HOME
CONTACT US
FAQ'S
 PROVIDERS
     Dental
     EPSDT
     Health Plans
     Provider Memos
           Archives
 PHARMACY
     Pharmacy Clinical
     Newsletters
 MANAGED CARE
      Quality Strategy
      Consumer Guides
      CMS Reports
 QUEST Integration
 QUEST
 QUEST EXPANDED ACCESS (QExA)
      Archive
 COMMUNITY CARE SERVICES (CCS)
 HIPAA       HIPAA-Client
      HIPAA-Providers
      HIPAA-MQD
      HIPAA-FAQ's
      HIPAA-Archives
 CERTIFICATION PROGRAMS
     Nurse Aide Training Program
     State Approved Feeding
     Assistants Training Program
     (FATP)
 

1115 Waiver Forum Non-Discrimination and Language Assistance Notice
KOLEA DHS Medicaid Online (DMO) Upgrade
Annual Plan Change Deadline
ICD-10 and ITOP Claims Update Intensive Behavioral Therapy (IBT)
Hawaii ICD-10 Implementation QUEST Integration Public Reporting
PERM QUEST Integration
Developmental Disability/Intellectual Disability (DD/ID) Hawaii HCBS Transition Plan HIPAA Privacy Notice MAGI Confidentiality
Recovery Audit Contractor (RAC) Bulletin
INFORMATION TO PROVIDERS FOR BILLING THE BREATHE NIOV™
Notice of the Current Approved 1115 Waiver Effective 1/1/2014
Pre-existing Condition Insurance Plan EHR Incentive Programs

1115 Waiver Forum

The Department of Human Services, Med-QUEST Division is planning the 1115 Waiver Forum, click here for more information.


Non-Discrimination and Language Assistance Notice

Department of Human Services/Med-QUEST Division complies with applicable Federal and state civil rights laws and does not discriminate, exclude people, or treat people differently because of:

  • Race
  • Color
  • National Origin
  • Age
  • Disability
  • Sex/gender (expression or identity)

Additional protected groups are covered under Hawaii Revised Statute.

Department of Human Services/Med-QUEST Division provides free aids and services to people with disabilities to communicate effectively with us, such as:
  • Qualified sign language interpreters
  • Written information in other formats (large print, audio, accessible electronic formats, other formats)

Department of Human Services/Med-QUEST Division provides free language services to people whose primary language is not English, such as:
  • Qualified interpreters
  • Information written in other languages


If you need these services, contact Med-QUEST Division at 1-877-628-5076.

If you believe that Department of Human Services/Med-QUEST Division has discriminated in any way on the basis of race, color, national origin, age, disability, sex/gender (expression or identity) or any protected groups that are covered under Hawaii Revised Statute you may file a discrimination complaint with:

Geneva Watts, Civil Rights Compliance Officer
Queen Liliuokalani Bldg.
1390 Miller St., Rm 214 Honolulu, HI 96813
(808) 586-4955 Fax Number: 808-586-4990
gwatts@dhs.hawaii.gov


You can file a discrimination complaint in person or by mail, fax, or email. DHS discrimination complaint and consent/release forms are available in 10 languages at http://humanservices.hawaii.gov in the Civil Rights Corner under forms.

You can also file a discrimination complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U. S. Department of Health and Human Services
Office of Civil Rights, Pacific Region
90 7th Street, Suite 4-100
San Francisco, CA 94103-6705
Telephone: (415) 437-8324

U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)


USHHS Discrimination Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

Click here for assistance in other languages.


Early Periodic Screening, Diagnostic, & Treatment (EPSDT) for Medicaid-Enrolled Individuals Under 21 Years of Age

Revised: October 2016

Medicaid-enrolled children under 21 years of age are eligible for EPSDT services. These medically necessary services, including behavior therapy for children, are provided at no cost to patient or family. The behavior therapies include intensive behavioral therapy for children with autism spectrum disorder (ASD) that include applied behavioral analysis (ABA) for the treatment of children with an autism spectrum disorder (ASD) diagnosis. For more information on EPSDT services and how you can get these benefits, please talk with your provider or the health plan you are enrolled in for help.

