reglab/statecodes huggingface dataset:
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1703.1 - ADMINISTRATIVE APPEALS › Section 17-1703.1-9 - Denial or dismissal of a request for hearing

Current through June, 2024
(a) A
				hearing shall not be granted by the department when either federal or state law
				requires automatic adjustment in the standard of assistance for classes of
				beneficiaries unless the appeal is for an incorrect determination of
				eligibility.
(b) A hearing shall
				not be granted by the department when the individual has withdrawn the request
				in writing. Where the individual verbally communicates a desire to withdraw the
				hearing request through a mode of communication described in section
				17-1703.1-4(a)(1) or (a)(3), the individual shall be advised that the
				withdrawal shall be submitted in writing or if the individual prefers, the
				department shall send a confirmation of the verbal request to withdraw to the
				individual.
(c) A hearing shall not
				be granted by the hearing officer when the individual has abandoned the
				request. Abandonment occurs when the individual, without good cause, fails to
				appear at the hearing scheduled for the individual.
(1) The hearing officer shall send the
				individual a letter stating that the appeal is considered abandoned unless
				there was good cause for the failure to appear. The individual shall be
				notified that the request shall continue only if the individual presents good
				cause for the failure to appear and contacts the agency within fifteen (15)
				calendar days of the notice. If no reply is received within the fifteen (15)
				calendar days, the hearing request shall be considered abandoned. If the
				fifteenth (15th) day falls on a weekend th or
				holiday, the fifteenth (15th ) day shall then be the
				first working day after the weekend or holiday.
(2) Good cause may be established on the
				basis of one of the following factors:
(A)
				Death in the family;
(B) Personal
				injury or illness which reasonably prohibits the individual from attending the
				hearing; or
(C) Sudden and
				unexpected emergencies.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1703.1 - ADMINISTRATIVE APPEALS › Section 17-1703.1-10 - Group hearings

Current through June, 2024
A series of individual requests for a hearing may be
				  consolidated into a single group hearing when the sole issue involved is one of
				  state or federal law or policy, or changes in state or federal law. Each
				  individual shall be permitted to present the individual's own case or be
				  represented by an authorized representative.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1703.1 - ADMINISTRATIVE APPEALS › Section 17-1703.1-11 - Expedited hearings

Current through June, 2024
(a) An expedited
				hearing request may be granted within three working days of the request for
				hearing, if the time otherwise permitted for a hearing as described in section
				17-1703.1-15(a)(1) or (a)(2) would jeopardize the individual's life or health
				or ability to attain, maintain or regain maximum function.
(b) If the department determines that the
				request does meet the criteria for an expedited hearing, it must:
(1) Initiate the hearing process as described
				in section 17-1703.1-12; and
(2)
				All matters relating to the hearing shall be heard and disposed of as
				expeditiously as the individual's health conditions requires, but no later than
				(3) working days after the department receives the request for an expedited
				hearing.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1703.1 - ADMINISTRATIVE APPEALS › Section 17-1703.1-12 - The hearing

Current through June, 2024
(a) The hearing
				shall include consideration of:
(1) Any
				adverse action by the department or managed care health plan which includes:
(A) Failure to determine eligibility within
				the specific time limits of the medical assistance programs;
(B) Refusal to consider a request for or
				failure to make a payment adjustment within time limits set by the medical
				assistance programs; or
(C)
				Discontinuance, termination, suspension, withholding, or reduction of medical
				assistance or coverage; and
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1703.1 - ADMINISTRATIVE APPEALS › Section 17-1703.1-13 - Hearing involving medical issues

Current through June, 2024
When the hearing involves medical issues such as issues
				  concerning a diagnosis, an examining physician's report, or a medical review
				  team's decision, the hearing officer may require an additional medical
				  assessment of the individual. The evaluation shall be conducted by someone
				  other than the persons involved in making the original decision. The additional
				  medical assessment shall be obtained at the expense of the Med-QUEST Division
				  and made part of the record.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1703.1 - ADMINISTRATIVE APPEALS › Section 17-1703.1-14 - Hearing involving spousal support from institutionalized individuals

Current through June, 2024
(a) A hearing may be requested if either the
				institutionalized spouse or the community spouse is dissatisfied with the
				determination of the:
(1) Community spouse
				monthly income allowance;
(2)
				Computation of the spousal share of the resources; or
(3) Community spouse resource allowance. Any
				hearing request resulting from the determination of the community spouse
				resource allowance shall be held within thirty (30) days of the request for
				hearing.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1703.1 - ADMINISTRATIVE APPEALS › Section 17-1703.1-15 - Hearing decision

