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KOLEA DHS Medicaid Online (DMO) Upgrade Annual Plan Change Deadline
ICD-10 and ITOP Claims Update Intensive Behavioral Therapy (IBT)
Hawaii ICD-10 Implementation QUEST Integration Public Reporting
PERM QUEST Integration
Developmental Disability/Intellectual Disability (DD/ID) Hawaii HCBS Transition Plan HIPAA Privacy Notice MAGI Confidentiality
Recovery Audit Contractor (RAC) Bulletin
INFORMATION TO PROVIDERS FOR BILLING THE BREATHE NIOV™
Notice of the Current Approved 1115 Waiver Effective 1/1/2014
Pre-existing Condition Insurance Plan EHR Incentive Programs

KOLEA – On Line Eligibility Application

An easy and convenient way to apply for Medicaid, click here and you will be directed to our new secured Medicaid On - Line eligibility application (KOLEA).

Or for a fillable PDF Medical Assistance Application (DHS Form 1100), click here.

When you are ready to apply, create your personal user account and follow instructions on the screens.


DHS Medicaid Online (DMO) Upgrade

The Med-QUEST Division performed an upgrade to the DHS Medicaid Online (DMO). The upgrade is mostly esthetics but also includes the following:

  • New URL https://hiweb.statemedicaid.us, users are required to create a new account
  • Search for a record by clicking the appropriate radio button to display criteria
  • Menu bar, Member Eligibility Verification replaces Eligibility and Enrollment Status
  • Result screen will display navigational tabs at top of the screen

For providers that need help creating a new account or want to ask questions, call 952-5570 (Oahu) or 1-800-235-4378 (Neighbor Islands).


2015 Annual Plan Change Deadline Extended To October 30, 2015

The Med-QUEST Division extends the deadline for the 2015 QUEST Integration Annual Plan Change (APC) choice period to October 30, 2015. The division made the decision to extend the APC deadline after the telephone vendor reported it was experiencing equipment trouble October 14-16. This prevented the Med-QUEST call center from receiving telephone calls and APC plan change requests from clients.

The vendor successfully addressed the problem on October 17 and Med-QUEST call center is now able to receive calls.

QUEST Integration clients can submit their 2015 APC choice form using the business reply envelope enclosed in the open enrollment packet, fax the form to 1-800-576-5504, call 1-800-316-8005, or hand deliver to any MQD Eligibility office. Mail will need to be postmarked 10/30/15 and fax have date/time stamp of 10/30/15.

To find the office nearest you, click here.

OAHU SECTION
801 Dillingham Boulevard, 3rd Floor
Honolulu, HI 96817-4582

KAPOLEI UNIT
Kakuhihewa State Office Building
601 Kamokila Boulevard, Room 415
Kapolei, HI 96707-2021

EAST HAWAII SECTION
1404 Kilauea Avenue
Hilo, HI 96720

WEST HAWAII SECTION
Lanihau Professional Center
75-5591 Palani Road, Suite 3004
Kailua-Kona, HI 96740-3633

LANAI UNIT
730 Lanai Avenue
Lanai City, HI 96763

MAUI SECTION
Millyard Plaza
210 Imi Kala Street, Suite 101
Wailuku, HI 96793-1274

MOLOKAI UNIT
State Civic Center
65 Makaena Place, Room 110
Kaunakakai, HI 96748

KAUAI UNIT
4473 Pahee Street, Suite A
Lihue, HI 96766-2037


QUEST Integration Public Reporting

The Med-QUEST Division (MQD) is pleased to announce that the QUEST Integration public reporting information from January - June 2015 is now available. To access information on the performance of health plans participating in the QUEST Integration program, please click here.

January - March 2015 Public Summary Report

April - June 2015 Public Summary Report

July - September 2015 Public Summary Report

October - December 2015 Public Summary Report

The MQD thanks all that provided public input.


