Hawaii therapy practice guide: PT, OT and SLP

For OT, PT and SLP clinics in Hawaii: two boards and a program license the disciplines, a patient may start physical therapy without a referral, Med-QUEST covers children’s therapy under EPSDT and adults within its own rules, and telehealth follows the patient’s location. Every rule here is quoted from its source.⁠^1,2,3

Who licenses OTs, PTs and SLPs in Hawaii?

Two boards and a program license the three disciplines in Hawaii, and each publishes its own licensing law and renewal cycle.⁠^1,4,5 A clinic that employs more than one discipline keeps three registers, not one.

Physical therapists and physical therapist assistants answer to the Hawaii Board of Physical Therapy.⁠^{1,21,22,23,24,25,26} Occupational therapists and occupational therapy assistants answer to the Hawaii Occupational Therapy Program, Department of Commerce and Consumer Affairs.⁠^{4,27,28,29,30} Speech-language pathologists answer to the Hawaii Board of Speech Pathology and Audiology.⁠^{5,31,32,33,34,35} A license is a state authorization; a national certification (NBCOT for occupational therapy, the ASHA certificate for speech-language pathology, the NPTE for physical therapy) is a different thing and does not replace it. Compact privileges for practitioners licensed elsewhere are covered under telehealth below.

What does a Hawaii license renewal require?

Each regulator sets its own cycle and any continuing-education hours, listed in the table above, and the register template at the end of this page tracks them per clinician.⁠^1,4,5 A renewal missed is a lapse, and the regulator’s own rules say what a lapsed licensee may and may not do; the clinic reads those rules before a clinician’s renewal date passes, not after.

Can a patient see a Hawaii PT, OT or SLP without a referral?

State law answers this discipline by discipline, and a payer may still require a referral the law does not. For physical therapy, a licensed physical therapist may evaluate anyone without a referral and may treat with or without one, but must refer the patient to an appropriate healthcare provider when there is reasonable cause to believe a symptom or condition is beyond the physical therapist’s scope of practice or makes physical therapy contraindicated; Med-QUEST’s fee-for-service manual, as a payer, requires physical therapy to be prescribed by a physician.⁠^2,6 For occupational therapy, the Occupational Therapy Practice Act defines the practice and requires a license to practice it, and carries no provision that conditions an evaluation or treatment on a physician’s referral; Med-QUEST’s fee-for-service manual, as a payer, requires occupational therapy to be prescribed by a physician.⁠^36,37 For speech-language pathology, the licensure act defines the practice of speech pathology and requires a license, and carries no provision that conditions an evaluation or treatment on a physician’s referral; Med-QUEST’s fee-for-service manual covers speech services for a patient referred by a physician.⁠^38,39,40

The payer’s rule is separate. Medicare pays for outpatient therapy under a plan of care certified by a physician or nonphysician practitioner, and the regulation’s 2025 text lets a signed order or referral on file, with the plan delivered within 30 days of the initial evaluation, stand in for that signature on an initial plan.⁠¹² Med-QUEST’s referral and prior-authorization rules are in the next section. A commercial plan’s rule is in its member contract and provider manual, and the clinic keeps a copy of each.

How does Med-QUEST pay for pediatric and adult therapy?

Med-QUEST is Hawaii’s Medicaid program, run by the Department of Human Services, Med-QUEST Division, and a clinic enrolls through its provider enrollment route before it bills.⁠⁴¹ For children, the federal EPSDT benefit requires the state to cover services that correct or ameliorate a condition found at a screening, whether or not the state plan covers them for adults.⁠⁴² For members under 21, the EPSDT chapter covers every Medicaid service needed to correct or ameliorate a condition found at a screening, and lists therapy services among those covered once the physician submits a prior authorization and the Department of Human Services finds them medically necessary.⁠³

Med-QUEST’s fee-for-service manual covers physical and occupational therapy that restores function, on a plan of care prescribed by a physician, and excludes maintenance therapy, long-term maintenance and group exercise programs. Speech therapy is covered on a physician’s referral, without group or maintenance therapy.⁠⁷ In Med-QUEST’s fee-for-service manual a physical or occupational therapy evaluation needs no prior authorization, and the chart allows 12 visits or 36 units per 120 days for PT and for OT before a request is filed. Every speech evaluation and course of speech therapy needs prior authorization.⁠^43,44 Hawaii delivers Medicaid through QUEST Integration, which uses capitated managed care unless otherwise indicated. Med-QUEST lists five health plans (AlohaCare, HMSA, Kaiser Permanente, ’Ohana Health Plan and UnitedHealthcare Community Plan), and for current coverage information Med-QUEST directs providers to the QUEST Integration plan they participate in.⁠^45,46,47 The fee schedule is published by the agency, and a clinic reads the current file rather than a remembered rate.⁠⁴⁸

How does Med-QUEST want OT, PT and SLP claims coded?

Med-QUEST’s fee-for-service therapy chapter, revised February 2011, lists the evaluation codes 97001 to 97004 (one PT or OT evaluation per 120 days and one re-evaluation per 90 days without prior authorization) and covers up to three 15-minute units a day. A request beyond the limits goes on Form 1144 marked "EXCEEDS LIMITS", no earlier than 60 days from the start of therapy or after 8 visits, with modifier GP for PT and GO for OT. Speech requests go on Form 1144 with CMS-700 for initial services and CMS-701 for extensions, and speech therapy for children 0 to 6 needs a medical authorization. Group PT, group speech therapy and work hardening are not covered.⁠^{49,50,51,52,53} The codes, modifiers and authorization forms are the manual’s and change with it, so the clinic reads the current therapy sections before its first claim and records the manual’s page-updated date in the payer register.