Current through June, 2024
(a) All matters
				relating to the hearing shall be heard and disposed of as follows:
(1) Within ninety (90) calendar days from the
				date of request for a hearing that is submitted in accordance with section
				171703.1-4;
(2) Within forty-five
				(45) calendar days from the date of an appeal decision by the Health Insurance
				Exchange involving an earlier determination of Medicaid eligibility;
				or
(3) As expeditiously as the
				individual's health conditions requires, but no later than three (3) working
				days after the department receives the request for an expedited
				hearing.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1703.1 - ADMINISTRATIVE APPEALS › Section 17-1703.1-16 - Decisions pending over ninety days

Current through June, 2024
(a) When a final
				decision has not been made and implemented within ninety (90) days of the
				request, the department shall reduce the premium-share amount or spenddown
				amount to what existed prior to the hearing request or restore or grant any
				service which was reduced or denied, if the individual is not already receiving
				aid paid pending. When the hearing decision is pending over ninety (90) days,
				aid paid shall be determined in accordance with subsections (d) and
				(e).
(b) The hearing officer shall
				notify the Med-QUEST Division orally on the ninety-first
				(91st) day when a final decision is not reached
				within ninety (90) days. If the ninety-first (91st)
				day falls on a weekend or holiday, the ninety-first
				(91st) day shall then be the first working day
				following the weekend or holiday. A written confirmation shall be sent within
				three (3) working days.
(c) In
				situations where an individual has requested or is otherwise responsible for a
				delay in the hearing process, the time period shall be tolled only for the
				period of the delay.
(d) When a
				final decision is not made and implemented within ninety (90) days:
(1) The specific medical care denied the
				individual which is the issue on appeal shall be authorized from the
				ninety-first (91st) day until the hearing decision
				is made and implemented; or
(2) The
				individual applying for medical assistance shall be made presumptively eligible
				to secure assistance from the ninety-first (91st)
				day until the hearing decision is made and implemented.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1703.1 - ADMINISTRATIVE APPEALS › Section 17-1703.1-17 - Recovery of aid paid pending

Current through June, 2024
(a) Aid paid
				pending a hearing decision from the date aid paid pending begins through the
				ninetieth (90th) day shall be recoverable by the
				department if the department's action is sustained.
(b) If, for reasons other than a settlement
				negotiated by the state attorney general's office, the individual withdraws or
				abandons the request as specified in section 17-1703.1-9, the department or the
				managed care health plan shall recover the aid paid pending the hearing
				decision.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1704 - FRAUD PROVISIONS › Subchapter 2 - RECIPIENT FRAUD › Section 17-1704-3 - Investigation of suspected fraud

Current through June, 2024
(a) The department
				  shall identify situations in which there are questions of suspected fraud such
				  as, but not limited to, a recipient receiving medical assistance to which the
				  individual is not entitled through willful misrepresentation of circumstances
				  or the intentional concealment of information from the department.
(b) The DHS investigations office shall
				  investigate suspected fraud and refer these cases to law enforcement
				  officials.
(c) The methods of
				  investigation shall not infringe on the legal rights of the persons involved
				  and shall afford these individuals due process of law.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1704 - FRAUD PROVISIONS › Subchapter 2 - RECIPIENT FRAUD › Section 17-1704-4 - Penalty

Current through June, 2024
The department may initiate referral for prosecution of an
					 individual suspected of fraud. In addition, the individual may be subject to
					 any other criminal, civil, or administrative sanction authorized by
					 law.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1704 - FRAUD PROVISIONS › Subchapter 3 - PROVIDER FRAUD › Section 17-1704-5 - Preliminary investigation

Current through June, 2024
(a) DHS shall
				  conduct a preliminary investigation of all medicaid fraud complaints from
				  whatever sources received to determine whether there is sufficient basis to
				  warrant a full investigation.
(b)
				  If the findings of the preliminary investigation indicate there is potential
				  for criminal prosecution of fraud, the cases shall be referred to the medicaid
				  fraud control unit.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1704 - FRAUD PROVISIONS › Subchapter 3 - PROVIDER FRAUD › Section 17-1704-6 - Resolution of investigation