ICD-10 and ITOP Claims Update

The Med-QUEST Division (MQD) is issuing the following two memorandums on ICD-10 Conversion Guidelines and the Revised Guidelines for Submittal and Payment of Induced/Intentional Termination of Pregnancy (ITOP) Claims below. Please let us know if you have any questions by calling the provider hotline at 808-692-8099.


Link to ICD-10 Conversion Guidelines
Link to Revised Guidelines for ITOP Claims


Revised Memorandum that describes Coverage of Intensive Behavioral Therapy (IBT)

On August 28, 2015, the Department of Human Services, Med-QUEST Division (MQD) issued a revised memorandum that will replace QI-1504, FFS M15-03. The revised memorandum provides guidance regarding coverage of intensive behavioral therapy (IBT) that includes Applied Behavior Analysis (ABA) for the treatment of autism spectrum disorder (ASD).

Click here for a copy of the revised memorandum.

The MQD thanks all that provided public input.


Hawaii ICD-10 Implementation

Providers will need to use ICD-10 diagnosis codes for services provided to Medicaid beneficiaries on or after October 1, 2015. Med-QUEST Division (MQD) and the QUEST Integration health plans will not accept existing ICD-9 diagnoses codes for services delivered on or after October 1, 2015 – the new ICD-10 diagnoses codes MUST be used for these services. For more information, please click here.


PERM AUDIT FINDINGS

The Med-QUEST Division (MQD) was recently involved in the Centers for Medicare and Medicaid Services (CMS) Payment Error Rate Measurement (PERM) audit.
As a result of the audit, the PERM contractors found errors where medical records submitted for audit did not match the date of service submitted on the claim forms. If the documentation provided did not support the claim as billed, the claim was considered an error, which is subject to recovery by MQD. MQD is required to reimburse CMS for the identified payment errors and will be sending notification to providers to recover identified overpayments.
The audit also found providers not using their Social Security Number as their Tax Identification Number (TIN), were not submitting an Organization or Group NPI on their claim. MQD would like to remind providers the Organization/Group NPI is a requirement when submitting a claim to Medicaid.


QUEST Integration

Under the provision of Title 42, Section 431.420(c), of the Code of Federal Regulations, the State must hold a public forum to solicit comments on the progress of the demonstration project. Therefore, the Med-QUEST Division, hereby notifies the public that a post-award forum will be held to afford interested parties with an opportunity to provide meaningful comments on the progress of the demonstration. Please click on the link below for more details.

QUEST Integration Public Forum Flyer

QUEST Integration 1115 Waiver Public Forum

In lieu of joining the public forum in person or by VTC, written testimony may also be provided and must be received by the State from the date of publication of this notice through March 22, 2016 to:

Department of Human Services
Med-QUEST Division
Attention: Policy and Program Development Office
P.O Box 700190
Kapolei, Hawaii 96709-0190
or
quest_integration@dhs.hawaii.gov


Developmental Disability/Intellectual Disability (DD/ID) 1915 (c) HCBS Waiver


Latest updates on the My Choice My Way transition plan

Statewide Transition Plan

Waiver Specific Transition Plans

Provider Remediation

Heightened Scrutiny

Public comments

Public Input/Stakeholder Engagement
Public input will be ongoing. Public input is welcomed to the State Department of Human Services, Med-QUEST Division by:
NEW Telephone:808-692-8102
Fax:808-692-8087
NEW Email:mychoicemyway@dhs.hawaii.gov
Mailing Address: Department of Human Services Med-QUEST Division
Attention: Health Care Services Branch
P.O. Box 700190
Kapolei, Hawaii 96709-0190

Surveys

Validation

Public Notifications

Public Forum

Information sessions

Other My Choice My Way documents


HIPAA Privacy Notice (DHS 8030)

HIPAA Privacy Notice (DHS 8030) effective 11/01/2014 has been added to the MQD Forms webpage under HIPAA forms and notices. Click here to view.


Medicaid Eligibility Review for Modified Adjusted Gross Income (MAGI) Individuals

The Department of Human Services, Med-QUEST Division, is posting frequently asked questions regarding Medicaid eligibility review for MAGI individuals. Click here to view the FAQs.


