reglab/statecodes huggingface dataset:
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1719.1 - STATE FUNDED AGED, BLIND, AND DISABLED PROGRAM › Subchapter 1 - GENERAL PROVISIONS › Section 17-1719.1-1 - Purpose

Current through June, 2024
This chapter establishes the State Funded Aged, Blind, and
					 Disabled Program for certain lawfully present non-pregnant adult non-citizens
					 who are aged, blind, or disabled and ineligible under chapter 17-1719 solely
					 due to citizenship or non-citizen status.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1719.1 - STATE FUNDED AGED, BLIND, AND DISABLED PROGRAM › Subchapter 1 - GENERAL PROVISIONS › Section 17-1719.1-2 - General requirements

Current through June, 2024
(a) The
				  confidentiality, administrative appeal, fraud, medical assistance recovery,
				  application processing, eligibility review, and adverse action provisions
				  described in subtitle 12 shall apply to an individual who applies or is
				  determined eligible under this chapter. For purposes of this chapter,
				  references to the terms "Medicaid" or "federal medical assistance" in the
				  provisions listed above shall be replaced with 'state medical assistance under
				  chapter 17-1719.1", when applicable.
(b) Processing of applications shall be:
(1) In accordance with chapter 17-1711.1;
				  however, subsections 17-1711.1-32(b)-(e) shall not apply; and
(2) Subject to section
				  17-1719.1-13.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1719.1 - STATE FUNDED AGED, BLIND, AND DISABLED PROGRAM › Subchapter 2 - ELIGIBILITY REQUIREMENTS › Section 17-1719.1-8 - Purpose

Current through June, 2024
This subchapter describes the basic, categorical, and
					 financial eligibility requirements for participation under this
					 chapter.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1719.1 - STATE FUNDED AGED, BLIND, AND DISABLED PROGRAM › Subchapter 2 - ELIGIBILITY REQUIREMENTS › Section 17-1719.1-9 - Basic requirements

Current through June, 2024
To be eligible under this chapter, an individual
					 shall:
(1) Meet the basic eligibility
				  requirements described in chapter 17-1714.1, with the exception of citizenship
				  or non-citizen status;
(2) Be a
				  lawfully present non-citizen;
(3)
				  Not be a beneficiary of Executive Actions including but not limited to,
				  Deferred Action for Childhood Arrivals (DACA), or Deferred Action for Parental
				  Accountability (DAPA); and
(4) Be
				  ineligible for Medicaid, with the exception of emergency medical assistance.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1719.1 - STATE FUNDED AGED, BLIND, AND DISABLED PROGRAM › Subchapter 2 - ELIGIBILITY REQUIREMENTS › Section 17-1719.1-10 - Categorical requirements for an aged, blind, or disabled individual

Current through June, 2024
To be eligible under this chapter, an aged, blind, or
					 disabled individual shall meet the categorical requirements for being aged,
					 blind, or disabled, respectively, as described in chapter
					 17-1719.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1719.1 - STATE FUNDED AGED, BLIND, AND DISABLED PROGRAM › Subchapter 2 - ELIGIBILITY REQUIREMENTS › Section 17-1719.1-11 - Income requirements

Current through June, 2024
(a) The applicable
				  standards of assistance for participation under this chapter are set forth
				  under chapter 17-1719.
(b) An
				  individual who meets the requirements of more than one standard of assistance
				  shall have eligibility determined based on the standard of assistance that
				  would be most beneficial to the individual.
(c) Countable income, as set forth in chapter
				  17-1724.1, after allowable disregards and exemptions, shall be compared to the
				  standards of assistance set forth under chapter 17-1719.
(d) An individual applying for medical
				  assistance under this chapter shall not be required to apply for or receive
				  SSI.
(e) If an individual's income
				  exceeds the applicable standards of assistance set forth under chapter 17-1719,
				  the provisions relating to an individual with excess income described in
				  chapter 1730.1 shall apply.
(f) An
				  individual who is requesting or receiving coverage of long-term care services
				  shall be subject to chapter 17-1724.1, subchapter 8.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1719.1 - STATE FUNDED AGED, BLIND, AND DISABLED PROGRAM › Subchapter 2 - ELIGIBILITY REQUIREMENTS › Section 17-1719.1-12 - Asset requirements

Current through June, 2024
(a) The personal
				  reserve standards are the maximum amount of countable assets, as set forth in
				  chapter 17-1719, that may be held by the household while establishing or
				  maintaining eligibility for medical assistance under this chapter and are equal
				  to the resource limits employed by the SSI program.
(b) An individual or household whose equity
				  in non-exempt assets as determined in chapter 17-1725.1 exceeds the personal
				  reserve standard for medical assistance for a household of applicable size
				  shall be ineligible for medical assistance under this chapter.
(c) An individual who is requesting or
				  receiving coverage of long-term care services shall be subject to the
				  requirements of chapter 17-1725.1, subchapter 7.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1719.1 - STATE FUNDED AGED, BLIND, AND DISABLED PROGRAM › Subchapter 2 - ELIGIBILITY REQUIREMENTS › Section 17-1719.1-13 - Application periods