Current through June, 2024
A full investigation shall continue until:
(1) Appropriate criminal or civil legal
				  action is initiated;
(2) The matter
				  is resolved between the department and the provider through any one or
				  appropriate combination of the following actions:
(A) A monitoring program of provider's
				  medicaid practice is established to ensure corrective measures have been
				  introduced;
(B) A demand letter is
				  sent to the provider requiring repayment of overpayments to the provider made
				  by the medical assistance program and warning the provider that payment on that
				  provider's pending claims may be withheld in part or in whole to be applied to
				  overpayments previously made to the provider by the medical assistance
				  program;
(C) All claims of a
				  provider are placed on review prior to payment;
(D) In the event that the department is
				  unable to determine whether the actions of a provider constitute improper
				  medical practice, the department requests an opinion of the Hawaii Medical
				  Association peer review committee; and
(E) The provider is suspended or terminated
				  from participation in the medical assistance program as described in sections
				  17-1736-17 and 17-1736-18.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1705 - MEDICAL ASSISTANCE RECOVERY › Subchapter 1 - GENERAL PROVISIONS › Section 17-1705-1 - Purpose

Current through June, 2024
The purpose of this chapter is to establish the
					 requirements for applicants and recipients of medical assistance. Applicants
					 and recipients shall:
(1) Assign their
				  rights to third party payments and medical support;
(2) Cooperate in obtaining third party
				  payments for medical assistance, pursuing any third party who may be liable for
				  medical support, and obtaining child support; and
(3) Be required to satisfy all conditions set
				  forth by the third party to receive coverage, to the extent coverage is
				  available through that third party, before Medicaid reimbursement is
				  allowed.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1705 - MEDICAL ASSISTANCE RECOVERY › Subchapter 1 - GENERAL PROVISIONS › Section 17-1705-3 - Administrative procedures

Current through June, 2024
(a) The adverse
				  action notice requirements of chapter 17-1713 shall apply unless otherwise
				  indicated in this chapter.
(b) The
				  administrative hearing requirements of chapter 17-1703 shall apply.
(c) The department shall restore to the
				  individual any future rights to benefits assigned to the department when
				  medical assistance terminates and after all medical expenses have been
				  met.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1705 - MEDICAL ASSISTANCE RECOVERY › Subchapter 2 - ASSIGNMENT OF AND COOPERATION IN OBTAINING THIRD PARTY PAYMENTS › Section 17-1705-6 - Purpose

Current through June, 2024
The purpose of this chapter is to establish the
					 requirements for assignment of and cooperation in obtaining third party
					 payments that applicants and recipients shall be required to meet to receive
					 medical assistance.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1705 - MEDICAL ASSISTANCE RECOVERY › Subchapter 2 - ASSIGNMENT OF AND COOPERATION IN OBTAINING THIRD PARTY PAYMENTS › Section 17-1705-7 - Medical assignment requirements

Current through June, 2024
(a) All individuals
				  applying for or receiving medical assistance shall assign to the department or
				  health plan:
(1) The individual's rights to
				  any third party payments; and
(2)
				  The rights of any other family member included in the application or receiving
				  assistance for whom the applicant or recipient can legally make an
				  assignment.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1705 - MEDICAL ASSISTANCE RECOVERY › Subchapter 2 - ASSIGNMENT OF AND COOPERATION IN OBTAINING THIRD PARTY PAYMENTS › Section 17-1705-8 - Cooperation requirements

Current through June, 2024
(a) All applicants
				  and recipients of medical assistance shall be required to cooperate with the
				  department or health plan in obtaining third party payments unless there is
				  good cause for refusing to cooperate.
(b) Cooperation shall include:
(1) Identifying any third party who may be
				  liable for services covered under the Medicaid program;
(2) Providing relevant information or
				  attesting to the lack of information, under penalty of perjury, to assist the
				  department or health plan in pursuing any such potentially liable third
				  party;
(3) Appearing at a
				  department designated location to provide information or evidence relevant to
				  the case;
(4) Appearing as a
				  witness at a court or other proceeding;
(5) Paying to the department or health plan
				  any support or medical care funds received that are covered by the assignment
				  of rights; and
(6) Taking any other
				  reasonable steps to assist in securing medical support and payments.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1705 - MEDICAL ASSISTANCE RECOVERY › Subchapter 2 - ASSIGNMENT OF AND COOPERATION IN OBTAINING THIRD PARTY PAYMENTS › Section 17-1705-9 - Good cause determination

Current through June, 2024
(a) The department
				  shall make a determination that cooperation is against the best interests of
				  the individual or other family member to whom financial or medical assistance
				  is being furnished when it is anticipated that cooperation will result in
				  reprisal against, and cause physical or emotional harm to, the individual or
				  other family member.
(b) When the
				  department determines that good cause exists, the department shall make a
				  further determination of whether collection activities could proceed without
				  risk of harm to the family provided the activities will not involve the
				  family's participation.
(c) The
				  determination shall be made on a case-by-case evaluation of the circumstances
				  and the family shall be notified of the decision.
(d) The good cause claim procedures of
				  subchapter 4 shall apply.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1705 - MEDICAL ASSISTANCE RECOVERY › Subchapter 2 - ASSIGNMENT OF AND COOPERATION IN OBTAINING THIRD PARTY PAYMENTS › Section 17-1705-10 - Denial or termination of medical assistance

