Bills

SB 1281: Telehealth; Interactive Telecommunications Systems; Insurance Reimbursement

Session Year: 2025-2026
House: Senate
Latest Version Date: 2025-04-24

Current Status:

In Progress

(2025-06-25: Act 217, on 06/25/2025 (Gov. Msg. No. 1319).)

Introduced

In Committee

First Chamber

In Committee

Second Chamber

Final Decking

Enacted

What does this bill do?

This bill extends the sunset date of a 2023 law that allows health insurers to pay for services delivered by telehealth using interactive telecommunications systems until December 31, 2027. It keeps those telehealth payment rules in place for providers, patients, and insurers.

Version:

Extends the sunset date of Act 107, SLH 2023, which allows for the reimbursement of services provided through telehealth via an interactive telecommunications system, until 12/31/2027. (CD1)

Version:

SB1281 CD1

THE SENATE	S.B. NO.	1281
THIRTY-THIRD LEGISLATURE, 2025		S.D. 2
STATE OF HAWAII		H.D. 2
		C.D. 1

A BILL FOR AN ACT

RELATING TO TELEHEALTH.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

SECTION 1. 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 This Act shall take effect upon its approval; provided that on December 31, [~~2025,~~] 2027, this Act shall be repealed and sections 346-59.1, 431:10A-116.3, 432:1-601.5, 432D-23.5, and 453‑1.3, Hawaii Revised Statutes, shall be reenacted in the form in which they read on the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 2. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 3. This Act shall take effect on July 1, 2025.

Report Title:

Telehealth; Interactive Telecommunications Systems; Insurance Reimbursement

Description:

Extends the sunset date of Act 107, SLH 2023, which allows for the reimbursement of services provided through telehealth via an interactive telecommunications system, until 12/31/2027. (CD1)

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

SB1281 SD2

THE SENATE	S.B. NO.	1281
THIRTY-THIRD LEGISLATURE, 2025		S.D. 2
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)~~] (4) [~~Such~~] 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~~] before the initial audio-only visit, or within twelve months [~~prior to~~] before 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.

"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.

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~~] before the initial audio-only visit, or within twelve months [~~prior to~~] before 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:

"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.

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~~] before the initial audio-only visit, or within twelve months [~~prior to~~] before 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.

"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~~] before the initial audio-only visit, or within twelve months [~~prior to~~] before 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 on December 31, 2050.

Report Title:

Telehealth; Audio-Only; Medicare; Insurance Reimbursement; Report; Sunset Repeal

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. Effective 12/31/2050. (SD2)

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

SB1281 SD1

THE SENATE	S.B. NO.	1281
THIRTY-THIRD LEGISLATURE, 2025		S.D. 1
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:

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.

"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 the use of video technology; provided that verification of the patient's lack of video capability shall be appended to any claim for telehealth services furnished using two-way, real‑time, audio-only communications technology.

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[.];

(3) A summary of the telehealth claims reimbursed during the preceding year, pursuant to Act , Session Laws of Hawaii 2025; and

[~~(3)~~] (4) [~~Such~~] 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~~] before the initial audio-only visit, or within twelve months [~~prior to~~] before 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.

"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 the use of video technology; provided that verification of the patient's lack of video capability 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.

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:

"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 the use of video technology; provided that verification of the patient's lack of video capability 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.

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.

"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 the use of video technology; provided that verification of the patient's lack of video capability 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 the use of video technology; provided that verification of the patient's lack of video capability shall be appended to any claim for telehealth services furnished using two-way, real‑time, audio-only communications technology.

(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 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 on December 31, 2050.

Report Title:

Telehealth; Audio-Only; Medicare; Insurance Reimbursement; Sunset Repeal

Description:

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

SB1281

THE SENATE	S.B. NO.	1281
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:

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.

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[.];

(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.

"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.

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:

"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.

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.

"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.