EPSDT provides:

  • Preventative care for members from newborn through age 20
  • Complete medical, mental and behavioral health, and dental care
  • Services and medicines
  • Treatment for problems that are identified
  • Intensive Behavioral Therapies (e.g. Applied Behavioral Analysis (ABA) services for members with an Autism Spectrum Disorder (ASD) diagnosis.


EPSDT checkups include:

  • Complete physical exam
  • Lab tests (as needed)
  • Immunizations
  • Vision/Hearing screening
  • Developmental/Behavioral and Mental health screening (as needed)
  • Referrals to specialists (as needed)
  • Oral (mouth) check
  • Prescription medications (as needed)


EPSDT is provided at no cost to you

Dental care is also covered for children under age 21

For help finding a dentist, call Community Case Management Corporation toll free at 1-888-792-1070.


KOLEA – On Line Eligibility Application

An easy and convenient way to apply for Medicaid, click here and you will be directed to our new secured Medicaid On - Line eligibility application (KOLEA).

Or for a fillable PDF Medical Assistance Application (DHS Form 1100), click here.

When you are ready to apply, create your personal user account and follow instructions on the screens.


DHS Medicaid Online (DMO) Upgrade

The Med-QUEST Division performed an upgrade to the DHS Medicaid Online (DMO). The upgrade is mostly esthetics but also includes the following:

  • New URL https://hiweb.statemedicaid.us, users are required to create a new account
  • Search for a record by clicking the appropriate radio button to display criteria
  • Menu bar, Member Eligibility Verification replaces Eligibility and Enrollment Status
  • Result screen will display navigational tabs at top of the screen

For providers that need help creating a new account or want to ask questions, call 952-5570 (Oahu) or 1-800-235-4378 (Neighbor Islands).


2016 Annual Plan Change October 1-31, 2016

The Med-QUEST Division QUEST Integration Annual Plan Change (APC) choice period is October 1-31, 2016. The five (5) available health plans serving QUEST Integration members are AlohaCare, HMSA, Kaiser Permanente, ‘Ohana Health Plan, and UnitedHealthcare Community Plan.

Kaiser Permanente serves the islands of Maui and Oahu. Kaiser Permanente met its enrollment limit and therefore is not offered as a choice at this time.

Members currently enrolled in Kaiser Permanente can remain with the health plan.

Your new health plan will take effect on January 1, 2017.

If you do not want to change your health plan, do not return the plan change form. You will remain in your same health plan as long as you remain eligible.

To make a health plan change, you have three (3) options:

Complete the Choice Form and Mail it to:
Med-QUEST Enrollment Services
P.O. Box 700190
Kapolei, Hawaii 96709-0190

Complete the Choice Form and Fax it to: 1-800-576-5504

Call Med-QUEST Enrollment Services Section at: 1-800-316-8005
Press 0 to speak with a call center representative.

Mail will need to be postmarked October 31, 2016 and fax have date/time stamp of October 31, 2016.”


QUEST Integration Public Reporting

The Med-QUEST Division (MQD) is pleased to announce that the QUEST Integration public reporting information from January - June 2015 is now available. To access information on the performance of health plans participating in the QUEST Integration program, please click here.

January - March 2015 Public Summary Report

April - June 2015 Public Summary Report

July - September 2015 Public Summary Report

October - December 2015 Public Summary Report

The MQD thanks all that provided public input.


ICD-10 and ITOP Claims Update

The Med-QUEST Division (MQD) is issuing the following two memorandums on ICD-10 Conversion Guidelines and the Revised Guidelines for Submittal and Payment of Induced/Intentional Termination of Pregnancy (ITOP) Claims below. Please let us know if you have any questions by calling the provider hotline at 808-692-8099.


