Hawaii Telemedicine Laws: Licensure, Prescribing, Parity

Hawaii requires a Hawaii license to treat a patient located in the state by telehealth. It offers no out-of-state telehealth registration, requires an in-person consultation before a physician establishes a relationship for prescribing opiates (with one narrow same-group exception), requires anyone prescribing a controlled substance to be physically in Hawaii when they prescribe, and mandates payment parity for insurers, mutual benefit societies, and HMOs, subject to plan terms. The rules sit in HRS § 453-1.3 for physicians, parallel insurance code sections, and HRS § 346-59.1 plus a Med-QUEST memo for Medicaid. Hawaii's audio-only rules are temporary: unless the legislature acts, they lapse on December 31, 2027, when the telehealth sections revert to their pre-2023 text.

Licensure: a Hawaii license, with consultation exceptions

HRS § 453-2(a) bars practicing medicine or surgery in Hawaii without a valid unrevoked license or a limited and temporary license from the Hawaii Medical Board. Under HRS § 453-1.3(e), a relationship "may be established via a telehealth interaction; provided that the physician has a license to practice medicine in the State." Once a relationship exists, subsection (f) lets the patient or a Hawaii-licensed physician use telehealth for any authorized purpose, including consulting a provider licensed in another state.

Section 453-2(b) lists exceptions; those bearing on telehealth include:

• Consultation. A physician licensed in the state where they reside may consult, including by telephonic or other telehealth means, with a Hawaii-licensed physician, provided the out-of-state physician does not open an office, appoint a place to meet patients, or receive calls in Hawaii for care of a patient located there; the Hawaii physician retains control and remains responsible for the patient's care; and the laws on contagious diseases are not violated.
• Emergencies. The chapter does not prohibit service in an emergency.
• Radiology, one direction only. A radiologist licensed elsewhere may use telehealth while located in Hawaii to serve a patient in the state where the radiologist is licensed. A 2007 session law note bars reading it to cover patients in Hawaii.

Section 453-1.3 covers physicians only; other professions follow their own practice acts.

Hawaii joined the Interstate Medical Licensure Compact through Act 112 of 2023 (HRS chapter 453B), and licenses by compact have been available since January 1, 2025. As of the Hawaii Medical Board's May 2026 notice, Hawaii is not yet a state of principal license, so physicians must enter the compact through another member state; Act 163 of 2025 authorized the criminal history checks Hawaii needs to become one. It is not a member of the Nurse Licensure Compact, the Physical Therapy Compact, or the Counseling Compact, and PSYPACT legislation has been introduced but not enacted. See our cross-state licensing tracker.

Prescribing: an in-person rule for opiates

Section 453-1.3(b) requires a documented patient evaluation, including history and a discussion of physical symptoms adequate to establish a diagnosis and to identify underlying conditions or contraindications to the treatment. Subsection (c) holds telehealth treatment recommendations, including electronic prescriptions, to the same standards as traditional settings that do not include an in-person visit but in which prescribing is appropriate, such as on-call telephone encounters and those with a follow-up visit arranged. A prescription based solely on an online questionnaire "does not constitute an acceptable standard of care."

For prescribing opiates, the physician-patient relationship "shall only be established after an in-person consultation between the prescribing physician and the patient." Subsection (c) gives one exception: a patient seen in person by a health care provider in the same medical group as the prescribing provider may be prescribed an opiate for a three-day supply or less by telehealth. Separately, subsection (g) says the section's physician-patient relationship prerequisite does not apply to telehealth consultations for emergency department services.

Chapter 329 adds controlled-substance duties, including:

• a state controlled-substance registration for practitioners who prescribe or dispense (HRS § 329-33(c));
• registration with the electronic prescription accountability system, the state's prescription monitoring program, as part of that registration (HRS § 329-101(b)); we found no statutory duty to query it before prescribing;
• a physical-presence rule: all controlled-substance prescriptions "shall originate from within the State" (HRS § 329-38(h)(1)), and a practitioner who facilitates a written prescription or issues an oral prescription for a controlled substance "when not physically in the State" commits a class C felony (HRS § 329-41(a)(8), (c)). The Department of Law Enforcement, which issues Hawaii controlled-substance registrations, reads these sections to mean a prescriber "MUST be physically within the borders of the State of Hawaii when issuing a prescription for a controlled substance." A Hawaii license, a Hawaii registration, and the federal telemedicine rule do not change this;
• a 30-day supply cap on Schedule II narcotics, except single unit dose packages that exceed it and terminally ill patients a physician certifies (HRS § 329-38(a)(2)); and
• a seven-day limit on initial concurrent prescriptions for an opioid and a benzodiazepine, unless the patient qualifies under chapter 327L (Hawaii's medical aid in dying law) or a longer supply is medically necessary for post-operative pain, chronic pain, substance use or opioid dependence, cancer, palliative care, or hospice care, in which case the practitioner must document the condition and that an alternative was not appropriate treatment (HRS § 329-38(c)).

