reglab/statecodes huggingface dataset:
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 2 - INPATIENT AND OUTPATIENT HOSPITAL SERVICES, PHYSICIANS SERVICES › Section 17-1737-4 - Length of inpatient hospital care and extension of stay

Current through June, 2024
(a)
				  The UCC of an acute hospital facility shall determine the medical necessity for
				  admission and continued stay for all recipients.
(b) The length of stay for the service
				  category maternity after the delivery of a live newborn shall be limited to two
				  days after delivery for a normal delivery and four days after delivery for a
				  Cesarean section delivery. Stays exceeding these limitations must be authorized
				  for medical necessity by the DHS's medical consultant or its authorized
				  representative.
(c) A request for
				  the extension of hospital stay shall be requested only when a patient is
				  awaiting placement in a long term care facility.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 2 - INPATIENT AND OUTPATIENT HOSPITAL SERVICES, PHYSICIANS SERVICES › Section 17-1737-5 - Physician services

Current through June, 2024
(a) Physician
				  services means services provided within the scope of practice of medicine or
				  osteopathy as defined by state law.
(b) Medicaid payments shall be made for
				  medically necessary services when the services are provided by a physician
				  authorized by the department at locations including, but not limited to:
(1) The physician's office;
(2) A clinic;
(3) A private home;
(4) An approved hospital;
(5) An approved skilled nursing or
				  intermediate care facility; or
(6)
				  A licensed care home or adult family boarding home.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 2 - INPATIENT AND OUTPATIENT HOSPITAL SERVICES, PHYSICIANS SERVICES › Section 17-1737-5.1 - Physician assistant services

Current through June, 2024
(a) A physician
				  assistant is an individual who is an employee of a supervising physician and
				  has been certified by the board of medical examiners, State of Hawaii, with the
				  department of commerce and consumer affairs, to practice medicine under a
				  physician supervision. The supervising physician must be a Hawaii Medicaid
				  provider.
(b) Physician assistant
				  services can only be provided to patients who have established a physician
				  patient relationship with the supervising physician. The physician assistant
				  shall only render services that are in the physician assistant's scope of
				  practice in the State of Hawaii.
(c) Physician supervision:
(1) Means overseeing the activities of, an
				  accepting responsibility for, the medical services rendered by a physician
				  assistant. The supervising physician also is responsible for assuring that the
				  physician assistant's services are medically appropriate for the
				  patient.
(2) Supervision may be
				  direct. Direct supervision shall require the physical presence of the
				  supervising physician to be at the same location the services are rendered and
				  only for those services the supervising physician is authorized to provide that
				  are within the scope of practice of a physician assistant.
(3) If supervision by the physician is other
				  than direct, the physician must be in the State of Hawaii and available at all
				  times by two way radio, telephone, fax machine, modem, or other
				  telecommunication devices. The physician assistant's progress note must
				  indicate that the physician was not physically present. The physician must
				  review the progress note written by the physician assistant and sign and date
				  it. The date must be the date he or she actually reviewed the progress
				  note.
(4) A supervising physician
				  can be a physician or group of physicians or an osteopathic physician and
				  surgeon licensed to practice medicine and surgery in the State who in writing
				  accepts the responsibility for the supervision of services rendered by a
				  physician assistant.
(5) The
				  physician assistant notes for services shall be personally acknowledged by the
				  supervising physician (no personal stamps allowed as acknowledgement) within
				  seven working days of service even if services are not claimed for
				  payment.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 2 - INPATIENT AND OUTPATIENT HOSPITAL SERVICES, PHYSICIANS SERVICES › Section 17-1737-6 - Outpatient hospital services

Current through June, 2024
Outpatient hospital services means preventive, diagnostic,
					 therapeutic, rehabilitative, or palliative services provided to an outpatient
					 by or under the direction of a physician or dentist and which are furnished by
					 an institution meeting the following requirements:
(1) Is licensed or formally approved as a
				  hospital by the State; and
(2)
				  Meets the requirements for medicare participation.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 2 - INPATIENT AND OUTPATIENT HOSPITAL SERVICES, PHYSICIANS SERVICES › Section 17-1737-7 to 17-1737-10 - Reserved

Current through June, 2024
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 3 - PSYCHIATRIC CARE › Section 17-1737-12 - Authorized providers of psychiatric services

