reglab/statecodes huggingface dataset:
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 17-1736-21 - Disclosure by providers of information on persons convicted of crimes

Current through June, 2024
(a) The provider shall disclose to DHS the
				  identity of any person who has an ownership or controlling interest in the
				  provider, or who is an agent, managing employee, or employee of the provider
				  and who has been convicted of a criminal offense relating to that person's
				  involvement in the medical assistance program, medicare, or any Title XX
				  service program since the start of those programs.
(b) DHS shall notify DHHS immediately of any
				  disclosures made pursuant to subsection (a).
(c) DHS may refuse to enter into or renew an
				  agreement with a provider if a person with ownership or controlling interest in
				  that provider, or an agent or managing employee of that provider is a person
				  who has been convicted of a criminal offense relating to the person's
				  involvement in a program established under the medical assistance program,
				  medicare, or any Title XX program.
(d) DHS may refuse to enter into or may
				  terminate a provider agreement if the full and accurate disclosure requirements
				  under this section are not met by the provider.
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 17-1736-22 - Cause for suspension or termination of providers

Current through June, 2024
DHS may suspend or terminate a provider from the medical
					 assistance program based upon any one or combination of reasons established in
					 section 17-1736-33(c).
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 17-1736-23 - Suspension or termination

Current through June, 2024
(a) The decision to
				  suspend or terminate a provider from participation in the medical assistance
				  program and the duration of any suspension shall be made by the DHS
				  director.
(b) The duration of the
				  suspension imposed by the DHS director shall be conditioned upon the
				  seriousness of the infraction but shall not exceed a period of five
				  years.
(c) The DHS director shall
				  suspend or terminate any provider in the medical assistance program who has
				  been suspended or terminated from the medicare program. Suspension or
				  termination from the medical assistance program if based upon suspension from
				  the medicare program shall be at least under the same conditions and for the
				  same period of time as the suspension from the medicare program. The DHS
				  director may determine that more stringent action under the medical assistance
				  program than was taken under the medicare program is justified. In that event,
				  the director shall take such steps as the director deems appropriate subject to
				  the provisions of subchapter 3.
(d)
				  The DHS director shall suspend or terminate any provider in the medical
				  assistance program whose license, certification, authorization or permit to
				  practice is not current or has been suspended, revoked, or restricted by a
				  state or federal government, court, or agency.
(e) A provider who has terminated from the
				  medical assistance program for a violation may not petition the director for
				  reinstatement to the program for a period of five years at which time
				  reinstatement may be permitted by the director, if justified, provided that at
				  the time reinstatement is requested that no medicare sanctions remain
				  applicable.
(f) All legal actions,
				  both civil and criminal, against providers certified under the medicaid program
				  shall be handled by the State's medicaid fraud control unit.
(g) Actions for suspension or termination of
				  a provider may be initiated or continued even though a provider voluntarily
				  withdraws from the program. The procedures for determining whether suspension
				  or termination are appropriate and the length of time shall be governed by this
				  subchapter and subchapter 3.
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 17-1736-24 - Notification and effective date of suspension or termination of provider certification

Current through June, 2024
(a) The provider
				  shall be informed by certified mail of DHS's intent to suspend or terminate the
				  provider's participation as a medical assistance provider. The notice shall
				  include the following:
(1) The reasons for
				  the action;
(2) If the action is a
				  suspension, the duration of the suspension;
(3) The provider's rights to request an
				  administrative review, and to be represented at the provider's own expense by
				  legal counsel or a designated representative at the administrative hearing
				  provided for by subchapter 3; and
(4) The effective date of the suspension or
				  termination.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1736 - PROVIDER PROVISIONS › Subchapter 3 - ADMINISTRATIVE PROCEEDINGS FOR PROVIDER REVIEW › Section 17-1736-31 - Purpose

Current through June, 2024
The purpose of this chapter shall be to establish
					 provisions for a provider's right to review and hearing following any
					 administrative decision made by the DHS which directly and adversely affects
					 the rights of that provider or the reimbursement claimed under the medical
					 assistance program.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1736 - PROVIDER PROVISIONS › Subchapter 3 - ADMINISTRATIVE PROCEEDINGS FOR PROVIDER REVIEW › Section 17-1736-33 - Providers' right to review

Current through June, 2024
(a) A provider may
				  request an administrative hearing following the department's administrative
				  decision to do any one of the following:
(1)
				  Withhold, terminate, or suspend a provider's certification to participate in
				  the medical assistance program;
(2)
				  Withhold payment of claims as a result of audit or investigation;
(3) Recover money claimed to have been
				  overpaid to the provider by medicaid; or
(4) Impose remedies established in section
				  17-1736-40 for nursing facilities that do not meet the requirements of
				  participation.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1736 - PROVIDER PROVISIONS › Subchapter 3 - ADMINISTRATIVE PROCEEDINGS FOR PROVIDER REVIEW › Section 17-1736-34 - Limitation of the right to review