Does Med-QUEST pay for therapy in schools?

Through School-Based Claiming, the Hawaii State Department of Education draws federal Medicaid reimbursement for certain medically necessary, health-related services it provides to eligible students.⁠⁵⁴ A school’s billing is the district’s, under its own program; an outpatient clinic’s claim for the same child is a separate matter with its own eligibility and authorization.

Does Med-QUEST cover therapy by telehealth?

Section 346-59.1 bars Med-QUEST’s managed care and fee-for-service programs from denying coverage for a service delivered by telehealth that would be covered in person, sets reimbursement through an interactive telecommunications system equal to in-person reimbursement, and allows no geographic restriction.⁠⁵⁵ The telehealth section below covers the state’s own rules for the session itself.

What are Hawaii’s telehealth rules for therapy?

A therapist treating a patient by video needs authority to practice where the patient is located at the time of the session, and the federal telehealth site says so plainly: licensure follows the patient’s location, and a compact privilege is one route to it.⁠⁸ Hawaii’s insurance telehealth statute, section 431:10A-116.3, counts practitioners licensed by the State and working within their scope of practice as health care providers, and lets a telehealth interaction establish the provider-patient relationship where none exists.⁠⁵⁶

A compact privilege is not a national license: it is a privilege to practice in the specific member state that issued it, under that state’s licensing law, and a state that has enacted the compact may not yet be issuing privileges, which is why the table names the commission’s current status.⁠⁹ Section 431:10A-116.3 bars an accident and health or sickness plan from requiring in-person contact before it pays for services appropriately provided through telehealth, and sets reimbursement for telehealth through an interactive telecommunications system equal to in-person reimbursement. Section 346-59.1 applies the same coverage and payment rule to the State’s Medicaid managed care and fee-for-service programs (Med-QUEST).⁠^57,58

Which business steps are specific to Hawaii?

The entity is registered with the Business Registration Division of the Department of Commerce and Consumer Affairs, and the choice of entity is shaped by the state’s rule on who may own a therapy business.⁠¹⁵ Hawaii’s Professional Corporation Act limits professional corporations to services that only persons licensed under named chapters may render (among them medicine, nursing, dentistry, pharmacy and psychology), and the list does not include the physical therapy, occupational therapy or speech pathology chapters (461J, 457G and 468E). A therapy clinic may organize as a limited liability company, which chapter 428 allows for any lawful purpose, subject to the laws regulating the business.⁠^16,17 State tax registration is with the Department of Taxation, for a general excise tax license.⁠⁵⁹ Hawaii has no sales tax; its general excise tax falls on the gross income of every business, services included, so a therapy clinic holds a general excise tax license and pays 4 percent on its gross receipts from patients and payers (plus any county surcharge), whether it bills for treatment or sells goods. The exemption for Medicare, Medicaid and TRICARE receipts names hospitals, medical clinics, health care facilities and medical or dental practitioners, a term the statute defines as physicians, osteopathic physicians, dentists, advanced practice registered nurses and pharmacists.⁠^60,61,62,63 Every Hawaii employer other than the State, the counties and other public entities must secure workers’ compensation for its employees, by insuring with an authorized carrier, by depositing approved security, or by approved self-insurance, with no minimum number of employees.⁠⁶⁴ A city or county business license is a local question, answered by the city hall of the clinic’s address. The startup-costs guide carries the budget worksheet these registrations go into.

What record and privacy rules apply in Hawaii?

Hawaii’s section 622-58 requires a health care provider to keep medical records at least seven years after the last entry, and a minor’s for the period of minority plus seven years after the age of majority, and to preserve basic information for twenty-five years (minority plus twenty-five for a minor). The section borrows the definition in section 671-1, which names physicians, osteopathic physicians, surgeons, physician assistants, podiatrists, health care facilities, midwives and their employees, so it binds a therapist employed by one of them, and an independent OT, PT or SLP clinic writes its own policy at or above those figures.⁠^13,14 Two federal periods sit beside it and are often confused with it: Medicare requires 7 years for documentation of orders, certifications, referrals and payment requests, and HIPAA requires 6 years for its own compliance documentation, and neither sets the retention period for the clinical chart.⁠^65,66

Hawaii’s Health Care Privacy Harmonization Act (section 323B-3) deems any use or disclosure of health information that HIPAA’s Privacy Rule permits, and any authorization that meets 45 CFR 164.508, to comply with every Hawaii law on the confidentiality of that information, so a HIPAA-compliant clinic meets the state’s rules on disclosure.⁠⁶⁷ Section 487N-2 requires a business that owns or licenses Hawaii residents’ personal information, in any form, to notify the affected people of a security breach without unreasonable delay, and to notify the state Office of Consumer Protection and the national consumer reporting agencies when it notifies more than one thousand people at once. Section 323B-3 deems a HIPAA-compliant breach notice to satisfy state law for protected health information.⁠^68,69 Section 350-1.1 makes any licensed or registered professional of the healing arts or any health-related occupation who examines, treats or provides other professional services a mandated reporter, who must immediately report suspected child abuse or neglect orally to the Department of Human Services or the police and follow with a written report.⁠⁷⁰

Which Hawaii rules shape a pediatric clinic?

