reglab/statecodes huggingface dataset:
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1737 - SCOPE AND CONTENTS OF THE FEE FOR SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 10 - SUBACUTE CARE › Section 17-1737-119 - Physician services

Current through June, 2024
Physician services shall include, but not be limited
					 to:
(1) The evaluation and completion
				  of forms used to establish and continue the subacute level of care for a
				  recipient;
(2) Physicians visits at
				  least weekly during the first month and a minimum of once every two weeks
				  thereafter until the stability of the patient's condition allows for monthly
				  visits;
(3) A plan of care shall be
				  entered into the medical record and shall include:
(A) Medical history, physical findings, and
				  diagnosis indicating the need for admission;
(B) A description of the functional level of
				  the patient;
(C) Objectives to be
				  achieved by the plan of care;
(D)
				  Any orders for medications, treatments, restorative, and rehabilitative
				  services, activities, therapies, social services, therapeutic diet, and special
				  procedures recommended for the health and safety of the patient;
(E) Plans for continuing care, including
				  review and modification to the plan of care;
(F) Plans for discharge, including
				  responsible family member or care givers; and
(G) The attending or staff physician and
				  other personnel involved in the recipients care shall review each plan of care
				  at least every thirty days.
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 10 - SUBACUTE CARE › Section 17-1737-121 - Exclusions

Current through June, 2024
Subacute payments shall not be made for the following
					 patients:
(1) Patients who are
				  medically unstable and require acute inpatient care in an acute care hospital;
				  or
(2) Patients whose level of care
				  is appropriately level C (SNF), level A (ICF), level B (ICF-MR), or lower.
				  Included in this group are the following:
(A)
				  Stable newborns or premature infants under one year of age who require training
				  of the sucking reflex and monitoring of weight and oral feeding to gain weight
				  sufficient for discharge to the home setting;
(B) Stable children, newborns, or infants
				  under the care of the child protective services awaiting placement;
				  and
(C) Patients in terminal phases
				  of disease who request or whose legal guardians have requested in writing the
				  desire not to be resuscitated and no subacute services have been or will be
				  rendered.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1738 - TARGETED CASE MANAGEMENT SERVICES › Subchapter 1 - GENERAL PROVISIONS › Section 17-1738-1 - Purpose

Current through June, 2024
(a) The purpose of this chapter shall be to
				  establish the rules relating to the provision of targeted case management
				  services for eligible recipients.
(b) The provisions of this chapter shall be
				  covered under the fee-for-service basis.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1738 - TARGETED CASE MANAGEMENT SERVICES › Subchapter 2 - DEVELOPMENTALLY DISABLED AND MENTALLY RETARDED PERSONS › Section 17-1738-3 - Eligibility requirements

Current through June, 2024
An individual shall meet the following conditions to
					 qualify for targeted case management services:
(1) Is eligible for medical assistance from
				  the department; and
(2) Is eligible
				  for developmental disability or mental retardation services from DOH.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1738 - TARGETED CASE MANAGEMENT SERVICES › Subchapter 2 - DEVELOPMENTALLY DISABLED AND MENTALLY RETARDED PERSONS › Section 17-1738-4 - Provider requirements

Current through June, 2024
(a) The provisions
				  of chapter 17-1736 shall be applicable to the provider of targeted case
				  management services.
(b) Case
				  managers shall meet the state civil service requirements for the titles of
				  Social Worker III or IV, or Registered Professional Nurse III or IV, or meet
				  the definition of a Qualified Mental Retardation Professional as defined in
				  42 C.F.R. section
				  483.430.
(c) The case manager shall work under the
				  direction of a supervisor who assigns, monitors, and evaluates the work
				  performance of the case manager.
(d) Targeted case management services for the
				  DD/MR shall be provided, purchased, or arranged by DOH.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1738 - TARGETED CASE MANAGEMENT SERVICES › Subchapter 2 - DEVELOPMENTALLY DISABLED AND MENTALLY RETARDED PERSONS › Section 17-1738-5 - Covered services

Current through June, 2024
(a) Covered
				  services means services that are reimbursable by medicaid, and are grouped
				  under the following three categories:
(1)
				  Case assessment;
(2) Case planning;
				  and
(3) Ongoing monitoring and
				  service coordination.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1738 - TARGETED CASE MANAGEMENT SERVICES › Subchapter 2 - DEVELOPMENTALLY DISABLED AND MENTALLY RETARDED PERSONS › Section 17-1738-6 - Limitation of services