Current through June, 2024
A provider shall not have a right to an administrative
					 hearing if:
(1) The provider fails to
				  request in writing a fair hearing from the med-QUEST administrator of DHS
				  within the time specified in section 17-1736-33(b);
(2) The administrative action is one of
				  suspension or termination, based upon a final administrative decision of a
				  state or federal agency withdrawing the license, certification, authorization,
				  or permit of the provider to practice or furnish the health care specialty for
				  which the provider is certified under the Hawaii medical assistance program;
				  or
(3) The administrative action is
				  for suspension or termination and is based upon a state or federal court
				  conviction of the provider of an offense involving fraud or abuse relating to
				  the medicaid program.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1736 - PROVIDER PROVISIONS › Subchapter 3 - ADMINISTRATIVE PROCEEDINGS FOR PROVIDER REVIEW › Section 17-1736-35 - Appearance by representatives of the provider and the department

Current through June, 2024
(a) In all matters involving an
				  administrative hearing, a provider may represent him or herself or be
				  represented by an attorney or other person. A provider shall not have a right
				  to legal counsel appointed at state expense. If the provider is represented by
				  another person, that person's name, address, and telephone number shall be
				  provided to the DHS med-QUEST administrator and to the hearing officer prior to
				  the administrative hearing,
(b)
				  Upon receipt of the name of the provider's representative, the med-QUEST
				  administrator shall provide to that representative, the name, address, and
				  telephone number of the department's representative.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1736 - PROVIDER PROVISIONS › Subchapter 3 - ADMINISTRATIVE PROCEEDINGS FOR PROVIDER REVIEW › Section 17-1736-36 - Forms for papers

Current through June, 2024
An original and two copies of all papers filed in any
					 proceeding under this chapter shall be filed with the department, shall be
					 typewritten on one side only, and be on 8 ½ by 13 inch white paper.
					 Documents shall bear on the first page the title of the proceeding at the top
					 of the page, together with any administrative or court number assigned to the
					 hearing, and the signatures of the party or the party's
					 representative.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1736 - PROVIDER PROVISIONS › Subchapter 3 - ADMINISTRATIVE PROCEEDINGS FOR PROVIDER REVIEW › Section 17-1736-37 - Notice, service, and proof of service

Current through June, 2024
(a) All papers,
				  notices, and other documents shall be served by the party offering them upon
				  all other parties to the proceeding. Proof of service upon the parties shall be
				  filed with the DHS.
(b) Service of
				  process may be accomplished in any manner permitted by law. The department
				  shall serve the provider in person or by mail. If the provider is represented
				  by an attorney or other person, service upon that attorney or other person
				  shall be sufficient.
(c) Proof of
				  service of any document shall be by certificate of attorney, affidavit, or
				  acknowledgment.
(d) Where written
				  notice is required by this chapter, notice shall be considered effective on the
				  date of mailing.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1736 - PROVIDER PROVISIONS › Subchapter 3 - ADMINISTRATIVE PROCEEDINGS FOR PROVIDER REVIEW › Section 17-1736-38 - Notice of formal hearing; notice of decision

Current through June, 2024
(a) The
				  department shall notify any provider, who is entitled to an administrative
				  hearing in accordance with section 17-1736-34 of the scheduled date and
				  location of the administrative hearing. Such notice shall be in writing and
				  mailed to the provider no fewer than thirty calendar days before the scheduled
				  date of hearing.
(b) The department
				  shall notify any provider who has received an administrative hearing of the
				  hearing officer's decision by mailing a written copy of the decision within
				  fourteen calendar days of the date of the decision.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1736 - PROVIDER PROVISIONS › Subchapter 3 - ADMINISTRATIVE PROCEEDINGS FOR PROVIDER REVIEW › Section 17-1736-39 - Conduct of hearing

Current through June, 2024
(a) The hearing
				  shall be conducted by an impartial hearing officer appointed by the DHS
				  director. Prior to conducting the hearing, the hearing officer shall become
				  familiar with sections
				  84-1 to
				  84-19, HRS, and the
				  published opinions of the state ethics commission and determine that
				  participation as an administrative hearing officer will create no conflicts of
				  interest or ethical violations.
(b)
				  Testimony shall be taken only on oath or affirmation and such testimony shall
				  be subject to sections
				  710-1060,
				  710-1061,
				  and
				  710-1062,
				  HRS.
(c) Each party may:
(1) Call and examine witnesses;
(2) Introduce exhibits into
				  evidence;
(3) Cross-examine
				  witnesses called by the other party;
(4) Object to the presentation of any
				  evidence deemed by the party to be not properly admitted;
(5) Present rebuttal evidence to the opposing
				  party's case-in-chief; and
(6)
				  Present an opening statement to the hearing officer prior to the taking of
				  evidence, and a closing argument to the hearing officer at the conclusion of
				  the taking of evidence.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1736 - PROVIDER PROVISIONS › Subchapter 3 - ADMINISTRATIVE PROCEEDINGS FOR PROVIDER REVIEW › Section 17-1736-40 - Witnesses and subpoenas

