services to be claimed must be included in that single submission.
- The service date on the claim is the date that the patient was treated at the originating site regardless of whether asynchronous or synchronous technology was used.
- When asynchronous technology is used and the service date on the claim does not match the clinical notes (interpretation of the x-rays was done on a different day from when the patient was seen), a notation in clinical records should explain the discrepancy for auditing purposes.
The FFS reimbursement fee is based on the location of the eligible Medicaid provider at the time of service, Oahu or Neighboring Island.
Clinics that qualify for FQHC Prospective Payment System (PPS) reimbursement may submit telehealth claims using PPS reimbursement, as long as both the patient and dentist were each physically located at separate eligible FQHC/RHC sites during the encounter and the diagnosis.
SOURCE: HI Med-QUEST Medicaid Provider Manual: Dental, pg. 37-38 (Apr. 2024). HI Dept of Human Services, Med-QUEST, Memo No. QI-2338/FFS 23-22, CCS-2311. (Accessed Jun. 2024).
Applied Behavioral Analysis & Autism Spectrum Disorder
Applied behavioral analysis services (including family adaptive behavior treatment guidance) can be provided through telehealth. MedQuest provides some areas of consideration when approving ABA services through telehealth (see memo). Memo QI 2301/FFS 23-01 Updates policy.
SOURCE: QI-2020 (Jun. 17, 2020), HI Med-Quest memo QI-2301/FFS 23-01.(January 13, 2023) (Accessed Jun. 2024).
Federally Qualified Health Centers
Providers who are eligible to bill for Hawaii Medicaid services are also eligible providers who can bill for telehealth. Eligible services will be consistent with Memo QI-1702A and FFS 19-01. See memo for specific billing scenarios. Memo QI- 2139/FFS 21-15 replaces Memo QI-1702A. See Attachment C in QI-2338/FFS 23-22, CCS-2311.
SOURCE: Med-QUEST Memo 20-07 (Mar. 16, 2020), QI-2139 Tele-Health Law (Act 226, SLH 2016) Implementation (Replaces QI-1702A) HI Dept of Human Services, Med-QUEST, Memo No. QI-2338/FFS 23-22, CCS-2311. (Accessed Jun. 2024).
Community Integration Services (CIS)-Supportive Housing Services
CIS services may be rendered via telehealth as appropriate, as long as the required face-to-face interaction requirements are met (See Section 16, Service Settings for more information). Services rendered via telehealth shall be billed with the additional and appropriate telehealth modifiers, and applicable POS codes, as outline in memorandum QI-1702A (NOTE: QI 1702A was replaced with QI-2338/FFS 23-22/CCS 2311). Services may also be rendered via an approved telehealth modality, if determined by the health plan to be appropriate and effective and agreed to by the member.
SOURCE: Med-QUEST Memo QI-2105 (April 1, 2021). (Accessed Jun. 2024).
Induced/Intentional Termination of Pregnancy (ITOP) Evaluation & Management Services
Telehealth (audio-visual modality) may be used for evaluation and management services performed prior to the date of the medical ITOP. Codes in the range of 99201-99215 with modifiers 95, GQ, or GT are allowed.
SOURCE: Med-QUEST Memo FFS 2105 (May 7, 2021). (Accessed Jun. 2024).
QUEST Integration Health Plans & Community Case Management Agencies
Assessments and re-assessments may be conducted using telehealth and telecommunications technology only if an in-person interaction is not an option and should only be used on an exception basis. In-person interactions with members using appropriate safety precautions is the current expectation. Where possible, members at greatest risk and need should be prioritized to receive in-person interactions before members at lower risk and need.
The health plan must document the reason for conducting an interaction using a technology option.
SOURCE: Memo QI-2107A (April 29, 2021). (Accessed Jun. 2024).
Chronic Hepatitis C Infection
An in-person or telehealth/phone visit may be scheduled, if needed, for patient support, assessment of symptoms, and/or new medications.
SOURCE: HI Med-Quest Memo QI-2227/FFS 22-08 (December 30, 2022). (Accessed Jun. 2024).
Health and Functional Assessments
The assessment should include a face-to-face interview. Assessments and reassessments may be conducted by telehealth, based on member’s choice and preference. If using telehealth, it must meet privacy requirements.
SOURCE: HI Med-Quest Memo QI-2406, (Feb. 28, 2024), pg. 49, (Accessed Jun. 2024).
