Specific Provisions Covering Public

HRS div. 1, tit. 20, ch. 346, pt. II

in effect

HRS §346-51.5 Expenditure of temporary assistance for needy families funds

346-51.5. Expenditure of temporary assistance for needy families funds (a) Funds received by the State under the temporary assistance for needy families program block grant shall be subject to appropriation by the legislature and shall not be expended by the department without a legislative appropriation. (b) No later than thirty days before the convening of each regular session, the department shall submit to the legislature: (1) A plan, developed in consultation with temporary assistance for needy families program heads of households and other community members familiar with such families' situations and needs, that: (A) Details how the funds received under the temporary assistance for needy families program shall be expended; and (B) Describes the desired outcomes from the expenditure of the funds; (2) A report about the continuing strategic planning process, with the assistance of the financial assistance advisory council, to: (A) Involve the community in planning for the future use of temporary assistance for needy families funds; and (B) Set annual goals and outcomes for existing and new programs receiving temporary assistance for needy families funds, pursuant to section 346-14.5; and (3) A report on the effectiveness and level of success in reaching the desired outcomes under: (A) Paragraphs (1) and (2); and (B) Programs from the previous two fiscal years using temporary assistance for needy families funds. (c) During the interim following the regular session of 2006 and thereafter when the legislature is not in session, the department may receive and expend federal funds related to the temporary assistance for needy families program pursuant to [section] 346-8, subject to approval by the governor, which are supplemental to the temporary assistance for needy families block grant or are obtained competitively under the temporary assistance for needy families program. The department shall submit to the legislature a report no later than twenty days before the convening of each regular session regarding: (1) Any funds received and expended; (2) The purposes for which the funds were expended; and (3) Outcomes achieved, pursuant to this section. [L 2006, c 302, §1]

HRS §346-52 Aged, blind, and permanently and totally disabled persons; eligibility for assistance

346-52. Aged, blind, and permanently and totally disabled persons; eligibility for assistance A person shall be eligible for public assistance who meets the requirements established by the federal supplemental security income program or its successor agency, provided the person is also determined needy in accordance with state standards. [L 1975, c 145, pt of §1(3); gen ch 1985]

