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. The Centers for Medicare & Medicaid Services (CMS) and their consultants from Noblis conducted an ICD-10 training in Hawaii on May 28-29, 2015. The training covered ICD-10 conversion and the impact it will have on Home and Community Based Services providers, Behavioral Health providers, Managed Care Alignment, and Analytics. The handouts for these training sessions are below:
The Med-QUEST Division (MQD) will start public reporting on its QUEST Integration program in September 2015. MQD wants individuals in the community to have access to information on the performance of health plans participating in the QUEST Integration program. MQD is interested in receiving input from the community on the public reporting format. Below are charts and graphs that provide information on various measurements related to members, providers, behavioral health services, service coordination and utilization of Medicaid services. The numbers in the chart and graphs are sample numbers and not used as actual reported data.
As part of the My Choice My Way transition plan, waiver participant and provider surveys will be mailed the week of April 22, 2015.
By completing this survey, you will give us more information about how you are getting services. You will get a call from a Service Coordinator or Case Manager to ask if you need help filling out the survey. You may also ask a family member or friend to assist you. The first page of the survey will have simple instructions on how to complete the survey. On the last page you will have the chance to provide any comments. Please return the survey in the enclosed postage-paid return envelope by May 18, 2015.
By completing this survey, you will provide us information to help create a better picture of your setting. Participation in this assessment process is mandatory. The first page of the survey will have simple instructions on how to complete the survey. On the last page, you will have the opportunity to provide any comments. We will assume that any provider who does not submit a completed survey is not in compliance with the new regulations. Please return the survey in the enclosed postage-paid return envelopes by May 11, 2015.
Hawaii’s transition plan addresses areas of assessment, remediation, and public input. DHS is partnering with Medicaid waiver participants, families of individuals with disabilities, provider associations, advocates, other State agencies, and other stakeholders throughout this process to provide input into the plan. One goal of the plan is to assure that providers have access to needed information to assist with transition activities. The final outcome of implementation of the My Choice My Way transition plan will be that Medicaid waiver participants will be served in a way that will enable them to live and thrive in truly integrated community settings. Below are summary documents of the My Choice My Way transition plan.
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).
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.
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:
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.
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 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
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.