Current through June, 2024
Individuals and facilities authorized to participate under
					 the Medicaid program shall meet the provisions of chapter 17-1736. In addition
					 the authorized provider shall meet the following requirements:
(1) Psychiatrists shall be:
(A) Licensed to practice in the
				  state;
(B) Have completed an
				  approved three year residency training program or "Certified" by the American
				  Board of Psychiatry and Neurology; and
(C) In active clinical practice;
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 3 - PSYCHIATRIC CARE › Section 17-1737-13 - Psychiatric consultation

Current through June, 2024
(a) A
				  psychiatrist's or psychologist's consultation shall be for diagnostic
				  evaluation and treatment planning of a patient.
(1) Consultation shall be limited to a total
				  of two hours, in one or two visits, for interview and documentation.
(2) Prior authorization is not
				  required.
(3) A copy of the report
				  shall be provided to the department's medical or psychiatric consultant upon
				  the department's request.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 3 - PSYCHIATRIC CARE › Section 17-1737-14 - Diagnostic and evaluative procedures for psychiatric care

Current through June, 2024
(a) Psychological testing shall be authorized
				  as a diagnostic or evaluative procedure.
(b) Prior authorization is required for all
				  psychological testing except when given in an inpatient facility or when
				  requested by the department's professional staff.
(1) The request for prior authorization shall
				  be completed, signed, and dated by the psychiatrist or psychologist;
(2) The request for prior authorization shall
				  be received in the medical assistance program (medicaid) office within five
				  working days from the date of testing. The postmarked date shall be accepted
				  provided it is within the five working days requirement;
(3) Reimbursement to the psychiatrist or
				  psychologist shall be denied when forms are not received within the specified
				  time.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 3 - PSYCHIATRIC CARE › Section 17-1737-15.1 - Examination for, determination, and certification of mental disability

Current through June, 2024
(a) The department shall designate providers
				  to conduct the mental examinations.
(1)
				  Selection of the providers shall be based on the following:
(A) Past history of conducting and reporting
				  on mental examinations that meet the department's standards.
(B) An understanding of the purpose,
				  pertinent issues and potential problems of the new examination and the services
				  that the department expects it to provide.
(C) Responsiveness and responsibility to
				  assist the department in achieving its goals.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 3 - PSYCHIATRIC CARE › Section 17-1737-16 - Medical Evaluation

Current through June, 2024
(a) Applicants who
				  have been determined eligible for medicaid due to mental impairment shall be
				  required to enter into outpatient treatment. They shall also be required to be
				  medically evaluated by a physician to eliminate the possibility that their
				  mental impairment is due to a physical illness.
(b) The medical evaluation may include and
				  shall be limited to:
(1) History and physical
				  examination;
(2) Complete blood
				  count (CBC), urinalysis, and SMAC 2 0 or its equivalent; and
(3) Additional tests or further studies may
				  be done if they are medically indicated. Justification for further studies
				  shall be provided to the department's medical or psychiatric consultant upon
				  the department's request.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 3 - PSYCHIATRIC CARE › Section 17-1737-17 - Psychiatric service and treatment

Current through June, 2024
(a) Psychiatric
				  service shall be allowed where:
(1) It is
				  provided under an individualized treatment or diagnostic plan which may
				  be
(2) revised during treatment if
				  necessary. Psychiatric service furnished without a planned program of therapy
				  does not constitute treatment and is not reimbursable; and
(3) There is a reasonable expectation that
				  service will improve the patient's condition. If the patient's condition is not
				  altered after the authorized outpatient visits in the authorized period of
				  treatment the frequency and number of subsequent outpatient visits requested
				  may be reduced.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 3 - PSYCHIATRIC CARE › Section 17-1737-18 - Inpatient psychiatric care

Current through June, 2024
(a) Inpatient
				  psychiatric care shall be provided only in an authorized psychiatric facility
				  and by authorized psychiatric providers.
(b) Admission to a psychiatric facility shall
				  be by:
(1) A psychiatrist; or
(2) A non-psychiatrist physician with a
				  psychiatrist concurring that admission is needed.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 3 - PSYCHIATRIC CARE › Section 17-1737-18.1 - Inpatient psychiatric Services for individuals under age twenty-one in psychiatric facilities or programs