Current through June, 2024
(a) Each party to
				  the administrative hearing shall arrange for the presence of its witnesses at
				  the hearing.
(b) The DHS director
				  hereby designates the hearing officer as a representative of the director,
				  empowered to conduct a hearing. Any party to the administrative hearing may
				  request of the hearing officer a subpoena to compel the attendance of a witness
				  or the production of books, papers, documents, or other objects deemed relevant
				  to the investigation, except that no subpoena shall affect any privilege
				  established by law. Each subpoena shall be signed by the administrative hearing
				  officer who at any point in the proceedings may, on the hearing officer's own
				  motion, subpoena witnesses, books, papers, documents, correspondence,
				  memoranda, or other records in furtherance of the administrative
				  hearing.
(c) Applications for
				  subpoenas for the production by a witness of books, papers, documents,
				  correspondence, memoranda, or other written records, shall be made by affidavit
				  to the hearing officer and shall contain:
(1)
				  The name and address of the organization upon whom the subpoena is to be
				  served;
(2) A description of the
				  documents, papers, books, correspondence, memoranda, photographs, or other
				  written records that are desired;
(3) A statement by the affiant that to the
				  best of the affiant's knowledge and belief, the person to be subpoenaed has
				  information about or possesses the documents, papers, books, correspondence,
				  memoranda, photographs, or other objects that the subpoena seeks; and
(4) The basis for the affiant's belief that
				  the person or organization has information about or possesses the documents,
				  papers, books, correspondence, memoranda, photographs, or other objects that
				  the subpoena seeks.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1736 - PROVIDER PROVISIONS › Subchapter 3 - ADMINISTRATIVE PROCEEDINGS FOR PROVIDER REVIEW › Section 17-1736-41 - Amendments

Current through June, 2024
(a) If during the course of the hearing,
				  evidence taken reveals that the provider was involved with conduct which would
				  properly be the basis for suspension, termination, or other administrative
				  sanction, and which was not alleged by the State as grounds for suspension,
				  termination, or other administrative sanction, the State, at the discretion of
				  the hearing officer, may amend its allegations to conform with the
				  evidence.
(b) If, during the course
				  of an administrative hearing, it becomes apparent to either party or to the
				  administrative hearing officer that an absent party should be joined or
				  afforded the opportunity to make an appearance, then the State, at the
				  discretion of the hearing officer, may amend its allegations to include the
				  additional party, or if appropriate, substitute the additional party for the
				  present provider.
(c) Where
				  allegations are amended pursuant to subsection (a), or parties are added or
				  substituted pursuant to subsection (b), the administrative hearing shall be
				  continued for the length of time the hearing officer deems appropriate to
				  afford any additional party notice and to afford any existing or additional
				  party a chance to address additional allegations.
(d) Notice of amendments or substitutions
				  shall be mailed in writing to the last known address of each party affected by
				  the amendment or substitution.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1736 - PROVIDER PROVISIONS › Subchapter 3 - ADMINISTRATIVE PROCEEDINGS FOR PROVIDER REVIEW › Section 17-1736-42 - Continuances or further hearings

Current through June, 2024
(a) At any time
				  during the administrative hearing, if the hearing officer determines that the
				  hearing shall be held at another time or at any other locations in the State,
				  the hearing officer, at the hearing officer's discretion or on the motion of
				  any party, may continue the hearing.
(b) If the hearing officer determines at any
				  point in the hearing that it is necessary to seek additional evidence, the
				  hearing officer may continue the hearing to a later date and seek additional
				  evidence, or direct one or both parties to seek further evidence, provided that
				  the hearing officer shall furnish written justification on the record for any
				  continuance under this section lasting in excess of thirty days. Failure of
				  either party to provide additional evidence as directed by the hearing officer
				  shall not be used as the sole basis for an adverse decision against that party
				  on the issues presented at the hearing. In the event that further evidence is
				  not produced as directed, the hearing officer shall proceed to a decision based
				  upon the entirety of the evidence presented at the hearing.
(c) Written notice of the time and place of
				  any continued or additional hearings shall be given in accordance with section
				  17-1736-37, except that when a continuance or additional hearing to a certain
				  date is ordered during a hearing, then oral notice of the time and place of the
				  hearing shall be sufficient for all parties present at the hearing.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1736 - PROVIDER PROVISIONS › Subchapter 3 - ADMINISTRATIVE PROCEEDINGS FOR PROVIDER REVIEW › Section 17-1736-43 - Record of hearing

