HOUSE OF REPRESENTATIVES

H.B. NO.

384

THIRTY-FIRST LEGISLATURE, 2021

 

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 431:10A-116.3, Hawaii Revised Statutes, is amended to read as follows:

"431:10A‑116.3 Coverage for telehealth. (a) It is the intent of the legislature to recognize the application of telehealth as a reimbursable service by which an individual shall receive medical services from a health care provider without face-to-face contact with the health care provider.

(b) No accident and health or sickness insurance plan that is issued, amended, or renewed shall require face-to-face contact between a health care provider and a patient as a prerequisite for payment for services appropriately provided through telehealth in accordance with generally accepted health care practices and standards prevailing in the applicable professional community at the time the services were provided. The coverage required in this section may be subject to all terms and conditions of the plan agreed upon among the enrollee or subscriber, the insurer, and the health care provider. No accident and health or sickness insurance plan shall exclude a service for coverage solely because the service is provided through telehealth and is not provided through face-to-face contact between a health care provider and a patient for services appropriately provided through telehealth.

(c) Reimbursement for services provided through telehealth 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.

(d) Notwithstanding chapter 453 or rules adopted pursuant thereto, in the event that a health care provider-patient relationship does not exist between the patient and the health care provider to be involved in a telehealth interaction between the patient and the health care provider, a telehealth mechanism may be used to establish a health care provider-patient relationship.

(e) All insurers shall provide current and prospective insureds with written disclosure of coverages and benefits associated with telehealth services, including information on copayments, deductibles, or coinsurance requirements under a policy, contract, plan, or agreement. The information provided shall be current, understandable, and available prior to the issuance of a policy, contract, plan, or agreement, and upon request after the policy, contract, plan, or agreement has been issued.

(f) Services provided by telehealth pursuant to this section shall be consistent with all federal and state privacy, security, and confidentiality laws.

(g) No insurer shall apply any deductible to services provided through telehealth that accumulates separately from the deductible that applies in the aggregate to all items and services covered under the accident and health or sickness insurance plan.

(h) Any copayment or coinsurance applied to services provided through telehealth by an insurer shall be equivalent to the copayment or coinsurance applied to the same services provided via face-to-face contact between a health care provider and a patient.

(i) An insurer shall not impose any annual or lifetime durational limits or annual or lifetime maximum benefits for services provided through telehealth that are not equally imposed upon all coverages and benefits under the accident and health or sickness insurance plan.

(j) An insurer shall not impose any type of utilization review on services provided through telehealth unless this type of utilization review is imposed when the same services are provided through face-to-face contact. Any type of utilization review that is imposed on services provided through telehealth shall not occur with greater frequency or more stringent application than this form of utilization review is imposed on the same services provided through face-to-face contact.

(k) An insurer shall not restrict coverage for services provided through telehealth to services provided by a particular vendor, or other third-party, or services provided through a particular electronic communications technology platform; provided that nothing in this subsection shall require an insurer to cover any electronic communications technology platform that does not comply with all federal and state privacy, security, and confidentiality laws.

(l) An insurer shall not place any restrictions on prescribing medications through telehealth that are more restrictive than what is required under applicable state and federal laws.

[(g)] (m) 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] electronic mail text, in combination or by itself, does not constitute a telehealth service for the purposes of this chapter. "Telehealth" includes audio-only telephone when no other means of telecommunications services are available to the patient, due to lack of availability of the services or lack of adequate broadband access, or the use of other means of telecommunications services are infeasible, impractical, or otherwise not medically advisable, as determined by the health care provider providing telehealth services to the patient or as determined by another health care provider with an existing relationship with the patient."

SECTION 2. Section 432:1-601.5, Hawaii Revised Statutes, is amended to read as follows:

"432:1‑601.5 Coverage for telehealth. (a) It is the intent of the legislature to recognize the application of telehealth as a reimbursable service by which an individual shall receive medical services from a health care provider without face-to-face contact with the health care provider.

(b) No mutual benefit society plan contract that is issued, amended, or renewed shall require face-to-face contact between a health care provider and a patient as a prerequisite for payment for services appropriately provided through telehealth in accordance with generally accepted health care practices and standards prevailing in the applicable professional community at the time the services were provided. The coverage required in this section may be subject to all terms and conditions of the plan agreed upon among the enrollee or subscriber, the mutual benefit society, and the health care provider. No mutual benefit society plan contract shall exclude a service for coverage solely because the service is provided through telehealth and is not provided through face-to-face contact between a health care provider and a patient for services appropriately provided through telehealth.

(c) Reimbursement for services provided through telehealth 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.

(d) Notwithstanding chapter 453 or rules adopted pursuant thereto, in the event that a health care provider-patient relationship does not exist between the patient and the health care provider to be involved in a telehealth interaction between the patient and health care provider, a telehealth mechanism may be used to establish a health care provider-patient relationship.

(e) All [insurers] mutual benefit societies shall provide current and prospective enrollees or subscribers with written disclosure of coverages and benefits associated with telehealth services, including information on copayments, deductibles, or coinsurance requirements under a policy, contract, plan, or agreement. The information provided shall be current, understandable, and available prior to the issuance of a policy, contract, plan, or agreement, and upon request after the policy, contract, plan, or agreement has been issued.

(f) Services provided by telehealth pursuant to this section shall be consistent with all federal and state privacy, security, and confidentiality laws.

(g) No mutual benefit society shall apply any deductible to services provided through telehealth that accumulates separately from the deductible that applies in the aggregate to all items and services covered under the mutual benefit society plan contract.

(h) Any copayment or coinsurance applied to services provided through telehealth by a mutual benefit society shall be equivalent to the copayment or coinsurance applied to the same services provided via face-to-face contact between a health care provider and a patient.