ELIGIBLE PROVIDERS
Eligible providers are health care providers who are eligible to bill Hawai’i Medicaid; practicing within their scope; and delivering services which can be appropriately and effectively administered through telehealth.
SOURCE: HI Dept of Human Services, Med-QUEST, Memo No. QI-2338/FFS 23-22, CCS-2311. (Accessed Jun. 2024).
Dentistry
Clinics that qualify for FQHC Prospective Payment System (PPS) reimbursement may submit telehealth claims using PPS reimbursement, as long as both the patient and dentist were each physically located at separate eligible FQHC/RHC sites during the encounter and the diagnosis.
SOURCE: HI Med-QUEST Medicaid Provider Manual: Dental, pg. 38 (Apr. 2024) (Accessed Jun. 2024).
Federally Qualified Health Centers
Providers who are eligible to bill for Hawaii Medicaid services are also eligible to bill for telehealth. Refer to HRS §346-53.64 (5) for the list of providers who may provide PPS services. See Attachment C in QI-2338/FFS 23-22, CCS-2311.
SOURCE: Med-QUEST FFS Memo 20-03 (Mar. 16, 2020), HI Med-QUEST Medicaid Provider Manual: Federally Qualified Health Centers, Chapter 21 (21.2.1),pg. 2 , HI Dept of Human Services, Med-QUEST, Memo No. QI-2338/FFS 23-22, CCS-2311. (Accessed Jun. 2024).
ELIGIBLE SITES
All providers prescribing controlled substances must be located in the State of Hawai’i. Until December 31, 2024, Federally Qualified Health Center (FQHC) behavioral health providers may be located at a non-HRSA approved site or satellite within the United States and the United States’ territories. If the FQHC provider is prescribing controlled substances, they must be located in the State of Hawai’i.
Originating/Spoke Site – 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 the patient. The originating site includes a patient’s residence. The U.S. Department of Health and Human Services Office for Civil Rights expects that patients should not receive telehealth services in public or semi-public settings, absent patient consent or exigent circumstances.
Distant/Hub Site – The location of the enrolled Hawai’i Medicaid provider delivering Medicaid eligible services through telehealth. The U.S. Department of Health and Human Services Office for Civil Rights expects health care providers will implement HIPAA safeguards and conduct telehealth in private settings, such as a doctor in a clinic or office connecting to a patient who is at home or at another clinic.
Non-FQHC Providers
With one exception, the provider must be located within the United States and the United States’ territories is eligible to be a distant site for delivery and payment purposes. Exception: If prescribing controlled substances, the provider must be located in the State of Hawai’i.
FQHC Providers
With exceptions, the FQHC provider must be located at their contracted FQHC’s HRSA approved site or satellite.
Exceptions:
- Until December 31, 2024, FQHC behavioral health providers may be located at a non-HRSA approved site or satellite within the United States and the United States’ territories.
- If prescribing controlled substances, the provider must be located in the State of Hawai’i.
SOURCE: HI Dept of Human Services, Med-QUEST, Memo No. QI-2338/FFS 23-22, CCS-2311. (Accessed Jun. 2024).
Eligible originating sites listed in the Administrative Rules:
- The office of a physician or practitioner
- Hospitals;
- Critical Access Hospitals;
- Rural Health Clinics;
- Federally Qualified Health Centers;
- Federal telehealth demonstration project sites.
SOURCE: Code of HI Rules 17-1737-51.1(d), p. 70 – Law passed & state plan amendment accepted prohibiting this limitation, however the prohibiting language is still present in regulation (Accessed Jun. 2024).
In statute, these locations are also included:
- A patient’s home;
- Other non-medical environments such as school-based health centers, university-based health centers, or the work location of a patient.
SOURCE: HI Revised Statutes § 346-59.1. (Accessed Jun. 2024).
Approved state plan amendment authorizes HI Medicaid to remove geographic and originating site requirements.
SOURCE: HI State Plan Amendment 16-0004. (Accessed Jun. 2024).
Federally Qualified Health Centers:
The criteria for sites eligible to receive PPS payment is the same regardless whether or not tele-health is utilized. The services must be provided at an HRSA approved site or satellite. 5C (Other Activities/Locations) sites are not eligible to receive PPS reimbursement in Hawaii and therefore are not eligible to receive PPS for tele-health services.
