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QUEST Integration Open Enrollment KOLEA MAGI PERM
QUEST Integration Procurement – 2013 Contract Award
Quest Expanded Access (QExA) Medicaid Provider Application/Change
Confidentiality QUEST Integration
Recovery Audit Contractor (RAC) Bulletin
Primary Care Physician (PCP) enhanced reimbursement
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

QUEST Integration Open Enrollment

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.

Please find the following attachments:

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.


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).

When you are ready to apply, create your personal user account and follow instructions on the screens.


Payment Error Rate Measurement (PERM)

The State of Hawaii Med-QUEST Division is pleased to announce that there will be a Provider Education Webinar/Conference Calls for Upcoming PERM Cycle 3 (FY2014), click here for more information.


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.


QUEST Integration Procurement – 2013 Contract Award

The Med-QUEST Division is pleased to announce that it has finalized the procurement process for the QUEST Integration program. The Division is awarding contracts to five health plans:

  • AlohaCare
  • Hawaii Medical Service Association (HMSA)
  • Kaiser Foundation Health Plan
  • ‘Ohana Health Plan, and
  • UnitedHealthcare Community Plan
All of the health plans will be providing services to QUEST Integration members Statewide except for Kaiser Foundation Health Plan that has chosen to focus their efforts on the islands of Oahu and Maui. The health plans will start provision of services to QUEST Integration members on January 1, 2015. The Division looks forward to partnering with these health plans on the provision of services to our beneficiaries. We sincerely appreciate all of the community interest shown in the QUEST Integration procurement.

For more information on the Quest Integration Procurement please click here.


2013 Quest Expanded Access (QExA) Annual Plan Change

QExA Annual Plan Change period is November 1-18, 2013

The new health plan will begin January 1, 2014


Medicaid Provider Application/Change Request Form

Medicaid Provider Application/Change Request Form (DHS 1139 Rev 09/13)
Click here for application.


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.


QUEST Integration

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.

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.


Primary Care Physician (PCP) enhanced reimbursement

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.


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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