Current through June, 2024
A verbatim record of all portions of the hearing shall be
					 made. The record may be in the form of a transcript of verbatim shorthand, or
					 by an audio or video recording, provided that in the event any party to the
					 hearing notifies the hearing officer in writing of an intent to file exceptions
					 to the hearing officer's findings of fact as provided in section
					 91-11,
					 HRS, or if any party appeals an agency decision, as provided in section
					 91-14,
					 HRS, a verbatim written transcript shall be prepared.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1736 - PROVIDER PROVISIONS › Subchapter 3 - ADMINISTRATIVE PROCEEDINGS FOR PROVIDER REVIEW › Section 17-1736-44 - Decision of the hearing officer

Current through June, 2024
(a) At the
				  conclusion of the evidence and arguments by the parties, the hearing officer
				  shall declare the hearing to be closed, at which time each party shall have
				  thirty calendar days, not counting the day that the hearing is closed, to
				  present written proposed findings of fact.
(b) At the conclusion of the thirty day
				  period prescribed in subsection (a), the hearing officer shall have sixty
				  calendar days to prepare a written decision accompanied by separate findings of
				  fact, conclusions of law, and basis for findings. The hearing officer, if
				  clarification of any evidence or any proposed finding of fact is desired, may
				  reconvene the hearing to clarify the existing evidence. The period of time
				  during which the hearing has been reconvened shall toll the time within which
				  the hearing officer is required to prepare the written decision.
(c) The hearing officer shall not have
				  informal, unrecorded conversations with any party concerning the case. All
				  discussions concerning the evidence shall be at sessions of record with all
				  parties to the hearing present except to the extent those discussions are
				  required for the disposition of ex parte matters authorized by law.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1736 - PROVIDER PROVISIONS › Subchapter 3 - ADMINISTRATIVE PROCEEDINGS FOR PROVIDER REVIEW › Section 17-1736-45 - Dismissal upon failure to appear at hearings

Current through June, 2024
(a) If,
				  after timely, proper written notice, a provider fails to appear at a scheduled
				  hearing, the hearing officer may issue a written dismissal of the provider's
				  request for an administrative hearing, which shall be mailed to each party with
				  notice to the provider that the provider may request written
				  consideration.
(b) In order to
				  request written consideration, the provider shall, within ten days of the
				  mailing of written dismissal, appeal to the hearing officer in writing showing
				  good cause for the provider's failure to appear at the hearing. The hearing
				  officer may, in the hearing officer's sound discretion, either sustain the
				  dismissal, or reinstate the hearing with proper written notice to parties. In
				  the event that the hearing officer sustains the dismissal, the hearing officer
				  shall provide a written dismissal order including the circumstances upon which
				  the dismissal is based.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1736 - PROVIDER PROVISIONS › Subchapter 3 - ADMINISTRATIVE PROCEEDINGS FOR PROVIDER REVIEW › Section 17-1736-46 - Administrative appeal to the director

Current through June, 2024
(a) In the event of
				  a decision adverse to the provider, a copy of the order and decision shall be
				  served upon all parties pursuant to section 17-1736-37. The provider shall have
				  ten calendar days following the date of mailing of the order and decision to
				  file written exceptions and present written argument to the DHS
				  director.
(b) The director shall
				  have thirty calendar days following the receipt of written exceptions and
				  argument to decide the appeal. The director's decision on the appeal must be
				  based upon the applicable rules and the facts as established in the record,
				  provided that the director may communicate with the hearing officer while
				  deciding the appeal. The director may sustain or reverse the decision and order
				  of the the hearing officer and in either event, shall within thirty calendar
				  days, mail the decision on appeal to all parties. The decision of the hearing
				  officer and any appeal made to the DHS director shall be subject to judicial
				  review as provided in section
				  91-14,
				  HRS.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1736 - PROVIDER PROVISIONS › Subchapter 3 - ADMINISTRATIVE PROCEEDINGS FOR PROVIDER REVIEW › Section 17-1736-57 - Determination of medicaid reimbursement for hospital and institutional providers

Current through June, 2024
The provider shall be notified of the reimbursement
					 determination (NPR) and notice of PPS rate through the fiscal agent. The
					 notices shall be sent to the provider by certified mail.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1736 - PROVIDER PROVISIONS › Subchapter 3 - ADMINISTRATIVE PROCEEDINGS FOR PROVIDER REVIEW › Section 17-1736-58 - Hospital and institutional provider's right to review