HRS §346-53 Determination of amount of assistance

346-53. Determination of amount of assistance (a) This subsection does not apply to general assistance to households without minor dependents. The standard of need shall equal the poverty level established by the federal government in 2006, prorated over a twelve-month period based on family size. The assistance allowance provided shall be based on a percentage of the standard of need. For other work eligible households and non-work eligible households and households in which all caretaker relatives are minors, living independently with minor dependents and attending school, the assistance allowance shall be set no higher than sixty-two and one-half per cent and no lower than forty-four per cent of the standard of need. For all other households, the assistance allowance shall be set no higher than sixty-two and one-half per cent of the standard of need and set no lower than thirty-four per cent of the standard of need. The standard of need shall be determined by dividing the 2006 federal poverty level by twelve and rounding down the quotient. The remaining quotient shall be multiplied by the per cent as set by the director by rules pursuant to chapter 91, and the final product shall be rounded down to determine the assistance allowance; provided that: (1) The department may increase or reduce the assistance allowance as determined in this subsection for work eligible households for the purpose of providing work incentives or services under part XI; (2) No reduction shall be allowed that jeopardizes eligibility for or receipt of federal funds; (3) Reductions in the assistance allowance shall be limited to no more than one per year; and (4) No work eligible household, which includes an adult who has received sixty cumulative months of temporary assistance to needy families with minor dependents, shall be eligible for an assistance allowance, unless authorized by federal regulations. (b) The director shall determine the allowance for general assistance to households without minor dependents based upon the total amount appropriated for general assistance to households without minor dependents, among other relevant factors. (c) The director, pursuant to chapter 91, shall determine the rate of payment for domiciliary care, including care provided in licensed developmental disabilities domiciliary homes, community care foster family homes, and certified adult foster homes, to be provided to recipients who are eligible for federal supplemental security income or public assistance, or both. The director shall provide for level of care payment and needs allowance as follows: (1) For adult residential care homes classified as facility type I, licensed developmental disabilities domiciliary homes as defined under section 321-15.9, community care foster family homes as defined under section 321-481, and certified adult foster homes as defined under section 321-11.2, the state supplemental payment, which includes the care rate and needs allowance, shall not exceed $829; and (2) For adult residential care homes classified as facility type II, the state supplemental payment, which includes the care rate and needs allowance, shall not exceed $937. If the operator does not provide the quality of care consistent with the needs of the individual to the satisfaction of the department, the department may remove the recipient to another facility. The department shall handle abusive practices under this section in accordance with chapter 91. Nothing in this subsection shall allow the director to remove a recipient from an adult residential care home or other similar institution if the recipient does not desire to be removed and the operator is agreeable to the recipient remaining, except where the recipient requires a higher level of care than provided or where the recipient no longer requires any domiciliary care. (d) On July 1, 2006, and thereafter, as the department determines a need, the department shall authorize a payment, as allowed by federal law, for resident clients receiving supplemental security income in adult residential care home type I and type II facilities, licensed developmental disabilities domiciliary homes as defined under section 321-15.9, community care foster family homes as defined under section 321-481, and certified adult foster homes as defined under section 321-11.2, when state funds appropriated for the purpose of providing payments under subsection (c) for a specific fiscal year are not expended fully within a period that meets the requirements of the department's maintenance of effort agreement with the Social Security Administration. The payment shall be made with that portion of state funds identified in this subsection that has not been expended. The department shall determine the rate of payment to ensure compliance with its maintenance of effort agreement with the Social Security Administration. (e) The department shall pay rental and utility (to include gas, electricity, and water only) deposits once only for any person eligible for financial assistance by the department. However, under extraordinary circumstances as determined by the department, an additional rental deposit, utility deposit, or both, may be granted. (f) Any recipient may petition the department for additional assistance when the recipient's need is due to emergencies caused by seismic wave, tsunami, hurricane, volcanic eruption, typhoon, earthquake, flood, or fire determined by the director to have caused losses as to require and justify additional assistance from the State. In addition, any recipient may petition the department for additional assistance for the replacement or repair of household appliances. The additional assistance shall be paid on an emergency basis, as determined by the department, to meet the cost of replacing or repairing household appliances. If the cost of repairs of household appliances is less than one-half the unit cost of the item, the department shall pay for the cost of repairs. If the cost of repairs of household appliances is one-half the unit cost of the item or more, the department shall replace the household appliance; provided that the replacement cost shall not exceed $350. For the purposes of this subsection, "household appliances" means a refrigerator or a range. The department shall establish an emergency fund, not to exceed one per cent of total financial assistance from state funds required by this chapter in the previous fiscal year. The director shall adopt rules pursuant to chapter 91 for determining in which cases to grant lump sum payments to recipients petitioning for additional assistance. (g) The department shall include protective child care payment as a special needs item in the financial assistance standard for cases of child neglect or abuse requiring placement of a child in child care. The referral for protective child care payment shall be from the department's child welfare program and the rate of payment shall be set by the department. (h) The director shall adopt rules pursuant to chapter 91 to implement this section. [L 1975, c 145, pt of §1(3); am L 1976, c 73, §3; am L 1978, c 104, §1 and c 107, §6; am L 1979, c 52, §§3, 5; am L 1980, c 120, §3; am L 1983, c 196, §2; am L 1985, c 272, §9; gen ch 1985; am L 1987, c 25, §1 and c 344, §2; am L 1988, c 213, §1 and c 327, §2; am L 1989, c 154, §2, c 233, §1, and c 379, §1; am L 1990, c 321, §2; am L 1993, c 356, §2; am L 1995, c 70, §1 and c 166, §1; am L 1996, c 300, §§4, 6; am L 1997, c 200, §§5, 9, 11 and c 340, §2; am L 1998, c 127, §§4, 5; am L 2000, c 80, §1; am L 2005, c 168, §3; am L 2006, c 265, §§1, 2 and c 287, §2; am L 2007, c 237, §4; am L 2008, c 220, §12 as superseded by L Sp 2008, c 11, §12; am L 2009, c 101, §2; am L 2012, c 93, §3; am L 2024, c 20, §1; am L 2025, c 45, §2]

HRS §346-53.1 Summer electronic benefits transfer for children program

346-53.1. Summer electronic benefits transfer for children program (a) Subject to the availability of funds, the department may implement the federal summer electronic benefits transfer for children program. To implement the program, the department shall work with the department of education to maximize participation in the federal summer electronic benefits transfer for children program established pursuant to the federal Consolidated Appropriations Act, 2023, P.L. 117-328. (b) To the extent that appropriations or private funds are made available, the department may contract with one or more providers to administer the summer electronic benefits transfer for children program. (c) The department may accept grants, donations, and contributions from private or public sources for the purposes of this section, which may be expended consistent with the grantors' or donors' wishes. [L 2024, c 155, §2]

HRS §346-53.2 Temporary assistance for needy families; funding and programs; public comment