Current through June, 2024
(a) The department
				  shall begin receiving applications for state medical assistance under this
				  chapter starting on the effective date of this chapter, and may stop accepting
				  applications pursuant to subsection (d).
(b) After the initial application period
				  under subsection (a) is closed, the department shall accept applications under
				  this chapter only during an announced open application period.
(c) Prior to the start of an open application
				  period, the department shall issue a public notice at least once statewide
				  announcing the start of an open application period.
(d) The department may close the initial
				  application period, or any subsequent open application period, by issuing a
				  public notice once statewide at least thirty days prior to the date the
				  application period will be closed. Applications received by the department
				  after the open application period has ended shall be denied.
(e) The restriction on submission of an
				  application under subsection (b) shall not apply to an individual who loses
				  eligibility under the Children Group as a result of reaching age nineteen years
				  or under the Pregnant Women Group as a result of reaching the end of the
				  post-partum period, and who is eligible under this chapter.
(f) Upon adoption of this chapter, an
				  individual receiving state medical assistance as an aged, blind or disabled
				  individual shall be deemed eligible under this chapter.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1719.1 - STATE FUNDED AGED, BLIND, AND DISABLED PROGRAM › Subchapter 2 - ELIGIBILITY REQUIREMENTS › Section 17-1719.1-14 - Eligibility review requirements

Current through June, 2024
(a) An eligible
				  individual shall receive an eligibility review every twelve months.
(b) Eligibility shall be redetermined in
				  accordance with chapter 17-1712.1 and chapter 17-1714.1, subchapter
				  5.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1719.1 - STATE FUNDED AGED, BLIND, AND DISABLED PROGRAM › Subchapter 3 - FREEDOM OF CHOICE, ENROLLMENT, BENEFITS AND DISENROLLMENT › Section 17-1719.1-20 - Purpose

Current through June, 2024
This subchapter addresses freedom of choice, enrollment,
					 benefits and disenrollment for an individual who is eligible under this
					 chapter.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1719.1 - STATE FUNDED AGED, BLIND, AND DISABLED PROGRAM › Subchapter 3 - FREEDOM OF CHOICE, ENROLLMENT, BENEFITS AND DISENROLLMENT › Section 17-1719.1-21 - Freedom of choice

Current through June, 2024
(a) An individual
				  eligible under this chapter, with the exception of an individual identified in
				  section 17-1735.1-2(a), shall be provided a choice of a health plan and a
				  provider as described in chapter 17-1720.1.
(b) An individual eligible under this chapter
				  identified in section 17-1735.1-2(a) shall choose a department approved
				  provider as described in section 17-1736-3.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1719.1 - STATE FUNDED AGED, BLIND, AND DISABLED PROGRAM › Subchapter 3 - FREEDOM OF CHOICE, ENROLLMENT, BENEFITS AND DISENROLLMENT › Section 17-1719.1-22 - Enrollment into a participating health plan

Current through June, 2024
(a) An
				  individual eligible under this chapter, with the exception of an individual
				  identified in section 17-1735.1-2(a), shall be enrolled in a health plan as
				  described in chapter 17-1720.1, subchapter 2.
(b) An individual eligible under this chapter
				  identified in section 17-1735.1-2(a) shall not be enrolled into a plan, and
				  services shall be provided on a fee-for-service basis.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1719.1 - STATE FUNDED AGED, BLIND, AND DISABLED PROGRAM › Subchapter 3 - FREEDOM OF CHOICE, ENROLLMENT, BENEFITS AND DISENROLLMENT › Section 17-1719.1-23 - Benefits

Current through June, 2024
(a) An individual eligible under this chapter
				  shall be provided a standard benefits package by a participating health plan
				  and other services when appropriate as described in chapter 17-1720.
(b) An aged, blind or disabled individual
				  identified in section 17-1735.1-2(a) shall be provided coverage under the
				  fee-for-service provisions described in chapter 17-1737.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1719.1 - STATE FUNDED AGED, BLIND, AND DISABLED PROGRAM › Subchapter 3 - FREEDOM OF CHOICE, ENROLLMENT, BENEFITS AND DISENROLLMENT › Section 17-1719.1-24 - Disenrollment from a health plan

Current through June, 2024
An enrollee shall be disenrolled from a health plan under
					 the provisions described in chapter 17-1720.1.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1719.1 - STATE FUNDED AGED, BLIND, AND DISABLED PROGRAM › Subchapter 3 - FREEDOM OF CHOICE, ENROLLMENT, BENEFITS AND DISENROLLMENT › Section 17-1719.1-25 to 17-1719.1-29 - Reserved

Current through June, 2024
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1720 - BENEFITS PACKAGE › Subchapter 2 - SCOPE AND CONTENT OF SERVICES › Section 17-1720-6 - Covered services