(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 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:

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

Date	Status
Jun 25, 2025	Act 217, on 06/25/2025 (Gov. Msg. No. 1319).
Jun 25, 2025	Act 217, 06/25/2025 (Gov. Msg. No. 1319).
May 2, 2025	Enrolled to Governor.
May 2, 2025	Received notice of passage on Final Reading in House (Hse. Com. No. 821).
May 1, 2025	Received notice of Final Reading (Sen. Com. No. 888).
Apr 30, 2025	Passed Final Reading as amended in CD 1 with none voting aye with reservations; none voting no (0) and Representative(s) Cochran, Pierick excused (2).
Apr 30, 2025	Passed Final Reading, as amended (CD 1). Ayes, 25; Aye(s) with reservations: none . 0 No(es): none. 0 Excused: none.
Apr 24, 2025	Forty-eight (48) hours notice Wednesday, 04-30-25.
Apr 24, 2025	Reported from Conference Committee (Conf Com. Rep. No. 67) as amended in (CD 1).
Apr 24, 2025	48 Hrs. Notice (as amended CD 1) 04-30-25.
Apr 24, 2025	Reported from Conference Committee as amended CD 1 (Conf. Com. Rep. No. 67).
Apr 23, 2025	The Conference Committee recommends that the measure be Passed, with Amendments. The votes were as follows: 5 Ayes: Representative(s) Takayama, Matayoshi, Keohokapu-Lee Loy, Olds, Alcos; Ayes with reservations: none; 0 Noes: none; and 0 Excused: none.
Apr 23, 2025	The Conference committee recommends that the measure be PASSED, WITH AMENDMENTS. The votes of the Senate Conference Managers were as follows: 3 Aye(s): Senator(s) Aquino, Keohokalole, Fevella; Aye(s) with reservations: none ; 0 No(es): none; and 1 Excused: Senator(s) Hashimoto.
Apr 22, 2025	Conference committee meeting to reconvene on 04-23-25 3:15PM; Conference Room 329.
Apr 21, 2025	Conference committee meeting to reconvene on 04-22-25 3:30PM; Conference Room 329.
Apr 17, 2025	Conference committee meeting scheduled for 04-21-25 3:30PM; Conference Room 329.
Apr 21, 2025	Received notice of appointment of House conferees (Hse. Com. No. 754).
Apr 17, 2025	House Conferees Appointed: Takayama, Matayoshi, Keohokapu-Lee Loy Co-Chairs; Olds, Alcos.
Apr 15, 2025	Received notice of Senate conferees (Sen. Com. No. 789).
Apr 15, 2025	Senate Conferees Appointed: Aquino Chair; Keohokalole Co-Chair; Hashimoto, Fevella.
Apr 10, 2025	Received notice of disagreement (Sen. Com. No. 779).
Apr 10, 2025	Senate disagrees with House amendments.
Apr 10, 2025	Received from House (Hse. Com. No. 676).
Apr 8, 2025	Passed Third Reading as amended in HD 2 with none voting aye with reservations; none voting no (0) and Representative(s) Cochran, Marten excused (2). Transmitted to Senate.
Apr 4, 2025	Forty-eight (48) hours notice Tuesday, 04-08-25.
Apr 4, 2025	Reported from FIN (Stand. Com. Rep. No. 2003) as amended in HD 2, recommending passage on Third Reading.
Mar 28, 2025	The committee on FIN recommend that the measure be PASSED, WITH AMENDMENTS. The votes were as follows: 14 Ayes: Representative(s) Yamashita, Takenouchi, Grandinetti, Holt, Keohokapu-Lee Loy, Kitagawa, Kusch, Lamosao, Lee, M., Miyake, Morikawa, Templo, Alcos, Reyes Oda; Ayes with reservations: none; Noes: none; and 2 Excused: Representative(s) Hussey, Ward.
Mar 25, 2025	Bill scheduled to be heard by FIN on Friday, 03-28-25 2:00PM in House conference room 308 VIA VIDEOCONFERENCE.