The Department of Health’s Early Intervention Section runs Hawaii’s IDEA Part C program for infants and toddlers from birth to three with a developmental delay or at risk of one. Its services include occupational therapy, physical therapy and speech and language therapy, every eligible child has a care coordinator, and there is no cost to families, with Medicaid or private insurance billed when parents permit. Referrals go to the information and referral line, 808-594-0066 on Oahu or 1-800-235-5477 from the Neighbor Islands, or by fax on the referral form.⁠^18,19,20 A child who turns three moves from early intervention to the school district’s evaluation, and a private clinic’s services run beside both systems rather than inside them. Section 431:10A-133 requires individual and group accident and health or sickness policies issued or renewed after January 1, 2016 to cover the diagnosis and treatment of autism for covered people under fourteen, including therapeutic care by licensed speech pathologists, registered occupational therapists and licensed physical therapists when prescribed and medically necessary. Applied behavior analysis is capped at $25,000 a year for children thirteen and under, and the cap does not apply to other services.⁠⁷¹ The autism insurance mandates guide covers how such a mandate meets a plan’s own terms.

Which Hawaii rules shape an adult clinic?

Medicare claims from Hawaii go to Noridian Healthcare Solutions, the Medicare Administrative Contractor for Jurisdiction E, Part B (California, Hawaii, Nevada and the Pacific territories), whose local coverage articles for therapy are the ones a Hawaii clinic reads.⁠⁷² Med-QUEST’s adult therapy rules are in the Medicaid section above. Hawaii’s workers’ compensation medical fee schedule caps charges at 110 percent of the Medicare fee schedule for Hawaii or the supplemental schedule in Exhibit A, dated January 1, 2026. Its rules name physical therapists and occupational therapists among providers of service and pay their licensed or certified assistants 60 percent of the scheduled fee.⁠^73,74,75

Which associations and directory pages serve Hawaii?

The state chapters are APTA Hawaii for physical therapy and the Hawaii Speech-Language-Hearing Association for speech-language pathology.⁠^76,77 On DrSensory, families browse Hawaii clinics by discipline on the occupational therapy, physical therapy and speech therapy pages for the state, which the directory builds from the clinic addresses it holds; a clinic appears on the pages of its own address.⁠⁷⁸

Which Hawaii cities have DrSensory city pages?

Beyond its three Hawaii pages, the directory publishes city pages for one Hawaii city, Honolulu, three pages across the three disciplines, each listing the clinics whose address is in that city; a clinic appears on the city page of its address without any action of its own, and a city or discipline without a page is reached through the state page.⁠⁷⁸

How many Hawaii PT, OT and SLP clinics does DrSensory list?

DrSensory lists 24 PT, OT and SLP clinics in Hawaii, on its occupational therapy, physical therapy and speech therapy pages for the state.⁠⁷⁸

Where does each requirement come from, and what does the clinic do?

Which templates does a Hawaii launch need?

How might two Hawaii clinics plan a launch?