Current through June, 2024
(a) The services
				  minimally required to be provided by each participating health plan are
				  described in section
				  17-1720-10 and shall be known as
				  the standard benefits package.
(b)
				  The standard benefits package is based on a twelve-month benefit period.
				  Service limits are prorated for any benefit period less than twelve-months. If
				  an enrollee changes health plans during a benefit period, the remaining unused
				  service limits will be covered by the new health plan for the duration of the
				  benefit period.
(c) Based on
				  clinical eligibility and medical necessity, a participating health plan may
				  provide services described in section
				  17-1720-14 to an
				  enrollee.
(d) Based on level of
				  care eligibility, the enrollee shall be provided services described in sections
				  17-1720-18 or
				  17-1720-22 by the health
				  plan.
(e) A health plan may, at the
				  health plan's option, or as otherwise required by the contract between the
				  health plan and the department or the state plan, provide medically necessary
				  services which exceed the requirements of the standard benefits package.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1720 - BENEFITS PACKAGE › Subchapter 3 - STANDARD BENEFITS PACKAGE › Section 17-1720-10 - Standard benefits package

Current through June, 2024
Within a twelve-month benefit period, participating health
					 plans shall provide the following medically necessary services which minimally
					 include, but are not limited to, the following and which may require prior
					 authorization and be subject to limitations as described in chapter
					 17-1737:
(1) Medical inpatient days
				  for medically necessary inpatient hospital care related to medical care,
				  surgery, post-stabilization, acute rehabilitation and behavioral health
				  inpatient days for psychiatric care include, but are not limited to, the
				  following:
(A) Semi-private room and board
				  and general nursing care for inpatient stays related to medical care, surgery,
				  and psychiatric care;
(B) Intensive
				  care room and board and general nursing care for medical care and
				  surgery;
(C) Use of an operating
				  room and related facilities, inpatient anesthesia, radiology, laboratory and
				  other diagnostic services agreed upon by the plan medical director for medical
				  care and surgery;
(D) Drugs,
				  dressings, blood derivatives and their administration, general medical
				  supplies, and diagnostic and therapeutic procedures as prescribed by the
				  attending physician; and
(E) Other
				  ancillary services associated with hospital care except private duty nursing.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1720 - BENEFITS PACKAGE › Subchapter 4 - SPECIALIZED BEHAVIORIAL HEALTH SERVICES › Section 17-1720-14 - Specialized behavioral health services

Current through June, 2024
(a) In addition to
				  services included in the standard benefits package under section
				  17-1720-10 and based on clinical
				  eligibility and medical necessity, the following specialized behavioral health
				  services may be provided for an enrollee with a severe and persistent mental
				  illness, serious mental illness, or requiring support for emotional and
				  behavioral development:
(1) Biopsychosocial
				  rehabilitation;
(2)
				  Clubhouse;
(3) Community based
				  residential programs;
(4) Crisis
				  management;
(5) Crisis residential
				  services;
(6) Financial
				  management;
(7) Hospital-based
				  residential services;
(8) Intensive
				  case management;
(9) Intensive
				  family intervention;
(10) Intensive
				  outpatient hospital services;
(11)
				  Peer Specialist;
(12) Substance
				  abuse treatment provided by a licensed or a certified substance abuse
				  counselor;
(13) Supportive
				  employment;
(14) Supported housing;
				  and
(15) Therapeutic living
				  supports and therapeutic foster care supports.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1720 - BENEFITS PACKAGE › Subchapter 5 - HOME AND COMMUNITY BASED SERVICES › Section 17-1720-18 - Home and Community Based Services (HCBS

Current through June, 2024
(a) The
				  participating health plan is not required to provide HCBS to an enrollee if:
(1) The enrollee chooses institutional
				  services;
(2) The enrollee cannot
				  be served safely in the community;
(3) There are no adequate or appropriate
				  providers for needed services; or
(4) The cost of providing services in the
				  home or community setting is expected to exceed the cost of providing care in
				  an institution.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1720 - BENEFITS PACKAGE › Subchapter 7 - DENTAL SERVICES › Section 17-1720-26 - Dental Services

Current through June, 2024
(a) Required
				  preventive dental services and medically necessary dental services shall only
				  be provided on a fee-for-service basis under section
				  17-1737-75.
(b) The health plans shall coordinate with
				  the department or its designee to refer an eligible individual to the
				  department's dental third party administrator for non-medically related dental
				  services.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1720 - BENEFITS PACKAGE › Subchapter 8 - EXCLUSIONS AND LIMITATIONS › Section 17-1720-31 - Exclusions and limitations