Current through June, 2024
(a)
				  A provider may request an administrative hearing if it is dissatisfied with the
				  department's determination of medicaid reimbursement:
(1) Following any request for rate
				  reconsideration determination under PPS; or
(2) Following the issuance of an NPR under
				  cost reimbursement; and
(3) The
				  amount in dispute is at least $1,000.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1736 - PROVIDER PROVISIONS › Subchapter 3 - ADMINISTRATIVE PROCEEDINGS FOR PROVIDER REVIEW › Section 17-1736-59 - Limitation of the right to review for hospital and institutional providers

Current through June, 2024
A provider shall not have the right to an administrative
					 hearing as provided under this subchapter if:
(1) The provisions of section 17-1736-58 are
				  not met; or
(2) The administrative
				  hearing concerns the following:
(A) A
				  determination of non-payment for items or services provided a recipient but
				  which are not covered by the medicaid program;
(B) The constitutionality of the law, rules,
				  or medicaid reimbursement methodology;
(C) Issues not addressed on the NPR or in the
				  notice of rate reconsideration determination;
(D) Issues related to DHHS rules or policies;
				  or
(E) Issues not addressed in the
				  Hawaii Administrative Rules.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1736 - PROVIDER PROVISIONS › Subchapter 3 - ADMINISTRATIVE PROCEEDINGS FOR PROVIDER REVIEW › Section 17-1736-60 - Appearance by representatives of hospital and institutional providers and the department

Current through June, 2024
(a) In all matters
				  involving an administrative hearing, a provider may choose representation by
				  itself or by an attorney or other person. A provider shall not have a right to
				  legal counsel appointed at state expense.
(b) If the provider is represented by another
				  person, that person's name, address, and telephone number shall be provided to
				  the DHS med-QUEST administrator prior to the administrative hearing.
(c) Upon receipt of the name of the
				  provider's representative, the med-QUEST administrator shall provide to that
				  representative, the name, address, and telephone number of the department's
				  representative.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1736 - PROVIDER PROVISIONS › Subchapter 3 - ADMINISTRATIVE PROCEEDINGS FOR PROVIDER REVIEW › Section 17-1736-61 - Forms for papers for hospital and institutional providers

Current through June, 2024
An original and two copies of all papers filed in any
					 proceeding under this subchapter shall be filed with the department and shall
					 be typewritten on one side only.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1736 - PROVIDER PROVISIONS › Subchapter 3 - ADMINISTRATIVE PROCEEDINGS FOR PROVIDER REVIEW › Section 17-1736-62 - Notice, service, and proof of service for hospital and institutional providers

Current through June, 2024
(a) All papers,
				  notices, and other documents shall be served by the party offering them upon
				  all other parties to the proceeding. Proof of service upon the parties shall be
				  filed with the DHS.
(b) Service of
				  process may be accomplished by any manner permitted by law. The department
				  shall serve the provider in person or by mail. If the provider is represented
				  by an attorney or other person, service upon that attorney or other person
				  shall be sufficient.
(c) Proof of
				  service of any document shall be by certificate of attorney, affidavit, or
				  acknowledgement.
(d) Where written
				  notice is required by these rules, notice shall be considered effective on the
				  date of mailing.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1736 - PROVIDER PROVISIONS › Subchapter 3 - ADMINISTRATIVE PROCEEDINGS FOR PROVIDER REVIEW › Section 17-1736-63 - Notice of formal hearing; notice of results of formal hearing for hospital and institutional providers

Current through June, 2024
(a) The department
				  shall notify any provider who is entitled to an administrative hearing of the
				  scheduled date and location of the administrative hearing. The notice shall be
				  in writing and mailed to the provider not less than thirty calendar days before
				  the scheduled date of hearing.
(b)
				  The department shall notify by mail any provider who has received an
				  administrative hearing of the hearing officer's decision.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1736 - PROVIDER PROVISIONS › Subchapter 3 - ADMINISTRATIVE PROCEEDINGS FOR PROVIDER REVIEW › Section 17-1736-64 - Waiver of the right for oral hearing for hospital and institutional providers