Current through June, 2024
(a) Reimbursement
				  for case assessment and case planning shall be limited to no more than one each
				  for a recipient in a calendar year unless the recipient requires a reassessment
				  due to a major change in level of functioning due to health, socio-emotional or
				  environmental factors, in which case a second assessment or case plan may be
				  reimbursed.
(b) Reimbursement for
				  ongoing monitoring and service coordination shall be limited to one claim for
				  each recipient per month, and shall be only for the services rendered by or
				  under the supervision of the recipient's designated case manager.
(c) Ongoing monitoring or service
				  coordination shall not be available to recipients who are inpatients in acute
				  hospitals, or residents of nursing or ICF-MR facilities.
(d) Case management services are not
				  reimbursable when rendered to a recipient who, on the date of service, is
				  enrolled in a health maintenance organization.
(e) Recipients receiving services under Home
				  & Community-Based Waiver Services shall be eligible to receive
				  non-duplicative case management services as targeted case management services
				  under section 17-1738-5.
(f) The
				  following activities are considered necessary for the proper and efficient
				  administration of the medicaid state plan, and are not reimbursable:
(1) Medicaid eligibility determinations and
				  re-determinations;
(2) Medicaid
				  pre-admission screening;
(3) Prior
				  authorization for medicaid services;
(4) Medicaid utilization review;
(5) EPSDT administration; and
(6) Activities associated with the lock-in
				  provisions of section 17-1741-8.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1738 - TARGETED CASE MANAGEMENT SERVICES › Subchapter 2 - DEVELOPMENTALLY DISABLED AND MENTALLY RETARDED PERSONS › Section 17-1738-7 - Reimbursement for services

Current through June, 2024
(a) Payment for
				  targeted case management services shall be based on a rate negotiated by the
				  department.
(b) Services shall be
				  reimbursable only for calendar months during which at least one face-to-face or
				  telephone contact is made with the recipient or collaterals.
(c) Payment shall not be made for services
				  for which another payer is liable, nor for services for which no payment
				  liability is incurred.
(d) Payment
				  shall be made for only one recipient even though more than one recipient may
				  have been serviced during the unit of service.
(e) Requests for payments shall be submitted
				  on a form specified by the department and shall include the:
(1) Date of service;
(2) Recipient's name and identification
				  number;
(3) Name of the provider
				  and person who provided the service;
(4) Nature, procedure code, units of service;
				  and
(5) Place of service.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1738 - TARGETED CASE MANAGEMENT SERVICES › Subchapter 2 - DEVELOPMENTALLY DISABLED AND MENTALLY RETARDED PERSONS › Section 17-1738-8 - Funding for services

Current through June, 2024
Funding for targeted case management services is shared by
					 the federal and state governments. The State's share of the funds shall be met
					 by DOH.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1738 - TARGETED CASE MANAGEMENT SERVICES › Subchapter 2 - DEVELOPMENTALLY DISABLED AND MENTALLY RETARDED PERSONS › Section 17-1738-9 - Documentation requirements

Current through June, 2024
The provider shall be responsible for maintaining an
					 accurate and current written documentation in the recipient's case record of
					 services and activities, including but not limited to the following:
(1) Copies of ISP developed through case
				  management;
(2) Copies of any
				  change or revisions to the ISP as developed through a client and team meeting,
				  or otherwise with the consent of the recipient or guardian;
(3) Progress notes on objectives for which
				  the case manager has primary responsibility at the frequency called for in the
				  ISP;
(4) Documentation of case
				  management activities designed to locate, refer, obtain, and coordinate
				  services outside and inside the agency, as needed by the individual whether for
				  placement in residential alternatives, day program, respite, recreational, and
				  social activities and other programs and services as appropriate and
				  needed;
(5) Copies of significant
				  correspondence concerning contacts within the past year with the recipient or
				  guardian, service providers, physicians, attorneys, state and federal agencies,
				  family members, and significant others in the recipient's life;
(6) Correspondence or memoranda concerning
				  any significant events in the recipient's life which required case management
				  assistance; and
(7) Service logs to
				  summarize monthly case management activities on behalf of the
				  recipient.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1738 - TARGETED CASE MANAGEMENT SERVICES › Subchapter 2 - DEVELOPMENTALLY DISABLED AND MENTALLY RETARDED PERSONS › Section 17-1738-12 - Termination of services

Current through June, 2024
Services shall be terminated when any of the following
					 occurs:
(1) The recipient is
				  determined ineligible for medical assistance;
(2) The recipient no longer meets the
				  requirement of section 17-1738-3(2);
(3) The recipient and the case manager
				  mutually decide that services are no longer necessary;
(4) The recipient refuses to continue
				  receiving services in the manner specified in the service plan; or
(5) There has been no face-to-face contact
				  between the recipient and the case manager for ninety consecutive days unless
				  the recipient is institutionalized.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1738 - TARGETED CASE MANAGEMENT SERVICES › Subchapter 2 - DEVELOPMENTALLY DISABLED AND MENTALLY RETARDED PERSONS › Section 17-1738-13 - Appeals and hearings