Mar 21, 2025	Report adopted; referred to the committee(s) on FIN with none voting aye with reservations; none voting no (0) and Representative(s) Cochran, Garrett, Kapela, Kitagawa, Ward excused (5).
Mar 21, 2025	Reported from CPC (Stand. Com. Rep. No. 1474), recommending referral to FIN.
Mar 19, 2025	The committee on CPC recommend that the measure be PASSED, UNAMENDED. The votes were as follows: 8 Ayes: Representative(s) Matayoshi, Chun, Ichiyama, Iwamoto, Kong, Lowen, Tam, Pierick; Ayes with reservations: none; 0 Noes: none; and 2 Excused: Representative(s) Ilagan, Marten.
Mar 14, 2025	Bill scheduled to be heard by CPC on Wednesday, 03-19-25 2:00PM in House conference room 329 VIA VIDEOCONFERENCE.
Mar 14, 2025	Passed Second Reading as amended in HD 1 and referred to the committee(s) on CPC with none voting aye with reservations; none voting no (0) and Representative(s) Cochran, Holt, Iwamoto, Ward excused (4).
Mar 14, 2025	Reported from HLT (Stand. Com. Rep. No. 1228) as amended in HD 1, recommending passage on Second Reading and referral to CPC.
Mar 12, 2025	The committee on HLT recommend that the measure be PASSED, WITH AMENDMENTS. The votes were as follows: 8 Ayes: Representative(s) Takayama, Keohokapu-Lee Loy, Amato, Chun, Marten, Olds, Takenouchi, Garcia; Ayes with reservations: none; Noes: none; and 1 Excused: Representative(s) Alcos.
Mar 7, 2025	Bill scheduled to be heard by HLT on Wednesday, 03-12-25 9:00AM in House conference room 329 VIA VIDEOCONFERENCE.
Mar 6, 2025	Referred to HLT, CPC, FIN, referral sheet 19
Mar 6, 2025	Pass First Reading
Mar 4, 2025	Received from Senate (Sen. Com. No. 292) in amended form (SD 2).
Mar 4, 2025	Report adopted; Passed Third Reading, as amended (SD 2). Ayes, 25; Aye(s) with reservations: none . Noes, 0 (none). Excused, 0 (none). Transmitted to House.
Feb 28, 2025	48 Hrs. Notice 03-04-25.
Feb 28, 2025	Reported from CPN (Stand. Com. Rep. No. 899) with recommendation of passage on Third Reading, as amended (SD 2).
Feb 26, 2025	The committee(s) on CPN recommend(s) that the measure be PASSED, WITH AMENDMENTS. The votes in CPN were as follows: 3 Aye(s): Senator(s) Keohokalole, Fukunaga, McKelvey; Aye(s) with reservations: none ; 0 No(es): none; and 2 Excused: Senator(s) Richards, Awa.
Feb 25, 2025	The committee(s) on CPN deferred the measure until 02-26-25 9:31AM; Conference Room 229 & Videoconference.
Feb 20, 2025	The committee(s) on CPN deferred the measure until 02-25-25 9:30AM; Conference Room 229 & Videoconference.
Feb 14, 2025	The committee(s) on CPN will hold a public decision making on 02-20-25 9:30AM; Conference Room 229 & Videoconference.
Feb 14, 2025	Report adopted; Passed Second Reading, as amended (SD 1) and referred to CPN.
Feb 14, 2025	Reported from HHS (Stand. Com. Rep. No. 580) with recommendation of passage on Second Reading, as amended (SD 1) and referral to CPN.
Feb 5, 2025	The committee(s) on HHS recommend(s) that the measure be PASSED, WITH AMENDMENTS. The votes in HHS were as follows: 4 Aye(s): Senator(s) San Buenaventura, Aquino, Hashimoto, Keohokalole; Aye(s) with reservations: none ; 0 No(es): none; and 1 Excused: Senator(s) Fevella.
Jan 31, 2025	The committee(s) on HHS has scheduled a public hearing on 02-05-25 1:00PM; Conference Room 225 & Videoconference.
Jan 27, 2025	Referred to HHS, CPN.
Jan 23, 2025	Introduced and passed First Reading.
Jan 21, 2025	Pending Introduction.

