Coverage for telephonic behavioral health services among Gov. Ige’s intent to veto bills


Nicole Pasia


Hawaii health care organizations are urging Gov. David Ige to reconsider his intent to veto a bill that would allow insurers to offer telephonic behavioral health services, or audio-only telehealth, as a covered benefit. Ige released his intent to veto list on June 27th, containing a total of 30 bills.


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HB 1980, which would allow insurers to cover telephonic behavioral health services, or audio-only telehealth, unanimously passed the House and Senate in March after agreeing to a clause that would neither mandate nor prohibit payers from providing coverage. 

A report from the House Committee on Health, Human Services, and Homelessness found demand for telehealth, particularly for behavioral health services, significantly increased during the COVID-19 pandemic. The report also stated that coverage for audio-only services would help mitigate digital disparities for individuals who have limited access to audio-visual technology.

In Ige’s veto rationale, he appreciated the intent of the bill but had concerns over its vague language. 

“The vague wording can be construed to either restrict when a health plan may voluntarily provide coverage or provide purely permissive authority for health plans to provide coverage. This may prompt health insurance plans to restrict or exclude coverage for telephonic services due to concerns of compliance with this bill. This could especially impact patients in rural and underserved areas, those with limited digital skills, or those with limited access to reliable internet service.”

Supporters of the bill argue the language is clear enough to establish guidelines for providers to receive reimbursement. 

“[The Hawaii Association of Health Plans] is requesting that Governor Ige allow HB 1980 to become law as we believe it will increase access to health care in Hawaii by creating a distinction to allow for reimbursement for telephone calls,” said HAHP President Jennifer Diesman in a statement. “… HB 1980 creates a statutory distinction between telehealth visits, already established in Hawaii Revised Statutes, and telephone calls by behavioral health providers, which is important given that there are clinical differences between in-person visits, telehealth (video), and audio-only telephone calls. We do not believe that HB 1980 will restrict access and harm the community by placing unreasonable conditions to be met before a behavioral health provider can get reimbursement from health insurers for a telephone call with patients.”

Hilton Raethel, President and CEO of the Healthcare Association of Hawaii, acknowledged the potential risk for providers to request equal reimbursement for telehealth services instead of full in-person visits. However, he noted that payers reserve the right to conduct reimbursement audits after they occur. 

“We believe the benefits far outweigh the potential risks in terms of potential abuse, because you can always monitor for that,” he said. 

Ige intends to veto other health policy bills, including a ban on the sale of flavored tobacco products and clarification on state and county emergency management authority. He has until July 12th to finalize his veto decisions. Bills that are not vetoed by then will become law with or without his signature. 

Scott Saiki, Speaker of the Hawaii House of Representatives, released a statement on the legislature’s next steps regarding the vetoes: 

“After the House committee chairs have an opportunity to review the Governor’s list, we will meet with the House members to determine whether to override any vetoes. We will also have to determine whether the Senate is willing to override.”

The legislature may choose to convene before noon on July 12th to act on vetoed bills, including amending the bill to meet the governor’s objections. A two-thirds majority is needed in both chambers to override the veto.