Current through June, 2024
(a) Inpatient
				  psychiatric services for recipients under age twenty-one shall be provided:
(1) Under the direction of a
				  physician;
(2) By:
(A) A psychiatric hospital or an inpatient
				  psychiatric program that is accredited by the joint commission on accreditation
				  of healthcare organizations; or
(B)
				  A psychiatric facility which is accredited by the joint commission on
				  accreditation of healthcare organizations, the commission on accreditation of
				  rehabilitation facilities, the council on accreditation
(C) of services for families and children, or
				  by any other accrediting organization, with comparable standards that is
				  recognized by the State; and
(D) Is
				  authorized to practice under the Medicaid program and meets the provisions of
				  chapter 17-1736.
(3)
				  Before the individual reaches the age twenty-one or, if the individual was
				  receiving the services immediately before he or she reached age twenty-one,
				  services will continue until the earlier of the following:
(A) The date the individual no longer
				  requires the services; or
(B) The
				  date the individual reaches age twenty-two.
(4) To an individual certified to be in need
				  of the services.
(A) Ambulatory care
				  resources available in the community do not meet the treatment needs of the
				  recipient; and
(B) The services can
				  reasonably be expected to improve the recipient's condition or prevent further
				  regression so that the services will no longer be needed.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 3 - PSYCHIATRIC CARE › Section 17-1737-19 - Licensed general hospital

Current through June, 2024
(a) A patient
				  admitted to a licensed general hospital for a medical condition may be provided
				  psychiatric care on the medical unit only when it is determined through
				  psychiatric consultation that the patient's condition does not require the
				  patient to be admitted to a psychiatric facility.
(1) A maximum of four visits for psychiatric
				  care shall be allowed.
(A) Prior
				  authorization is required before inpatient psychiatric services for recipients
				  under age twenty-one are provided.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 3 - PSYCHIATRIC CARE › Section 17-1737-20 - Inpatient care for substance abusers

Current through June, 2024
(a) Prior
				  authorization for medical pensioners plan cases are required for inpatient care
				  for alcohol and non-alcohol substance abuse regardless of whether the patient
				  is admitted to a medical unit of the hospital or to the psychiatric unit of the
				  hospital.
(b) Inpatient care for
				  alcohol substance abuse shall be as follows:
(1) Patients requiring only detoxification
				  shall be referred to a detoxification facility for treatment;
(2) If a detoxification facility is not
				  available, the attending physician may admit the patient to a licensed general
				  hospital; and
(3) Patients
				  requiring detoxification in addition to psychiatric or medical care shall be
				  referred to an authorized inpatient psychiatric facility for psychiatric care
				  or to a licensed general hospital for medical care.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 3 - PSYCHIATRIC CARE › Section 17-1737-21 - Outpatient psychiatric care

Current through June, 2024
(a) Outpatient
				  psychiatric care shall be provided by authorized psychiatric
				  providers.
(b) Prior authorization
				  is required for outpatient psychiatric care for:
(1) All eligible recipients in need of
				  outpatient psychiatric care;
(2)
				  Non-Medicaid patients who become eligible for medical assistance and whose
				  outpatient visits may be covered retroactively. The prior authorization form
				  shall be submitted by the provider immediately upon learning that the patient
				  became eligible for retroactive coverage; and
(3) Medicaid patients with third party
				  coverage or any other available resources except for Medicare.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 3 - PSYCHIATRIC CARE › Section 17-1737-22 - Exclusions to the psychiatric program

Current through June, 2024
Excluded from the psychiatric program are: Partial
					 hospitalization, day, evening, and night care;
(1) Residential treatment centers;
(2) Skilled nursing facilities;
(3) Intermediate care facilities;
(4) Consortiums; and
(5) Home visits to a residence, care home,
				  boarding home, or other living arrangement, except in an emergency
				  situation.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 4 - LONG TERM INSTITUTIONAL SERVICES › Section 17-1737-26 - Scope and purpose

Current through June, 2024
(a) This subchapter
				  governs the standard for payment which providers of long-term institutional
				  services shall meet to qualify for medical payments for services provided to
				  medicaid recipients.
(b) This
				  subchapter shall ensure provision of effective and appropriate long-term
				  institutional services and the on-going evaluation of the quality,
				  appropriateness and timeliness of such services to medicaid
				  recipients.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 4 - LONG TERM INSTITUTIONAL SERVICES › Section 17-1737-28 - Eligibility requirements