346-53.2. Temporary assistance for needy families; funding and programs; public comment (a) The department, to the extent allowed under section 346-10, shall make all data relating to temporary assistance for needy families funds available to the senate and house of representatives committees having primary jurisdiction over fiscal, health, and human services issues, upon request. The committees shall jointly evaluate the implementation of the state temporary assistance for needy [families] program and program expenditures and make annual recommendations for appropriations. (b) The legislature may conduct hearings to receive public comment relating to the implementation of the state temporary assistance for needy families program and the optimal expenditure of program funds. The legislature shall determine the number and timing of hearings to be held; provided that if hearings are held, no fewer than one hearing on each island of the State shall be held annually; provided further that the senate and house of representatives committees having primary jurisdiction over fiscal, health, and human services matters shall jointly conduct the public hearings. [L 2005, c 165, §2]

HRS §346-53.3 Temporary assistance for needy families and food

346-53.3. Temporary assistance for needy families and food stamps for individuals with a felony conviction which has as an element the possession, use, or distribution of a controlled substance. Section 115(a) of Public Law 104-193 shall not apply in Hawaii to persons who are complying with treatment or who have not refused or failed to comply with treatment. [L 1997, c 128, §2; am L 1999, c 27, §1]

HRS §346-53.4 Reimbursement to expanded adult residential care home operators

346-53.4. Reimbursement to expanded adult residential care home operators Qualified expanded adult residential care home operators under section 321-15.62 who accept residents certified by the department as requiring skilled nursing facility level care shall be reimbursed based on the severity of the resident's disability. [L 1998, c 132, §2]

HRS §346-53.6 Federally qualified health centers; rural health clinics; reimbursement

346-53.6. Federally qualified health centers; rural health clinics; reimbursement (a) Notwithstanding any law or waiver to the contrary, federally qualified health centers and rural health clinics, as defined in section 1905(1) of the Social Security Act (42 U.S.C. 1396 et seq.), shall be reimbursed in accordance with section 1902(bb) of the Social Security Act, as that section was originally added in 2000 by section 702(b) of Public Law 106-554 and as amended in 2001 by section 2(b)(1) of Public Law 107-121, and services of federally qualified health centers and rural health clinics shall remain mandatory services as provided in sections 1902(a)(10)(A) and 1905(a)(2)(B) and (C) of the Social Security Act. (b) Reimbursement rates paid to federally qualified health centers may be adjusted if costs exceed 1.75 per cent for changes related to the intensity, duration, or amount of service provided, facilities, regulatory requirements, or other extraordinary circumstances; provided that the federally qualified health center shall submit to the department an adjusted cost report covering a period of the previous two years. The director shall review the filing within a period of sixty days. The period may be extended by the director for an additional period not to exceed thirty days upon written notice to the filer. A filing shall be deemed to be approved unless disapproved by the director within the initial filing period or any extension thereof. (c) The State may terminate the reimbursement methodology set forth in this section only in the event that changes in the relevant sections of the Social Security Act prohibit this reimbursement methodology. [L 2006, c 297, §2]

HRS §346-53.61 Centers for Medicare and Medicaid Services approval

346-53.61. Centers for Medicare and Medicaid Services approval The department shall implement sections 346-53.62, 346-53.63, and 346-53.64, subject to approval of the Hawaii medicaid state plan by the Centers for Medicare and Medicaid Services. [L Sp 2008, c 8, pt of §2] Note Section effective upon approval of the Hawaii medicaid state plan by the Centers for Medicare and Medicaid Services. L Sp 2008, c 8, §9.

HRS §346-53.63 Federally qualified health center or rural health clinic; adjustment for changes to scope of services