Sources

1. Hawaii. Hawaii Board of Physical Therapy. Checked October 30, 2026.
2. Hawaii Board of Physical Therapy. Hawaii Administrative Rules section 16-110-3, When referrals required. Checked October 30, 2026.
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   “A licensed physical therapist may perform an evaluation of any person without a referral. A physical therapist may treat a patient with or without a referral unless the physical therapist has reasonable cause to believe that the patient has a symptom or condition that is either beyond the physical therapist’s scope of practice, or for which physical therapy is contraindicated, in which case the physical therapist shall refer that patient to an appropriate healthcare provider.”
3. Hawaii Department of Human Services, Med-QUEST Division. Hawaii Medicaid Provider Manual, Chapter 5, EPSDT (March 2011). Checked October 29, 2026.
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   “Federal requirements imposed by the EPSDT statutory provisions of the Omnibus Budget Reconciliation Act of 1989 (OBRA ’89) mandate that the State cover all Title XIX services included in Section 1905 (a) of the Act, when medically needed, to correct or ameliorate defects and physical and mental illness and conditions discovered as a result of EPSDT screening. ... Other services are covered under EPSDT for clients up to the age of 21 years when the client’s physician has completed and submitted a prior authorization and DHS has determined that the services are medically necessary. ... These services may include skilled nursing services, case management, medical equipment, therapy services, and other home and community based services.”
4. Hawaii. Hawaii Occupational Therapy Program, Department of Commerce and Consumer Affairs. Checked October 30, 2026.
5. Hawaii. Hawaii Board of Speech Pathology and Audiology. Checked October 30, 2026.
6. Hawaii Department of Human Services, Med-QUEST Division. Hawaii Medicaid Provider Manual, Chapter 17, Rehabilitative Therapy Services (revised February 2011), section 17.2.2. “Services must be included in a plan of care and must be prescribed by a physician.” Checked October 29, 2026.
7. Hawaii Department of Human Services, Med-QUEST Division. Hawaii Medicaid Provider Manual, Chapter 17, Rehabilitative Therapy Services (revised February 2011), section 17.2. Checked October 29, 2026.
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   “Medicaid covers physical therapy, which provides maximum reduction of a physical disability and restoration of the patient to the best possible functional level. Services should be directed toward restoring a disabled person to self-care and possible independent living or gainful employment. Services must be included in a plan of care and must be prescribed by a physician. ... Maintenance therapy for the purpose of maintaining function is not covered. ... Long-term maintenance and group exercise programs are not covered.”
8. U.S. Department of Health and Human Services. Getting started with licensure (Telehealth.HHS.gov, last updated February 21, 2024). Checked October 26, 2026.
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   “Health professionals must meet the licensure requirements of the state where they are located and be licensed or legally permitted to practice in the state where the patient is located”. Its companion page, Licensing across state lines (last updated April 30, 2025): “The ability to deliver health care services across state lines varies based on state regulations”; “Prior to an appointment, providers should verify patient location and obtain consent”; “Compacts allow participating health care providers to practice in participating states”.
9. PT Compact Commission. PT Compact Map. “Non-Members (10) ... California ... Florida ... Hawaii ...” Checked October 30, 2026.
10. Occupational Therapy Compact Commission. Before You Apply for an OT Compact Privilege. Checked October 30, 2026.
11. Audiology and Speech-Language Pathology Interstate Compact Commission. Compact Map. “Legislation Enacted - Not Yet Issuing Privileges: 33 ... Legislation Enacted - Issuing Privileges: 4 ...” Checked October 30, 2026.
12. Code of Federal Regulations. 42 CFR 424.24, Requirements for medical and other health services furnished by providers under Medicare Part B (eCFR, up to date as of October 22, 2026; paragraph (c), outpatient physical therapy, occupational therapy and speech-language pathology services). Checked October 26, 2026.
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    “The individual needs, or needed, physical therapy, occupational therapy, or speech-language pathology services.”; “The services were furnished while the individual was under the care of a physician, nurse practitioner, clinical nurse specialist, or physician assistant.”; “The initial certification must be obtained as soon as possible after the plan is established.”; “Recertification is required at least every 90 days.”; “When it is recertified, the plan or other documentation in the patient’s record must indicate the continuing need for physical therapy, occupational therapy or speech-language pathology services.”; “the therapist has documented evidence that the plan of treatment has been delivered to the physician, NP, PA, or CNS within 30 days of completion of the initial evaluation, the certification does not need to be signed by a physician, NP, CNS, or PA who has knowledge of the case.”; “No references to an order or referral in this subsection shall be construed to require an order or referral for outpatient physical therapy, occupational therapy, or speech-language pathology services.”.
13. Hawaii State Legislature. Hawaii Revised Statutes section 622-58. Checked October 30, 2026.
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    “The health care provider shall retain medical records in the original or reproduced form for a minimum of seven years after the last data entry except in the case of minors whose records shall be retained during the period of minority plus seven years after the minor reaches the age of majority. ... The health care provider, or the health care provider’s successor, shall be liable for the preservation of basic information from the medical record for twenty-five years after the last entry, except in the case of minors, whose records shall be retained during the period of minority plus twenty-five years after the minor reaches the age of majority.”
14. Hawaii State Legislature. Hawaii Revised Statutes section 671-1. “"Health care provider" means a physician, osteopathic physician, surgeon, or physician assistant licensed under chapter 453; podiatrist licensed under chapter 463E; health care facility as defined in section 323D-2; midwife licensed under chapter 457J; and the employees of any of them.” Checked October 30, 2026.
15. Hawaii Department of Commerce and Consumer Affairs, Business Registration Division. Business Registration Division (BREG). Checked October 30, 2026.
16. Hawaii State Legislature. Hawaii Revised Statutes section 415A-2. “"Professional service" means any service that lawfully may be rendered only by persons licensed under chapters 442, 448, 453, 455, 457, 459, 461, 463E, 465, 466, 471, and 605.” Checked October 30, 2026.
17. Hawaii State Legislature. Hawaii Revised Statutes section 428-111(a). “A limited liability company may be organized under this chapter for any lawful purpose, subject to any law of this State governing or regulating business.” Checked October 30, 2026.
18. Hawaii State Department of Health. Early Intervention Section. Checked October 30, 2026.