The spoke (originating site) is the location where the patient is located whether accompanied or not by a health care provider through telehealth. The originating site includes a patient’s residence.
SOURCE: HI Med-QUEST FFS Memo 20-03. (Accessed Jun. 2024).
Dental
The Medicaid rules for claims for teledentistry-related services will be consistent with the State’s rules on where teledentistry may be used.
The FFS reimbursement fee is based on the location of the eligible Medicaid provider at the time of service, Oahu or Neighboring Island.
Clinics that qualify for FQHC Prospective Payment System (PPS) reimbursement may submit telehealth claims using PPS reimbursement, as long as both the patient and dentist were each physically located at separate eligible FQHC/RHC sites during the encounter and the diagnosis. (Form 5b service sites registered with Med-QUEST as a Medicaid location and issued a HRSA Notice of Award identifying the specific service location address). Refer to Provider Memo QI-2338/ FFS 23-22. The first lines of these claims should be D9999 or D0140, according to PPS claim submission rules.
Claims for patients that were located at “public health settings” not federally registered as a FQHC or RHC service site are not eligible for PPS reimbursement.
All claims must indicate the treatment location in the “Remarks” section of the claim form. This is the location of the patient, including the name and address of “public health setting.” For example: Roosevelt High School, 1120 Nehoa Street, Honolulu, 96822. Claims that do not include the specific location of the patient will be denied.
SOURCE: HI Med-QUEST Medicaid Provider Manual: Dental, pg. 37-38 (Apr. 2024) (Accessed Jun. 2024).
GEOGRAPHIC LIMITS
All providers prescribing controlled substances must be located in the State of Hawai’i. Until December 31, 2024, Federally Qualified Health Center (FQHC) behavioral health providers may be located at a non-HRSA approved site or satellite within the United States and the United States’ territories. If the FQHC provider is prescribing controlled substances, they must be located in the State of Hawai’i.
Originating/Spoke Site – 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 schoolbased health centers, university-based health centers, or the work location of the patient. The originating site includes a patient’s residence. The U.S. Department of Health and Human Services Office for Civil Rights expects that patients should not receive telehealth services in public or semi-public settings, absent patient consent or exigent circumstances.
Distant/Hub Site – The location of the enrolled Hawai’i Medicaid provider delivering Medicaid eligible services through telehealth. The U.S. Department of Health and Human Services Office for Civil Rights expects health care providers will implement HIPAA safeguards and conduct telehealth in private settings, such as a doctor in a clinic or office connecting to a patient who is at home or at another clinic.
Non-FQHC Providers
With one exception, the provider must be located within the United States and the United States’ territories is eligible to be a distant site for delivery and payment purposes. Exception: If prescribing controlled substances, the provider must be located in the State of Hawai’i.
FQHC Providers
With exceptions, the FQHC provider must be located at their contracted FQHC’s HRSA approved site or satellite.
Exceptions:
- Until December 31, 2024, FQHC behavioral health providers may be located at a non-HRSA approved site or satellite within the United States and the United States’ territories.
- If prescribing controlled substances, the provider must be located in the State of Hawai’i.
SOURCE: HI Dept of Human Services, Med-QUEST, Memo No. QI-2338/FFS 23-22, CCS-2311. (Accessed Jun. 2024).
Telehealth services may only be provided to patients if they are presented from an originating site located in either:
- A federally designated Rural Health Professional Shortage Area;
- A county outside of a Metropolitan Statistical Area;
- An entity that participates in a federal telemedicine demonstration project.
SOURCE: Code of HI Rules 17-1737.-51.1. (Accessed Jun. 2024). – Law passed (HI Statute Section 346-59.1(c) & state plan amendment accepted prohibiting this limitation, however the prohibiting language is still present in regulation.)
Approved state plan amendment authorizes HI Medicaid to remove geographic and originating site requirements.
SOURCE: HI State Plan Amendment 16-0004. (Accessed Jun. 2024).
Teledentistry
The Medicaid rules for claims for teledentistry-related services will be consistent with the State’s rules on where teledentistry may be used.
The FFS reimbursement fee is based on the location of the eligible Medicaid provider at the time of service, Oahu or Neighboring Island.
SOURCE: HI Med-QUEST Medicaid Provider Manual: Dental, pg. 37 (Apr. 2024) (Accessed Jun. 2024).
FACILITY/TRANSMISSION FEE
No reference found.
