Hawaii Administrative Rules
Title 17 - DEPARTMENT OF HUMAN SERVICES
Department of Human Services
Chapter 1739.1 - AUTHORIZATION, PAYMENT, AND CLAIMS IN THE FEE-FOR-SERVICE MEDICAL ASSISTANCE PROGRAM FOR NON-INSTITUTIONAL SERVICES
Section 17-1739.1-8 - Medicaid payments for other noninstitutional items and services not included in the Medicaid fee schedule
Current through August, 2024
The following services shall be limited to billed charges not to exceed Medicare's upper limit of payment or the rate established by the department:
(1) Hearing aids;
(2) Home health agency services;
(3) Outpatient hospital services;
(4) Emergency room services;
(5) Frames for eyeglasses;
(6) Hearing devices shall be the actual claim charge or $300, whichever is lower. Exceptions may be made for special models or modifications.
(7) Clinic services (other than physician-based clinics); The types of clinics include government sponsored non-profit, and hospital-based clinics.
(8) Teaching physicians shall be paid to the teaching fund, not to the physician;
(9) Prescribed drugs shall be made as described in section 17-1739.1-11.
(10) The Hawaii Medicaid program shall not pay more than the billed amount for any noninstitutional item or service or more than the amount permitted by federal law or regulation; and
(11) Payments to a facility for non-emergency care rendered in an emergency room and to an emergency room physician for the screening and assessment of a patient who receives non-emergency care.