Current through June, 2024
(a) A provider may
				  request that the hearing officer base the decision solely upon the documentary
				  evidence submitted for the record without an oral hearing or appearance by
				  either party. The request may be made at any time before or during the hearing.
				  A waiver of an oral hearing is valid only if all parties agree with the request
				  and if it is approved by the hearing officer.
(b) Approval of the request shall rest
				  exclusively with the hearing officer.
(c) Where a request has been made and
				  approved, the parties shall file with the hearing officer a written waiver of
				  their right to a personal appearance before the hearing officer. The waiver may
				  be withdrawn by any party with adequate notice to the opposing party and to the
				  hearing officer as specified in section 17-1736-63.
(d) Once a waiver has been withdrawn, as
				  provided in subsection (c), the hearing officer shall promptly notify all
				  parties of the withdrawal and the need for an oral hearing. The hearing shall
				  be held within one hundred eighty calendar days following the date of
				  withdrawal of the waiver.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1736 - PROVIDER PROVISIONS › Subchapter 3 - ADMINISTRATIVE PROCEEDINGS FOR PROVIDER REVIEW › Section 17-1736-65 - Prehearing conference for hospital and institutional providers

Current through June, 2024
(a) At any time before the actual formal
				  hearing as specified in section 17-1736-64 or 17-1736-66, a prehearing
				  conference may be held to clarify the issues under dispute.
(b) The conference shall be informal in
				  nature, and a record as described in section 17-1736-71 shall not be
				  required.
(c) The decision to have,
				  or to not have a prehearing conference shall rest solely with the hearing
				  officer. The decision shall not be subject to appeal.
(d) The decision to record or not record the
				  prehearing conference shall rest solely with the hearing officer. The decision
				  shall not be subject to appeal.
(e)
				  At the sole discretion of the hearing officer, a prehearing order regarding the
				  proceedings may be issued. The order shall control the subsequent course of the
				  evidentiary hearing unless modified at the hearing to prevent manifest
				  injustice. The prehearing order regarding the proceedings shall not be subject
				  to appeal.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1736 - PROVIDER PROVISIONS › Subchapter 3 - ADMINISTRATIVE PROCEEDINGS FOR PROVIDER REVIEW › Section 17-1736-66 - Conduct of hearing for hospital and institutional providers

Current through June, 2024
(a) The hearing shall be conducted by an
				  impartial hearing officer appointed by the DHS director. Before conducting the
				  hearing, the hearing officer shall become familiar with sections
				  84-1 to
				  84-19, HRS, and the
				  published opinions of the State's ethics commission and determine that
				  participation as an administrative hearing officer shall not create conflicts
				  of interest or ethical violations.
(b) Testimony shall be taken only on oath or
				  affirmation and the testimony shall be subject to sections
				  710-1060,
				  710-1061,
				  and
				  710-1062,
				  HRS.
(c) Each party may:
(1) Call and examine witnesses;
(2) Introduce exhibits into
				  evidence;
(3) Cross-examine
				  witnesses called by the other party;
(4) Object to the presentation of any
				  evidence deemed by the party to be not properly admitted;
(5) Present rebuttal evidence to the opposing
				  party's case-in-chief; and
(6)
				  Present an opening statement to the hearing officer before the taking of
				  evidence, and a closing argument to the hearing officer at the conclusion of
				  the taking of evidence.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1736 - PROVIDER PROVISIONS › Subchapter 3 - ADMINISTRATIVE PROCEEDINGS FOR PROVIDER REVIEW › Section 17-1736-67 - Prehearing discovery for hospital and institutional providers

Current through June, 2024
Any party may request data from any other party to the
					 proceeding. If the requested party does not respond within fifteen calendar
					 days of the request, the requesting party may notify the hearing officer. Upon
					 notice, the hearing officer shall allow the requested party fifteen calendar
					 days to state why the requested data was not furnished. If inadequate or no
					 response is received, the hearing officer may take one of the following
					 actions:
(1) Subpoena the requested
				  data under section 17-1736-68;
(2)
				  Issue an order that the matters regarding which the request was made or any
				  designated facts shall be taken to be established for the purposes of the
				  hearing in accordance with the claim of the requesting party;
(3) Issue an order prohibiting the
				  non-compliant party from supporting or opposing designated claims or defenses,
				  or prohibiting that party from introducing designated matters in evidence;
				  or
(4) Issue an order continuing or
				  suspending further proceedings in the provider's request for review until the
				  requested data is furnished as provided for in section 17-1736-70.
(5) The hearing officer, on the application
				  of one of the parties, shall have the authority to determine that the request
				  is unduly burdensome.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1736 - PROVIDER PROVISIONS › Subchapter 3 - ADMINISTRATIVE PROCEEDINGS FOR PROVIDER REVIEW › Section 17-1736-68 - Witnesses and subpoenas for hospital and institutional providers