Current through June, 2024
(a) The
				  department shall deny or terminate medical assistance to any applicant or
				  recipient who refuses to cooperate in obtaining third party payments, unless
				  good cause exists.
(b) The
				  department shall deny or terminate medical assistance to applicants or
				  recipients who refuse to assign the individual's own rights or the rights of
				  any other family member for whom the applicant or recipient can legally make an
				  assignment.
(c) The department
				  shall provide assistance to individuals who:
(1) Cannot legally assign the individual's
				  own rights or the rights of other family members;
(2) Have good cause for refusing to
				  cooperate; and
(3) Would otherwise
				  be eligible for assistance but for the refusal by a person legally able to make
				  the assignment or to cooperate.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1705 - MEDICAL ASSISTANCE RECOVERY › Subchapter 3 - ASSIGNMENT OF AND COOPERATION IN OBTAINING MEDICAL SUPPORT › Section 17-1705-16 - Purpose

Current through June, 2024
The purpose of this subchapter is to establish the
					 requirements for applicants and recipients of medical assistance. Applicants
					 and recipients shall:
(1) Assign their
				  rights to medical support; and
(2)
				  Cooperate in obtaining medical support.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1705 - MEDICAL ASSISTANCE RECOVERY › Subchapter 3 - ASSIGNMENT OF AND COOPERATION IN OBTAINING MEDICAL SUPPORT › Section 17-1705-17 - Assignment of rights to support

Current through June, 2024
(a) All individuals
				  shall assign to the state any rights the individuals may have to receive
				  medical support payments on the individual's own behalf or on behalf of any
				  other family member applying for or receiving assistance.
(b) If the caretaker relative with whom the
				  child is living, fails to complete the assignment, the caretaker relative shall
				  be ineligible for medical assistance.
(c) The department shall provide medical
				  assistance to individuals who would otherwise be eligible but for the refusal
				  of the caretaker relative to complete the assignment.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1705 - MEDICAL ASSISTANCE RECOVERY › Subchapter 3 - ASSIGNMENT OF AND COOPERATION IN OBTAINING MEDICAL SUPPORT › Section 17-1705-18 - Cooperation in obtaining support

Current through June, 2024
(a) Each individual
				  applying for or receiving medical assistance shall be required to cooperate
				  with the department in:
(1) Identifying and
				  locating the parent of the child for whom medical services are being
				  claimed;
(2) Establishing the
				  paternity of a child born out of wedlock for whom medical services are being
				  claimed;
(3) Obtaining support
				  payments due the individual and the child for whom medical services are being
				  claimed; and
(4) Obtaining any
				  other payments due the individual and the child for whom medical services are
				  being claimed.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1705 - MEDICAL ASSISTANCE RECOVERY › Subchapter 3 - ASSIGNMENT OF AND COOPERATION IN OBTAINING MEDICAL SUPPORT › Section 17-1705-19 - Determination of good cause for refusing to cooperate

Current through June, 2024
(a)
				  The department shall determine whether good cause exists for the family's
				  failure to comply with the requirements of section 17-1705-18:
(1) With respect to establishing paternity or
				  securing support for a child, the department shall make a determination that
				  good cause exists only if the evidence establishes that cooperation is against
				  the best interest of the child.
(2)
				  With respect to securing support for individuals not covered by paragraph (1),
				  the department shall make a determination that good cause exists only if the
				  evidence establishes that cooperation will result in reprisal against or cause
				  physical or emotional harm to the applicant or recipient.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1705 - MEDICAL ASSISTANCE RECOVERY › Subchapter 3 - ASSIGNMENT OF AND COOPERATION IN OBTAINING MEDICAL SUPPORT › Section 17-1705-20 - Circumstances under which cooperation may be against the best interest of the child