Date	Description	Location	Votes
Apr 30, 2025	Final Reading	House Floor	48 0 2 Passed
Apr 30, 2025	Final Reading	Senate Floor	25 0 0 Passed
Apr 8, 2025	Third Reading	House Floor	48 0 2 Passed
Mar 28, 2025	The committee on FIN recommend that the measure be PASSED, WITH AMENDMENTS	House Standing Committee on Finance	14 0 2 Passed
Mar 19, 2025	The committee on CPC recommend that the measure be PASSED, UNAMENDED	House Standing Committee on Consumer Protection & Commerce	8 0 2 Passed
Mar 12, 2025	The committee on HLT recommend that the measure be PASSED, WITH AMENDMENTS	House Standing Committee on Health	8 0 1 Passed
Mar 4, 2025	Third Reading	Senate Floor	25 0 0 Passed
Feb 26, 2025	The committee(s) on CPN recommend(s) that the measure be PASSED, WITH AMENDMENTS	Senate Standing Committee on Commerce and Consumer Protection	3 0 2 Passed
Feb 5, 2025	The committee(s) on HHS recommend(s) that the measure be PASSED, WITH AMENDMENTS	Senate Standing Committee on Health and Human Services	4 0 1 Passed

Key

Pro

Against

Did Not Vote

This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.

Positions by individuals are not included.

* Testimony in a hearing

** Position recorded in bill analysis

*** Position recorded in written testimony

Organization	Position	Date
AARP Hawaii	** Support
AlohaCare	*** Support	Feb 20, 2025
AlohaCare	** Support
Alzheimer's Association-Hawaii	** Support
American Cancer Society Cancer Action Network	** Support
American Diabetes Association	** Support
Department of Health	** Support
Department of Health	*** Support	Mar 28, 2025
Department of Human Services	*** Support	Mar 28, 2025
Disability and Communication Access Board	** Support
Federally Qualified Health Centers	*** Support	Mar 12, 2025
Hawaii Association of Health Plans	** Support
Hawaii Medical Association	** Support
Hawaii Medical Service Association	** Support
Hawaii Medical Service Association	** Support
Hawaii Mental Health Hui	*** Support	Mar 12, 2025
Hawaii Substance Abuse Coalition	** Support
Hawaii Academy of Family Physicians	** Support
Hawaii Mental Health Coalition	** Support
Hawaii Pacific Health	** Support
Hawaii Primary Care Association	** Support
Hawaiʻi Mental Health Coalition	** Support
Hawaiʻi Mental Health Coalition	*** Support	Mar 28, 2025
Hawaiʻi Mental Health Hui	** Support
Hawai‘i Mental Health Hui	*** Support	Mar 19, 2025
Healthcare Association of Hawaii	** Support
Hina Mauka	** Support
John A. Burns School of Medicine	*** Support	Mar 28, 2025
Office of Hawaiian Affairs	** Support
Philippine Medical Association of Hawaiʻi	** Support
Philippine Medical Association of Hawaiʻi	** Support
Philippine Medical Association of Hawaii	*** Support	Feb 5, 2025
Philippine Medical Association of Hawai‘i	*** Support	Feb 20, 2025
State Council on Mental Health	** Support
State Health Planning and Development Agency	** Support
The Queen's Health Systems	** Support
University of Hawaii System	** Support
Waianae Coast Comprehensive Health Center (WCCHC)	*** Support	Mar 28, 2025

* Testimony in a hearing

** Position recorded in bill analysis

*** Position recorded in written testimony

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CONFERENCE COMMITTEE REP. NO. 67

Honolulu, Hawaii

, 2025

RE: S.B. No. 1281

S.D. 2

H.D. 2

C.D. 1

Honorable Ronald D. Kouchi

President of the Senate

Thirty-Third State Legislature

Regular Session of 2025

State of Hawaii

Honorable Nadine K. Nakamura

Speaker, House of Representatives

Thirty-Third State Legislature

Regular Session of 2025

State of Hawaii

Sir and Madam:

Your Committee on Conference on the disagreeing vote of the Senate to the amendments proposed by the House of Representatives in S.B. No. 1281, S.D. 2, H.D. 2, entitled:

"A BILL FOR AN ACT RELATING TO TELEHEALTH,"

having met, and after full and free discussion, has agreed to recommend and does recommend to the respective Houses the final passage of this bill in an amended form.