Current through June, 2024
A participating health plan shall not provide coverage for
					 certain services, procedures, medications, supplies, equipment, or other items
					 that are:
(1) Specifically excluded
				  from coverage by State or federal requirements;
(2) Provided by providers not licensed or
				  certified in the State to perform the service;
(3) Available without charge to the general
				  public through a separate state or federally administered federally-funded
				  program;
(4) Covered by a third
				  party medical or liability insurance, including Medicare;
(5) Required to receive prior authorization
				  but did not receive it;
(6)
				  Experimental in nature and have not been approved by the United States Food and
				  Drug Administration, or both;
(7)
				  Elective and do not improve outcomes such as decreasing risk of morbidity or
				  mortality;
(8) Without sufficient
				  evidence of effectiveness or net benefits as determined by the department and
				  not covered under the currently approved Medicaid State Plan, Medicaid waivers,
				  or both;
(9) Comparatively
				  effective to a tolerated lower cost alternative; or
(10) Otherwise determined by the department
				  to be non-covered, excluded, or limited.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1720.1 - FREEDOM OF CHOICE, ENROLLMENT AND DISENROLLMENT › Subchapter 1 - GENERAL PROVISIONS › Section 17-1720.1-1 - Purpose

Current through June, 2024
This chapter describes the freedom of choice, enrollment
					 and disenrollment provisions for individuals participating in the demonstration
					 project authorized by Section 1115 of the Social Security
					 Act.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1720.1 - FREEDOM OF CHOICE, ENROLLMENT AND DISENROLLMENT › Subchapter 2 - FREEDOM OF CHOICE › Section 17-1720.1-7 - Purpose

Current through June, 2024
This subchapter describes the provisions regarding an
					 eligible individual's freedom of choice in the selection of a participating
					 health plan and a primary care provider.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1720.1 - FREEDOM OF CHOICE, ENROLLMENT AND DISENROLLMENT › Subchapter 2 - FREEDOM OF CHOICE › Section 17-1720.1-8 - Choice of health plans

Current through June, 2024
(a) Except for the
				  conditions in section 17-1720.1-13, an eligible individual shall be allowed to
				  select from among the participating health plans, of which the individual is
				  not subject to an enrollment limit, servicing the geographic area in which the
				  individual resides. This provision shall not apply to an enrolled individual
				  identified in subsection (c).
(b)
				  If a health plan has reached its maximum enrollment, the eligible individual
				  shall select another participating health plan that is available. If only one
				  other participating health plan is available, subsection (c) shall
				  apply.
(c) In the absence of a
				  choice of health plans in a service area, an eligible individual shall be
				  enrolled in the participating health plan accepting new members.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1720.1 - FREEDOM OF CHOICE, ENROLLMENT AND DISENROLLMENT › Subchapter 2 - FREEDOM OF CHOICE › Section 17-1720.1-9 - Choice of primary care providers

Current through June, 2024
(a) In accordance
				  with the procedures established by the participating health plan, an eligible
				  individual shall be allowed to select a primary care provider from among those
				  available within the health plan's provider network.
(b) In the absence of a timely selection
				  among the available primary care providers within the health plan's provider
				  network, the enrolled individual shall be assigned to a primary care provider
				  by the health plan.
(c) An enrolled
				  individual may change their primary care provider as frequently as, and for
				  whatever reason, they choose. Exceptions to this provision shall be determined
				  by the department.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1720.1 - FREEDOM OF CHOICE, ENROLLMENT AND DISENROLLMENT › Subchapter 3 - ENROLLMENT › Section 17-1720.1-15 - Purpose

Current through June, 2024
The purpose of this subchapter is to describe the
					 selection and subsequent enrollment provisions into a participating health
					 plan. An eligible individual described in section
					 17-1735.1-2(a) 
					 shall be provided fee-for-service coverage and will not have the freedom to
					 choose and be enrolled in a participating health plan.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1720.1 - FREEDOM OF CHOICE, ENROLLMENT AND DISENROLLMENT › Subchapter 3 - ENROLLMENT › Section 17-1720.1-16 - Selection of a health plan for a newly eligible individual

Current through June, 2024
(a) With the exception of conditions in
				  section 17-1720.1-17, at the time of notification of application approval, an
				  eligible individual shall be provided the opportunity to select a participating
				  health plan to provide the covered services effective the applicable date
				  described in section 17-1720.1-21.
(b) In the absence of a choice of health plan
				  open to new members in a service area, an individual who resides in that
				  particular service area shall be auto-assigned to the participating health plan
				  open to new members.
(c) If the
				  individual selects a health plan at the time of notification of application
				  approval, the department shall send an enrollment notice identifying the
				  selected health plan and informing the enrolled individual of the sixty (60)
				  calendar days grace period from the date of enrollment to select a different
				  health plan available in the service area in which the individual resides and
				  which is open to new members.
(d)
				  If the individual does not select a health plan at the time of notification of
				  application approval, the individual shall be auto-assigned to a health plan by
				  the department to provide the covered services effective the applicable date
				  described in section 17-1720.1-21.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1720.1 - FREEDOM OF CHOICE, ENROLLMENT AND DISENROLLMENT › Subchapter 3 - ENROLLMENT › Section 17-1720.1-17 - Assignment to a health plan for a newly eligible individual

