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Human Services Hawaii.gov

Fee Schedules

Click on the tabs below to view the fee schedules.

Applied Behavior Analysis (ABA) Rate Study Background

The State of Hawai`i Med-QUEST Division (MQD) conducted an Applied Behavior Analysis (ABA) rate study for its Medicaid program. This work is in compliance with the Hawai`i State Legislature’s House Resolution #207 passed in 2023.The project provides insight into the current costs associated with ABA service delivery and staffing requirements. 

The 2023 ABA Rate Study includes the following ABA Services:

  • Behavior Identification Assessment
  • Behavior Identification Supporting Assessment
  • Direct Treatment by Protocol
  • Group Treatment by Protocol
  • Direct Treatment with Protocol Modification
  • Family Training
  • Multiple-Family Training
  • Group Treatment with Protocol Modification
  • Direct Treatment of Severe Maladaptive Behavior

The rate study includes­­­ a range for “comparison” payment rates for MQD and legislature’s consideration. Any funding increases will need to be appropriated by the state legislature to be implemented. If approved, final comparison rates will be published for the use of providers and MCOs to consider when negotiating managed care contracts, and for MQD and other stakeholders to use when evaluating changes to overall funding.

Timeline

9/25/2023: ABA Rate Study Stakeholder Kick off meeting Recording | Slide deck

9/28/2023: ABA Rate Study Provider Survey meeting. Recording

DUE 11/06/2023 ABA Rate Study Provider Survey

11/7/2023: ABA Stakeholder Meeting #2 Recording | Slide deck.

12/4/2023: ABA Rate Study Meeting #3 Recording | Slide deck

12/21/2023: HI ABA Rate Study

10/30/2024: ABA Rate Study Meeting #4

Current ABA policy and FFS rates.

 

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:

  • Case Management Agency
  • Community Care Foster Family Home
  • Expanded Adult Residential Care Home
  • Homemaker/Companion/Chore (PA1)
  • Personal Care/Personal Assistance/Attendant Care (PA2)
  • Private Duty Nursing (RN and LPN)
  • Self-Directed Personal Assistance

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:

  • Adult Day Care
  • Adult Day Health
  • Assisted Living Facilities
  • Home Delivered Meals
  • Level 3 for Residential Services (CCFFH/EARCH-1) and CCMA services
  • Overnight Respite Care  

Survey Tools

 

Reports

  • HI Phase II HCBS Rate Study Report 20240110 - PDF
  • SR4 SD1 Rate Study Report to the Thirty-Second Hawaii State Legislature 2023 – PDF
  • HI HCBS Rate Study Report 20221230 – PDF

Presentations

  • Phase II HCBS Cost and Wage Survey for ADC/ADH Training 05/15/23 – Recording
  • Phase II HI HCBS Rate Study Phase II Assisted Living Facilities Presentation 04/26/23 – PDF
  • Phase II HCBS Rate Study Kick-off Presentation 03/08/2023 – PDF
  • Phase I Hawaii HCBS Rate Study Presentation 2/14/23 – PDF
  • Phase I HCBS Cost and Wage Survey Training Presentation 9/28/22 – PDF
    • Phase I HCBS Cost and Wage Survey Training - Recording
  • Phase I HCBS Rate Study Kick-off Meeting 7/15/2022 - PDF
    • Phase I HCBS Rate Study Kick-off Webinar 7/15/22 - Recording

Timeline

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

Contact Information:

HCBS Rate Study Email (for other questions): 

[email protected]

Please add “HCBS Rate Study” to the email Subject line

Fax: 

808-692-8087

Mailing Address: 

Department of Human Services Med-QUEST Division
Attention: Health Care Services Branch

P.O. Box 700190
Kapolei, Hawaii 96709-0190

Current Medicaid Fee-for-Service (FFS) Fee Schedule

Medicaid Fee Schedule Disclaimer:

The fee schedule is based on Medicare’s previous year’s schedule and does not apply to all provider types. For a list of eligible provider types, refer to MQD Memo QI-2341. Fees for certain provider types may be lower than those shown on the fee schedule if the provider type is not listed in MQD Memo QI-2341.

A fee of $0.00 on the fee schedule for any code does not necessarily mean that the code is not covered by Hawaii’s Medicaid program. For current coverage information, please contact the QI (QUEST Integration) health plan in which you participate.

If you have questions regarding coverage or fees under the Medicaid Fee-For-Service (FFS) program, contact the Conduent Call Center at (800) 235-4378 or (808) 952-5570, or email  [email protected].

The Medicaid Fee Schedule may change without notice.

Archive

2021 Medicaid Fee Schedule

2020 Medicaid Fee Schedule

2013 Medicaid Fee Schedule

State of Hawai`i Department of Human Services Med-QUEST Division

Inpatient All Patient Refined Diagnosis Related Group (APR DRG) Payment Methodology

Overview

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

Resources

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

Hawai’i January 2024 DRG Calculator v.1.0

MQD APR DRG Answers to FAQs – February 10, 2021

MQD Hospital Stakeholder APR DRG Presentation – April 5, 2021

Contact

For questions or feedback on the proposed new APR DRG methodology, please email Eric Nouchi at MQD at [email protected].  

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