The purpose of this measure is to extend the sunset date of Act 107, Session Laws of Hawaii 2023, which allows for the reimbursement of services provided through telehealth via an interactive telecommunications system, until December 31, 2027.

Your Committee on Conference finds that the use and expansion of telehealth services and technology in the State have been recognized as ways to increase timely access to health care, particularly in rural areas of the State. Your Committee on Conference further finds that Act 107, Session Laws of Hawaii 2023 (Act 107), temporarily allows for the reimbursement of services provided through an interactive telecommunication system and two‑way, real-time audio-only communications for telehealth purposes, supporting numerous telehealth initiatives in the State that are successfully improving access to care in various settings. Your Committee on Conference additionally finds that Act 107 is slated to be repealed on December 31, 2025. This measure extends the sunset date of Act 107 by two years to ensure a continuum of care for residents in rural communities and to allow the State the opportunity to adjust to any new federal policies that may be implemented before permanently codifying Act 107.

Your Committee on Conference has amended this measure by changing its effective date to July 1, 2025.

As affirmed by the record of votes of the managers of your Committee on Conference that is attached to this report, your Committee on Conference is in accord with the intent and purpose of S.B. No. 1281, S.D. 2, H.D. 2, as amended herein, and recommends that it pass Final Reading in the form attached hereto as S.B. No. 1281, S.D. 2, H.D. 2, C.D. 1.

Respectfully submitted on behalf of the managers:

ON THE PART OF THE HOUSE

ON THE PART OF THE SENATE

____________________________ GREGG TAKAYAMA Co-Chair		____________________________ HENRY J.C. AQUINO Chair
____________________________ SCOT Z. MATAYOSHI Co-Chair		____________________________ JARRETT KEOHOKALOLE Co-Chair
____________________________ SUE L. KEOHOKAPU-LEE LOY Co-Chair

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STAND. COM. REP. NO. 2003

Honolulu, Hawaii

, 2025

RE: S.B. No. 1281

S.D. 2

H.D. 2

Honorable Nadine K. Nakamura

Speaker, House of Representatives

Thirty-Third State Legislature

Regular Session of 2025

State of Hawaii

Madame:

Your Committee on Finance, to which was referred S.B. No. 1281, S.D. 2, H.D. 1, entitled:

"A BILL FOR AN ACT RELATING TO TELEHEALTH,"

begs leave to report as follows:

Your Committee received testimony in support of this measure from the Department of Health; Office of Hawaiian Affairs; University of Hawaii System; State Council on Mental Health; Hawaii Substance Abuse Coalition; AARP Hawaii; Healthcare Association of Hawaii; Hawaii Pacific Health; Hawaii Primary Care Association; Hawaii Association of Health Plans; Hawaii Medical Service Association; Hawaii Mental Health Coalition; Alzheimer's Association-Hawaii; Hawaii Medical Association; American Cancer Society Cancer Action Network; and one individual. Your Committee received comments on this measure from the Department of Human Services; State Health Planning and Development Agency; AlohaCare; and Waianae Coast Comprehensive Health Center.

Your Committee has amended this measure by changing the effective date to July 1, 3000, to encourage further discussion.

As affirmed by the record of votes of the members of your Committee on Finance that is attached to this report, your Committee is in accord with the intent and purpose of S.B. No. 1281, S.D. 2, H.D. 1, as amended herein, and recommends that it pass Third Reading in the form attached hereto as S.B. No. 1281, S.D. 2, H.D. 2.

Respectfully submitted on behalf of the members of the Committee on Finance,

____________________________

KYLE T. YAMASHITA, Chair

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STAND. COM. REP. NO. 1474

Honolulu, Hawaii

, 2025

RE: S.B. No. 1281

S.D. 2

H.D. 1

Honorable Nadine K. Nakamura

Speaker, House of Representatives

Thirty-Third State Legislature

Regular Session of 2025

State of Hawaii

Madame:

Your Committee on Consumer Protection & Commerce, to which was referred S.B. No. 1281, S.D. 2, H.D. 1, entitled:

"A BILL FOR AN ACT RELATING TO TELEHEALTH,"

begs leave to report as follows:

Your Committee received testimony in support of this measure from the Department of Health; Department of Human Services; Office of Hawaiian Affairs; University of Hawaiʻi System; Disability and Communication Access Board; State Health Planning and Development Agency; State Council on Mental Health; Healthcare Association of Hawaii; Hawaiʻi Pacific Health; Hawaii Medical Association; Hawaii Substance Abuse Coalition; Hawaiʻi Primary Care Association; American Cancer Society Cancer Action Network; AlohaCare; Alzheimer's Association-Hawaii; AARP Hawaiʻi; Hawaiʻi Mental Health Hui; Hawaii Medical Service Association; and three individuals. Your Committee received comments on this measure from the Department of Commerce and Consumer Affairs and Hawaii Association of Health Plans.

Your Committee finds that the use and expansion of telehealth services and technology in the State have been recognized as a way to increase access and reduce delays to health care, particularly in rural areas of the State. Due to the COVID-19 pandemic, telehealth became essential as the health care system and patients adjusted to the new realties, and as a result, the United States Centers for Medicare and Medicaid Services authorized, among other changes, reimbursement for audio-only telehealth services.

Your Committee further finds that the State, through the enactment of Act 107, Session Laws of Hawaii 2023, aligned state laws regarding reimbursements for telehealth services with the guidance provided by the Centers for Medicare and Medicaid Services. However, the existing uncertainties surrounding federal health care policies necessitates that any further amendments to the laws regarding reimbursements for telehealth services should be paused until policies are settled. This measure extends the sunset date of Act 107 to give the State the opportunity to adjust to any new federal policies that may be implemented or clarified.

As affirmed by the record of votes of the members of your Committee on Consumer Protection & Commerce that is attached to this report, your Committee is in accord with the intent and purpose of S.B. No. 1281, S.D. 2, H.D. 1, and recommends that it be referred to your Committee on Finance.

Respectfully submitted on behalf of the members of the Committee on Consumer Protection & Commerce,

____________________________

SCOT Z. MATAYOSHI, Chair

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STAND. COM. REP. NO. 1228

Honolulu, Hawaii

, 2025

RE: S.B. No. 1281

S.D. 2

H.D. 1

Honorable Nadine K. Nakamura

Speaker, House of Representatives

Thirty-Third State Legislature

Regular Session of 2025

State of Hawaii

Madame:

Your Committee on Health, to which was referred S.B. No. 1281, S.D. 2, entitled:

"A BILL FOR AN ACT RELATING TO TELEHEALTH,"

begs leave to report as follows:

The purpose of this measure is to:

(1) Update the State's laws on telehealth services to conform with federal Medicare regulations;

(2) Require the Insurance Commissioner to report to the Legislature on reimbursements claimed in the previous calendar year for certain telehealth services; and

(3) Repeal the sunset date of Act 107, Session Laws of Hawaii 2023.

Your Committee received testimony in support of this measure from the Office of Hawaiian Affairs; Disability and Communication Access Board; State Council on Mental Health; Hawaii Primary Care Association; Hawaii Substance Abuse Coalition; Hawaii Academy of Family Physicians; AARP Hawaii; American Cancer Society Cancer Action Network; Waianae Coast Comprehensive Health Center; Hawaii Mental Health Coalition; Alzheimer's Association-Hawaii; AlohaCare; and three individuals. Your Committee received testimony in opposition to this measure from the Hawaii Medical Service Association. Your Committee received comments on this measure from the Department of Health; Department of Commerce and Consumer Affairs; Department of Human Services; Department of the Attorney General; University of Hawaii System; Healthcare Association of Hawaii; Hawaii Medical Association; and Hawaii Association of Health Plans.

Your Committee also finds that this measure is intended to conform telehealth definitions under state law to be consistent with recent federal guidance. However, your Committee notes that there are currently numerous uncertainties regarding federal health care policy, including how the federal government may interpret reimbursement guidelines for audio-only telehealth services. Given the lack of certainty surrounding federal policies in this area, your Committee believes that attempting to conform state law to federal regulations may be premature at this point.