Current through June, 2024
(a) Cooperation
				  shall be against the best interest of the child only if it is reasonably
				  anticipated to result in physical or emotional harm to the child or to the
				  parent or caretaker relative, and the harm reduces the parent's or caretaker
				  relative's capacity to care for the child adequately.
(b) Physical or emotional harm shall be of a
				  serious nature that would affect the parent's or caretaker relative's ability
				  to function if cooperation is required.
(c) A determination that good cause exists
				  shall also be applied in cases where:
(1) The
				  child was conceived as a result of incest or forcible rape;
(2) Legal proceedings for the adoption of the
				  child are pending before a court; or
(3) The individual is currently being
				  assisted by a public or private licensed social agency toresolve the issue of
				  whether to keep the child or relinquish the child for adoption. The discussions
				  on whether to keep or give up the child shall not have gone on for more than
				  three months.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1705 - MEDICAL ASSISTANCE RECOVERY › Subchapter 3 - ASSIGNMENT OF AND COOPERATION IN OBTAINING MEDICAL SUPPORT › Section 17-1705-21 - Granting or continuation of assistance

Current through June, 2024
The department shall not deny, delay, or discontinue
					 medical assistance pending the final good cause determination if the individual
					 has complied with the requirement to provide evidence and all other eligibility
					 requirement have been met.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1705 - MEDICAL ASSISTANCE RECOVERY › Subchapter 4 - GOOD CAUSE CLAIM PROCEDURES › Section 17-1705-26 - Purpose

Current through June, 2024
This subchapter establishes the procedures for providing
					 notice and processing an individual's good cause claim for refusing to
					 cooperate in obtaining third party payments for medical assistance or securing
					 medical support.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1705 - MEDICAL ASSISTANCE RECOVERY › Subchapter 4 - GOOD CAUSE CLAIM PROCEDURES › Section 17-1705-27 - Notice to applicant of right to claim good cause

Current through June, 2024
(a)
				  The department shall notify applicants and recipients of medical assistance of
				  the right to claim good cause as an exception to the cooperation
				  requirement.
(b) The applicant or
				  recipient shall be informed in writing that:
(1) The potential benefits a child may derive
				  from establishing paternity and securing support and the potential benefits for
				  providing information to assist the department in pursuing third party
				  liability for medical services;
(2)
				  By law, cooperation in establishing paternity, securing support, and
				  identifying and providing information to assist the department in pursuing
				  third party liability for medical services is a condition of
				  eligibility;
(3) An unexcused
				  refusal to cooperate shall result in loss of medical eligibility for the needy
				  caretaker relative;
(4) The
				  individual has the right to claim good cause for refusing to cooperate and if
				  the department determines there is good cause, the individual shall be excused
				  from the cooperation requirements of sections 17-1705-8 and 17-1705-18;
				  and
(5) Upon an individual's
				  request or following receipt of a good cause claim, the department shall
				  provide further notice to the individual with additional details concerning a
				  good cause claim.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1705 - MEDICAL ASSISTANCE RECOVERY › Subchapter 4 - GOOD CAUSE CLAIM PROCEDURES › Section 17-1705-28 - Processing good cause claims

Current through June, 2024
(a) An applicant or
				  recipient who refuses to cooperate and who claims to have good cause shall:
(1) Specify the circumstances which the
				  individual believes establishes good cause to be excused from the cooperation
				  requirement;
(2) Provide
				  corroboration of the good cause circumstances in accordance with section
				  17-1705-29 within twenty days from the day a good cause claim is
				  filed;
(3) Provide additional
				  corroborative evidence the department deems necessary to make a good cause
				  determination; and
(4) Be notified
				  promptly by the department of the specific types of additional evidence
				  required.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1705 - MEDICAL ASSISTANCE RECOVERY › Subchapter 4 - GOOD CAUSE CLAIM PROCEDURES › Section 17-1705-29 - Evidence

Current through June, 2024
Good cause shall be corroborated with the following types
					 of evidence:
(1) Birth certificates or
				  medical or law enforcement records which indicate that the child was conceived
				  as a result of incest or forcible rape;
(2) Court documents which indicate legal
				  proceedings for adoption are pending before a court;
(3) Court, medical, child protective
				  services, social services, psychological, or law enforcement records which
				  indicate that the alleged father, absent parent, or others may inflict physical
				  or emotional harm on the child or other family member;
(4) Medical records which indicate emotional
				  health history and present emotional health status of the child or family
				  member or written statements from mental health professionals indicating a
				  prognosis concerning the diagnosis or emotional health of the individual or
				  family if cooperation is required;
(5) A written statement from a public or
				  licensed private social agency that the parent or other caretaker is being
				  assisted to resolve the issue of where to keep the child or relinquish the
				  child for adoption; or
(6) Sworn
				  notarized statements from persons other than the individual with knowledge of
				  the circumstances which provide the basis for the good cause claim.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1705 - MEDICAL ASSISTANCE RECOVERY › Subchapter 4 - GOOD CAUSE CLAIM PROCEDURES › Section 17-1705-30 - Renewal of good cause claim