Current through June, 2024
(a) Each party to the administrative hearing
				  shall arrange for the presence of its witnesses at the hearing.
(b) The DHS director shall designate the
				  hearing officer as a representative of the director and empowered to conduct a
				  hearing. Any party to the administrative hearing may request of the hearing
				  officer a subpoena to compel the attendance of a witness or the production of
				  books, papers, documents, or other objects deemed relevant to the
				  investigation, except that no subpoena shall affect any privilege established
				  by law. Each subpoena shall be signed by the administrative hearing officer who
				  at any point in the proceedings may, subpoena witnesses, books, papers,
				  documents, correspondence, memoranda, or other records in furtherance of the
				  administrative hearing.
(c)
				  Applications for subpoenas for the production by a witness of books, papers,
				  documents, correspondence, memoranda, or other written records, shall be made
				  by affidavit to the hearing officer and shall contain all of the following:
(1) The name and address of the person or
				  organization upon whom the subpoena is to be served;
(2) A description of the documents, papers,
				  books, correspondence, memoranda, photographs, or other written records that
				  are desired;
(3) A statement by the
				  affiant that to the best of the affiant's knowledge and belief, the person to
				  be subpoenaed has information about or possesses the documents, papers, books,
				  correspondence, memoranda, photographs, or other objects that the subpoena
				  seeks; and
(4) The basis for the
				  affiant's belief that the person or organization has information about or
				  possesses the documents, papers, books, correspondence, memoranda, photographs,
				  or other objects that the subpoena seeks.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1736 - PROVIDER PROVISIONS › Subchapter 3 - ADMINISTRATIVE PROCEEDINGS FOR PROVIDER REVIEW › Section 17-1736-69 - Amendments for hospital and institutional providers

Current through June, 2024
(a)
				  If, subsequent to the provider's request for hearing under section
				  17-1736-58(b), the provider identifies further issues with which it disagrees,
				  the provider, with notice to the opposing party and to the hearing officer, may
				  include those issues in the appeal. The provider shall only amend the appeal if
				  the initial request was made in accordance with section 17-1736-58, and the
				  additional issues are not excluded as specified in section 17-1736-59. The
				  provider shall not amend the appeal following the close of the formal hearing.
				  Final determination of the right to amend shall be at the sole discretion of
				  the hearing officer.
(b) Where the
				  issues are amended pursuant to subsection (a), the administrative hearing
				  process shall be continued for a length of time as the hearing office deems
				  appropriate to afford all parties notice and a chance to examine and address
				  the additional issues.
(c) Notice
				  of amendments shall be served in accordance with section 17-1736-62.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1736 - PROVIDER PROVISIONS › Subchapter 3 - ADMINISTRATIVE PROCEEDINGS FOR PROVIDER REVIEW › Section 17-1736-70 - Continuances or further hearings for hospital and institutional providers

Current through June, 2024
(a) At any time during the administrative
				  hearing, if the hearing officer determines that the hearing shall be held at
				  another time or at any other location in the State, the hearing officer shall
				  have discretion to continue the hearing.
(b) If the hearing officer determines at any
				  point in the hearing that it is necessary to seek additional evidence, the
				  hearing may be continued at a later date or one or both parties may be directed
				  to seek further evidence, provided the hearing officer furnish written
				  justification on the record for any continuance under this section lasting in
				  excess of thirty days. Failure of either party to provide additional evidence
				  as directed by the hearing officer shall not be used as the sole basis for an
				  adverse decision against that party on the issues presented at the hearing. In
				  the event that further evidence is not produced as directed, the hearing office
				  shall proceed to a decision based upon the entirety of the evidence presented
				  at the hearing.
(c) Written notice
				  of the time and place of any continued or additional hearings shall be given in
				  accordance with section 17-1736-63, except when a continuance or additional
				  hearing to a certain date is ordered during a hearing, then oral notice of the
				  time and place of the hearing shall be sufficient for all parties present at
				  the hearing.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1736 - PROVIDER PROVISIONS › Subchapter 3 - ADMINISTRATIVE PROCEEDINGS FOR PROVIDER REVIEW › Section 17-1736-71 - Record of hearing for hospital and institutional providers

Current through June, 2024
A verbatim record of all portions of the hearing shall be
					 made. The record may be in the form of a transcript of verbatim shorthand, or
					 by an audio or video recording. If any party to the hearing notifies the
					 hearing officer in writing of an intent to file exceptions to the hearing
					 officer's findings of fact as provided in section
					 91-11,
					 HRS, or if a party appeals an agency decision, as provided in section
					 91-14,
					 HRS, a verbatim written transcript shall be prepared.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1736 - PROVIDER PROVISIONS › Subchapter 3 - ADMINISTRATIVE PROCEEDINGS FOR PROVIDER REVIEW › Section 17-1736-72 - Decision of the hearing officer for hospital and institutional providers