Current through June, 2024
(a) The individual
				  applicant shall meet the basic eligibility requirements of the medicaid program
				  in order to qualify for medicaid assistance.
(b) Long-term institutional services shall be
				  available to recipients who have been approved by the department to receive
				  these services.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 4 - LONG TERM INSTITUTIONAL SERVICES › Section 17-1737-29 - Content of NF services

Current through June, 2024
(a) Long-term
				  institutional services shall be provided by free-standing or distinct part NFs
				  that shall meet the eligibility requirements specified in chapters 17-1736 and
				  17-1739.
(b) NFs shall provide:
(1) Skilled nursing care and related services
				  for residents who require medical or nursing care;
(2) Rehabilitation services for the
				  rehabilitation of injured, disabled, or sick persons; or
(3) On a regular basis, health-related care
				  and services to individuals who because of their mental or physical condition
				  require care and services (above the level of room and board) which can be made
				  available to them only through institutional facilities, and is not primarily
				  for the care and treatment of mental diseases.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 4 - LONG TERM INSTITUTIONAL SERVICES › Section 17-1737-31 - Determining the applicant's or recipient's need for long-term institutional services

Current through June, 2024
(a) The provision
				  for the determination of need for admission to a long-term institution are
				  based on a physician's and other appropriate health care professional's
				  assessment of the applicant's or recipient's condition and recommendation of
				  the applicant's or recipient's need for a specific acuity level (or level of
				  medical care).
(b) Their
				  recommendation of the applicant's or recipient's need for a specific acuity
				  level (or level of medical care) shall be based on the following criteria:
(1) Acuity Level A recipient requires
				  licensed nursing and ancillary nursing personnel services on a regular and
				  long-term basis to maintain, improve, or safeguard health, or to minimize
				  disability or pain. The services provided shall be beyond room, board, and
				  personal care services available in personal care home, and shall:
(A) Be available to recipients who require
				  assistance with the normal activities of daily living twenty-four hours a
				  day;
(B) Be ordered by a physician
				  and shall be provided under the direction of the attending physician or staff
				  physician;
(C) Be planned,
				  provided, and maintained by licensed and ancillary nursing personnel and other
				  professional personnel, in accordance with a written resident care
				  plan;
(D) Be provided on an
				  inpatient basis only after consideration of the recipient's condition and the
				  feasibility and availability of utilizing more economical alternative
				  facilities and services have been ruled out; and
(E) Be less than twenty-four hours of skilled
				  nursing or regular rehabilitation services;
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 4 - LONG TERM INSTITUTIONAL SERVICES › Section 17-1737-32 - Authorization for admission to a NF or ICF-MR

Current through June, 2024
(a) Authorization
				  by the department for the recommended acuity level (or level of medical care)
				  required by an applicant or recipient shall be in accordance with the
				  provisions of chapter 1739 and section 17-1737-31.
(b) Authorization granted by the department
				  for admission to a NF or ICF-MR shall be based on the determination that the
				  applicant or recipient requires the services stipulated in sections 17-1737-29
				  and 17-1737-30.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 4 - LONG TERM INSTITUTIONAL SERVICES › Section 17-1737-33 - Preadmission screening and resident review (PASRR)

Current through June, 2024
The state PASRR program shall require that:
(1) NFs shall not admit, on or after January
				  1, 1989, any new resident with:
(A) "Mental
				  illness" as defined in section 17-1737-27 unless the state mental health
				  authority has determined, based on an independent physical and mental
				  evaluation performed by a person or entity other than the state mental health
				  authority, prior to admission, whether:
(i)
				  Because of the physical and mental condition of the individual, the individual
				  requires the level of services provided by a NF; and
(ii) If the individual requires such level of
				  services, the individual requires active treatment for mental illness;
				  or
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 4 - LONG TERM INSTITUTIONAL SERVICES › Section 17-1737-35 - Utilization control for ICF-MRs