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    “The Early Intervention Section (EIS) is a federal and state-mandated program that provides services to support the development of infants and toddlers from birth to three years of age. ... The Department of Health (DOH) is the lead agency for the implementation of Part C, Individuals with Disabilities Education Act (IDEA) for the State of Hawaii.”
19. Hawaii State Department of Health. Early Intervention Services. Checked October 30, 2026.
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    “If you are concerned about a child’s development or would like to make a referral, please call our Early Intervention information and referral line at 808-594-0066 for Oahu or 1-800-235-5477 for Neighbor Islands. To make a referral by fax, please download the EI referral form and instructions ... Eligibility: A child is eligible for services if a child has a delay in development or is at-risk of developing a delay. ... No Cost: There is no cost to families and no income restrictions. Whenever possible, however, payments are accessed through Medicaid or private medical insurance with parental permission.”
20. Hawaii State Department of Health. Types of Services. “The following is a list of services that are provided by EIS. ... Occupational Therapy ... Physical Therapy ... Speech and Language Therapy ...” Checked October 30, 2026.
21. Hawaii Department of Commerce and Consumer Affairs, Professional and Vocational Licensing Division. Board of Physical Therapy. “(Renew by December 31 every even-numbered year) ... All licenses regardless of issuance date, are subject to renewal by December 31, every even-numbered year. Licenses not renewed by license expiration date are unlicensed and may not practice.” Checked October 30, 2026.
22. Hawaii State Legislature. Hawaii Revised Statutes section 461J-10(a). Checked October 30, 2026.
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    “The biennial renewal fee shall be paid to the department of commerce and consumer affairs on or before December 31 of each even-numbered year. Failure, neglect, or refusal of any licensee to pay the biennial renewal fee on or before such date shall constitute a forfeiture of the license.”
23. Hawaii State Legislature. Hawaii Revised Statutes section 461J-10.1. Checked October 30, 2026.
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    “Beginning with the December 31, 2016, renewal, each licensed physical therapist shall be required to obtain at least thirty units of approved continuing competence units in each two-year license renewal period, where one continuing competence unit is equivalent to at least fifty minutes of classroom or hands-on instruction. (b) For first-time license renewals, if the initial license was issued less than twelve months prior to the renewal date, no continuing competence units will be required for the first renewal period. If the initial license was issued more than twelve months prior to the renewal date, the licensee shall be required to obtain fifteen units of approved continuing competence units for the first renewal period.”
24. Hawaii Board of Physical Therapy. Important Announcement Regarding the Continuing Competence Requirements under HRS Chapter 461J (Rev 0617). Checked October 30, 2026.
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    “At least twenty-four (24) CCUs in subjects related to either: a. The professional practice of physical therapy ... or b. Patient/client management ... Two (2) CCUs in ethics, laws, and rules (jurisprudence), or some combination thereof (Please note: the two (2) CCUs must cover Hawaii’s laws and rules governing the practice of physical therapy. ... Four (4) CCUs in life support for health care professionals ...”
25. Hawaii Board of Physical Therapy. Frequently Asked Questions Regarding the Continuing Competence Requirements under HRS Chapter 461J (Rev 0220). “Currently, physical therapist assistants are not subject to continuing competence requirements.” Checked October 30, 2026.
26. Hawaii Board of Physical Therapy. Hawaii Administrative Rules section 16-110-4(a), (b)(8) and (d). Checked October 30, 2026.
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    “A physical therapist shall supervise all physical therapy care provided by physical therapist assistants, and support or auxiliary personnel. ... Telecommunications accessibility at all times when the supervising physical therapist is not on site and the ability to be on site within two hours if the supervising physical therapist’s physical presence is needed. ... A supervising physical therapist may supervise a maximum of three persons, which may include any combination of the following: ... A temporary physical therapist licensee; ... A student; or ... A physical therapist assistant.”
27. Hawaii Department of Commerce and Consumer Affairs, Professional and Vocational Licensing Division. Occupational Therapy Program. “(Renew by December 31 every even-numbered year) ... All Licenses regardless of issuance date, are subject to renewal by December 31 of every even-numbered year. Licenses not renewed by the expiration date are unlicensed and may not practice.” Checked October 30, 2026.
28. Hawaii State Legislature. Hawaii Revised Statutes section 457G-6(a). “The biennial renewal fee shall be paid to the department on or before December 31 of each even-numbered year. Failure, neglect, or refusal of any licensee to pay the biennial renewal fee on or before this date shall constitute a forfeiture of the license.” Checked October 30, 2026.
29. Hawaii Department of Commerce and Consumer Affairs, Professional and Vocational Licensing Division. Occupational Therapist (OT) and Occupational Therapy Assistant (OTA) Frequently Asked Questions. “Are there continuing education (“CE”) requirements for licensure renewal? No, there are no CE requirements for renewal.” Checked October 30, 2026.
30. Hawaii State Legislature. Hawaii Revised Statutes section 457G-2.7. Checked October 30, 2026.
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    “An occupational therapy assistant may practice occupational therapy only under the supervision of, and in partnership with, an occupational therapist who is licensed to practice occupational therapy in the State. The occupational therapist shall be responsible for occupational therapy evaluation, appropriate reassessment, treatment planning, interventions, and discharge from occupational therapy based on standard professional guidelines. ... The supervising occupational therapist shall: (1) Determine the frequency, level, and nature of supervision with input from the occupational therapy assistant; ... The supervising occupational therapist shall supervise the occupational therapy assistant to ensure that the occupational therapy assistant: (1) Does not initiate or alter a treatment program without prior evaluation by and approval of the supervising occupational therapist ...”
31. Hawaii Department of Commerce and Consumer Affairs, Professional and Vocational Licensing Division. Board of Speech Pathology and Audiology. Checked October 30, 2026.
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    “(Renew by December 31 every odd-numbered year) ... All Licenses regardless of issuance date, are subject to renewal by December 31 of every odd-numbered year. Licenses not renewed by license expiration date are unlicensed and may not practice.”
32. Hawaii State Legislature. Hawaii Revised Statutes section 468E-14(a). “Licenses issued under this chapter expire at midnight, December 31 of each odd-numbered year if not renewed.” Checked October 30, 2026.
