Hawaii Administrative Rules
Title 17 - DEPARTMENT OF HUMAN SERVICES
Department of Human Services
Chapter 1735.2 - GENERAL PROVISIONS FOR PARTICIPATING HEALTH PLANS
Section 17-1735.2-4 - Requirements of participating health plans
Universal Citation: HI Admin Rules 17-1735.2-4
Current through November, 2024
(a) Health plans participating in the medical assistance program shall abide by the provisions of their respective contracts with the department as well as federal and state statutes and regulations.
(b) The requirements of each participating health plan shall include, but are not limited to, the following:
(1) Provision of
all services required by the contract between the respective plan and the
department;
(2) Provision of a
primary care provider for each eligible individual who is enrolled in the
health plan;
(3) Provision of a
case management system to ensure that health services identified by an eligible
individual's primary care provider as medically necessary are
received;
(4) Development and
maintenance of a sufficient network of health care providers to ensure the
provision of required health services are provide to an eligible individual in
a timely manner;
(5) Maintenance of
adequate support staff and systems to administer and conduct business
functions;
(6) Development and
maintenance of required information systems;
(7) Development and maintenance of a quality
assurance program;
(8) Development
and maintenance of a grievance and appeal system for a dissatisfied eligible
individual;
(9) Development and
maintenance of a toll-free telephone hotline in the State to confirm
enrollment, respond to inquiries from an eligible individual, and provide
information to the general public; and
(10) Maintenance of a medical records system
to enable the provision of information pertinent to the care and management of
an eligible individual to the department.
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