Hawaii Administrative Rules
Title 17 - DEPARTMENT OF HUMAN SERVICES
Department of Human Services
Chapter 1735.1 - GENERAL PROVISIONS FOR FEE FOR-SERVICE MEDICAL ASSISTANCE
Section 17-1735.1-2 - An individual covered under fee-for-service medical assistance
Universal Citation: HI Admin Rules 17-1735.1-2
Current through August, 2024
(a) An individual eligible for fee-for-service coverage under the medical assistance program includes, but is not limited to:
(1) A child in receipt of
foster care, kinship guardianship or adoption assistance, under age twenty-one
who is a resident of the State, and placed in another state as described in
chapter 17-1715;
(2) A non-citizen
ineligible for Medicaid assistance who receives emergency medical services as
described in chapter 17-1723.1;
(3)
An individual who enters the State of Hawaii Organ and Tissue Transplant
(SHOTT) program as described in chapter 17-1737;
(4) An incarcerated individual who is
admitted as an inpatient in a medical institution not on the grounds of the
incarceration facility;
(5) An
individual who receives a determination of eligibility on or after the start
date of a new health plan contract period that is retroactive to a date prior
to the start of the new health plan contract period with incurred services
during the period from the effective date of coverage up to the start date of
the new health plan contract period;
(6) A medically needy individual who is not
aged, blind or disabled as described in chapter 171730.1; or
(7) An individual who is eligible for the
Qualified Medicare Beneficiaries (QMB), Specified Low Income Medicare
Beneficiaries (SLMB), Qualified Disabled and Working Individuals (QDWI), or
Qualifying Individuals (QI) program described in chapter 17-1722.
(b) While enrolled in a participating health plan, an individual is excluded from the fee-for-service program, except for the following additional services that may be provided on a fee-for-service basis, subject to approval by the department:
(1) Services provided through the Medicaid
waiver program for an individual with developmental disabilities or
intellectual disabilities (DD-ID);
(2) ICF-ID institutional services;
(3) School-based health related
services;
(4) Early intervention
program services;
(5) Specialized
behavioral health services; and
(6)
Dental services as described in section 171737-75.
(c) The department shall determine on a case-by-case basis, whether an individual enrolled in a managed care program may have additional services covered on a fee-for-service basis.
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