33. Hawaii Board of Speech Pathology and Audiology. Speech Pathologist and Audiologist Frequently Asked Questions (February 2018). “Are there continuing education (CE) requirements for licensure renewal? No, there are no CE requirements for renewal.” Checked October 30, 2026.
34. Hawaii State Legislature. Hawaii Revised Statutes section 468E-12.5. Checked October 30, 2026.
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    “Engages in clinical or academic practice under the supervision of a licensed speech pathologist during the period of time needed to fulfill the necessary requirements for licensure as a speech pathologist pursuant to section 468E-5; ... A provisional licensee may only practice speech pathology under the supervision of the licensed speech pathologist named on the provisional license. (c) A provisional license issued pursuant to this section shall be valid for one year from the date of issuance and may be renewed for an additional one-year period ...”
35. Hawaii Department of Commerce and Consumer Affairs, Professional and Vocational Licensing Division. Board of Speech Pathology and Audiology. “Speech Pathology and Audiology License Types ... Audiologist ... Speech Pathologist ...” Checked October 30, 2026.
36. Hawaii State Legislature. Hawaii Revised Statutes section 457G-1.5. Checked October 30, 2026.
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    “The practice of occupational therapy is the therapeutic use of everyday life activities with individuals or groups for the purpose of participation in roles and situations in home, school, workplace, community, and other settings. ... No person shall engage in the practice of occupational therapy gratuitously or for pay, offer to practice occupational therapy, offer occupational therapy, or represent, advertise, or announce, either publicly or privately, that the person is an occupational therapist, unless the person is appropriately licensed under this chapter.”
37. Hawaii Department of Human Services, Med-QUEST Division. Hawaii Medicaid Provider Manual, Chapter 17, Rehabilitative Therapy Services (revised February 2011), section 17.1.2. “Services must be included in a plan of care and must be prescribed by a physician.” Checked October 29, 2026.
38. Hawaii State Legislature. Hawaii Revised Statutes section 468E-2. “"The practice of speech pathology" means the application of principles, methods, and procedures of measurement, prediction, evaluation, testing, counseling, consultation, and instruction related to the development and disorders of speech and related language and hearing for the purpose of modifying speech and related language and hearing disorders.” Checked October 30, 2026.
39. Hawaii State Legislature. Hawaii Revised Statutes section 468E-8(a). “After December 31, 1988, no person shall engage in the practice of speech pathology or audiology unless the person is licensed in accordance with this chapter or as otherwise provided in this chapter.” Checked October 30, 2026.
40. Hawaii Department of Human Services, Med-QUEST Division. Hawaii Medicaid Provider Manual, Chapter 17, Rehabilitative Therapy Services (revised February 2011), section 17.4.2. “Services for individuals with a speech disorder(s) means diagnostic, screening, preventive or corrective services provided by, or under the direction of a speech pathologist to whom a patient is referred by a physician.” Checked October 29, 2026.
41. Hawaii Department of Human Services, Med-QUEST Division. Be a New Provider. Checked October 30, 2026.
42. Medicaid.gov (Centers for Medicare & Medicaid Services). Early and Periodic Screening, Diagnostic, and Treatment (Medicaid benefit page). Checked October 26, 2026.
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    “The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid.”; “It is the responsibility of states to determine medical necessity on a case-by-case basis.”.
43. Hawaii Department of Human Services, Med-QUEST Division. Hawaii Medicaid Provider Manual, Chapter 17, Rehabilitative Therapy Services (revised February 2011), section 17.3. Checked October 29, 2026.
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    “Occupation and/or Physical Therapy services are available without prior authorization within the following guidelines: ... The initial evaluation for physical or occupation therapy does not require prior authorization. ... Clients are allowed up to 36 units or 12 visits of PT and/or OT as long as these services(s) does not/do not exceed 36 units, or 12 visits for PT and/or OT in a 12-day period. ... 12 visits or 36 therapy and or modality units per 120 days for PT and OT. ... Thus, no PA is required for 12 PT and/or 12 OT visits per 120 days.”
44. Hawaii Department of Human Services, Med-QUEST Division. Hawaii Medicaid Provider Manual, Chapter 17, Rehabilitative Therapy Services (revised February 2011), sections 17.4.4 and 17.4.5. Checked October 29, 2026.
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    “All recommended speech evaluations shall require prior authorization by the department’s medical consultants according to the following procedures: ... Inpatient (excluding acute level of care) and outpatient speech therapy require prior approval on Form 1144, with the appropriate CMS form attached.”
45. Hawaii Department of Human Services, Med-QUEST Division. QUEST Integration. “QUEST Integration is a continuation and expansion of the state’s ongoing demonstration that is funded through Title XIX, Title XXI and the State. QUEST Integration uses capitated managed care as a delivery system unless otherwise indicated.” Checked October 30, 2026.
46. Hawaii Department of Human Services, Med-QUEST Division. Managed Care Providers. “AlohaCare Provider Directory ... HMSA Provider Directory ... Kaiser Permanente Provider Directory ... Ohana Health Plan Provider Directory ... UnitedHealthcare Community Plan Provider Directory ...” Checked October 30, 2026.
47. Hawaii Department of Human Services, Med-QUEST Division. Fee Schedules. “A fee of $0.00 on the fee schedule for any code does not necessarily mean that the code is not covered by Hawaii’s Medicaid program. For current coverage information, please contact the QI (QUEST Integration) health plan in which you participate.” Checked October 30, 2026.
48. Hawaii Department of Human Services, Med-QUEST Division. Fee Schedules. Checked October 30, 2026.
49. Hawaii Department of Human Services, Med-QUEST Division. Hawaii Medicaid Provider Manual, Chapter 17, Rehabilitative Therapy Services (revised February 2011), section 17.3 chart. Checked October 29, 2026.
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    “97001 ... PT evaluation. ... 1 per 120 days ... 97002 ... Pt re-evaluation. ... 1 per 90 days ... 97003 ... OT evaluation. ... 1 per 120 days ... 97004 ... OT re-evaluation. ... 1 per 90 days ...”
50. Hawaii Department of Human Services, Med-QUEST Division. Hawaii Medicaid Provider Manual, Chapter 17, Rehabilitative Therapy Services (revised February 2011), section 17.3. Checked October 29, 2026.
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    “Submit and 1144 form no earlier than 2 months (60days) from the start date of therapy or after at least 8 initial therapy visits have been completed. b) Write on the top of the 1144 form “EXCEEDS LIMITS”. c) Submit the specific CPT code (s) with the appropriate modifier; “GP” for PT and “GO” for OT services.”
51. Hawaii Department of Human Services, Med-QUEST Division. Hawaii Medicaid Provider Manual, Chapter 17, Rehabilitative Therapy Services (revised February 2011), section 17.3. “For modalities designated in 15-minute units, Medicaid will cover up to 3, 15-minute units per day (45 minutes) or total of 36 units.” Checked October 29, 2026.