Current through June, 2024
(a) An individual meeting one of the
				  following conditions will be auto-assigned to a health plan at the time of
				  determination of eligibility.
(1) A newborn
				  of an enrolled individual shall be enrolled into the health plan of the mother,
				  retroactive to the date of birth. The newborn auto-assignment shall be
				  effective for at least the first (1st) thirty (30)
				  calendar days following the birth;
(2) An individual who lost eligibility for a
				  period of six (6) months or less shall be re-enrolled into their previous
				  health plan;
(3) An enrolled
				  individual who enters into the child welfare system shall remain in their
				  current health plan;
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1720.1 - FREEDOM OF CHOICE, ENROLLMENT AND DISENROLLMENT › Subchapter 3 - ENROLLMENT › Section 17-1720.1-19 - Exemptions to a health plan's enrollment limit

Current through June, 2024
(a) The
				  department may implement an enrollment limit on any health plan that has an
				  enrollment equal to or exceeding the maximum enrollment allowed for the service
				  area as determined by the department and the enrollment limit shall be
				  effective at the start of and remain in effect for the benefit year.
(b) Subject to approval by the department, a
				  health plan may self-impose an enrollment limit, and the enrollment limit shall
				  be effective when enrollment has reached the self-imposed limit as determined
				  by the department.
(c) When a
				  health plan has an enrollment limit, the health plan may not be available for
				  selection and shall not be available for auto-assignment until the restriction
				  is lifted.
(d) The following
				  eligible individuals shall be exempt from a participating health plan's
				  enrollment limit:
(1) A newborn born to an
				  enrolled individual shall be enrolled in the mother's health plan for a minimum
				  of thirty (30) days, or if the mother is not eligible, enrolled in the health
				  plan of the:
(A) Youngest enrolled household
				  member; or
(B) Primary household
				  member if there is no sibling enrolled.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1720.1 - FREEDOM OF CHOICE, ENROLLMENT AND DISENROLLMENT › Subchapter 3 - ENROLLMENT › Section 17-1720.1-20 - Annual plan change period

Current through June, 2024
(a) An individual
				  shall be allowed to change enrollment from one participating health plan to
				  another participating health plan within the service areas in which the
				  individual resides that is open to receiving new members during the annual plan
				  change period.
(b) The annual plan
				  change period shall occur each calendar year at a time designated by the
				  department.
(c) An individual who
				  does not request to change health plan enrollment during annual plan change
				  shall remain in their current health plan.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1720.1 - FREEDOM OF CHOICE, ENROLLMENT AND DISENROLLMENT › Subchapter 3 - ENROLLMENT › Section 17-1720.1-21 - Effective date of enrollment

Current through June, 2024
(a) The effective
				  date of enrollment for a newly eligible individual shall be one of the
				  following:
(1) The date a completed
				  application is received by the department;
(2) Any date specified by the applicant on
				  which appropriate Medicaid eligible services were incurred in accordance with
				  chapter 171730.1 and is no earlier than the first
				  (1st) day of the third
				  (3rd) month prior to the month the application is
				  received by the department for individuals applying for the coverage of
				  long-term care services or the tenth (10 ) calendar day immediately prior to
				  the date the application is received by the department for all other
				  individuals;
(3) The start date of
				  the participating health plan contract period in which an eligibility
				  determination is made for retroactive coverage; or
(4) The date when all eligibility
				  requirements were met.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1720.1 - FREEDOM OF CHOICE, ENROLLMENT AND DISENROLLMENT › Subchapter 4 - DISENROLLMENT › Section 17-1720.1-27 - Purpose

Current through June, 2024
The purpose of this subchapter is to describe the
					 requirements for disenrollment from a participating health plan.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1720.1 - FREEDOM OF CHOICE, ENROLLMENT AND DISENROLLMENT › Subchapter 4 - DISENROLLMENT › Section 17-1720.1-28 - Authority to disenroll

Current through June, 2024
The department shall have the sole authority to disenroll
					 an individual from a participating health plan.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1722 - SPECIAL MEDICAL ASSISTANCE COVERAGES AND PROGRAMS › Subchapter 1 - GENERAL PROVISIONS › Section 17-1722-1 - Purpose

Current through June, 2024
The purpose of this chapter is to describe certain special
					 coverages of the medical assistance program and to establish the requirements
					 for eligibility and participation in the coverages.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1722 - SPECIAL MEDICAL ASSISTANCE COVERAGES AND PROGRAMS › Subchapter 2 - Qualified Severely Impaired Individuals › Section 17-1722-4 - Eligibility requirements

Current through June, 2024
(a) A qualified
				  severely impaired individual is a person:
(1)
				  Who, for the month preceding the month to which this section applies;
(A) Received SSI, SSP, or both on the basis
				  of blindness or disability; and
(B)
				  Was eligible for medical assistance; and
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1722 - SPECIAL MEDICAL ASSISTANCE COVERAGES AND PROGRAMS › Subchapter 2 - Qualified Severely Impaired Individuals › Section 17-1722-5 - Provision of coverage

Current through June, 2024
(a) Coverage for a
				  qualified severely impaired individual shall be through enrollment in a health
				  plan as described in chapter 17-1720.1.
(b) Coverage under this section excludes
				  payment for Medicare Part A premiums.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1722 - SPECIAL MEDICAL ASSISTANCE COVERAGES AND PROGRAMS › Subchapter 3 - QUALIFIED MEDICARE BENEFICIARIES › Section 17-1722-9 - Purpose