Current through June, 2024
(a) In all cases
				  where an initial determination has been made that there is good cause for
				  refusal to cooperate, the recipient shall have the responsibility of renewing a
				  good cause claim at each annual redetermination of eligibility.
(b) If the department determines that
				  circumstances have changed and good cause no longer exists, the department
				  shall proceed to enforce the cooperation requirements.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1705 - MEDICAL ASSISTANCE RECOVERY › Subchapter 5 - THIRD PARTY LIABILITY › Section 17-1705-37 - Determining liability of third parties

Current through June, 2024
The department or health plan shall determine the legal
					 liability of third parties to pay for services under the medical assistance
					 program.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1705 - MEDICAL ASSISTANCE RECOVERY › Subchapter 5 - THIRD PARTY LIABILITY › Section 17-1705-38 - Medical payment involving third party

Current through June, 2024
(a) The liability
				  of a third party shall be treated as a resource applicable to the cost of
				  needed medical services when:
(1) It has been
				  verified that a legal obligation actually exists; and
(2) The amount of the obligation may be
				  determined within thirty days from the time of the recipient's need for medical
				  care.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1705 - MEDICAL ASSISTANCE RECOVERY › Subchapter 6 - RECOVERY OF OVERPAYMENT TO PROVIDERS › Section 17-1705-45 - Recoupment of overpayment to providers

Current through June, 2024
(a) The department
				  shall recoup overpayment to providers when overpayment occurred for reasons
				  including, but not limited to one of the following:
(1) Ineligible provider;
(2) Noncovered service;
(3) Noncovered drug;
(4) No approved prior authorization when a
				  service requires one;
(5) Incorrect
				  payment allowance identified through post payment review by department staff;
				  or
(6) Claim processing
				  error.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1705 - MEDICAL ASSISTANCE RECOVERY › Subchapter 7 - RECIPIENT RECOVERY › Section 17-1705-52 - Recovery of medical care payments from recipients

Current through June, 2024
(a) Payments
				  made to medical care providers and payments made to health plans shall be
				  recovered by the department from individuals who:
(1) Provided erroneous information in
				  qualifying for medical assistance;
(2) Failed to report a change in
				  circumstances which would have rendered the individual or household ineligible
				  for continued medical assistance;
(3) Failed to notify the department that a
				  family member is no longer a member of the assistance household;
(4) Failed to pay the premium-share assessed
				  to the family; or
(5) Were
				  adversely affected by a fair hearing decision, and who received medical
				  assistance services pending the fair hearing decision.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1705 - MEDICAL ASSISTANCE RECOVERY › Subchapter 7 - RECIPIENT RECOVERY › Section 17-1705-53 - Recovery of misspent funds

Current through June, 2024
(a) Individuals
				  subject to recovery of misspent funds under the medical assistance program
				  shall be provided written notice by the department stating:
(1) The reasons, date, and the amount of the
				  alleged misspent funds;
(2)
				  Proposed amount to be repaid each month;
(3) Period over which the repayment shall be
				  made ;
(4) Method by which the
				  proposed overpayment shall be recovered; and
(5) The right to request a hearing if the
				  individual disagrees with the department's proposed action.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1705 - MEDICAL ASSISTANCE RECOVERY › Subchapter 7 - RECIPIENT RECOVERY › Section 17-1705-54 - Fraud

Current through June, 2024
If fraud is suspected in any misspent funds under the
					 medical assistance program, the department shall refer the case to the
					 appropriate agency to pursue the investigation of suspected fraud and take
					 action as deemed appropriate.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1705 - MEDICAL ASSISTANCE RECOVERY › Subchapter 7 - RECIPIENT RECOVERY › Section 17-1705-55 - Suspension and waiver of overpayment

Current through June, 2024
(a) The collection
				  activities on a closed medical assistance case may be suspended when:
(1) The department has sent one demand letter
				  requesting payment for overpayments under $100, two demand letters for
				  overpayments between $100 and $400, three demand letters for more than $400 and
				  the department's investigative and recovery services office determines that the
				  cost of further collection action is likely to exceed the amount that can be
				  recovered; or
(2) The assistance
				  unit cannot be located Collection activities shall not be suspended until the
				  department has initiated action to locate the former recipients. In locating
				  the former recipients, the department shall use appropriate data sources such
				  as state unemployment insurance files, state automobile registration, and the
				  Social Security Administration's benefit data exchange (BENDEX).
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1705 - MEDICAL ASSISTANCE RECOVERY › Subchapter 7 - RECIPIENT RECOVERY › Section 17-1705-56 - Limiting provisions