52. Hawaii Department of Human Services, Med-QUEST Division. Hawaii Medicaid Provider Manual, Chapter 17, Rehabilitative Therapy Services (revised February 2011), section 17.4.5. Checked October 29, 2026.
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    “For all initial service authorization requests, Form CMS-700 (11-91) Plan of Treatment for Outpatient Rehabilitation must be submitted with Form 1144. ... For authorization requests to extend services, Form CMS-701 (11-91) Updated Plan of Progress for Outpatient Rehabilitation must be submitted with Form 1144. ... A medical authorization is required for speech therapy for patients age 0 – 6 years old ...”
53. Hawaii Department of Human Services, Med-QUEST Division. Hawaii Medicaid Provider Manual, Chapter 17, Rehabilitative Therapy Services (revised February 2011), sections 17.3 and 17.4.3. “NON-COVERED: ... 97545,97546 ... Work hardening ... 97150 ... Group P.T. ... Group speech therapy is not covered.” Checked October 29, 2026.
54. Hawaii State Department of Education. Partners and Resources. “School-Based Claiming ... HIDOE is eligible to receive federal reimbursement from the Medicaid program for certain medically necessary, health-related services we provide to eligible students.” Checked October 30, 2026.
55. Hawaii State Legislature. Hawaii Revised Statutes section 346-59.1. Checked October 30, 2026.
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    “The State’s medicaid managed care and fee-for-service programs shall not deny coverage for any service provided through telehealth that would be covered if the service were provided through in-person consultation between a patient and a health care provider. ... 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; ... There shall be no geographic restrictions or requirements for telehealth coverage or reimbursement under this section.”
56. Hawaii State Legislature. Hawaii Revised Statutes section 431:10A-116.3(d) and (g). Checked October 30, 2026.
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    “Notwithstanding chapter 453 or rules adopted pursuant thereto, in the event that a health care provider-patient relationship does not exist between the patient and the health care provider to be involved in a telehealth interaction between the patient and the health care provider, a telehealth mechanism may be used to establish a health care provider-patient relationship. ... "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 ...”
57. Hawaii State Legislature. Hawaii Revised Statutes section 431:10A-116.3(b) and (c). Checked October 30, 2026.
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    “No accident and health or sickness insurance plan that is issued, amended, or renewed shall require in-person contact between a health care provider and a patient as a prerequisite for payment for services appropriately provided through telehealth in accordance with generally accepted health care practices and standards prevailing in the applicable professional community at the time the services were provided. ... 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 ...”
58. Hawaii State Legislature. Hawaii Revised Statutes section 346-59.1(a) and (b), Coverage for telehealth. Checked October 30, 2026.
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    “(a) The State’s medicaid managed care and fee-for-service programs shall not deny coverage for any service provided through telehealth that would be covered if the service were provided through in-person consultation between a patient and a health care provider. (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 ...”
59. Hawaii Department of Taxation. General Excise Tax (GET) Information. Checked October 30, 2026.
60. Hawaii Department of Taxation. General Excise Tax (GET) Information. Checked October 30, 2026.
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    “Hawaii does not have a sales tax; instead, we have the GET, which is assessed on all business activities. The tax rate is 0.15% for Insurance Commission, 0.5% for Wholesaling, Manufacturing, Producing, Wholesale Services, and Use Tax on Imports For Resale, and 4% for all others. ... The Legislature also authorized county governments to adopt a county surcharge on state GET at the 4% rate.”
61. Hawaii State Legislature. Hawaii Revised Statutes section 237-13(6)(A). Checked October 30, 2026.
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    “Upon every person engaging or continuing within the State in any service business or calling including professional services not otherwise specifically taxed under this chapter, there is likewise hereby levied and shall be assessed and collected a tax equal to four per cent of the gross income of the business ...”
62. Hawaii State Legislature. Hawaii Revised Statutes section 237-24.3(12). Checked October 30, 2026.
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    “Amounts received by a hospital, infirmary, medical clinic, health care facility, or pharmacy, or a medical or dental practitioner, for healthcare-related goods or services purchased under the medicare, medicaid, or TRICARE programs. ... "Medical or dental practitioner" means a physician or osteopathic physician licensed pursuant to chapter 453; a dentist licensed under chapter 448; an advanced practice registered nurse licensed pursuant to chapter 457; or a pharmacist licensed pursuant to chapter 461 ...”
63. Hawaii Department of Taxation. General Excise Tax (GET) Information. “How can I apply for a GET license? Register online through the DOTAX website at Hawaii Tax Online. Complete the Form BB-1, State of Hawaii Basic Business Application, BB-1 Packet, and pay a one-time $20 registration fee.” Checked October 30, 2026.
64. Hawaii State Legislature. Hawaii Revised Statutes section 386-121(a). Checked October 30, 2026.
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    “Employers, except the State, any county or political subdivision of the State, or other public entity within the State, shall secure compensation to their employees in one of the following ways: (1) By insuring and keeping insured the payment of compensation with any stock, mutual, reciprocal, or other insurer authorized to transact the business of workers’ compensation insurance in the State ...”
65. Code of Federal Regulations. 42 CFR 424.516, Additional provider and supplier requirements for enrolling and maintaining active enrollment status in the Medicare program (eCFR, up to date as of October 22, 2026; paragraph (f), Maintaining and providing access to documentation). Checked October 26, 2026.
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    “A provider or a supplier that furnishes covered ordered, certified, referred, or prescribed Part A or B services, items or drugs is required to—”; “Maintain documentation (as described in paragraph (f)(1)(ii) of this section) for 7 years from the date of service; and”; “Upon the request of CMS or a Medicare contractor, to provide access to that documentation”; “The documentation includes written and electronic documents (including the NPI of the physician or, when permitted, other eligible professional who ordered, certified, referred, or prescribed the Part A or B service, item, or drug) relating to written orders, certifications, referrals, prescriptions, and requests for payments for Part A or B services, items or drugs.”.
66. Code of Federal Regulations. 45 CFR 164.316, Policies and procedures and documentation requirements (eCFR, up to date as of October 22, 2026; HIPAA Security Rule; paragraph (b)). Checked October 26, 2026.