Current through June, 2024
The purpose of this subchapter is to establish the
					 requirements for eligibility of qualified medicare beneficiaries and
					 limitations of coverage for that assistance group.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1722 - SPECIAL MEDICAL ASSISTANCE COVERAGES AND PROGRAMS › Subchapter 3 - QUALIFIED MEDICARE BENEFICIARIES › Section 17-1722-10 - Eligibility requirements

Current through June, 2024
A qualified medicare beneficiary shall meet all of the
					 conditions as follows:
(1) Entitled to
				  hospital insurance benefits under the medicare program;
(2) In receipt of income which does not
				  exceed the federal poverty level for the household of applicable
				  size;
(3) In possession of assets
				  which do not exceed three times the resource limit of the supplemental security
				  income program adjusted by the annual percentage increase in the consumer price
				  index; and
(4) Required to meet
				  basic eligibility conditions, detailed in chapter 17-1714.1, including:
(A) A resident of the State;
(B) A citizen of the United States or a legal
				  resident non-citizen;
(C) Not a
				  resident of a public institution;
(D) Assign to the department any benefits
				  from a third party for coverage of medical expenses, to the extent of medical
				  costs paid by the department; and
(E) Furnish a social security number and
				  verification of that number.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1722 - SPECIAL MEDICAL ASSISTANCE COVERAGES AND PROGRAMS › Subchapter 3 - QUALIFIED MEDICARE BENEFICIARIES › Section 17-1722-11 - Treatment of income and assets

Current through June, 2024
The income and assets of a qualified medicare beneficiary
					 shall be treated as described in chapters 17-1724.1 and
					 17-1725.1.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1722 - SPECIAL MEDICAL ASSISTANCE COVERAGES AND PROGRAMS › Subchapter 3 - QUALIFIED MEDICARE BENEFICIARIES › Section 17-1722-12 - Limitations of coverage

Current through June, 2024
Individuals eligible under this subchapter shall be
					 limited to coverage of the premiums, deductibles, and co-insurance amounts
					 under the Medicare Part A and B.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1722 - SPECIAL MEDICAL ASSISTANCE COVERAGES AND PROGRAMS › Subchapter 3 - QUALIFIED MEDICARE BENEFICIARIES › Section 17-1722-13 - Effective date of coverage

Current through June, 2024
(a) Coverage as a
				  qualified medicare beneficiary begins on the first day of the month after the
				  month in which determination of eligibility is made.
(b) The retroactive provisions under chapter
				  17-1711.1 do not apply.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1722 - SPECIAL MEDICAL ASSISTANCE COVERAGES AND PROGRAMS › Subchapter 4 - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES › Section 17-1722-17 - Purpose

Current through June, 2024
The purpose of this subchapter is to establish the
					 requirements for eligibility of specified low income medicare beneficiaries and
					 the limitations of coverage for that assistance group.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1722 - SPECIAL MEDICAL ASSISTANCE COVERAGES AND PROGRAMS › Subchapter 4 - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES › Section 17-1722-18 - Eligibility requirements

Current through June, 2024
A specified low income medicare beneficiary shall meet all
					 of the conditions as follows:
(1)
				  Entitled to hospital insurance benefits under the medicare program;
(2) In receipt of income which does not
				  exceed one hundred twenty per cent of the federal I poverty level;
(3) In possession of assets which do not
				  exceed three times the resource limit of the supplemental security income
				  program adjusted by the annual percentage increase in the consumer price index;
				  and
(4) Required to meet basic
				  eligibility conditions detailed in chapter 17-1714.1 including:
(A) A resident of the State;
(B) A citizen of the United States or a legal
				  resident non-citizen;
(C) Not a
				  resident of a public institution;
(D) Furnish a social security number and
				  verification of that number.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1722 - SPECIAL MEDICAL ASSISTANCE COVERAGES AND PROGRAMS › Subchapter 4 - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES › Section 17-1722-19 - Treatment of income and assets. The income and assets of a specified low income medicare

Current through June, 2024
The income and assets of a specified low income medicare
					 beneficiary shall be treated as described in chapters 17-1724.1 and
					 17-1725.1.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1722 - SPECIAL MEDICAL ASSISTANCE COVERAGES AND PROGRAMS › Subchapter 4 - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES › Section 17-1722-20 - Provision of coverage

Current through June, 2024
(a) Coverage as a
				  specified low income Medicare beneficiary shall be limited to the payment of
				  the Medicare supplemental medical insurance premium.
(b) Coverage shall be effective in the month
				  in which eligibility begins, no earlier than the first day of the three months
				  prior to the month the application was received by the department.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1722 - SPECIAL MEDICAL ASSISTANCE COVERAGES AND PROGRAMS › Subchapter 5 - QUALIFIED DISABLED AND WORKING INDIVIDUALS › Section 17-1722-25 - Purpose