Current through June, 2024
(a) No liens or
				  encumbrances shall be imposed upon both real and personal property of
				  applicants or recipients prior to their deaths except under the circumstances
				  described in section 17-1705-53 or 17-1705-57.
(b) No adjustment or recovery shall be made
				  for correctly made medical assistance payments, except in the case of the
				  following:
(1) Individuals in nursing
				  facilities, intermediate care facilities for the mentally retarded, or other
				  medical institutions for all individuals on or after October 1, 1993;
				  or
(2) Benefits paid on or after
				  October 1, 1993 for individuals age fifty-five or older at the time services
				  were received.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1705 - MEDICAL ASSISTANCE RECOVERY › Subchapter 7 - RECIPIENT RECOVERY › Section 17-1705-57 - Liens on real property of institutionalized individuals

Current through June, 2024
(a) A lien may be placed on the real property
				  of a medically institutionalized individual for the amount of medical
				  assistance received, after a determination by the department that the
				  individual cannot reasonably be expected to be discharged from the medical
				  institution and returned home.
(b)
				  A lien may not be placed on the home property of a medically institutionalized
				  individual if any of the following individuals are lawfully residing in the
				  home:
(1) The individual's spouse;
(2) The individual's dependent child;
				  or
(3) The individual's sibling who
				  has an equity interest in the home and who was residing in the home for a
				  period of at least one year prior to the individuals admission to the medical
				  institution.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1705 - MEDICAL ASSISTANCE RECOVERY › Subchapter 8 - THIRD PARTY LIABILITY SUBROGATION › Section 17-1705-67 - Accident liability

Current through June, 2024
(a) An applicant or
				  recipient shall inform the department or health plan of an involvement in an
				  accident within thirty days of the accident.
(b) The applicant or recipient shall be
				  required to complete the assignment of rights form to assist the department or
				  health plan in subrogation action.
(c) Refusal to sign the assignment of rights
				  form constitutes cause for termination of medical coverage or denial of medical
				  assistance application.
(d) Upon
				  receipt of the assignment of rights form, the department or health plan shall
				  immediately pursue possible recovery of medical care expenses paid on behalf of
				  the recipient through the appropriate agencies.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1705 - MEDICAL ASSISTANCE RECOVERY › Subchapter 8 - THIRD PARTY LIABILITY SUBROGATION › Section 17-1705-68 - Termination or waiver of subrogation

Current through June, 2024
(a) Pursuit of
				  recovery shall cease if:
(1) The recoverable
				  amount is less than the expense of pursuing the recovery;
(2) The case is more than five years old and
				  amount recoverable is less than $1,000 and there are no outstanding federal or
				  state issues;
(3) The department or
				  health plan does not have any legal recourse to pursue recovery; or
(4) The whereabouts of the recipient are
				  unknown,
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1706 - INCOME TAX SETOFF PROGRAM › Section 17-1706-1 - Purpose

Current through June, 2024
The purpose of this chapter is to establish the provisions
				  by which the state income tax refunds of those persons who owe a debt to the
				  department of human services, Med-QUEST division, shall be setoff to recover
				  this debt, and to establish the provisions of the administrative hearing
				  process to contest the tax setoff. These rules do not afford the debtor the
				  opportunity to a hearing on any issue which has been previously litigated or
				  for which an opportunity to a hearing has been previously
				  provided.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1706 - INCOME TAX SETOFF PROGRAM › Section 17-1706-3 - Tax setoff process

Current through June, 2024
(a) The department
				shall setoff any valid debt due and owing the department by the debtor against
				any debtor's refund. Any amount of the refund in excess of the amount retained
				to satisfy the debt shall be refunded to the debtor.
(b) The department shall compile an annual
				list of debtors identified for a tax setoff.
(c) A pretax setoff notice shall be mailed to
				each debtor.
(d) The debtor shall
				be provided an opportunity for an informal review of the debt.
(e) All debtors who receive an adverse
				informal review decision shall be provided an opportunity to request an
				administrative hearing.
(f) The
				informal review and pretax setoff administrative hearing shall be conducted and
				concluded prior to the setoff of the debtor's state tax refund.
(g) The debtor's name shall be referred to
				the comptroller, department of accounting and general services (DAGS), for tax
				setoff if no pretax setoff review is requested; or if the debt is established
				in the review or the pretax setoff administrative hearing.
(h) At the time the setoff is identified, the
				debtor shall be notified by the comptroller (DAGS) of the State's intention to
				apply the state income tax refund against the debt.
(i) The debtor shall be provided the
				opportunity to request an administrative hearing to contest the setoff,
				regardless of whether an administrative hearing was requested at the time of
				the pretax setoff notice.
(j) The
				setoff against the debtor's state income tax refund shall become final if an
				administrative hearing is not requested.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1706 - INCOME TAX SETOFF PROGRAM › Section 17-1706-4 - Pretax setoff notice