Current through June, 2024
(a) This section
				  defines the utilization control process which shall be administered in
				  accordance with state and federal regulations to achieve optimal quality
				  control of the utilization of services provided under the state plan.
(b) The provisions for the utilization
				  control for ICF-MRs are as follows:
(1) A
				  written certification or recertification statement that the client require a
				  specific level of care is required as follows:
(A) Admission certification shall be provided
				  by a physician or a nurse practitioner or a clinical nurse specialist who is
				  not an employee of the facility but is working in collaboration with a
				  physician, on admission or not more than sixty days prior to authorization of
				  medicaid payment for the provision of long-term institutional services to the
				  client;
(B) A recertification
				  statement shall be provided by a physician or a physician assistant under the
				  supervision of a physician or a nurse practitioner or a clinical nurse
				  specialist who is not an employee of the facility but is working in
				  collaboration with a physician, no more than twelve months following
				  certification and thereafter no more than twelve months intervals until
				  discharge from the ICF-MR;
(C) The
				  written certification and recertification statements shall be placed on a form
				  designed either by the facility or the department specifically for
				  certification and recertification documentations, and said form shall be placed
				  in each client's active medical record; and
(D) The written certification and
				  recertification statements shall clearly indicate the client's need for a
				  specific level of care, and shall include:
(i) A physician's signature or initials
				  clearly identified with the acronym "M.D." for medical doctor, or "D.O." for
				  doctor of osteopathy;
(ii) A
				  physician assistant's signature or initials, clearly identified with the
				  acronym "P.A." for physician assistant;
(iii) A nurse practitioner's signature or
				  initials, clearly identified with the acronym "R.N.C." or "R.N." whichever is
				  appropriate; or
(iv) A clinical
				  nurse specialist's signature or initials clearly identified with the acronym
				  "R.N.M.S." or "R.N.C.S." whichever is appropriate; and
(v) The date of certification or
				  recertification statement is signed or initialed by a physician or a physician
				  assistant or a nurse practitioner or a clinical nurse specialist;
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 4 - LONG TERM INSTITUTIONAL SERVICES › Section 17-1737-36 - Inspection of care (IOC) reviews in ICF-MR facilities

Current through June, 2024
(1)
				  Inspection of care team members shall be employees of the department, and may
				  consist of a physician or a registered nurse, and a social worker. One of the
				  team members shall be a QMRP. If a physician is not on the team, a physician
				  shall be available to provide consultation to the team;
(2) Frequency of inspection shall be based on
				  the quality of care and services provided by the facility, and on the condition
				  of clients in the facility. However, at the minimum, each client shall be
				  evaluated once annually;
(3) No
				  facility shall be notified of the time of inspection more than forty-eight
				  hours before the scheduled arrival of the team;
(4) Method of inspection shall be by personal
				  contact with and observation of each client, and review of each client's
				  medical record to determine the following:
(A) Whether the facility services are
				  adequate to meet the health needs of each client, the rehabilitative and social
				  needs of each client and to promote maximum physical, mental, and psychosocial
				  functioning;
(B) Whether continued
				  stay in the facility is necessary and desirable;
(C) Whether it is feasible to meet the
				  client's health needs, and in an ICF-MR the client's rehabilitative needs
				  through alternative institutional or noninstitutional services; and
(D) Whether each client is receiving active
				  treatment in accordance with the provisions of section 17-1737-30;
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 4 - LONG TERM INSTITUTIONAL SERVICES › Section 17-1737-37 - Other service requirements

Current through June, 2024
(a) Providers of
				  long-term institutional services shall establish and implement written policies
				  and procedures that govern access to, duplication of, and dissemination of
				  information from applicants' or recipients' records:
(1) The following information about
				  applicants and recipients shall not be released:
(A) Names and addresses;
(B) Eligibility status, the amount of
				  assistance, or both;
(C) Medical
				  services provided;
(D) Social and
				  economic conditions or circumstances;
(E) The department's evaluation of personal
				  information; and
(F) Medical data,
				  including diagnosis and past history of disease or disability; and
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 4 - LONG TERM INSTITUTIONAL SERVICES › Section 17-1737-38 - Termination of long-term institutional services