Link to ICD-10 Conversion Guidelines
Link to Revised Guidelines for ITOP Claims


Revised Memorandum that describes Coverage of Intensive Behavioral Therapy (IBT)

On August 28, 2015, the Department of Human Services, Med-QUEST Division (MQD) issued a revised memorandum that will replace QI-1504, FFS M15-03. The revised memorandum provides guidance regarding coverage of intensive behavioral therapy (IBT) that includes Applied Behavior Analysis (ABA) for the treatment of autism spectrum disorder (ASD).

Click here for a copy of the revised memorandum.

The MQD thanks all that provided public input.


Hawaii ICD-10 Implementation

Providers will need to use ICD-10 diagnosis codes for services provided to Medicaid beneficiaries on or after October 1, 2015. Med-QUEST Division (MQD) and the QUEST Integration health plans will not accept existing ICD-9 diagnoses codes for services delivered on or after October 1, 2015 – the new ICD-10 diagnoses codes MUST be used for these services. For more information, please click here.


PERM AUDIT FINDINGS

The Med-QUEST Division (MQD) was recently involved in the Centers for Medicare and Medicaid Services (CMS) Payment Error Rate Measurement (PERM) audit.
As a result of the audit, the PERM contractors found errors where medical records submitted for audit did not match the date of service submitted on the claim forms. If the documentation provided did not support the claim as billed, the claim was considered an error, which is subject to recovery by MQD. MQD is required to reimburse CMS for the identified payment errors and will be sending notification to providers to recover identified overpayments.
The audit also found providers not using their Social Security Number as their Tax Identification Number (TIN), were not submitting an Organization or Group NPI on their claim. MQD would like to remind providers the Organization/Group NPI is a requirement when submitting a claim to Medicaid.


QUEST Integration

Under the provision of Title 42, Section 431.420(c), of the Code of Federal Regulations, the State must hold a public forum to solicit comments on the progress of the demonstration project. Therefore, the Med-QUEST Division, hereby notifies the public that a post-award forum will be held to afford interested parties with an opportunity to provide meaningful comments on the progress of the demonstration. Please click on the link below for more details.

QUEST Integration Public Forum Flyer

QUEST Integration 1115 Waiver Public Forum

In lieu of joining the public forum in person or by VTC, written testimony may also be provided and must be received by the State from the date of publication of this notice through March 22, 2016 to:

Department of Human Services
Med-QUEST Division
Attention: Policy and Program Development Office
P.O Box 700190
Kapolei, Hawaii 96709-0190
or
quest_integration@dhs.hawaii.gov


Developmental Disability/Intellectual Disability (DD/ID) 1915 (c) HCBS Waiver


Latest updates on the My Choice My Way transition plan

Statewide Transition Plan

Waiver Specific Transition Plans

Provider Remediation

Heightened Scrutiny

Public Notice and Comments

Public Input/Stakeholder Engagement
Public input will be ongoing. Public input is welcomed to the State Department of Human Services, Med-QUEST Division by:
Fax:808-692-8087
NEW Email:mychoicemyway@dhs.hawaii.gov
Mailing Address: Department of Human Services Med-QUEST Division
Attention: Health Care Services Branch
P.O. Box 700190
Kapolei, Hawaii 96709-0190

Surveys

Validation

Public Notifications

Public Forum

Information sessions

Other My Choice My Way documents


HIPAA Privacy Notice (DHS 8030)

HIPAA Privacy Notice (DHS 8030) effective 11/01/2014 has been added to the MQD Forms webpage under HIPAA forms and notices. Click here to view.


Medicaid Eligibility Review for Modified Adjusted Gross Income (MAGI) Individuals

The Department of Human Services, Med-QUEST Division, is posting frequently asked questions regarding Medicaid eligibility review for MAGI individuals. Click here to view the FAQs.


