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KOLEA Department Medicaid Only (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 Hawaii HCBS Transition Plan
HIPAA Privacy Notice MAGI Confidentiality
Recovery Audit Contractor (RAC) Bulletin
Notice of the Current Approved 1115 Waiver Effective 1/1/2014
Pre-existing Condition Insurance Plan EHR Incentive Programs

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.

Department Medicaid Only (DMO) Upgrade

The Med-QUEST Division performed an upgrade to the Department Medicaid Only (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).

2015 Annual Plan Change Deadline Extended To October 30, 2015

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.

To find the office nearest you, click here.

801 Dillingham Boulevard, 3rd Floor
Honolulu, HI 96817-4582

Kakuhihewa State Office Building
601 Kamokila Boulevard, Room 415
Kapolei, HI 96707-2021

1404 Kilauea Avenue
Hilo, HI 96720

Lanihau Professional Center
75-5591 Palani Road, Suite 3004
Kailua-Kona, HI 96740-3633

730 Lanai Avenue
Lanai City, HI 96763

Millyard Plaza
210 Imi Kala Street, Suite 101
Wailuku, HI 96793-1274

State Civic Center
65 Makaena Place, Room 110
Kaunakakai, HI 96748

4473 Pahee Street, Suite A
Lihue, HI 96766-2037

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

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.

Payment Error Rate Measurement (PERM)
Audit Federal Fiscal Year 2014

The State of Hawaii Med-QUEST Division Fee-For-Service providers are subject to the PERM audit conducted by Centers for Medicare and Medicaid Services (CMS), click here for more information.

QUEST Integration

1115 Waiver Demonstration Post Award Public Forum

Thank you to all who attended the Med-QUEST Division 1115 waiver demonstration post-award public forum on May 26, 2015. Below are the two presentations from the forum:

QUEST Integration (QI) Public Forum PowerPoint presentation
1115 Waiver Demonstration Post Award Public Forum
Questions and Answers: 1115 Demonstration Project Post Award Forum

If you were unable to attend or have any additional questions or comments, please submit them to MQD at:


My Choice My Way- Hawaii’s HCBS Transition Plan

The Department of Human Services (DHS) submitted its My Choice My Way transition plan to the Centers for Medicare & Medicaid Services (CMS) on March 9, 2015. Below is a copy of the submittal to CMS.

My Choice My Way transition plan submittal

Information Session

Info Session Handout July 30, 2015
Info Session Presentation July 30, 2015

Residential Participant Survey
Residential Provider Survey
Non-Residential Participant
Non-Residential Provider Survey

Letters are being sent in October to providers that have been selected for validation. The purpose of the validation review is to confirm the findings from the provider survey. The validation period will occur from October 15, 2015 to December 11, 2015. The provider will receive a call from a reviewer during this time to schedule a site visit at least one-week prior to the visit. A team of at least two (2) individuals will conduct the validation. The visit will take about three (3) hours.
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.

Residential Validation Tool
Non Residential Validation Tool

My Choice My Way transition plan requirements

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.

Summary Documents:

HCBS Final Rule Summary

What is My Choice My Way?

HCBS Rule Presentation – January 14, 2015

Question and Answer for My Choice My Way transition

Individuals may continue to submit questions or comments to:

Email: mychoicemyway@medicaid.dhs.state.hi.us

Mailing address: Med-QUEST Division
Attention: Health Care Services Branch
P.O. Box 700190
Kapolei, Hawaii 96709-0190

Telephone: 808-692-8094
Fax: 808-692-8087

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.


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.


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:


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