Current through June, 2024
(a) The provider
				  shall be entitled to the appeal and hearing process in accordance with the
				  provisions of chapter 17-1736.
(b)
				  The applicant or recipient who is denied eligibility for medical assistance or
				  whose eligibility is terminated shall be entitled to the appeal and hearing
				  process in accordance with chapter 17-1703.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1738 - TARGETED CASE MANAGEMENT SERVICES › Subchapter 3 - SEVERELY DISABLED MENTALLY ILL › Section 17-1738-14 - Eligibility requirements

Current through June, 2024
An individual shall meet the following conditions to
					 qualify for targeted case management services:
(1) Is eligible for medical assistance from
				  the department; and
(2) Is eligible
				  for mental health services from DOH for persons with severe, disabling mental
				  illness.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1738 - TARGETED CASE MANAGEMENT SERVICES › Subchapter 3 - SEVERELY DISABLED MENTALLY ILL › Section 17-1738-15 - Provider requirements

Current through June, 2024
(a) The provisions
				  of chapter 17-1736 shall be applicable to the provider of targeted case
				  management services.
(b) Case
				  managers shall meet the state civil service requirements for one of the
				  following titles:
(1) Social Worker III or
				  IV;
(2) Registered Professional
				  Nurse III or IV;
(3) Case Manager
				  I, II, III, IV, or V; or
(4)
				  Qualified Mental Health Professional as defined by DOH.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1738 - TARGETED CASE MANAGEMENT SERVICES › Subchapter 3 - SEVERELY DISABLED MENTALLY ILL › Section 17-1738-16 - Covered services

Current through June, 2024
(a) Covered
				  services means services that are reimbursable by medicaid, and are grouped
				  under the following three categories:
(1)
				  Case assessment;
(2) Case planning;
				  and
(3) Ongoing monitoring and
				  service coordination.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1738 - TARGETED CASE MANAGEMENT SERVICES › Subchapter 3 - SEVERELY DISABLED MENTALLY ILL › Section 17-1738-17 - Limitation of services

Current through June, 2024
(a) Reimbursement
				  for case assessment and case planning shall be limited to no more than one each
				  for a recipient in a calendar year unless the recipient requires a reassessment
				  due to a major change in level of functioning due to health, socio-emotional,
				  or environmental factors, in which case a second assessment or case plan may be
				  reimbursed.
(b) Reimbursement for
				  ongoing monitoring and service coordination shall be limited to one claim for
				  each recipient per month, and shall be only for the services rendered by or
				  under the supervision of the recipient's designated case manager.
(c) Ongoing monitoring or service
				  coordination shall not be available to recipients who are inpatients in acute
				  hospitals, or residents of nursing or ICF-MR facilities.
(d) Case management services are not
				  reimbursable when rendered to a recipient who, on the date of service, is
				  enrolled in a health maintenance organization.
(e) Recipients receiving services under Home
				  & Community-Based Waiver Services shall be eligible to receive
				  non-duplicative case management services as targeted case management services
				  under section 17-1738-5.
(f) The
				  following activities are considered necessary for the proper and efficient
				  administration of the medicaid state plan, and are not reimbursable:
(1) Medicaid eligibility determinations and
				  redeterminations ;
(2) Medicaid
				  pre-admission screening;
(3) Prior
				  authorization for medicaid services;
(4) Medicaid utilization review;
(5) EPSDT administration; and
(6) Activities associated with the lock-in
				  provisions of section 17-1741-8.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1738 - TARGETED CASE MANAGEMENT SERVICES › Subchapter 3 - SEVERELY DISABLED MENTALLY ILL › Section 17-1738-18 - Reimbursement for services

Current through June, 2024
(a) Payment for
				  targeted case management services shall be based on a rate negotiated by the
				  department.
(b) Services shall be
				  reimbursable only for calendar months during which at least one face-to-face or
				  telephone contact is made with the recipient or collaterals.
(c) Payment shall not be made for services
				  for which another payer is liable, nor for services for which no payment
				  liability is incurred.
(d) Payment
				  shall be made for only one recipient even though more than one recipient may
				  have been serviced during the unit of service.
(e) Requests for payments shall be submitted
				  on a form specified by the department and shall include the:
(1) Date of service;
(2) Recipient's name and identification
				  number;
(3) Name of the provider
				  and person who provided the service;
(4) Nature, procedure code, units of service;
				  and
(5) Place of service.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1738 - TARGETED CASE MANAGEMENT SERVICES › Subchapter 3 - SEVERELY DISABLED MENTALLY ILL › Section 17-1738-19 - Funding for services