Current through June, 2024
(a) Medicaid
				  payments for long-term institutional services shall be terminated when a
				  recipient is deemed to no longer require a specific level of care in accordance
				  with the provisions of section 17-1737-31 and the recipient refuses to transfer
				  to an available appropriate placement.
(b) The provider agreement shall be
				  terminated when the provider fails to provide long-term institutional services
				  in accordance with the terms stipulated in the provider agreement.
(c) The appeal and hearing provisions of
				  chapter 17-1736 shall apply.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 4 - LONG TERM INSTITUTIONAL SERVICES › Section 17-1737-39 - Sharing of federal financial participation payment penalty assessment

Current through June, 2024
(a) The department shall allocate to the
				  provider any or all federal financial participation payment penalties which are
				  assessed the department by the Health Care Financing Administration of the
				  Department of Health and Human Services for provider's failure to meet the
				  utilization control requirements in accordance with the provisions of sections
				  17-1737-34 and 17-1737-35.
(b) The
				  amount shall be determined by a committee composed of representatives from the
				  department and other interested private and public agencies.
(c) The appeal and hearing provisions of
				  chapter 17-1736 shall apply.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 4 - LONG TERM INSTITUTIONAL SERVICES › Section 17-1737-40 - Remedies for nursing facilities that do not meet the requirements for participation

Current through June, 2024
(a) The department
				  shall impose one or more of the following remedies when a nursing facility does
				  not meet one or more of the requirements of participation and its deficiencies
				  constitute immediate jeopardy or widespread actual harm that does not
				  constitute immediate jeopardy to the health and safety of its residents:
(1) Remove the jeopardy and appoint temporary
				  management to oversee correction of the deficiencies and assure the health and
				  safety of the facility's residents while corrections are being made to bring
				  the facility into compliance with all of the requirements of participation, or
				  to oversee orderly closure of a facility.
(A)
				  Temporary management shall be state personnel, private individuals, or a team
				  with education and requisite work experience in nursing home administration
				  that qualifies the individual(s) to correct the deficiencies in the facility to
				  be managed; and be licensed in accordance with state law. The following
				  individuals are not eligible to serve as temporary managers:
(i) Any individual who has been found guilty
				  of misconduct by any licensing board or professional society in any
				  state;
(ii) Has or whose immediate
				  family members have any financial interest in the facility managed;
				  or
(iii) Any individual who
				  currently serves or, within the past two years, has served as a member of the
				  staff of the facility;
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 4 - LONG TERM INSTITUTIONAL SERVICES › Section 17-1737-41 - State-approved feeding assistant training program

Current through June, 2024
(a) A
				  state-approved feeding assistant training program shall include a minimum of
				  ten clock hours of training, provided by Medicaid or Medicare and Medicaid
				  certified nursing facilities, with a minimum of four clock hours of practical
				  training directly supervised by a registered nurse licensed in
				  Hawaii.
(b) A state-approved
				  feeding assistant training program shall include, but not be limited to, the
				  following:
(1) Feeding techniques;
(2) Assistance with feeding and
				  hydration;
(3) Communication and
				  interpersonal skills;
(4)
				  Appropriate responses to resident behavior;
(5) Safety and emergency procedures,
				  including the Heimlich maneuver;
(6) Infection control;
(7) Resident rights; and
(8) Recognizing changes in residents that are
				  inconsistent with their normal behavior and the importance of reporting those
				  changes to the supervisory nurse.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 5 - PREVENTIVE AND REHABILITATIVE SERVICES › Section 17-1737-43 - Preventive services

Current through June, 2024
(a) Preventive
				  services means services provided by a physician or other licensed practitioner
				  of the healing arts within the scope of a practice under state law to:
(1) Prevent disease, disability, and other
				  health problems or their progress;
(2) Prolong life; and
(3) Promote physical and mental health and
				  efficiency.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 5 - PREVENTIVE AND REHABILITATIVE SERVICES › Section 17-1737-44 - Rehabilitative services

Current through June, 2024
(a) Rehabilitative
				  services means those medical and remedial items or services which are
				  prescribed by a licensed physician for the purpose of maximum reduction of a
				  patient's physical or mental disability and restoration of the patient to the
				  patient's best possible functional level.
(b) Rehabilitative services shall be directed
				  to restoring a disabled person toward the following goals:
(1) Self-care and possible independent
				  living; or
(2) Substantial gainful
				  employment.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 5 - PREVENTIVE AND REHABILITATIVE SERVICES › Section 17-1737-45 - Home health services