Current through June, 2024
(a) At the conclusion of the evidence and
				  argument by the parties, the hearing officer shall declare the hearing closed,
				  at which time each party shall have thirty calendar days, not counting the day
				  that the hearing is closed, to present written proposed findings of
				  fact.
(b) At the conclusion of the
				  thirty day period prescribed in subsection (a), the hearing officer shall have
				  sixty calendar days to prepare a written decision accompanied by separate
				  findings of fact, conclusions of law, and basis for findings. The hearing
				  officer, if clarification of any evidence or any proposed finding of fact is
				  desired, may reconvene the hearing to clarify the existing evidence. The period
				  of time during which the hearing has been reconvened shall toll the time within
				  which the hearing officer is required to prepare the written
				  decision.
(c) The hearing officer
				  shall not have informal, unrecorded conversations with any party concerning the
				  case. All discussions concerning the evidence shall be at sessions of record
				  with all parties to the hearing present, except to the extent those discussions
				  are required for the disposition of ex parte matters authorized by
				  law.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1736 - PROVIDER PROVISIONS › Subchapter 3 - ADMINISTRATIVE PROCEEDINGS FOR PROVIDER REVIEW › Section 17-1736-73 - Dismissal upon failure to appear at hearings for hospital and institutional providers

Current through June, 2024
(a) If, after
				  timely, proper written notice, a provider fails to appear at a scheduled
				  hearing, the hearing officer may issue a written dismissal of the provider's
				  request for an administrative hearing, which shall be mailed to each party with
				  notice that the provider may request written consideration.
(b) In order to request written
				  consideration, the provider shall, within ten days of the mailing of written
				  dismissal, appeal to the hearing officer in writing showing good cause for the
				  provider's failure to appear at the hearing. At the sole discretion of the
				  hearing officer, the hearing officer may either sustain the dismissal or
				  reinstate the hearing with proper written notice to parties. If the hearing
				  officer sustains the dismissal, the hearing officer shall provide a written
				  dismissal order including the circumstances upon which the dismissal is
				  based.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1736 - PROVIDER PROVISIONS › Subchapter 3 - ADMINISTRATIVE PROCEEDINGS FOR PROVIDER REVIEW › Section 17-1736-74 - Administrative review by the director for hospital and institutional providers

Current through June, 2024
(a) The DHS director shall have the authority
				  to review the hearing officer's written decision. The review may take place
				  following issuance of the decision as specified in section
				  17-1736-63.
(b) The director shall
				  have thirty calendar days following the date of the hearing officer's decision
				  to mail notice of review to the parties of the director's intention to review
				  the decision. The director's review shall be based upon the applicable rules
				  and the facts as established in the record, provided that the director may
				  communicate with the hearing officer during the review.
(c) The director may sustain, reverse,
				  modify, or remand the decision of the hearing officer and in any event shall
				  mail notice of his intention to review within thirty calendar days following
				  the date of the hearing officer's decision.
(d) The director's decision shall be mailed
				  to all parties within thirty days following the notice of review.
(e) The decision of the hearing officer and
				  DHS director shall be subject to judicial review as provided in section
				  91-14,
				  HRS.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1736 - PROVIDER PROVISIONS › Subchapter 3 - ADMINISTRATIVE PROCEEDINGS FOR PROVIDER REVIEW › Section 17-1736-75 - Reopenings for hospital and institutional providers

Current through June, 2024
(a)
				  A hearing officer may reopen a decision at any time within three years after
				  the date of the decision.
(b)
				  Notice shall be given to all parties of the hearing officer's intent to reopen
				  and the reasons therefore.
(c) The
				  decision to reopen, or not to reopen rests solely with the hearing officer and
				  shall not be subject to appeal.
(d)
				  The three years time limit shall be waived if the reopening is due to evidence
				  of fraud.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 1 - GENERAL PROVISIONS › Section 17-1737-1 - Purpose

Current through June, 2024
This chapter shall set forth:
(1) Medical care and services provided to
				  eligible persons under the fee for service component of the medical assistance
				  program;
(2) Excluded services;
				  and
(3) Conditions for
				  payment.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 2 - INPATIENT AND OUTPATIENT HOSPITAL SERVICES, PHYSICIANS SERVICES › Section 17-1737-3 - Inpatient hospital care

Current through June, 2024
(a) Inpatient
				  hospital care means services that are ordinarily furnished in a hospital for
				  the care and treatment of inpatients under the direction of a physician,
				  podiatrist, or dentist and which is furnished by an institution meeting the
				  following requirements:
(1) Is not maintained
				  primarily for the treatment of tuberculosis, mental diseases, or Hansen's
				  disease;
(2) Is licensed as a
				  hospital by the State;
(3) Meets
				  the requirements for medicare participation; and
(4) Has in effect a utilization review plan
				  approved by the department.