Current through June, 2024
Funding for targeted case management services is shared by
					 the federal and state governments. The State's share of the funds shall be met
					 by DOH.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1738 - TARGETED CASE MANAGEMENT SERVICES › Subchapter 3 - SEVERELY DISABLED MENTALLY ILL › Section 17-1738-20 - Documentation requirements

Current through June, 2024
The provider shall be responsible for maintaining an
					 accurate and current written documentation in the recipient's case record of
					 services and activities, including but not limited to the following:
(1) Copies of ISP developed through case
				  management;
(2) Copies of any
				  change or revisions to the ISP as developed through a client and team meeting,
				  or otherwise with the consent of the recipient/guardian;
(3) Progress notes on objectives for which
				  the case manager has primary responsibility at the frequency called for in the
				  ISP;
(4) Documentation of case
				  management activities designed to locate, refer, obtain, and coordinate
				  services outside and inside the agency, as needed by the individual whether for
				  placement in residential alternatives, day program, respite,
				  recreational/social activities, and other programs/services as appropriate and
				  needed;
(5) Copies of significant
				  correspondence concerning contacts within the past year with the
				  recipient/guardian, service providers, physicians, attorneys, state and federal
				  agencies, family members, and significant others in the recipient's
				  life;
(6) Correspondence or
				  memoranda concerning any significant events in the recipient's life which
				  required case management assistance; and
(7) Service logs to summarize monthly case
				  management activities on behalf of the recipient.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1738 - TARGETED CASE MANAGEMENT SERVICES › Subchapter 3 - SEVERELY DISABLED MENTALLY ILL › Section 17-1738-23 - Termination of services

Current through June, 2024
Services shall be terminated when any of the following
					 occurs:
(1) The recipient is
				  determined ineligible for medical assistance;
(2) The recipient no longer meets the
				  requirement of section 17-1738-14(2);
(3) The recipient and the case manager
				  mutually decide that services are no longer necessary;
(4) The recipient refuses to continue
				  receiving services in the manner specified in the service plan; or
(5) There has been no face-to-face contact
				  between the recipient and the case manager for ninety consecutive days unless
				  the recipient is institutionalized.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1738 - TARGETED CASE MANAGEMENT SERVICES › Subchapter 3 - SEVERELY DISABLED MENTALLY ILL › Section 17-1738-24 - Appeals and hearings

Current through June, 2024
(a) The provider
				  shall be entitled to the appeal and hearing process in accordance with the
				  provisions of chapter 17-1736.
(b)
				  The applicant or recipient who is denied eligibility for medical assistance or
				  whose eligibility is terminated shall be entitled to the appeal and hearing
				  process in accordance with chapter 17-1703.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1738 - TARGETED CASE MANAGEMENT SERVICES › Subchapter 4 - INFANTS AND TODDLERS › Section 17-1738-25 - Eligibility requirements

Current through June, 2024
An individual shall meet the following conditions to
					 qualify for targeted case management services:
(1) Is eligible for medical assistance from
				  the department; and
(2) Is eligible
				  for early intervention services from DOH for infant and toddlers age zero to
				  three who have special needs.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1738 - TARGETED CASE MANAGEMENT SERVICES › Subchapter 4 - INFANTS AND TODDLERS › Section 17-1738-26 - Provider requirements

Current through June, 2024
(a) The provisions
				  of chapter 17-1736 shall be applicable to the provider of targeted case
				  management services.
(b) Case
				  managers shall meet the state civil service requirements for the titles of
				  Social Worker III or IV, or Registered Professional Nurse III or IV, or meet
				  the definition of a Qualified Care Coordinator as defined at
				  20 U.S.C. section
				  1472.
(c) The case manager shall work under the
				  direction of a supervisor who assigns, monitors, and evaluates the work
				  performance of the case manager.
(d) Targeted case management services for
				  infant and toddlers age zero to three who have special needs shall be provided,
				  purchased, or arranged by DOH.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1738 - TARGETED CASE MANAGEMENT SERVICES › Subchapter 4 - INFANTS AND TODDLERS › Section 17-1738-27 - Covered services

Current through June, 2024
(a) Covered
				  services means services that are reimbursable by medicaid, and are grouped
				  under the following three categories:
(1)
				  Case assessment;
(2) Case planning;
				  and
(3) Ongoing monitoring and
				  service coordination.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1738 - TARGETED CASE MANAGEMENT SERVICES › Subchapter 4 - INFANTS AND TODDLERS › Section 17-1738-28 - Limitation of services