Confidentiality

The federal “HITECH Act” requires all Health Insurance Portability and Accountability Act (HIPAA) covered entities to review and update policies relating to the protection of an individual’s personal and medical information. Please review the Department of Human Services latest Notice of Privacy Practices (NPP).

Click here for more information.


Recovery Audit Contractor (RAC) Bulletin

The State of Hawaii Med-QUEST Division is pleased to announce that Myers and Stauffer LC (Myers and Stauffer) has been selected to provide Recovery Audit Contractor Services, Click here for more information.


INFORMATION TO PROVIDERS FOR BILLING
THE BREATHE NIOV™

Medicaid will be following Medicare with regards to billing for the Non-invasive Open Ventilation System referred to as “Breathe NIOV™”. In order to insure that Medicaid does not pay for this miscellaneous code (E1399) Medicaid’s claims payment system has been set to require that any claims billed using a HCPCS code E1399 be medically reviewed. Below is Medicare’s Local Coverage Determination for this equipment:

Breathe NIOV™ - Coding Reminder - E1399 - DURABLE MEDICAL EQUIPMENT, MISCELLANEOUS

The Non-invasive OPEN Ventilation System (NIOV™) by Breathe Technologies, Inc. provides positive pressure inspiratory support for patients using oxygen. The correct HCPCS code to use for billing this item is:

E1399 - DURABLE MEDICAL EQUIPMENT, MISCELLANEOUS

Based on clinical data provided by the manufacturer, this item is effective only when used in conjunction with oxygen; therefore, it is classified as an accessory to oxygen equipment. Oxygen reimbursement is a bundled payment. All options, supplies and accessories are considered included in the monthly rental payment.

Note: Numerous sources, including the manufacturer materials and references in published clinical articles, use the term "ventilator" when discussing this device. For Medicare payment purposes, the NIOV™ device is NOT considered to be a ventilator or any other type of positive airway pressure device (CPAP, bi-level PAP, etc.). DMEPOS suppliers must not use HCPCS codes assigned to those products when submitting claims for the NIOV™ device.


Notice of the Current Approved 1115 Waiver Effective 1/1/2014

The State of Hawaii, Department of Human Services (the State), hereby notifies the public that it intends to seek a five-year renewal of its Section 1115 demonstration project from the Centers for Medicare & Medicaid Services (CMS). The State expects the current demonstration to expire on December 31, 2013.

Click here to view the Abbreviated Public Notice

Click here to view the Full Notice

Click below to view the Draft 1115 Application, Quality Assurance Monitoring Info, Behavioral Health Protocol, Behavioral Health Addendums A,B,C, & D

Click here to view the Draft 1115 Application
Click here to view the Quality Assurance Monitoring Info
Click here to view the Behavioral Health Protocol
Click here to view the Behavioral Health Addendum A
Click here to view the Behavioral Health Addendum B
Click here to view the Behavioral Health Addendum C
Click here to view the Behavioral Health Addendum D

Click here to view the Budget Neutrality (BN)

Click here to view the Current Approved 1115 Waiver (Eff. 6-14-12)
Click here to view the Complete Revised and Submitted 1115 Application


Pre-existing Condition Insurance Plan (PCIP)

The Affordable Care Act, PCIP provides health care coverage for uninsured people with pre-existing conditions until new insurance market rules go into effect in 2014. PCIP is provided through the U.S. Department of Health and Human Services and administered through the Office of Personnel Management. More information is available at: www.healthcare.gov

Additional information relating to PCIP is available through the Government Employee Health Association (GEHA). GEHA currently administers PCIP in 20 states.

GEHA website: www.pciplan.com


Med-QUEST Electronic Health Record (EHR) Incentive Program

The Department of Human Services, Med-QUEST Division is planning the Med-QUEST Electronic Health Record (EHR) Incentive Program, click here for more information.



   
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