Pursuant to sections 91-3 and 92-41, Hawaii Revised Statutes, notice is hereby given that the Department of Human Services will hold a public hearing to consider proposed amendments to existing rules, and the adoption of new rules of the Med-QUEST Division for the purpose of conforming to State and Federal Statutes.

The proposed amendments are based on State and Federal laws. Brief descriptions of the proposed changes are listed below.

CHAPTER 17-1714 – GENERAL ELIGIBILITY REQUIREMENTS.

§17-1714-2, Definitions. This section is amended to add the definitions of “DRA” and “U.S.”

§17-1714-4, Determination of identity. This section is amended to state that documentary evidence must be provided by all applicants and recipients as required under the Deficit Reduction Act (DRA) of 2005 with the exception of those who are exempt from providing identity documentation, and expands the list of acceptable identity documentation.

§17-1714-23, Eligibility requirements for residents of public institutions. Subsection (e) is amended for housekeeping purposes to state that an inmate of a public institution who is age sixty-five or older, or under age sixty-five and meets the categorical eligibility requirements for a blind or disabled individual, a pregnant woman, or an individual under age nineteen years of age, may be eligible, provided all other requirements are met, for inpatient services that are provided in a medical institution that is not located on the ground of the public institution.

§17-1714-30, Declaration of citizenship and alienage. Subsection (a) is amended as a requirement of the DRA to state that the department shall document each individual’s U.S. citizenship or nationality.

§17-1714-31, Documentation of citizenship. This section is amended to state that the department shall request satisfactory documentation of citizenship with the exception of those individuals who are exempt from providing citizenship documentation; provides a list of acceptable citizenship documentation; and states that the Department shall not delay assistance to the family due to the lack of citizenship verification of an individual if the rest of the family meets all other eligibility requirements.

CHAPTER 17-1722 – SPECIAL MEDICAL ASSISTANCE COVERAGES AND PROGRAMS
A new subchapter 13 provides the requirements for the provision of medical coverage to an individual who is receiving Social Security benefits as a disabled adult child. Individuals who meet the requirements of this subchapter shall be categorically eligible for medical assistance.

CHAPTER 17-1723 – MEDICAL ASSISTANCE TO ALIENS AND REFUGEES

§17-1723-5.1, Categorical requirements for the Title IV related medical assistance. Subsection (b) paragraph (2) is amended by inserting “consecutive” to clarify the time frame to be thirty consecutive days. Subsection (d) is amended by adding a new paragraph (1) to state that persons age sixty-five and older are ineligible for Title IV-related medical assistance and adding a new paragraph (3) to state that, “Persons who are age nineteen and older but under age sixty-five and are not a specified relative as described in this section. Paragraph (4) is amended by replacing “eighteen” with “nineteen” and adding a provision to state that paragraph (4) does not apply to a pregnant woman. Paragraphs have been renumbered.

CHAPTER 17-1725 – ASSETS

§17-1725-20, Equity value of real property. This section is amended to list the variables that must be taken into consideration when determining the fair market value of a property, and to list acceptable sources of verification of that value.

§17-1725-21, Treatment of some special forms of ownership of real or personal property.
This section is amended to specify the methodology for determining the fair market value of a property where the property is held in joint tenancy or tenancy in common. In addition, co-owned property may be exempted as an asset if the sale of the property would deprive a co-owner of their only place of residence.

CHAPTER 17-1727 – HAWAII HEALTH QUEST

§17-1727-13, Categorical requirements. Paragraph (3) is amended to replace “eighteen” with “nineteen” and to include pregnant women as those who may be employed, and receive or are eligible to receive employer-sponsored health care coverage through their employer.

§17-1727-42, Enrollees with premium-shares. This section is repealed.

§17-1727-50, Dental services. Subsection (a) is amended to address the coverage of dental services for individuals under age twenty-one in accordance to §17-1737-75. Subsection (c) is amended to reflect the dental benefits available to individuals twenty-one years and older in accordance with §17-1737-75.1

CHAPTER 17-1728 – QUEST-NET

§17-1728-8, Categorical eligibility requirements. Subsection (b)(5) is amended to allow an employed person who is under age nineteen to have employer-sponsored medical coverage available.

§17-1728-9, Financial eligibility requirements. Subsection (a) is amended to subject only persons who are age nineteen or older to the QUEST-Net assets test.

