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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:
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
HCBS Rate Study Background
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:
The 2023 Phase II Hawai’i HCBS Rate Study built upon the work completed under Phase I and included the following services:
Provider Survey
Reports
Presentations and other materials to reference
Please visit the QI memo page for the updated fee schedule and policy changes.
Contact Information
HCBS Rate Study Email (for other questions) | |
|---|---|
Fax | 808-692-8087 |
Mailing Address | Department of Human Services Med-QUEST Division Kapolei, Hawaii 96709-0190 |
Current Medicaid Fee-for-Service (FFS) Fee Schedule
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
2026
2025
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2022
2021
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:
Contact
For questions, or feedback on the proposed new APR DRG methodology, please email Eric Nouchi at MQD at
Home Health Rate Study Background
The State of Hawai`i Med-QUEST Division (MQD) is conducting a Home Health rate study for its Medicaid program. The project will provide better insight into the current costs associated with home health service delivery and staffing requirements. This work is in compliance with the Hawai`i State Legislature’s bill #HB713 passed in the 2025 session.
The 2025 Home Health Rate Study includes the following Home Health Services:
· Home Health Aide
· Nursing Services
· Physical Therapy
· Occupational Therapy
· Speech Therapy
The rate study will include a range of “comparison” payment rates for the legislature’s consideration. Any funding increases will need to be appropriated by the state legislature in order to be implemented. If approved, final comparison rates will be published for the use of providers and managed care organizations (MCOs) to consider when negotiating managed care contracts, and for MQD and other stakeholders to use when evaluating changes to overall funding.
Rate Study Reports and Presentations
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