Click on the tabs below to view the fee schedules.
HCBS Rate Study Background
MQD is conducting HCBS Provider Cost and Wages Surveys to collect data from HCBS Providers participating in the QUEST Integration (QI) Program.
The 2022 Phase I HCBS Rate Study focused on the following highly utilized services included in the MQD American Rescue Plan Act of 2021 (ARPA) spending plan:
Currently, the 2023 Phase II Hawai’i HCBS Rate Study will build upon the work completed under Phase I and will include the following services:
HCBS Cost and Wage Survey for ADC/ADH is due on MAY 26, 2023.
HCBS Cost and Wage Survey for ADC/ADH Training 05/15/23 – Recording
05/18/2023 - Phase II HCBS Rate Study Stakeholder Meeting for CCFFH/E-ARCH Providers
04/27/2023 – Phase II HCBS Rate Study Stakeholder Meeting for CCMA Providers
04/26/2023 – Phase II HCBS Rate Study Stakeholder Meeting for ALFs and Home-Delivered Meals
04/25/2023 – Phase II HCBS Rate Study Stakeholder Meeting for ADHs and ADCs
03/08/2023 – Phase II HCBS Rate Study Kick-off Meeting
02/14/2023 – Phase I HCBS Rate Study Final Stakeholder Meeting
12/30/2022 – Phase I HCBS Rate Study Final Report delivered
07/15/2022 – Phase I HCBS Rate Study Kick-off Meeting
HCBS Rate Study Email (for other questions):
Department of Human Services Med-QUEST Division
P.O. Box 700190
Current Medicaid Fee-for-Service (FFS) Fee Schedule
Medicaid Fee Schedule Disclaimer:
A zero ($0.00) payment listed on this fee schedule for any code does not mean that the code is not covered by Hawaii's Medicaid program. Please contact the QI (QUEST Integration) health plan in which you participate for current coverage information. If you are calling for information on coverage by the Medicaid Fee-For-Services (FFS) program, please contact the Conduent Call Center at (800) 235-4378 or (808) 952- 5570 or email your inquiry to [email protected].
The Medicaid Fee Schedule may change without notice.
State of Hawai`i Department of Human Services Med-QUEST Division
Inpatient All Patient Refined Diagnosis Related Group (APR DRG) Payment Methodology
Med-QUEST (MQD) implemented a new All Patient Refined Diagnosis Related Group (APR DRG) payment methodology for Medicaid fee-for-service (FFS) inpatient payment purposes for admissions beginning July 1, 2022. APR DRGs are a patient classification system developed by 3M™ and used by payers and providers to classify hospital inpatient stays into clinically meaningful diagnostic groups with similar average resource requirements. APR DRGs provide a mechanism for healthcare payers to make a single case rate payment for similar services provided in a hospital inpatient stay.
MQD's new inpatient APR DRG methodology is applicable to in-state general acute hospitals and children’s hospitals, excluding Critical Access Hospitals, freestanding rehabilitation hospitals, freestanding psychiatric hospitals, long-term acute care hospitals, military hospitals, Veterans Association hospitals, out-of-state hospitals, and State of Hawaii Organ and Tissue Transplant (SHOTT) services. MQD has directed the Medicaid Managed Care Organizations (MCOs) to pay applicable hospitals under this new APR DRG methodology and rates.
MQD has several goals and objectives for the new APR DRG payment methodology, consistent with its QUEST Demonstration goals to promote access, efficient utilization, stabilizing costs, and transforming service delivery. These goals and objectives include the following:
· Establish standardized payment benchmark
· Provide acuity measurement
· Promote equitability across providers
· Incentivize efficient delivery of care
· Enable state control of expenditures
For more information on MQD’s new APR DRG methodology, please refer to the following resources:
Approved SPA 21-0011-Attachment 4.19-A pages related to APR-DRG
MQD APR DRG QI-2211 Memo - July 1, 2022
Milliman Report “Hawai`i Proposed APR DRG Payment Model” – June 14, 2021
Hawai`i July 2022 DRG Calculator – v1.6
Hawai'i January 2023 DRG Calculator - v1.1
MQD APR DRG Answers to FAQs – February 10, 2021
MQD Hospital Stakeholder APR DRG Presentation – April 5, 2021
For questions or feedback on the proposed new APR DRG methodology, please email Eric Nouchi at MQD at [email protected].