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    “Maintain the policies and procedures implemented to comply with this subpart in written (which may be electronic) form; and”; “If an action, activity or assessment is required by this subpart to be documented, maintain a written (which may be electronic) record of the action, activity, or assessment.”; “Retain the documentation required by paragraph (b)(1) of this section for 6 years from the date of its creation or the date when it last was in effect, whichever is later.”.
67. Hawaii State Legislature. Hawaii Revised Statutes section 323B-3. Checked October 30, 2026.
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    “Notwithstanding any law to the contrary, any use or disclosure of individually identifiable health information by any covered entity or business associate that is permitted by 45 Code of Federal Regulations part 164, subpart E, shall be deemed to comply with all state laws relating to the use, disclosure, or confidentiality of such information. (b) Notwithstanding any law to the contrary, an authorization for release of individually identifiable health information that complies with 45 Code of Federal Regulations section 164.508 shall be deemed to comply with all state laws relating to individual authorization.”
68. Hawaii State Legislature. Hawaii Revised Statutes section 487N-2. Checked October 30, 2026.
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    “Any business that owns or licenses personal information of residents of Hawaii, any business that conducts business in Hawaii that owns or licenses personal information in any form (whether computerized, paper, or otherwise), or any government agency that collects personal information for specific government purposes shall provide notice to the affected person that there has been a security breach following discovery or notification of the breach. The disclosure notification shall be made without unreasonable delay ... In the event a business provides notice to more than one thousand persons at one time pursuant to this section, the business shall notify in writing, without unreasonable delay, the State of Hawaii’s office of consumer protection and all consumer reporting agencies ...”
69. Hawaii State Legislature. Hawaii Revised Statutes section 323B-3(c). “Notwithstanding any law to the contrary, any notice of breach of unsecured protected health information that complies with 45 Code of Federal Regulations part 164, subpart D, shall be deemed to comply with all state laws relating to notice of breach of protected health information.” Checked October 30, 2026.
70. Hawaii State Legislature. Hawaii Revised Statutes section 350-1.1. Checked October 30, 2026.
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    “the following persons who, in their professional or official capacity, have reason to believe that child abuse or neglect has occurred or that there exists a substantial risk that child abuse or neglect may occur in the reasonably foreseeable future, shall immediately report the matter orally to the department or to the police department: (1) Any licensed or registered professional of the healing arts or any health-related occupation who examines, attends, treats, or provides other professional or specialized services, including but not limited to physicians, ... and other health-related professionals; ... The initial oral report shall be followed as soon as possible by a report in writing to the department ...”
71. Hawaii State Legislature. Hawaii Revised Statutes section 431:10A-133. Checked October 30, 2026.
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    “Each individual or group accident and health or sickness insurance policy issued or renewed in this State after January 1, 2016, shall provide to the policyholder and individuals under fourteen years of age covered under the policy coverage for the diagnosis and treatment of autism. ... Coverage for applied behavioral analysis provided under this section shall be subject to a maximum benefit of $25,000 per year for services for children ages thirteen and under. ... Payments made by an insurer on behalf of a covered individual for any care, treatment, intervention, or service other than applied behavioral analysis shall not be applied toward the maximum benefit established under this subsection. ... "Therapeutic care" means services provided by licensed speech pathologists, registered occupational therapists, licensed social workers, licensed clinical social workers, or licensed physical therapists.”
72. Noridian Healthcare Solutions. Jurisdiction E - Part B. “Jurisdiction E - Medicare Part B ... California, Hawaii, Nevada, American Samoa, Guam, Northern Mariana Islands ...” Checked October 30, 2026.
73. Hawaii Department of Labor and Industrial Relations, Disability Compensation Division. Hawaii Administrative Rules section 12-15-90, Workers’ compensation medical fee schedule (January 1, 2026). Checked October 30, 2026.
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    “Charges for medical services shall not exceed one hundred ten per cent of participating fees prescribed in the Medicare Resource Based Relative Value Scale System fee schedule (Medicare Fee Schedule) applicable to Hawaii, or listed in Exhibit A, located at the end of this chapter, and made a part of this chapter, entitled "Workers’ Compensation Supplemental Medical Fee Schedule", dated January 1, 2026.”
74. Hawaii Department of Labor and Industrial Relations, Disability Compensation Division. Hawaii Administrative Rules section 12-15-36(c) and (d). Checked October 30, 2026.
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    “Physical therapists may have treatment in their discipline carried out by physical therapist assistants as recognized pursuant to 461J-3(e). ... The physical therapist assistants shall be compensated at sixty per cent of the fees authorized by section 12-15-90. (d) Occupational therapists may have treatment in their discipline carried out by certified occupational therapy assistants as recognized pursuant to chapter 457G. ... The certified occupational therapy assistants shall be compensated at sixty per cent of the fees authorized by section 12-15-90.”
75. Hawaii Department of Labor and Industrial Relations, Disability Compensation Division. Hawaii Administrative Rules section 12-15-34(i). “This section applies to providers of service other than physicians including physical therapists, occupational therapists, massage therapists, and acupuncturists.” Checked October 30, 2026.
76. APTA Hawaii. APTA Hawaii (the state association's site). Checked October 30, 2026.
77. the Hawaii Speech-Language-Hearing Association. the Hawaii Speech-Language-Hearing Association (the state association's site). Checked October 30, 2026.
78. DrSensory. Occupational therapy clinics in Hawaii, with the physical therapy and speech therapy pages for the state (the directory's state pages, built from the addresses it holds). Checked October 30, 2026.
79. DrSensory. Clinic Directory Pricing. “Claiming your listing is free. The subscription is $349.99 a year or $29.99 a month for your first location, and $99.99 a year or $9.99 a month for each additional location, not per therapist.” Checked October 30, 2026.

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. It is general guidance on running a therapy clinic in Hawaii, not legal, compliance, billing or financial advice. Rules change; the clinic confirms each with its source before acting on it.