§17-1728-19, Medical service not available to adults in QUEST-Net. This section is amended to remove the reference to dental services and funeral payment services from the list of medical services not available in the QUEST-Net program. Paragraphs (16) through (51) are renumbered as paragraphs (15) through (49), respectively.

§17-1728-20, Dental services for adults in QUEST-Net. Subsections (a) is
amended to reflect the dental benefits allowed to individuals age twenty-one and older in accordance to §17-1737-75.1. Subsection (b) is amended to state an individual age twenty-one and older in QUEST-Net shall receive dental treatment on a fee-for-service basis.

§17-1728-26, Financial responsibility of adult enrollees. Subsections (c) and (d) are amended to assess premium-share for an adult enrollee with income that exceeds two hundred per cent of the Federal Poverty Level (FPL) and to delete specific references to self-employed adults and their spouses. Subsection (e) is repealed. Subsection (f) is renumbered (e).

§17-1728-32, Purpose. This section is amended to delete “financial responsibility of enrollees for coverage of health care costs” for children who are eligible to participate in QUEST-Net.

§17-1728-34.1, Initial enrollment in QUEST-Net for children who are not blind or disabled. This section is amended to delete premium-share provisions. Subsections (c), (e), and (h) are repealed. Subsections (d) through (n) renumbered (c) through (k).

§17-1728-36, Financial responsibility of child enrollees. This section is repealed.

§17-1728-41, Purpose. This section is amended to delete “financial responsibility of enrollees for coverage of health care costs” for blind and disabled children who are eligible to participate in QUEST-Net.

§17-1728-45, Financial responsibilities of blind and disabled children in QUEST-Net. This section is repealed.

CHAPTER 17-1728.1 – QUEST-ADULT COVERAGE EXPANSION (ACE)

§17-1728.1-1, Purpose. This section is amended to state that QUEST-ACE program provides medical benefits to adults who are not enrolled or eligible to be enrolled in a health plan.

§17-1728.1-2, Definitions. This section is amended to add the definition of “Adult”, and to delete the definitions of “Childless adult”, “Dependent child” and “Premium-share”.

§17-1728.1-12, Basic eligibility requirements. This section is amended to delete “childless” from the basic eligibility of the QUEST-ACE program.

§17-1728.1-13, Categorical eligibility requirements. This section is amended to state that an individual who is eligible to participate in QUEST-ACE shall be: (1) age nineteen and older; (2) not enrolled or covered by a health plan; (3) not entitled for coverage by an employer sponsored health plan, with the exception of a financial assistance recipient and a person who is participating in the department’s grant diversion or supporting employment empowerment programs; and (4) not entitled to or enrolled in Medicare; or (5) unable to enroll in QUEST due to the limitations of the statewide enrollment.

§17-1728.1-14, Financial eligibility requirements. Subsection (a) is amended to state the countable asset standards of the QUEST-ACE program. Subsection (b) is amended to state that an individual who is not aged, blind or disabled and has countable income that exceeds the financial assistance payment standard and is equal to or below two hundred per cent of FPL shall be eligible for QUEST-ACE. Subsections (c) and (d) are added to state the income standards for an individual who is aged or disabled and an individual who is blind.

§17-1728.1-22, Standard benefits package. A new subsection (c) is added as a housekeeping measure to state that benefits provided under the QUEST standard benefits package for an individual under age twenty-one as described in chapter 17-1727 shall be provided for an individual under age twenty-one in QUEST-ACE.

§17-1728.1-25, Medical services not available in QUEST-ACE. This section is amended to remove the reference to dental services and funeral payment services from the list of medical services not available in the QUEST-ACE program. Paragraphs (16) through (51) are renumbered as paragraphs (15) through (49), respectively.

§17-1728.1-26, Dental services in QUEST-ACE. Subsections (a) and (b) are amended to reflect the dental benefits allowed to individuals twenty-one years and older shall be provided in accordance to §17-1737-75.1, and for an individual under age twenty-one, dental benefits are provided in accordance to §17-1737-75. Subsection (c) is added to state that all dental services required under the federally mandated Early and Periodic Screening, Diagnosis, and Treatment program for an individual under the age of twenty-one shall be provided by a participating dentist. Subsection (d) is added to state that the dental services described in subsections (a) through (c) shall be provided on a fee for service basis.

