Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1736 - PROVIDER PROVISIONS › Subchapter 2 - PROVIDERS OF THE FEE FOR SERVICE PROGRAM › Section 17-1736-13 - Application for provider participation

Current through June, 2024
(a) Any provider
				  who wishes to provide care, goods, or services to receive reimbursement from
				  the Hawaii medical assistance program, shall apply in writing to the med-QUEST
				  division of DHS. The provider shall, at the request of the DHS med-QUEST
				  administrator, supply all information requested concerning the provider's
				  education and qualifications as a provider, financial status of the provider's
				  practice, background history of the provider, and if the provider is required
				  to maintain a license, the status of that license. The DHS med-QUEST
				  administrator shall, in the administrator's sound discretion, have the right to
				  approve or deny any application for certification as a provider under the
				  Hawaii medical assistance program. If a provider is denied certification by the
				  DHS med-QUEST administrator, the provider may request a fair hearing as
				  provided by section 17-1736-33. Application forms to request certified provider
				  status shall be furnished by the DHS med-QUEST administration.
(b) Except for providers exempted in
				  subsections (c) and (d), all providers participating or applying to participate
				  in Hawaii's medical assistance program shall have a current and valid written
				  agreement or contract on file with DHS. Failure to maintain such a contract
				  shall constitute grounds for suspension, termination, or withholding payment of
				  claims submitted under the Hawaii medical assistance program until a current
				  and valid written agreement is signed and on file with DHS.
(c) A provider outside of the State of Hawaii
				  who furnishes goods and services authorized to be provided under the Hawaii
				  medical assistance program to eligible Hawaii residents visiting in that state
				  and urgently requiring care and services shall be exempt from the certification
				  requirement so long as that provider is properly licensed to provide health
				  care services in accordance with the laws of the provider's home state, and the
				  provider is certified by Medicaid in the provider's home state to furnish the
				  health care services actually rendered.
(d) Provider outside of the State of Hawaii
				  who satisfy the requirements of subsection (c) also furnish services not
				  available in Hawaii to eligible Hawaii residents as long as that provider
				  obtains prior oral or written authorization from the DHS med-QUEST division's
				  medical consultant prior to providing the goods, care, and services that the
				  provider deems necessary. The medical consultant granting the prior
				  authorization shall immediately reduce the substance of the authorization into
				  writing and mail a copy to the out-of-state provider.
(e) Pharmacy providers who are the exclusive
				  suppliers of prescribed drugs and supplies to a long term care facility shall
				  apply for a separate provider agreement and provider number for each facility
				  served as described in subsection (a).