Hawaii Administrative Rules
Title 17 - DEPARTMENT OF HUMAN SERVICES
Department of Human Services
Chapter 1736 - PROVIDER PROVISIONS
Subchapter 2 - PROVIDERS OF THE FEE FOR SERVICE PROGRAM
Section 17-1736-15 - Requirements for participation in the program by providers
Universal Citation: HI Admin Rules 17-1736-15
Current through August, 2024
(a) Except for payments authorized to out-of-state providers in emergency situations and to Qualified Medicare Beneficiaries (QMB) only providers, or as authorized under section 17-1736-13, payments under the medical assistance program for goods, care, and services shall be made only to providers approved by DHS to participate in the Hawaii medical assistance program.
(b) An individual, institution, or organization shall meet all of the following requirements in order to become and retain eligibility as a provider under the medical assistance program:
(1) The provider shall be licensed or
approved as follows:
(A) The provider, if an
individual, shall be licensed to practice the provider's profession in accord
with state law. Permits, temporary licenses, provisional licenses, expired or
unrenewed licenses, or any form of license or permit which requires supervision
of the licensee shall not serve to qualify the licensee as an approved provider
of service under the Hawaii medical assistance program;
(B) The provider, if a medical or health
related institution, shall be certified by the state department of health under
applicable public health rules of the state and standards of the federal
government. The following shall apply regarding Medicare certification for
participation in Medicaid:
(i) Hospitals are
required to be Medicare certified;
(ii) Facilities that provide SNF services are
required to be Medicare certified;
(iii) Facilities that provide SNF and ICF
services, but are not Medicare certified, may participate as an ICF;
and
(iv) Facilities that provide
ICF services only are unable to obtain Medicare certification, therefore,
participation as an ICF is allowed.
(C) The provider of any other health care
services shall comply with standards and all licensure, certification and other
requirements as applicable;
(2) The provider shall comply with the
non-discrimination provisions of Title VI of the Civil Rights Act of 1964 ( 42
U.S.C. §2000 d) by not discriminating against program beneficiaries on the
basis of race, color, national origin, or mental or physical handicap;
and
(3) The provider shall accept
Medicaid's established rates of payments whether based on DHS's fee schedule,
negotiated rate, reasonable cost reimbursement, or other adopted rates,
whichever is applicable, as payment in full for goods, care, or services
furnished. The provider shall not require any participation in payment by the
Medicaid recipient for goods, care, or services furnished by the provider. The
provider shall not demand or receive any additional payment from any Medicaid
recipient with the exception of the department's proviso for cost sharing of
medical care costs.
Disclaimer: These regulations may not be the most recent version. Hawaii may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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