(i) A mutual benefit society shall not impose any annual or lifetime durational limits or annual or lifetime maximum benefits for services provided through telehealth that are not equally imposed upon all coverages and benefits under the mutual benefit society plan contract.

(j) A mutual benefit society shall not impose any type of utilization review on services provided through telehealth unless this type of utilization review is imposed when the same services are provided through face-to-face contact. Any type of utilization review that is imposed on services provided through telehealth shall not occur with greater frequency or more stringent application than this form of utilization review is imposed on the same services provided through face-to-face contact.

(k) A mutual benefit society shall not restrict coverage for services provided through telehealth to services provided by a particular vendor, or other third-party, or services provided through a particular electronic communications technology platform; provided that nothing in this subsection shall require a mutual benefit society to cover any electronic communications technology platform that does not comply with all federal and state privacy, security, and confidentiality laws.

(l) A mutual benefit society shall not place any restrictions on prescribing medications through telehealth that are more restrictive than what is required under applicable state and federal laws.

[(g)] (m) 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] electronic mail text, in combination or by itself, does not constitute a telehealth service for the purposes of this chapter. "Telehealth" includes audio-only telephone when no other means of telecommunications services are available to the patient, due to lack of availability of the services or lack of adequate broadband access, or the use of other means of telecommunications services are infeasible, impractical, or otherwise not medically advisable, as determined by the health care provider providing telehealth services to the patient or as determined by another health care provider with an existing relationship with the patient."

SECTION 3. Section 432D-23.5, Hawaii Revised Statutes, is amended to read as follows:

"432D‑23.5 Coverage for telehealth. (a) It is the intent of the legislature to recognize the application of telehealth as a reimbursable service by which an individual shall receive medical services from a health care provider without face-to-face contact with the health care provider.

(b) No health maintenance organization policy, contract, plan, or agreement that is issued, amended, or renewed shall require face-to-face contact between a health care provider and a patient as a prerequisite for payment for services appropriately provided through telehealth in accordance with generally accepted health care practices and standards prevailing in the applicable professional community at the time the services were provided. The coverage required in this section may be subject to all terms and conditions of the plan agreed upon among the enrollee or subscriber, the health maintenance organization, and the health care provider. No health maintenance organization policy, contract, plan, or agreement shall exclude a service for coverage solely because the service is provided through telehealth and is not provided through face-to-face contact between a health care provider and a patient for services appropriately provided through telehealth.

(c) Reimbursement for services provided through telehealth 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.

(d) Notwithstanding chapter 453 or rules adopted pursuant thereto, in the event that a health care provider-patient relationship does not exist between the patient and the health care provider involved in a telehealth interaction between the patient and the health care provider, a telehealth mechanism may be used to establish a health care provider-patient relationship.

(e) All health maintenance organizations shall provide current and prospective [insureds] enrollees or subscribers with written disclosure of coverages and benefits associated with telehealth services, including information on copayments, deductibles, or coinsurance requirements under a policy, contract, plan, or agreement. The information provided shall be current, understandable, and available prior to enrollment in a policy, contract, plan, or agreement and upon request after enrollment in the policy, contract, plan, or agreement.

(f) Services provided by telehealth pursuant to this section shall be consistent with all federal and state privacy, security, and confidentiality laws.

(g) No health maintenance organization shall apply any deductible to services provided through telehealth that accumulates separately from the deductible that applies in the aggregate to all items and services covered under the health maintenance organization policy, contract, plan, or agreement.

(h) Any copayment or coinsurance applied to services provided through telehealth by a health maintenance organization shall be equivalent to the copayment or coinsurance applied to the same services provided through face-to-face contact.

(i) A health maintenance organization shall not impose any annual or lifetime durational limits or annual or lifetime maximum benefits for services provided through telehealth that are not equally imposed upon all coverages and benefits under the health maintenance organization policy, contract, plan, or agreement.

(j) A health maintenance organization shall not impose any type of utilization review on services provided through telehealth unless this type of utilization review is imposed when the same services are provided through face-to-face contact. Any type of utilization review that is imposed on services provided through telehealth shall not occur with greater frequency or more stringent application than this form of utilization review is imposed on the same services provided through face-to-face contact.

(k) A health maintenance organization shall not restrict coverage for services provided through telehealth to services provided by a particular vendor, or other third-party, or services provided through a particular electronic communications technology platform; provided that nothing in this subsection shall require a health maintenance organization to cover any electronic communications technology platform that does not comply with all federal and state privacy, security, and confidentiality laws.

(l) A health maintenance organization shall not place any restrictions on prescribing medications through telehealth that are more restrictive than what is required under applicable state and federal laws.

[(g)] (m) 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] electronic mail text, in combination or by itself, does not constitute a telehealth service for the purposes of this chapter. "Telehealth" includes audio-only telephone when no other means of telecommunications services are available to the patient, due to lack of availability of the services or lack of adequate broadband access, or the use of other means of telecommunications services are infeasible, impractical, or otherwise not medically advisable, as determined by the health care provider providing telehealth services to the patient or as determined by another health care provider with an existing relationship with the patient."

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

SECTION 5. This Act shall take effect upon its approval.

 

INTRODUCED BY:

_____________________________

 

 


 


 

Report Title:

Telehealth; Health Insurance; Coverage; Services

 

Description:

Prohibits health insurers, mutual benefit societies, and health maintenance organizations from excluding coverage of a service solely because the service is provided through telehealth and not through face-to-face contact. Requires parity between telehealth services and face-to-face services for purposes of deductibles, copayments, coinsurance, benefit limits, and utilization reviews. Clarifies the definition of "telehealth".

 

 

 

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.