Accordingly, your Committee has amended this measure by:

(1) Deleting the provisions that would have codified updates to the State's laws on telehealth services to conform with federal Medicare regulations and required the Insurance Commissioner to report certain reimbursement information to the Legislature;

(2) Extending the sunset date of Act 107, Session Laws of Hawaii 2023, to December 31, 2027; and

(3) Making technical, nonsubstantive amendments for the purposes of clarity, consistency, and style.

As affirmed by the record of votes of the members of your Committee on Health that is attached to this report, your Committee is in accord with the intent and purpose of S.B. No. 1281, S.D. 2, as amended herein, and recommends that it pass Second Reading in the form attached hereto as S.B. No. 1281, S.D. 2, H.D. 1, and be referred to your Committee on Consumer Protection & Commerce.

Respectfully submitted on behalf of the members of the Committee on Health,

____________________________

GREGG TAKAYAMA, Chair

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STAND. COM. REP. NO. 899

Honolulu, Hawaii

RE: S.B. No. 1281

S.D. 2

Honorable Ronald D. Kouchi

President of the Senate

Thirty-Third State Legislature

Regular Session of 2025

State of Hawaii

Sir:

Your Committee on Commerce and Consumer Protection, to which was referred S.B. No. 1281, S.D. 1, entitled:

"A BILL FOR AN ACT RELATING TO TELEHEALTH,"

begs leave to report as follows:

The purpose and intent of this measure is to:

(1) Update the State's laws on telehealth services to conform with federal Medicare regulations;

(2) Require the Insurance Commissioner to report to the Legislature on reimbursements claimed in the previous year for certain telehealth services; and

(3) Repeal the sunset date of Act 107, Session Laws of Hawaii 2023.

Your Committee received testimony in support of this measure from the State Health Planning and Development Agency, Disability and Communications Access Board, Office of Hawaiian Affairs, Hawaii Substance Abuse Coalition, The Queen's Health Systems, Waianae Coast Comprehensive Health Center, American Cancer Society Cancer Action Network, Hawaii Primary Care Association, Hawaiʻi Pacific Health, AlohaCare, AARP Hawaiʻi, American Diabetes Association, Alzheimer's Association-Hawaii, Hina Mauka, Philippine Medical Association of Hawaiʻi, Hawaiʻi Mental Health Coalition, and two individuals.

Your Committee received testimony in opposition to this measure from the Hawaii Medical Service Association.

Your Committee received comments on this measure from the Department of Commerce and Consumer Affairs, Department of the Attorney General, Department of Human Services, Department of Health, University of Hawaiʻi System, Hawaii Medical Association, Healthcare Association of Hawaii, and Hawaii Association of Health Plans.

Your Committee finds that the State's rural and underprivileged communities are often cut off from receiving essential health care services through telehealth because they lack the broadband coverage necessary to access this care. The use of standard telephone contact in telehealth, especially during the COVID-19 pandemic, has demonstrated the effectiveness of telehealth as a mode of essential health care delivery, particularly for those living in rural, isolated, or underprivileged communities, and particularly for behavioral health care in areas where video-equipped telehealth is unavailable. By permitting audio-only participation, individuals without access to the latest technology, or those who rely on traditional communication methods, would have greater opportunities to connect with and benefit from these services. Additionally, telehealth has proven to be a critical tool to improve health care access for Native Hawaiians and underserved communities in the State, given Hawaii's unique geography, which spans across multiple islands. Telehealth provides a practical solution to connect individuals with health care providers and has the potential to address disparities in health care access and outcomes. This measure establishes a timely and necessary framework to enhance and expand telehealth services in the State by extending and solidifying telehealth coverage and reimbursement requirements.

Your Committee has amended this measure by:

(1) Reverting to the definition of "interactive telecommunications system", as provided in the originally introduced version of this measure, to allow a patient to consent to the use of video technology; and

(2) Making technical, nonsubstantive amendments for the purposes of clarity and consistency.

As affirmed by the record of votes of the members of your Committee on Commerce and Consumer Protection that is attached to this report, your Committee is in accord with the intent and purpose of S.B. No. 1281, S.D. 1, as amended herein, and recommends that it pass Third Reading in the form attached hereto as S.B. No. 1281, S.D. 2.