Current through June, 2024
The purpose of this subchapter is to establish the
					 requirements for eligibility of qualified disabled and working individuals and
					 limitations of coverage for that assistance group.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1722 - SPECIAL MEDICAL ASSISTANCE COVERAGES AND PROGRAMS › Subchapter 5 - QUALIFIED DISABLED AND WORKING INDIVIDUALS › Section 17-1722-26 - Eligibility requirements

Current through June, 2024
A qualified disabled and working individual shall meet all
					 of the following requirements:
(1)
				  Entitled to enroll for hospital insurance benefits under Part A of Medicare
				  based on
				  42
				  U.S.C. §1395i-2(a)
				  which requires that the individual:
(A) Is
				  not yet sixty-five years of age;
(B) Has been entitled to Social Security
				  disability insurance benefits;
(C)
				  Continues to have a disabling physical or mental condition;
(D) Is found to be ineligible for continued
				  Social Security disability insurance benefits due to earnings exceeding the
				  substantial gainful activity (SGA) limits; and
(E) Is not otherwise entitled to
				  Medicare.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1722 - SPECIAL MEDICAL ASSISTANCE COVERAGES AND PROGRAMS › Subchapter 5 - QUALIFIED DISABLED AND WORKING INDIVIDUALS › Section 17-1722-27 - Treatment of income and assets

Current through June, 2024
The income and assets of a qualified disabled and working
					 individual shall be treated as described in chapters 171724.1 and
					 17-1725.1.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1722 - SPECIAL MEDICAL ASSISTANCE COVERAGES AND PROGRAMS › Subchapter 5 - QUALIFIED DISABLED AND WORKING INDIVIDUALS › Section 17-1722-28 - Limitations of coverage

Current through June, 2024
Individuals eligible under this subchapter shall only be
					 entitled to coverage of the premiums for hospital insurance coverage under the
					 medicare program.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1722 - SPECIAL MEDICAL ASSISTANCE COVERAGES AND PROGRAMS › Subchapter 5 - QUALIFIED DISABLED AND WORKING INDIVIDUALS › Section 17-1722-29 - Effective date of coverage

Current through June, 2024
Coverage as a qualified disabled and working individual
					 will coincide with the effective date of enrollment in Part A, as allowed under
					 section 1818A of the Social Security Act (
					 42 U.S.C.
					 §1395 i - 2(a) and determined by the
					 Social Security Administration but not earlier than the first day of the three
					 months prior to the month the application is received by the
					 department.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1722 - SPECIAL MEDICAL ASSISTANCE COVERAGES AND PROGRAMS › Subchapter 6 - MEDICAL PAYMENTS FOR PENSIONERS › Section 17-1722-33 - Purpose

Current through June, 2024
The purpose of this subchapter is to establish the program
					 of medical coverage of persons receiving pensions or retirement payments from
					 the state or counties of Hawaii.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1722 - SPECIAL MEDICAL ASSISTANCE COVERAGES AND PROGRAMS › Subchapter 6 - MEDICAL PAYMENTS FOR PENSIONERS › Section 17-1722-35 - Eligibility requirements

Current through June, 2024
(a) A pensioner, a
				  pensioner's spouse, or a pensioner's surviving spouse shall be eligible for
				  coverage of medical services by meeting any of the following conditions.
(1) The pensioner and the pensioner's spouse,
				  if any, are actually and solely dependent on the state or county pension for
				  maintenance and support;
(2) The
				  pensioner and the pensioner's spouse, if any, have total income from all
				  sources, including the pension, social security benefits, interest and
				  dividends, and any income of the spouse, of less than $2,400;
(3) The spouse of a pensioner is currently
				  eligible for coverage of medical care under this subchapter; or
(4) The spouse of a deceased pensioner who
				  was or would have been eligible under this subchapter remains
				  unmarried.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1722 - SPECIAL MEDICAL ASSISTANCE COVERAGES AND PROGRAMS › Subchapter 6 - MEDICAL PAYMENTS FOR PENSIONERS › Section 17-1722-36 - Treatment of income and assets

Current through June, 2024
An eligible pensioner and the pensioner's spouse, if any,
					 shall not be required to use any portion of the pensioner's or the pensioner's
					 spouse's income or resources to meet medical costs covered under the provisions
					 of this subchapter.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1722 - SPECIAL MEDICAL ASSISTANCE COVERAGES AND PROGRAMS › Subchapter 6 - MEDICAL PAYMENTS FOR PENSIONERS › Section 17-1722-37 - Limitations of coverage

Current through June, 2024
(a) Eligible
				  pensioners and pensioners' spouses shall be entitled to all health care
				  coverage provided to medical assistance recipients, except for:
(1) Payment of health insurance premiums
				  payments, including that of medicare; and
(2) Coverage of the portion of medical care
				  expenses paid by a third party.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1722 - SPECIAL MEDICAL ASSISTANCE COVERAGES AND PROGRAMS › Subchapter 6 - MEDICAL PAYMENTS FOR PENSIONERS › Section 17-1722-38 - Application for payment of medical services