Current through June, 2024
(a) Reimbursement
				  for case assessment and case planning shall be limited to no more than one each
				  for a recipient in a calendar year unless the recipient requires a reassessment
				  due to a major change in level of functioning due to health, socio-emotional,
				  or environmental factors, in which case a second assessment or case plan may be
				  reimbursed.
(b) Reimbursement for
				  ongoing monitoring and service coordination shall be limited to one claim for
				  each recipient per month, and shall be only for the services rendered by or
				  under the supervision of the recipient's designated case manager.
(c) Ongoing monitoring or service
				  coordination shall not be available to recipients who are inpatients in acute
				  hospitals, or residents of nursing or ICF-MR facilities.
(d) Case management services are not
				  reimbursable when rendered to a recipient who, on the date of service, is
				  enrolled in a health maintenance organization.
(e) Recipients receiving services under Home
				  & Community-Based Waiver Services shall be eligible to receive
				  non-duplicative case management services as targeted case management services
				  under section 17-1738-5.
(f) The
				  following activities are considered necessary for the proper and efficient
				  administration of the medicaid state plan, and are not reimbursable:
(1) Medicaid eligibility determinations and
				  redeterminations ;
(2) Medicaid
				  pre-admission screening;
(3) Prior
				  authorization for medicaid services;
(4) Medicaid utilization review;
(5) EPSDT administration; and
(6) Activities associated with the lock-in
				  provisions of section 17-1741-8.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1738 - TARGETED CASE MANAGEMENT SERVICES › Subchapter 4 - INFANTS AND TODDLERS › Section 17-1738-29 - Reimbursement for services

Current through June, 2024
(a) Payment for
				  targeted case management services shall be based on a rate negotiated by the
				  department.
(b) Services shall be
				  reimbursable only for calendar months during which at least one face-to-face or
				  telephone contact is made with the recipient or collaterals.
(c) Payment shall not be made for services
				  for which another payer is liable, nor for services for which no payment
				  liability is incurred.
(d) Payment
				  shall be made for only one recipient even though more than one recipient may
				  have been serviced during the unit of service.
(e) Requests for payments shall be submitted
				  on a form specified by the department and shall include the:
(1) Date of service;
(2) Recipient's name and identification
				  number;
(3) Name of the provider
				  and person who provided the service;
(4) Nature, procedure code, units of service;
				  and
(5) Place of service.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1738 - TARGETED CASE MANAGEMENT SERVICES › Subchapter 4 - INFANTS AND TODDLERS › Section 17-1738-30 - Funding for services

Current through June, 2024
Funding for targeted case management services is shared by
					 the federal and state governments. The State's share of the funds shall be met
					 by DOH.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1738 - TARGETED CASE MANAGEMENT SERVICES › Subchapter 4 - INFANTS AND TODDLERS › Section 17-1738-31 - Documentation requirements

Current through June, 2024
The provider shall be responsible for maintaining an
					 accurate and current written documentation in the recipient's case record of
					 services and activities, including but not limited to the following:
(1) Copies of IFSP developed through case
				  management;
(2) Copies of any
				  change or revisions to the IFSP as developed through a client and team meeting,
				  or otherwise with the consent of the recipient/guardian;
(3) Progress notes on objectives for which
				  the case manager has primary responsibility at the frequency called for in the
				  IFSP;
(4) Documentation of case
				  management activities designed to locate, refer, obtain, and coordinate
				  services outside and inside the agency, as needed by the individual whether for
				  placement in residential alternatives, day program, respite,
				  recreational/social activities, and other programs/services as appropriate and
				  needed;
(5) Copies of significant
				  correspondence concerning contacts within the past year with the
				  recipient/guardian, service providers, physicians, attorneys, state and federal
				  agencies, family members, and significant others in the recipient's
				  life;
(6) Correspondence or
				  memoranda concerning any significant events in the recipient's life which
				  required case management assistance; and
(7) Service logs to summarize monthly case
				  management activities on behalf of the recipient.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1738 - TARGETED CASE MANAGEMENT SERVICES › Subchapter 4 - INFANTS AND TODDLERS › Section 17-1738-34 - Termination of services

Current through June, 2024
Services shall be terminated when any of the following
					 occurs:
(1) The recipient is
				  determined ineligible for medical assistance;
(2) The recipient no longer meets the
				  requirement of section 17-1738-25(2);
(3) The recipient and the case manager
				  mutually decide that services are no longer necessary;
(4) The recipient refuses to continue
				  receiving services in the manner specified in the IFSP; or
(5) There has been no face-to-face contact
				  between the recipient and the case manager for ninety consecutive days unless
				  the recipient is institutionalized.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1738 - TARGETED CASE MANAGEMENT SERVICES › Subchapter 4 - INFANTS AND TODDLERS › Section 17-1738-35 - Appeals and hearings