Respectfully submitted on behalf of the members of the Committee on Commerce and Consumer Protection,

________________________________

JARRETT KEOHOKALOLE, Chair

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STAND. COM. REP. NO. 580

Honolulu, Hawaii

RE: S.B. No. 1281

S.D. 1

Honorable Ronald D. Kouchi

President of the Senate

Thirty-Third State Legislature

Regular Session of 2025

State of Hawaii

Sir:

Your Committee on Health and Human Services, to which was referred S.B. No. 1281 entitled:

"A BILL FOR AN ACT RELATING TO TELEHEALTH,"

begs leave to report as follows:

The purpose and intent of this measure is to:

(1) Update the State's laws on telehealth services to conform with federal Medicare regulations;

(2) Require the Insurance Commissioner to report to the Legislature on reimbursements claimed in the previous year for certain telehealth services; and

(3) Repeal the sunset date of Act 107, Session Laws of Hawaii 2023.

Your Committee received testimony in support of this measure from the Office of Hawaiian Affairs, Disability and Communication Access Board, University of Hawaiʻi System, AlohaCare, Hawaiʻi Mental Health Coalition, The Queen's Health Systems, AARP Hawaiʻi, Hawaiʻi Primary Care Association, American Cancer Society Cancer Action Network, Hawaiʻi Pacific Health, Hina Mauka, Hawaii Medical Association, Hawaii Substance Abuse Coalition, Philippine Medical Association of Hawaiʻi, Alzheimer's Association, and two individuals.

Your Committee received testimony in opposition to this measure from the Hawaii Medical Service Association.

Your Committee received comments on this measure from the Department of Human Services, Insurance Division of the Department of Commerce and Consumer Affairs, and Hawaii Association of Health Plans.

Your Committee finds that Hawaii's unique geography, spanning across multiple islands, presents significant challenges in accessing health care services, particularly for rural and remote communities and that telehealth is a critical tool to improve health care access for residents and underserved communities throughout the State. Your Committee further finds that aligning state requirements with federal law, including expanding the areas of health care practice that can be provided by audio-only services is essential for ensuring equal access to vital resources. This measure allows people to access health care services more easily through the use of telehealth, consistent with the framework provided under the Medicare program.

Your Committee has amended this measure by:

(1) Removing language in the definition of "interactive telecommunications system" that would have allowed a patient to not consent to the use of video technology and instead utilize two way, real-time, audio-only communication technology for any telehealth service;

(2) Inserting an effective date of December 31, 2050, to encourage further discussion; and

(3) Making technical, nonsubstantive amendments for the purposes of clarity and consistency.

As affirmed by the record of votes of the members of your Committee on Health and Human Services that is attached to this report, your Committee is in accord with the intent and purpose of S.B. No. 1281, as amended herein, and recommends that it pass Second Reading in the form attached hereto as S.B. No. 1281, S.D. 1, and be referred to your Committee on Commerce and Consumer Protection.

Respectfully submitted on behalf of the members of the Committee on Health and Human Services,

________________________________

JOY A. SAN BUENAVENTURA, Chair

Date	Testimony PDF
Mar 28, 2025	SB1281_HD1_TESTIMONY_FIN_03-28-25_.PDF
Mar 19, 2025	SB1281_HD1_TESTIMONY_CPC_03-19-25_.PDF
Mar 12, 2025	SB1281_SD2_TESTIMONY_HLT_03-12-25_.PDF
Feb 20, 2025	SB1281_SD1_TESTIMONY_CPN_02-20-25_.PDF
Feb 5, 2025	SB1281_TESTIMONY_HHS_02-05-25_.PDF

Discussed in Hearing

2MIN

Authors shown for version:
SB1281_CD1 (4/24/2025)

SB 1281: Telehealth; Interactive Telecommunications Systems; Insurance Reimbursement

Current Status:

What does this bill do?

Conference Committee

Conference Committee

House Standing Committee on Finance

House Standing Committee on Consumer Protection & Commerce

House Standing Committee on Health