Section 329-38(o) permits electronic prescriptions for Schedule II through V, but we found no state mandate to prescribe controlled substances electronically. Medicare Part D separately requires at least 70 percent of Part D Schedule II–V prescriptions to be electronic under 42 CFR 423.160, subject to exceptions and waivers.

Federal law adds a separate layer for controlled substances. Under the temporary rule DEA and HHS published December 31, 2025 (90 FR 61301), which runs through December 31, 2026, a DEA-registered practitioner may prescribe Schedule II–V controlled substances after a real-time audio-video telemedicine encounter without a prior in-person evaluation, when the rule's other conditions are met; audio-only encounters qualify only for Schedule III–V narcotic medications approved by the FDA to treat opioid use disorder. See our guide to federal telehealth laws.

Consent: general rules, and a Medicaid documentation duty

We found no telehealth-specific consent statute, and the Hawaii Medical Board's rules in HAR chapter 16-85 contain no telehealth provision. The board's general informed consent standards in HAR §§ 16-85-24 through 16-85-27 apply where standards of practice call for disclosure before treatment or a diagnostic procedure, and information may be given in writing, orally, or by audiovisual aids. Section 453-1.3(d) makes telehealth reports part of the patient's health record, available to the patient.

Med-QUEST adds duties for Medicaid providers. Audio-only care must be the patient's preference, with the reason documented. A provider without capacity to deliver in-person services must, at each appointment, tell the patient of the right to in-person care, that the provider cannot furnish it, and that the patient's health plan can help find a provider who can, and must document that it did so.

Medicaid: parity by statute, audio-only by memo

HRS § 346-59.1 bars Medicaid managed care and fee-for-service programs from denying coverage for a service delivered by telehealth that would be covered in person. Reimbursement via an interactive telecommunications system must equal in-person reimbursement; audio-only mental health reimbursement must meet 42 CFR 410.78. It forbids geographic and originating-site restrictions, and its telehealth definition covers store-and-forward, remote monitoring, live consultation, and mobile health.

The operating rules are in Med-QUEST Memo QI-2527 / FFS 25-12 / CCS-2509 of December 8, 2025. Distant sites anywhere in the United States and its territories qualify, with one exception: a provider prescribing controlled substances must be located in Hawaii. This tracks the state physical-presence rule for controlled-substance prescriptions described above, which applies whatever the payer. Claims carry modifier 95, GQ, or GT; teledentistry is handled in the fee-for-service manual.

Audio-only coverage in the memo is for diagnosis, evaluation, or treatment of a mental health disorder of a patient at home, effective through December 31, 2027. The provider must be able to offer audio-video care, and audio-only must be the patient's documented preference. An in-person visit must occur within the six months before the first audio-only service; if the provider or patient needs more time, the health plan may consider, case by case, a request to meet the requirement up to six months after the first audio-only visit. After that, at least one medically necessary service must be furnished in person within 12 months and every 12 months thereafter while audio-only care continues. If no service is needed within 12 months of the last in-person visit, the next medically necessary service must be in person, and the record must document why no in-person visit occurred in that 12-month period. The in-person service may be furnished by the same provider or by a provider of the same specialty or subspecialty in the same group practice. Claims carry modifier FQ. Clinical psychologists and clinical social workers may bill psychotherapy but not evaluation and management.

Private insurance: payment parity, with an audio-only discount

HRS § 431:10A-116.3 (accident and health insurers), § 432:1-601.5 (mutual benefit societies), and § 432D-23.5 (HMOs) use the same text. A plan may not require in-person contact as a prerequisite for payment for services appropriately provided by telehealth under prevailing professional standards. Coverage "may be subject to all terms and conditions of the plan" agreed among the enrollee, the insurer, and the provider.

Subsection (c) sets payment parity: reimbursement via an interactive telecommunications system "shall be equivalent" to in-person reimbursement. Home audio-only mental health care is the exception, paid at 80 per cent of the in-person rate. To be reimbursed for audio-only, the provider must first conduct an in-person visit or a non-audio-only telehealth visit within six months before the initial audio-only visit, or within twelve months before any later one. Insurers must disclose telehealth cost-sharing in writing before issuance and on request. See our reimbursement guide.

What to watch

First, the sunset. Act 107 of 2023 (HB 907) added reimbursement for home audio-only mental health care, including the 80 per cent private-plan rate and the prior-visit rule. Act 217 of 2025 (SB 1281), effective July 1, 2025, moved Act 107's repeal from December 31, 2025, to December 31, 2027. On that date, unless the legislature acts again, §§ 453-1.3, 346-59.1, 431:10A-116.3, 432:1-601.5, and 432D-23.5 revert to their text before Act 107: telehealth payment parity remains, and the audio-only provisions lapse. Later amendments the legislature exempted from the sunset stay in force. Second, HB 2558 (2026) would have let out-of-state physicians provide an initial telehealth consultation under conditions; it passed the House and was referred to Senate committees on March 12, 2026, with no later action recorded. Third, any movement on PSYPACT or on Hawaii becoming an IMLC state of principal license. For how state law works in general, see how state telemedicine laws work.