Current through June, 2024
(a) The provider
				  shall be entitled to the appeal and hearing process in accordance with the
				  provisions of chapter 17-1736.
(b)
				  The applicant or recipient who is denied eligibility for medical assistance or
				  whose eligibility is terminated shall be entitled to the appeal and hearing
				  process in accordance with chapter 17-1703.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1739 - AUTHORIZATION, PAYMENT, AND CLAIMS IN THE FEE-FOR-SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 3 - PROSPECTIVE PAYMENT FOR ACUTE CARE SERVICES › Section 17-1739-54 - Provider participation requirements for acute care facilities

Current through June, 2024
medicaid reimbursement for acute care services shall be
					 limited to those facilities which have:
(1) Applied to and been approved by the
				  department of medicaid participation;
(2) Received certification or recertification
				  from the state department of health under federal standards in force;
(3) Been licensed by the state department of
				  health; and
(4) Entered into a
				  nontransferable provider agreement with the department for no more than twelve
				  months coterminous with the state department of health's certification
				  period.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1739 - AUTHORIZATION, PAYMENT, AND CLAIMS IN THE FEE-FOR-SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 3 - PROSPECTIVE PAYMENT FOR ACUTE CARE SERVICES › Section 17-1739-56 - Services included in the prospective payment rate

Current through June, 2024
The prospective payment rate shall include all services
					 provided in an acute inpatient setting except:
(1) Professional component including
				  physician services or any other professional fees excluded under Part A
				  Medicare;
(2) Ambulance;
				  and
(3) Durable medical equipment
				  that is a take home item except for implanted devices.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1739 - AUTHORIZATION, PAYMENT, AND CLAIMS IN THE FEE-FOR-SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 3 - PROSPECTIVE PAYMENT FOR ACUTE CARE SERVICES › Section 17-1739-57 - Preparation of data for prospective payment rate calculation

Current through June, 2024
(a) The calculation of prospective payment
				  rates shall be based on facility-specific claims and cost data. Cost data shall
				  be abstracted at the time the rate calculation begins from finally-settled
				  uniform cost reports submitted to the department by each participating provider
				  in accordance with federal medicaid requirements. Except for the
				  disproportionate share adjustment, the cost report used for each facility shall
				  be the facility's report which ended during the state fiscal year selected as
				  the base year. For the first year of the prospective payment system, cost data
				  shall be abstracted from the medicaid target amount computation (TAC) cost
				  report. This cost report incorporates the adjustments made solely for the
				  purpose of target amount determination in addition to adjustments made for
				  final settlement. Supplemental cost reporting forms submitted by providers
				  shall be used as necessary. Claims data shall be derived from claims submitted
				  by participating providers for medicaid reimbursement. For the initial
				  calculation of base year rates, claims from 1982 and 1983 facility fiscal years
				  paid by December 31, 1984 shall be considered base year claim data. For
				  subsequent calculation of rates by reference to a new base year, the latest
				  available claims data for a two fiscal year period shall be used. Claims that
				  are paid by December 31 of the year following the year in which the last fiscal
				  year included in the data collection effort ends shall be considered as paid in
				  the fiscal year when the service was rendered.
(b) Additional cost data supplied by
				  participating providers shall be utilized to update cost data only as specified
				  in this subchapter. For subsequent calculation of rates by reference to a new
				  base year, providers will be given an opportunity to submit cost data similar
				  in nature to that included in the TAC cost reports, excluding capital related
				  costs.
(c) An inflation factor
				  shall be based on the latest available actual (or estimated if actual is not
				  available) national index for acute care facilities prepared by Data Resources,
				  Inc. This factor shall project the change in the cost of delivering inpatient
				  hospital services from one year to the next. The inflation factor shall be
				  published annually by the department.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1739 - AUTHORIZATION, PAYMENT, AND CLAIMS IN THE FEE-FOR-SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 3 - PROSPECTIVE PAYMENT FOR ACUTE CARE SERVICES › Section 17-1739-58 - Classification of acute inpatient facilities

Current through June, 2024
(a) For purposes of
				  establishing prospective payment rates, acute inpatient facilities shall be
				  classified into the following four mutually exclusive groups:
(1) Classification I - facilities averaging
				  less than two hundred fifty medicaid discharges per year;
(2) Classification II - facilities averaging
				  two hundred fifty medicaid discharges per year or more, which do not
				  participate in approved intern and resident teaching programs;
(3) Classification III - facilities averaging
				  two hundred fifty medicaid discharges per year or more, which participate in
				  approved intern and resident teaching programs; and
(4) Classification IV - The freestanding
				  rehabilitation hospital.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1739 - AUTHORIZATION, PAYMENT, AND CLAIMS IN THE FEE-FOR-SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 3 - PROSPECTIVE PAYMENT FOR ACUTE CARE SERVICES › Section 17-1739-59 - Service category designations

