The Med-QUEST Division QUEST Integration Annual Plan Change (APC) choice period is October 1-31, 2017. The five (5) available health plans serving QUEST Integration members are AlohaCare, HMSA, Kaiser Permanente, ‘Ohana Health Plan, and UnitedHealthcare Community Plan.
Kaiser Permanente QUEST Integration is ONLY available on O'ahu and Maui.
Your new health plan will take effect on January 1, 2018.
If you do not want to change your health plan, do not return the plan change form. You will remain in your same health plan as long as you remain eligible.
To make a health plan change, you have three (3) options:
Complete the Choice Form and Mail it to:
Med-QUEST Enrollment Services
P.O. Box 700190
Kapolei, Hawaii 96709-0190
Complete the Choice Form and Fax it to: 1-800-576-5504
Call Med-QUEST Enrollment Services Section at: 1-800-316-8005
Press 0 to speak with a call center representative.
Mail will need to be postmarked October 31, 2017 and fax have date/time stamp of October 31, 2017.
Department of Human Services/Med-QUEST Division complies with applicable Federal and state civil rights laws and does not discriminate, exclude people, or treat people differently because of:
Sex/gender (expression or identity)
Additional protected groups are covered under Hawaii Revised Statute.
Department of Human Services/Med-QUEST Division provides free aids and services to people with disabilities to communicate effectively with us, such as:
Qualified sign language interpreters
Written information in other formats (large print, audio, accessible electronic formats, other formats)
Department of Human Services/Med-QUEST Division provides free language services to people whose primary language is not English, such as:
Information written in other languages
If you need these services, contact Med-QUEST Division at 1-877-628-5076.
If you believe that Department of Human Services/Med-QUEST Division has discriminated in any way on the basis of race, color, national origin, age, disability, sex/gender (expression or identity) or any protected groups that are covered under Hawaii Revised Statute you may file a discrimination complaint with:
Geneva Watts, Civil Rights Compliance Officer
Queen Liliuokalani Bldg.
1390 Miller St., Rm 214 Honolulu, HI 96813
(808) 586-4955 Fax Number: 808-586-4990
You can file a discrimination complaint in person or by mail, fax, or email. DHS discrimination complaint and consent/release forms are available in 10 languages at http://humanservices.hawaii.gov in the Civil Rights Corner under forms.
You can also file a discrimination complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
U. S. Department of Health and Human Services
Office of Civil Rights, Pacific Region
90 7th Street, Suite 4-100
San Francisco, CA 94103-6705
Telephone: (415) 437-8324
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)
Medicaid-enrolled children under 21 years of age are eligible for EPSDT services. These medically necessary services, including behavior therapy for children, are provided at no cost to patient or family. The behavior therapies include intensive behavioral therapy for children with autism spectrum disorder (ASD) that include applied behavioral analysis (ABA) for the treatment of children with an autism spectrum disorder (ASD) diagnosis. For more information on EPSDT services and how you can get these benefits, please talk with your provider or the health plan you are enrolled in for help.
Preventative care for members from newborn through age 20
Complete medical, mental and behavioral health, and dental care
Services and medicines
Treatment for problems that are identified
Intensive Behavioral Therapies (e.g. Applied Behavioral Analysis (ABA) services for members with an Autism Spectrum Disorder (ASD) diagnosis.
EPSDT checkups include:
Complete physical exam
Lab tests (as needed)
Developmental/Behavioral and Mental health screening (as needed)
Referrals to specialists (as needed)
Oral (mouth) check
Prescription medications (as needed)
EPSDT is provided at no cost to you
Dental care is also covered for children under age 21
For help finding a dentist, call Community Case Management Corporation toll free at 1-888-792-1070.
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.
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
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).
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.
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.
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.
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).
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.
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:
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.
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 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
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.