Current through June, 2024
(a) A pensioner or
				  a surviving spouse shall sign an application form as a condition for approval
				  of the application.
(b) A relative,
				  friend, or a designee may be asked to complete and sign the application form on
				  behalf of a pensioner or spouse when the pensioner or spouse is determined by
				  the department to be unable to do so.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1722 - SPECIAL MEDICAL ASSISTANCE COVERAGES AND PROGRAMS › Subchapter 6 - MEDICAL PAYMENTS FOR PENSIONERS › Section 17-1722-39 - Eligibility review

Current through June, 2024
Eligibility reviews shall be conducted every six months or
					 at intervals determined necessary by the eligibility worker.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1722 - SPECIAL MEDICAL ASSISTANCE COVERAGES AND PROGRAMS › Subchapter 8 - SPECIAL GROUP FOR INDIVIDUALS FORMERLY COVERED BY SHIP › Section 17-1722-56 - Purpose

Current through June, 2024
The purpose of this subchapter is to establish the
					 eligibility requirements for a special group comprised of individuals who were
					 enrolled the state health insurance program who were not eligible for inclusion
					 in the Hawaii Med-QUEST program, and the coverage and limitations of coverage
					 for that group.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1722 - SPECIAL MEDICAL ASSISTANCE COVERAGES AND PROGRAMS › Subchapter 8 - SPECIAL GROUP FOR INDIVIDUALS FORMERLY COVERED BY SHIP › Section 17-1722-58 - Eligibility requirements

Current through June, 2024
(a) Members of this
				  group must have been eligible for SHIP as of July 31, 1994 and would have
				  maintained continued eligibility except for the discontinuance of SHIP, and
				  were not eligible for inclusion in the formerly known QUEST program as of
				  August 1, 1994.
(b) A member of
				  this group shall:
(1) Be a resident of the
				  State who is a citizen of the United States or a legal resident non -
				  citizen;
(2) Not be entitled to
				  benefits under the Medicaid program with the exception of those whose
				  eligibility is dependent on a spenddown of income;
(3) Not be entitled to insurance benefits
				  under the Medicare program;
(4) Not
				  be entitled to coverage under TRICARE or another federally sponsored program
				  except for benefits under the Native Hawaiian Health Care Act of
				  1988;
(5) Not be entitled for
				  insurance benefits under the Hawaii Prepaid Health Care Act; and
(6) Not have income exceeding three hundred
				  percent of the FPL.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1722 - SPECIAL MEDICAL ASSISTANCE COVERAGES AND PROGRAMS › Subchapter 8 - SPECIAL GROUP FOR INDIVIDUALS FORMERLY COVERED BY SHIP › Section 17-1722-59 - Personal reserve standards

Current through June, 2024
There are no personal reserve standards for individuals in
					 the special group.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1722 - SPECIAL MEDICAL ASSISTANCE COVERAGES AND PROGRAMS › Subchapter 8 - SPECIAL GROUP FOR INDIVIDUALS FORMERLY COVERED BY SHIP › Section 17-1722-60 - Treatment of income

Current through June, 2024
(a) The gross
				  income of members in the family unit will be considered in determining
				  eligibility, whether or not all family members are eligible for special group
				  benefits.
(b) Income that can be
				  used for the maintenance and support of the family members includes, but is not
				  limited to:
(1) Earned income from wages,
				  salaries, tips, or commissions;
(2)
				  Net income from self-employment or rentals;
(3) Interest income;
(4) Royalties and dividends;
(5) Pensions;
(6) Social Security benefits;
(7) SSI;
(8) UIB;
(9) TDI and workers' compensation;
				  and
(10) Monetary contributions and
				  gifts.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1722 - SPECIAL MEDICAL ASSISTANCE COVERAGES AND PROGRAMS › Subchapter 8 - SPECIAL GROUP FOR INDIVIDUALS FORMERLY COVERED BY SHIP › Section 17-1722-61 - Eligibility review

Current through June, 2024
(a) Eligibility
				  reviews shall be conducted annually or at intervals determined necessary by the
				  department
(b) Individuals who fail
				  to complete or fail to cooperate in the completion of the eligibility review
				  shall be ineligible for benefits under this group.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1722 - SPECIAL MEDICAL ASSISTANCE COVERAGES AND PROGRAMS › Subchapter 8 - SPECIAL GROUP FOR INDIVIDUALS FORMERLY COVERED BY SHIP › Section 17-1722-62 - Verification and reporting requirements

Current through June, 2024
(a) The department
				  may require individuals to furnish verification of eligibility
				  factors.
(b) Individuals shall
				  furnish the requested information within ten days of the request.
(c) Individuals who fail to respond within
				  ten days shall be given a second notice with a request to furnish the
				  information within five days.
(d)
				  Failure to respond to the second notice shall result in
				  disqualification.
(e) Individuals
				  are required to report to the department any changes that would affect their
				  eligibility or monthly cost share responsibility within ten days.