Current through June, 2024
(a) Services
				  provided by acute inpatient facilities shall be classified into one of four
				  mutually exclusive service categories:
(1)
				  Maternity - an inpatient stay which results in a delivery with a maternity
				  principal or secondary diagnosis code;
(2) Surgical - an inpatient stay with the
				  following characteristics:
(A) The claim has
				  not been classified as a maternity claim;
(B) The claim includes a surgical code that
				  is considered to be an operating room procedure; and
(C) The claim includes both:
(i) A surgical date; and
(ii) An operating room charge;
(3) Psychiatric - an
				  inpatient stay with a psychiatric primary diagnosis code and with no operating
				  room charge; or
(4) Medical - an
				  inpatient stay not classified into one of the above three service
				  categories.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1739 - AUTHORIZATION, PAYMENT, AND CLAIMS IN THE FEE-FOR-SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 3 - PROSPECTIVE PAYMENT FOR ACUTE CARE SERVICES › Section 17-1739-60 - Prospective payment rate

Current through June, 2024
Prospective payment rates to inpatient hospitals providing
					 acute care services in accordance with sections
					 17-1737-3 and
					 17-1737-4 shall be established in
					 accordance with the methodology set forth in this subchapter.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1739 - AUTHORIZATION, PAYMENT, AND CLAIMS IN THE FEE-FOR-SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 3 - PROSPECTIVE PAYMENT FOR ACUTE CARE SERVICES › Section 17-1739-61 - Preparation of data for calculation of base year prospective payment rates

Current through June, 2024
(a) The department shall prepare data for the
				  calculation of base year rates using the following general
				  methodology.
(b) Base year claim
				  charge data shall be prepared in order to establish charge ratios used in the
				  payment calculation:
(1) Claim charge data
				  for all Medicare cross-over claims shall be considered based on dates of
				  discharge which correspond to each facility's fiscal year end;
(2) If more than one year of claim charge
				  data is used, the charges reflected on the earlier year's claims data shall be
				  inflated to the period covered by the most recent year's claims data in
				  accordance with section 17-1739-57(c);
(3) Claims shall be edited and properly
				  classified;
(4) Claim charge data
				  including charge amounts, days of care, and number of discharges, shall be
				  classified into the four service categories identified in section 17-1739-59.
				  Combined claims for the delivery of a normal newborn shall be counted as one
				  discharge in the calculation process. Claims for newborns described in section
				  17-1739-66(a)(5) shall be classified into the appropriate service
				  category;
(5) Claim charge data for
				  surgical, maternity, and medical claims in classifications II and III
				  facilities shall be segregated into routine, special care, and ancillary
				  service charges. Nursery charges shall be included in the routine
				  charges;
(6) Claim charge data
				  shall be adjusted in the case of classifications II and III facilities to
				  delete nonpsychiatric ancillary claim charges associated with claims in excess
				  of $35,000; and
(7) Claim charge
				  data shall be adjusted to delete ancillary charges for wait listed
				  patients.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1739 - AUTHORIZATION, PAYMENT, AND CLAIMS IN THE FEE-FOR-SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 3 - PROSPECTIVE PAYMENT FOR ACUTE CARE SERVICES › Section 17-1739-62 - Calculation of base prospective rates for psychiatric services

Current through June, 2024
(a) A base per diem rate for acute
				  psychiatric inpatient services shall be established for all inpatient
				  facilities using the following general methodology:
(1) Deduct the capital related costs
				  allocated to psychiatric services on the base year cost report;
(2) Establish facility-specific ratios from
				  claim charge data for psychiatric routine, special care, and ancillary charges
				  and days to total routine, special care, and ancillary charges and
				  days;
(3) Multiply the ratios in
				  paragraph (2) by total medicaid inpatient costs excluding capital related cost,
				  and days for routine, special care, and ancillary services to achieve total
				  psychiatric routine, special care, and ancillary medicaid inpatient costs and
				  days as derived from the cost report; and
(4) Total the resulting psychiatric costs and
				  days for routine, special care, and ancillary services and achieve a
				  facility-specific average medicaid psychiatric cost per day by dividing total
				  psychiatric medicaid inpatient costs by total psychiatric inpatient medicaid
				  days.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1739 - AUTHORIZATION, PAYMENT, AND CLAIMS IN THE FEE-FOR-SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 3 - PROSPECTIVE PAYMENT FOR ACUTE CARE SERVICES › Section 17-1739-63 - Calculation of base year prospective rates for classification I - nonpsychiatric services

