Non-Discrimination and Language Assistance Notice
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

Non-Discrimination and Language Assistance Notice 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: Race Color National Origin Age Disability 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: Qualified interpreters 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 [email protected] 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) USHHS Discrimination Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html. Click here for assistance in other languages.

Early Periodic Screening, Diagnostic, & Treatment (EPSDT) for Medicaid-Enrolled Individuals Under 21 Years of Age Revised: October 2016 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. EPSDT provides: 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) Immunizations Vision/Hearing screening 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.

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).

2016 Annual Plan Change October 1-31, 2016 The Med-QUEST Division QUEST Integration Annual Plan Change (APC) choice period is October 1-31, 2016. The five (5) available health plans serving QUEST Integration members are AlohaCare, HMSA, Kaiser Permanente, �Ohana Health Plan, and UnitedHealthcare Community Plan. Kaiser Permanente serves the islands of Maui and Oahu. Kaiser Permanente met its enrollment limit and therefore is not offered as a choice at this time. Members currently enrolled in Kaiser Permanente can remain with the health plan. Your new health plan will take effect on January 1, 2017. 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, 2016 and fax have date/time stamp of October 31, 2016.�

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 [email protected]

Developmental Disability/Intellectual Disability (DD/ID) 1915 (c) HCBS Waiver The purpose of this posting is to provide public notice and elicit public input regarding proposed amendments to its current 1915(c) HCBS I/DD Waiver that serves individuals with developmental disabilities or intellectual disabilities who meet institutional level of care, and provided the choice to live in their own home or in the community with appropriate and quality supports designed to promote health, safety and independence. Public Notice details Proposed Rates details Public comments will be accepted for consideration from the date when this notice is published through February 3, 2017. Individuals may submit written comments using the following methods: By email: [email protected] (Please identify in the subject line: Waiver Amendment) By mail: Department of Health Developmental Disabilities Division Attention: Community Resources Branch Honolulu, Hawaii 96816 1915(c) I/DD Waiver Amendment 01 Submitted on February 28, 2017 1915(c) I/DD Waiver Amendment 01 DRAFT 1915(c) Letter of Approval Effective July 1, 2016 1915(c) HCB Services for People with Intellectual and Developmental Disabilities (I/DD Waiver) 1915(c) Public Comments

Latest updates on the My Choice My Way transition plan Hawai�i received Initial Approval for the My Choice My Way transition plan on January 13, 2017 New email address for the My Choice My Way questions or comments [email protected] Information on the transition plan can be found on the Med-QUEST website at http://www.med-quest.us/#hcbstran For the most updated information on the HCBS Final Rule, visit the Medicaid.gov website at https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Supports/Home-and-Community-Based-Services/Home-and-Community-Based-Services.html Statewide Transition Plan Hawai�i CMS Initial Approval Letter January 13, 2017 Transition Plan Amended January 13, 2017 Transition Plan Amended Submitted December 1, 2016 Transition Plan Amended Submitted May 11, 2016 Transition Plan Submitted March 9, 2015 State Systemic Assessment and Remediation Plan Waiver Specific Transition Plans 1115 Waiver- QUEST Integration 1915c Waiver- HCB Services for Persons with I/DD Provider Remediation Provider Compliance Matrix Residential Setting Analysis Tool Non-Residential Setting Analysis Tool Summary of provider compliance after survey and validation Provider Compliance List Provider Transition Plan Instructions and Template My Choice My Way Hawaii Big Tent Community Discussion Board Heightened Scrutiny State Heightened Scrutiny details CMS Heightened scrutiny details Public Notice and Comments Notice for Public Forum 2015 Notice for Public Forum 2016 Summary of 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: 808-692-8101 Fax: 808-692-8087 NEW Email: [email protected] Mailing Address: Department of Human Services Med-QUEST Division Attention: Health Care Services Branch P.O. Box 700190 Kapolei, Hawaii 96709-0190 Surveys Residential participant survey Residential provider survey Non-residential participant survey Non-residential provider survey Validation Residential validation tool Non-residential validation tool Summary of Validations Public Notifications Public notification 2015 Public notification 2016 Tribal consultation letter 2015 Tribal consultation letter 2016 Public Forum Public forum presentation January 14, 2015 Public forum presentation January 14, 2016 Information sessions Information session presentation 2016 Information session handout 2015 Information session presentation 2015 Information Session Presentation July 2016 Other My Choice My Way documents HCBS Final Rule Summary My Choice My Way

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.