The Med-QUEST Division extends the deadline for the 2015 QUEST Integration Annual Plan Change (APC) choice period to October 30, 2015. The division made the decision to extend the APC deadline after the telephone vendor reported it was experiencing equipment trouble October 14-16. This prevented the Med-QUEST call center from receiving telephone calls and APC plan change requests from clients.
The vendor successfully addressed the problem on October 17 and Med-QUEST call center is now able to receive calls.
QUEST Integration clients can submit their 2015 APC choice form using the business reply envelope enclosed in the open enrollment packet, fax the form to 1-800-576-5504, call 1-800-316-8005, or hand deliver to any MQD Eligibility office. Mail will need to be postmarked 10/30/15 and fax have date/time stamp of 10/30/15.
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.
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
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).
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.
Under the provision of Title 42, Section 441.304(f)(1) of the Code of Federal Regulations, the State of Hawaii, Department of Human Services and Department of Health (the State), hereby notifies the public that it intends to request from the Centers for Medicare & Medicaid Services, a five (5) year renewal of the Home and Community Based Services (HCBS) Waiver authorized in Section 1915(c) of the Social Security Act, which is set to expire on June 30, 2016. This renewal will be effective July 1, 2016.
The program under the 1915(c) HCBS Waiver permits the State to furnish an array of home and community based services that assist Medicaid beneficiaries to live in the community and avoid institutionalization. This program enables a person with developmental disabilities or intellectual disabilities who meets institutional level of care, the choice to live in their own home or in the community with appropriate and quality supports designed to promote health, safety and independence.
Public comments will be accepted for consideration till February 15, 2016. Please send your comments and questions to the Department of Health, Developmental Disabilities Division Community Resource Branch by email at firstname.lastname@example.org, phone 808-733-2135, or mail to DD-CRB 3627 Kilauea Avenue, Room 411 Honolulu, Hawaii 96816.
The purpose of the validation review was to confirm the findings from the provider survey. The validation period was from mid-October 2015 to mid-December 2015. A team of at least two (2) individuals will conduct the validation.
Participation in the validation process is mandatory to be able to continue to obtain reimbursement from a Medicaid health plan or participate as a provider in the developmental and intellectual disability (DD/ID) 1915(c) waiver.
Public Forum January 2016
The State held a public forum on January 14, 2016 to seek input on the updates made to the transition plan that was first submitted to CMS on March 2015. The transition plan includes updated remediation section, details on any setting brought forth for heightened scrutiny, and address other areas identified by CMS. Public comments will be accepted for consideration from February 1, 2016 to March 1, 2016. Please send your comments and questions to:
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.