Current through June, 2024
(a) A base per diem
				  rate for nonpsychiatric services for classification I facilities shall be
				  established using the following general methodology:
(1) Deduct the capital related costs
				  allocated to non-psychiatric services on the base year cost report;
(2) Calculate nonpsychiatric inpatient
				  medicaid facility costs and days for all facilities in classification I by
				  subtracting the facility's psychiatric costs and days for routine, special
				  care, and ancillary services as specified in section 17-1739-62 from the
				  facility's total allowable medicaid inpatient costs and days for routine,
				  special care, and ancillary services as derived from the cost report and as
				  calculated in section 17-1739-61; and
(3) Total the resulting costs, excluding
				  capital related costs, and days for routine, special care, and ancillary
				  services and achieve a facility-specific medicaid inpatient nonpsychiatric cost
				  per day by dividing total nonpsychiatric medicaid costs by total nonpsychiatric
				  inpatient medicaid days.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1739 - AUTHORIZATION, PAYMENT, AND CLAIMS IN THE FEE-FOR-SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 3 - PROSPECTIVE PAYMENT FOR ACUTE CARE SERVICES › Section 17-1739-64 - Calculation of base prospective rates for classifications II and III - nonpsychiatric services

Current through June, 2024
(a) The
				  facility-specific prospective payment base rates for nonpsychiatric services
				  rendered in facilities in classifications II and III shall be comprised of two
				  separately established rate components, one per diem rate for routine services
				  and one per discharge rate for ancillary services.
(b) The facility-specific base routine per
				  diem and per discharge ancillary rate for nonpsychiatric services for each
				  service category (maternity, surgical, and medical) shall be established using
				  the following general methodology:
(1) Deduct
				  the capital related costs allocated to nonpsychiatric services and ancillaries
				  on the base year cost report;
(2)
				  Determine separately for each service category the ratio of nonpsychiatric
				  claim charges, days, and discharges to total claim charges, days, and
				  discharges associated with routine, special care, and ancillary
				  components;
(3) Multiply the ratios
				  determined in paragraph (2) by total medicaid inpatient days, discharges and
				  costs, excluding capital related costs;
(4) Determine the routine per diem costs for
				  each service category by dividing the sum of routine and special care costs,
				  excluding capital related costs, by the sum of routine and special care days as
				  derived from the cost report; and
(5) Determine the facility ancillary cost per
				  discharge for each service category by dividing the ancillary service costs,
				  excluding capital related costs, by the discharges as derived from the cost
				  report.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1739 - AUTHORIZATION, PAYMENT, AND CLAIMS IN THE FEE-FOR-SERVICE MEDICAL ASSISTANCE PROGRAM › Subchapter 3 - PROSPECTIVE PAYMENT FOR ACUTE CARE SERVICES › Section 17-1739-65 - Addition of facility-specific factors

Current through June, 2024
(a) A facility's
				  payment rates as determined above shall be adjusted for facility-specific
				  factors, including capital, medical education, disproportionate share, and for
				  proprietary facilities, return on equity and gross excise tax. Adjustments
				  shall be calculated using the following general methodology.
(b) The interim capital adjustments shall be
				  determined according to the general procedures that are used to reimburse
				  providers for capital costs under Medicare, except that capital related costs
				  shall be reduced by ten per cent. At the option of the department, the
				  following procedure may be utilized:
(1) Each
				  facility shall identify its capital related costs associated with providing
				  acute care services. If a facility provides both acute and distinct part long
				  term care services, then only the capital related costs associated with acute
				  care shall be identified;
(2) Each
				  facility shall submit an estimate of its allowable capital related costs and
				  projected medicaid utilization for each PPS rate year. The projected medicaid
				  utilization shall be based upon the ratio of medicaid patient days to total
				  patient days;
(3) The department
				  shall review the estimates for reasonableness and determine an amount of
				  projected allowable capital related costs for each facility;
(4) For FY June 30, 1988, the projected
				  allowable capital related costs shall be reduced by seven per cent. For all
				  subsequent PPS fiscal years, the projected amount shall be reduced by ten per
				  cent;
(5) After the appropriate
				  reduction, the projected allowable capital related costs shall be divided by
				  twelve;
(6) The product of the
				  foregoing computation shall, at the department's option, be multiplied either
				  by the facility's projected medicaid utilization rate or by the facility's
				  actual medicaid utilization (based upon the ratio of medicaid patient days to
				  total patient days) reflected in the most recently filed cost report;
				  and
(7) The net result shall
				  constitute the interim capital component of the facility's PPS rate, which
				  shall be paid on a monthly basis throughout the fiscal year.