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KOLEA QUEST Integration Public Reporting
Hawaii ICD-10 Implementation
PERM QUEST Integration 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

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.


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. 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:

HI Analytics

HI ICD-10 Introduction

HI Managed Care Alignment

HI Overview Home and Community Based Services

HI Overview Mental Health

Existing CMS Resources


QUEST Integration Public Reporting

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.

Public Summary Quarterly Report

Annual Cost per Member in Long–Term Services and Supports *

Member Related (graph)

Provider Related (graph)

Behavioral Health (graph)

Service Coordination (graph)

Utilization Management (graph)

* Results not available until 2016.

Please review the charts and graphs and let MQD know of any suggested changes by Monday, July 13, 2015. You can submit your suggestions to MQD by:

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

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

Telephone: 808-692-8099
Fax: 808-692-8087


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:

quest_integration@medicaid.dhs.state.hi.us


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

When: July 30, 2015

Where: Hawaii State Lab
2725 Waimano Home Road
Pearl City, HI 96782

Video Conference Centers for Neighbor Islands
HILO – Hilo State Office Building, 75 Aupuni Street
MAUI – Puunene School, E Camp 5 Road, Puunene
KAUAI – Lihue State Office Building, 3060 Eiwa Street

Time: For participants, family, friends, and stakeholders 9:30 am to 11:00 am
For home and community based providers 1:00 pm to 3:00 pm

Due to limited seating MQD is no longer taking RSVPs for the sessions. The handout and Power Point are available below. To request these documents in an alternative format, please contact 808-692-8094.

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


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.


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.



   
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