§17-1728.1-37, Coverage of QUEST-ACE eligibles prior to the date of enrollment. Subsection (b) is amended by adding a new paragraph (3) to allow a five calendar day period prior to the date of applications as the eligible date of coverage if appropriate emergency room or hospital expenses, in accordance to this chapter, were incurred. Subsection (c) is amended to state that the provisions of the fee for service program that apply from the date of eligibility to the date of enrollment shall be limited to the QUEST-ACE benefits.

§17-1728.1-40, Financial responsibility of enrollees. This section is repealed.

§17-1728.1-41, Disenrollment from QUEST-ACE plans. Subsection (c) paragraph (1) is deleted because the financial responsibility of self-employed enrollees has been removed. Paragraphs (2) through (4) are renumbered (1) through (3), respectively.

CHAPTER 17-1730 – QUEST-SPENDDOWN PROGRAM:

§17-1730-2, Definitions. The definition of “standard of assistance” is amended by inserting “a State need standard, expressed in”. The amendment will be consistent with the term used in Chapter 17-1721.

§17-1730-8, Categorical eligibility requirements. This section is amended by amending subsection (b) paragraph (2) by inserting “consecutive” immediately after “thirty”. Subsection (d) is amended by adding a new paragraph (3) to read, “Persons who are age nineteen and older but under age sixty-five and do not meet the provisions of a specified relative as described in this section”; Paragraph (4) is amended by replacing “eighteen” with “nineteen” and state that paragraph (4) does not apply to a pregnant woman. Paragraphs have been renumbered due to the new paragraphs added.

A public hearing will be held at the following time and place:

Tuesday, January 20, 2009, 1:30 p.m., Liliuokalani Building, 1390 Miller Street, 2nd Floor Conference Rooms, Honolulu, Hawaii.

All interested parties are invited to attend the hearing and to state their views relative to the proposed rules either orally or in writing. Should written testimony be presented, five (5) copies shall be made available to the presiding officer at or before the public hearing to:

Department of Human Services
Med-QUEST Division
P. O. Box 700190
Kapolei, Hawaii 96709-0190

Residents of Hawaii, Kauai, Maui, and Molokai wishing to present oral testimonies may also contact the Med-QUEST Division on the respective islands no earlier than seven (7) days before the Honolulu hearing date to have their testimony recorded:

East Hawaii Section
88 Kanoelehua Avenue, Room 107
Hilo, Hawaii 96720 (933-0339)

West Hawaii Section
Lanihau Professional Center
75-5591 Palani Road, Ste. 3004
Kailua-Kona, Hawaii 96740 (327-4970)

Kauai Section
4473 Pahee Street, Suite A
Lihue, Hawaii 96766 (241-3575)

Maui Section
210 Imi Kala Street, Suite 101
Wailuku, Hawaii 96793 (243-5780)

Molokai Section
State Civic Center
65 Makaena Street, Room 110
Kaunakakai, Hawaii 96748 (553-1758)

Lanai Unit
Call toll free 1-800-894-5755

A copy of the proposed rules will be mailed at NO COST to any interested person by requesting a copy by writing to:

Department of Human Services
Med-QUEST Division
P. O. Box 700190
Kapolei, Hawaii 96709-0190

or by calling 692-8132. Neighbor island residents may request a copy of the proposed rules at NO COST by contacting the Med-QUEST Division Sections as noted above.

A copy of the proposed rule changes will be available for public viewing from the first working day that the legal notice appears in the Honolulu Star Bulletin, The Honolulu Advertiser, Hawaii Tribune Herald, West Hawaii Today, The Maui News, and The Garden Island, through the day the public hearing is held, from Monday – Friday between the hours of 7:45 a.m. to 4:30 p.m. at the appropriate Med-QUEST Division offices on their respective islands listed above. On Oahu, the proposed rules will be available at 601 Kamokila Boulevard, Room 518, Kapolei, Hawaii 96707 and 801 Dillingham Boulevard, 3rd Floor, Honolulu, Hawaii 96817.

Proposed rules are also available at the Virtual Rules Center located at the following website:

http://www.hawaii.gov/dhs/main/har/

Special accommodations (i.e. Sign Language Interpreter, large print, taped materials, or accessible parking) can be made, if requested at least seven (7) working days before the scheduled public hearing on Oahu by calling 692-8132. Neighbor island residents needing special accommodations should contact the Med-QUEST Division Sections on the respective islands with their requests.