Current through June, 2024
(a) Home health
				  services means services provided to a recipient by a home health agency or
				  under a home or community-based waiver:
(1)
				  At the recipient's place of residence or at a location other than a hospital,
				  skilled nursing facility, intermediate care facility - mental retardation, or
				  intermediate care facility;
(2) On
				  a physician's orders as part of a written plan of care that the physician
				  reviews every sixty days; and
(3)
				  Medical authorization as specified in section 17-1739-4 is needed for all home
				  health services, medical supplies, equipment and appliances unless otherwise
				  specified under this section.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 5 - PREVENTIVE AND REHABILITATIVE SERVICES › Section 17-1737-46 - Family planning services

Current through June, 2024
(a) All fee for
				  service medicaid recipients, male or female, including minors, who are sexually
				  active or of child-bearing age, shall be eligible for family planning services
				  and supplies.
(b) The department
				  shall furnish assistance to any eligible person by:
(1) Locating and referring to a recognized
				  provider those persons encountering difficulties in obtaining family planning
				  services; and
(2) Prompt attention
				  so that the eligible person shall be assured of receiving family planning
				  service within thirty days from the time of the request.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 5 - PREVENTIVE AND REHABILITATIVE SERVICES › Section 17-1737-47 - Hysterectomy

Current through June, 2024
(a) Hysterectomy means a medical procedure or
				  operation for the purpose of removing the uterus.
(b) Hysterectomies shall be covered under the
				  medicaid program when medically necessary except when performed:
(1) Solely for the purpose of rendering an
				  individual permanently incapable of reproducing; or
(2) Primarily for the purpose of rendering
				  the individual permanently incapable of reproducing when there is more than one
				  reason for the hysterectomy.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 5 - PREVENTIVE AND REHABILITATIVE SERVICES › Section 17-1737-48 - Sterilization

Current through June, 2024
(a) Sterilization means any medical
				  procedure, treatment, or operation for the purpose of rendering an individual
				  permanently incapable of reproducing. Sterilization shall be neither a
				  necessary part of the treatment of an existing accompaniment of an operation.
				  Sterilization under this program shall not be authorized for any individual who
				  is:
(1) Mentally incompetent;
(2) Incompetent under applicable state law to
				  give informed and binding consent because of mental incapacity;
(3) Under twenty-one years; or
(4) Institutionalized.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 5 - PREVENTIVE AND REHABILITATIVE SERVICES › Section 17-1737-49 - Respiratory care services

Current through June, 2024
(a) Respiratory
				  care services are services provided on a part time basis in the home of the
				  individual by a respiratory therapist or other health care professional trained
				  in respiratory therapy as defined in section 17-1737-2.
(b) Respiratory care services may be provided
				  for medicaid eligible individuals who meet the following criteria:
(1) Medically dependent on a ventilator
				  support for at least thirty consecutive days as an inpatient in an acute or
				  long term care facility;
(2)
				  Dependent on ventilator support for at least six hours per day;
(3) If respiratory care services were not
				  available, would require inpatient care in a hospital, or long-term care
				  institution;
(4) Eligible or would
				  be eligible for medicaid payments if institutional care were
				  required;
(5) Has adequate support
				  services to be cared for at home; and
(6) Wishes to be cared for at home.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 5 - PREVENTIVE AND REHABILITATIVE SERVICES › Section 17-1737-50 - Home pharmacy services

Current through June, 2024
(a) Home pharmacy
				  services are services related to the dispensing and clinical monitoring of
				  enteral and parenteral nutrition and therapeutic agents given intravenously or
				  by injection to recipients in their homes.
(b) Home pharmacy services shall be ordered
				  by a physician and shall include clinical monitoring by pharmacists and other
				  skilled medical professionals, such as registered nurses.
(c) Home pharmacy services may be provided to
				  Medicaid eligible individuals who:
(1)
				  Require the use of therapeutic intravenous or injectable agents including
				  analgesics, antibiotics, and fluids to treat their medical condition;
(2) Do not require acute hospital or nursing
				  facility care, have adequate support in the home, and can safely receive these
				  services in the home setting; and
(3) Wish to receive this care in the
				  home.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 5 - PREVENTIVE AND REHABILITATIVE SERVICES › Section 17-1737-51 - Sleep services