Confidentiality

The federal “HITECH Act” requires all Health Insurance Portability and Accountability Act (HIPAA) covered entities to review and update policies relating to the protection of an individual’s personal and medical information. Please review the Department of Human Services latest Notice of Privacy Practices (NPP).

Click here for more information.


Recovery Audit Contractor (RAC) Bulletin

The State of Hawaii Med-QUEST Division is pleased to announce that Myers and Stauffer LC (Myers and Stauffer) has been selected to provide Recovery Audit Contractor Services, Click here for more information.


INFORMATION TO PROVIDERS FOR BILLING
THE BREATHE NIOV™

Medicaid will be following Medicare with regards to billing for the Non-invasive Open Ventilation System referred to as “Breathe NIOV™”. In order to insure that Medicaid does not pay for this miscellaneous code (E1399) Medicaid’s claims payment system has been set to require that any claims billed using a HCPCS code E1399 be medically reviewed. Below is Medicare’s Local Coverage Determination for this equipment:

Breathe NIOV™ - Coding Reminder - E1399 - DURABLE MEDICAL EQUIPMENT, MISCELLANEOUS

The Non-invasive OPEN Ventilation System (NIOV™) by Breathe Technologies, Inc. provides positive pressure inspiratory support for patients using oxygen. The correct HCPCS code to use for billing this item is:

E1399 - DURABLE MEDICAL EQUIPMENT, MISCELLANEOUS

Based on clinical data provided by the manufacturer, this item is effective only when used in conjunction with oxygen; therefore, it is classified as an accessory to oxygen equipment. Oxygen reimbursement is a bundled payment. All options, supplies and accessories are considered included in the monthly rental payment.

Note: Numerous sources, including the manufacturer materials and references in published clinical articles, use the term "ventilator" when discussing this device. For Medicare payment purposes, the NIOV™ device is NOT considered to be a ventilator or any other type of positive airway pressure device (CPAP, bi-level PAP, etc.). DMEPOS suppliers must not use HCPCS codes assigned to those products when submitting claims for the NIOV™ device.


Notice of the Current Approved 1115 Waiver Effective 1/1/2014

The State of Hawaii, Department of Human Services (the State), hereby notifies the public that it intends to seek a five-year renewal of its Section 1115 demonstration project from the Centers for Medicare & Medicaid Services (CMS). The State expects the current demonstration to expire on December 31, 2013.

Click here to view the Abbreviated Public Notice

Click here to view the Full Notice

Click below to view the Draft 1115 Application, Quality Assurance Monitoring Info, Behavioral Health Protocol, Behavioral Health Addendums A,B,C, & D

Click here to view the Draft 1115 Application
Click here to view the Quality Assurance Monitoring Info
Click here to view the Behavioral Health Protocol
Click here to view the Behavioral Health Addendum A
Click here to view the Behavioral Health Addendum B
Click here to view the Behavioral Health Addendum C
Click here to view the Behavioral Health Addendum D

Click here to view the Budget Neutrality (BN)

Click here to view the Current Approved 1115 Waiver (Eff. 6-14-12)
Click here to view the Complete Revised and Submitted 1115 Application


Pre-existing Condition Insurance Plan (PCIP)

The Affordable Care Act, PCIP provides health care coverage for uninsured people with pre-existing conditions until new insurance market rules go into effect in 2014. PCIP is provided through the U.S. Department of Health and Human Services and administered through the Office of Personnel Management. More information is available at: www.healthcare.gov

Additional information relating to PCIP is available through the Government Employee Health Association (GEHA). GEHA currently administers PCIP in 20 states.

GEHA website: www.pciplan.com


Med-QUEST Electronic Health Record (EHR) Incentive Program

The Department of Human Services, Med-QUEST Division is planning the Med-QUEST Electronic Health Record (EHR) Incentive Program, click here for more information.



   
© Hawaii State Med-QUEST Division 2003-2007