The Department of Human Services (DHS) is required to submit a transition plan to CMS by March 17, 2015. Hawaii’s transition plan will address 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. There will be at least a 30-day public comment period before the statewide transition plan is submitted to CMS. The final outcome 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.
The Department of Human Services, Med-QUEST Division, has released its public file for the procurement for provision of Managed Health Care for the QUEST Integration population.
Click here to view the link to the public file.
We are reaching out to recipients and community partners related to
Med-QUEST Division's new program, QUEST Integration, and the upcoming Open Enrollment for QUEST Integration. With the attached documents and your help, we believe we will be better able to inform our community and recipients in receiving important information on QUEST Integration and the Open Enrollment period that will occur in September.
Should you have questions regarding QUEST Integration we are in the process of setting up an email mailbox for organizations to submit questions. The mailbox email address is: QUEST_Integration@medicaid.dhs.state.hi.us and should be ready to accept questions by the end of this month. We will be using this email mailbox to respond to emails and send out clarifications and information so we can better assist recipients. For that reason we ask that this email mailbox not be provided to recipients.
Recipients are encouraged to call the Med-QUEST Enrollment Call Center at
524-3370 (Oahu) or 1-800-316-8005 from the Neighbor Islands with their questions, Monday through Friday from 7:45 a.m. to 4:30 p.m.
Thank you for your assistance and we look forward to working with you as we make the transition to QUEST Integration.
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 seeks to improve the health care and to enhance and expand coverage for persons eligible for Medicaid and Children’s Health Insurance Program (CHIP) by the most cost effective and efficient means through the QUEST Integration (QI) program with an emphasis on prevention and quality health care.
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.
The Department of Human Services, Med-QUEST Division, is providing information
on the receipt of reimbursement increase to PCPs to Medicare rates for primary care services in
CY 2013 and 2014 to Medicaid beneficiaries in the FFS, QUEST and QExA programs.
Click here to view information on this enhanced reimbursement.
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.