Current through June, 2024
(a) Sleep services
				  are services provided for the diagnosis and treatment of sleep disorders and
				  shall:
(1) Be performed by sleep laboratories
				  or sleep disorder centers; and
(2)
				  Be provided to Medicaid eligible individuals only when ordered by a physician
				  and authorized by the department on form DHS 1144.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 5 - PREVENTIVE AND REHABILITATIVE SERVICES › Section 17-1737-51.1 - Telehealth services

Current through June, 2024
(a) Telehealth
				  services is the use of communication equipment to link health care
				  practitioners and patients in different locations. It may be used in place of a
				  face-to-face, "hands on" encounter for consultation, office visits, individual
				  psychotherapy and pharmacologic management. For purposes of this section, the
				  term "patient" refers to individuals eligible for medical assistance.
(b) Telehealth services may be provided to
				  patients only if they are presented from an originating site located in either
				  a:
(1) Rural Health Professional Shortage
				  Area (HPSA) as defined by section 332(a)(1)(A) of the Public Health Service
				  Act;
(2) In a county outside of a
				  Metropolitan Statistical Area, as defined by Section 1886(d)(2)(D) of the
				  Social Security Act; or
(3) From an
				  entity that participates in a Federal telemedicine demonstration project that
				  has been approved by the Secretary of Health and Human Services as of December
				  31, 2000.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 6 - EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT (EPSDT) › Section 17-1737-53 - Early and periodic screening, diagnosis, and treatment (EPSDT)

Current through June, 2024
(a) EPSDT means early screening and
				  diagnostic services to identify physical or mental defects in recipients; and,
				  to provide health care, treatment, and other measures to correct or ameliorate
				  any defects and chronic condition discovered.
(b) EPSDT includes services to:
(1) Seek out recipients and their families
				  and inform them of the benefits of prevention and the health services
				  available;
(2) Help the recipient
				  or family use health resources, including their own talents, effectively and
				  efficiently; and
(3) Assure the
				  problems identified are diagnosed and treated early, before they become more
				  complex and their treatment more costly.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 6 - EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT (EPSDT) › Section 17-1737-54 - Recipient eligibility requirements

Current through June, 2024
Early and Periodic Screening, Diagnosis, and Treatment
					 services shall be provided to eligible Medicaid recipients under age
					 twenty-one.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 6 - EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT (EPSDT) › Section 17-1737-55 - Informing

Current through June, 2024
(a) The department shall seek out individuals
				  and their families and inform them of the availability of EPSDT services by a
				  combination of written and oral methods to effectively explain the benefits of
				  prevention and the health services available:
(1) Within sixty days of the recipient's
				  initial eligibility determination; and
(2) Annually thereafter in case of recipient
				  or family who have not utilized EPSDT services.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 6 - EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT (EPSDT) › Section 17-1737-56 - Periodicity schedule

Current through June, 2024
(a) The scheduled
				  frequency of medical screening services shall be based on age:
(1) Infancy: by one month, at two, four, six,
				  nine, and twelve months;
(2) Early
				  childhood: at fifteen, eighteen, and twenty-four months and at three and four
				  years;
(3) Late childhood: at five,
				  six, eight, ten, and twelve years; and
(4) Adolescence: at fourteen, sixteen,
				  eighteen, and twenty years.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 6 - EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT (EPSDT) › Section 17-1737-57 - Screening

Current through June, 2024
(a) Upon request from the recipient or
				  family, the department shall assess the recipient's health status and needs
				  through initial and periodic health examinations and evaluations of the general
				  physical and mental health, growth, development, and nutritional status of
				  infants, children, and youth. Screening shall include, but not be limited to:
(1) Comprehensive health and developmental
				  history, including assessment of both physical and mental health
				  development;
(2) Comprehensive
				  unclothed physical examination;
(3)
				  Appropriate immunizations according to age and health history;
(4) Appropriate vision testing;
(5) Appropriate hearing testing;
(6) Appropriate laboratory tests, including
				  lead blood level assessment appropriate for age and risk factors;
(7) Routine dental examination furnished by
				  direct referral to a dentist which includes bitewing x-ray, scaling and
				  polishing, and topical application of fluoride as deemed necessary in
				  accordance with section 17-1737-75; and
(8) Health education including anticipatory
				  guidance.