Current through June, 2024
(a) The
				department's administrative services office, recovery section (ASO-recovery)
				shall mail a pretax setoff notice annually to all debtors as identified by the
				department's administrative services office.
(b) The notice shall inform debtors of:
(1) The department's intent to setoff the
				debtor's state income tax refunds due to nonpayment of a debt to the
				department;
(2) The total amount of
				the debt (to include financial, medical and food stamp programs);
(3) The opportunity to request an informal
				review of the debt within thirty calendar days from the date of the pretax
				setoff notice if they disagree with the department's intent;
(4) The office address and toll free
				telephone numbers at which an informal review can be requested;
(5) The opportunity to request a formal
				administrative hearing to all debtors who receive an adverse informal review
				decision;
(6) The commonly used
				defenses in tax setoff administrative hearings; and
(7) The opportunity to present the case
				independently or with the aid of others including legal counsel.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1706 - INCOME TAX SETOFF PROGRAM › Section 17-1706-5 - Informal review

Current through June, 2024
(a) A debtor may
				request an informal review from ASO-recovery orally or in writing. The request
				shall be received by ASO-recovery within thirty calendar days of the date of
				the pretax setoff notice.
(b) The
				informal review shall be conducted by telephone or in person at the request of
				the debtor as follows:
(1) ASO-recovery will
				review the debtor's account balances using account records and forward any
				unresolved requests to the investigations office (INVO).
(2) INVO will review the requests referred by
				ASO-recovery to resolve account balances using the case records and applicable
				Hawaii Administrative Rules.
(3)
				All debtors shall be informed in writing of:
(A) The disposition of the review;
(B) The opportunity to request an
				administrative hearing in writing within fourteen calendar days from the date
				of a written adverse informal review decision; and
(C) The office and address at which the
				request for an administrative hearing may be submitted.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1706 - INCOME TAX SETOFF PROGRAM › Section 17-1706-6 - Tax setoff notice

Current through June, 2024
(a) The tax setoff
				notice shall be mailed to prospective tax refund recipients who are identified
				as having a debt at the time that the state income tax refund is identified for
				setoff by DAGS.
(b) The notice
				shall inform the debtors of the following:
(1)
				The amount of the debtor's state income tax refund for a specified tax
				year;
(2) The amount of the
				debt;
(3) The amount that has been
				identified for setoff to repay a debt to the department;
(4) The balance of the state tax refund that
				is due to the debtor;
(5) The
				applicable state statute;
(6) The
				opportunity to request an administrative hearing within thirty calendar days of
				the date of the tax setoff notice;
(7) The setoff against the debtor's state
				income tax refund becomes final after thirty calendar days from the date of the
				tax setoff notice if an administrative hearing is not requested;
(8) The commonly used defenses in tax setoff
				administrative hearings;
(9) The
				rights of the debtor as specified in section 17-1706-8; and
(10) The office, address, and toll free
				telephone numbers to which a written request for an administrative hearing may
				be submitted.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1706 - INCOME TAX SETOFF PROGRAM › Section 17-1706-7 - Right to an administrative hearing

Current through June, 2024
(a) Identified
				debtors may request an administrative hearing as follows:
(1) Within fourteen calendar days of the date
				of the adverse pretax setoff review notice; and
(2) Within thirty calendar days of the date
				of the tax setoff notice.
(3) If
				the fourteenth or thirtieth day falls on a weekend or holiday, the fourteenth
				or thirtieth day shall then be the first working day after the weekend or
				holiday.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1706 - INCOME TAX SETOFF PROGRAM › Section 17-1706-8 - Rights of the claimant

Current through June, 2024
The claimant or the authorized representative shall have an
				  opportunity to:
(1) Examine the case
				record as well as all documents and records to be used at the hearing at a
				reasonable time before the date of the hearing as well as during the
				hearing;
(2) Present the case
				independently or with the aid of others including legal counsel;
(3) Bring witnesses, including an interpreter
				if the claimant is non-English speaking. If the claimant does not have an
				interpreter and the department believes an interpreter is necessary, an
				interpreter shall be obtained by the department;
(4) Establish all pertinent facts and
				circumstances;
(5) Advance any
				arguments appropriate to the issue being heard without undue interference;
				and
(6) Question or refute any
				testimony or evidence, and to confront and cross examine any witness.