346-53.63. Federally qualified health center or rural health clinic; adjustment for changes to scope of services (a) Prospective payment system rates may be adjusted for any increases or decreases in the scope of services furnished by a participating federally qualified health center or rural health clinic, provided that: (1) The federally qualified health center or rural health clinic notifies the department in writing of any changes to the scope of services and the reasons for those changes within sixty days of the effective date of the changes; (2) The federally qualified health center or rural health clinic submits data, documentation, and schedules that substantiate any changes in services and the related adjustment of reasonable costs following medicare principles of reimbursement; and (3) The federally qualified health center or rural health clinic proposes a projected adjusted rate within one hundred fifty days of the changes to the scope of services. (b) This proposed projected adjusted rate is subject to departmental approval. The proposed projected adjusted rate shall be calculated based on a consolidated basis where the federally qualified health center or rural health clinic takes all costs for the center that would include both the costs included in the base rate, as well as the additional costs, provided that the federally qualified health center or rural health clinic calculated the baseline prospective payment system rate based on total consolidated costs. A net change in the federally qualified health center's or rural health clinic's rate shall be calculated by subtracting the federally qualified health center's or rural health clinic's previously assigned prospective payment system rate from its projected adjusted rate. (c) Within one hundred twenty days of its receipt of the projected adjusted rate and all additional documentation requested by the department, the department shall notify the federally qualified health center or rural health clinic of its acceptance or rejection of the projected adjusted rate. Upon approval by the department, the federally qualified health center or rural health clinic shall be paid the projected rate, which shall be effective from the date of the change in scope of services through the date that a rate is calculated based upon the first full fiscal year that includes the change in scope of services. (d) The department shall review the calculated rate of the first full fiscal year cost report if the change of scope of service is reflected in more than six months of the report. For those federally qualified health centers or rural health clinics in which the change of scope of services is in effect for six months or less of the cost report fiscal year, review of the next full fiscal year cost report also is required. The department shall review the calculated inflated weighted average rate of these two cost reports. The total costs of the first year report shall be adjusted to the Medical Economic Index of the second year report. Each report shall be weighted based upon number of patient encounters. (e) Upon receipt of the cost reports, the prospective payment system rate shall be adjusted following a review by the fiscal agent of the cost reports and documentation. Adjustments shall be made for payments for the period from the effective date of the change in scope of services through the date of the final adjustment of the prospective payment system rate. (f) For the purposes of prospective payment system rate adjustment, a change in scope of services provided by a federally qualified health center or rural health clinic means the following: (1) The addition of a new service, such as adding dental services or any other medicaid covered service, that is not incorporated in the baseline prospective payment system rate or a deletion of a service that is incorporated in the baseline prospective payment system rate; (2) A change in service resulting from amended regulatory requirements or rules; (3) A change in service resulting from relocation; (4) A change in type, intensity, duration, or amount of service resulting from a change in applicable technology and medical practice used; (5) An increase in service intensity, duration, or amount of service resulting from changes in the types of patients served, including but not limited to populations with human immunodeficiency virus, acquired immunodeficiency syndrome, or other chronic diseases, or homeless, elderly, migrant, or other special populations; (6) A change in service resulting from a change in the provider mix of a federally qualified health center or a rural health clinic or one of its sites; (7) Any changes in the scope of a project approved by the federal Health Resources and Services Administration where the change affects a covered service; or (8) Changes in operating costs due to capital expenditures associated with a modification of the scope of any of the services, including new or expanded service facilities, regulatory compliance, or changes in technology or medical practices at the federally qualified health center or rural health clinic. (g) No change in costs, in and of itself, shall be considered a scope of service change unless the cost is allowable under medicaid principles of reimbursement and the net change in the federally qualified health center's or rural health clinic's per visit rate equals or exceeds three per cent for the affected federally qualified health center or rural health clinic site. For federally qualified health centers or rural health clinics that filed consolidated cost reports for multiple sites to establish their baseline prospective payment system rates, the net change of three per cent shall be applied to the average per visit rate of all the sites of the federally qualified health center or rural health clinic for purposes of calculating the costs associated with a scope of service change. For the purposes of this section, "net change" means the per visit change attributable to the cumulative effect of all increases or decreases for a particular fiscal year. (h) All references in this section to "fiscal year" shall be construed to be references to the fiscal year of the individual federally qualified health center or rural health clinic, as the case may be. [L Sp 2008, c 8, pt of §2] Note Section effective upon approval of the Hawaii medicaid state plan by the Centers for Medicare and Medicaid Services. L Sp 2008, c 8, §9. L Sp 2008, c 8, §4 provides: "SECTION 4. A federally qualified health center or rural health clinic shall submit a prospective payment system rate adjustment request under section [346-53.63], Hawaii Revised Statutes, within one hundred fifty days of the beginning of the calendar year occurring after the department of human services first adopts forms and issues written instructions for applying for a prospective payment system rate adjustment under section [346-53.63], Hawaii Revised Statutes, if, during the prior fiscal year, the federally qualified health center or rural health clinic experienced a decrease in the scope of services; provided that the federally qualified health center or rural health clinic either knew or should have known the rate adjustment would result in a significantly lower per-visit rate. As used in this paragraph, "significantly lower" means an average rate decrease in excess of three per cent. Notwithstanding any law to the contrary, the first full fiscal year's cost reports shall be deemed to have been submitted in a timely manner if filed within one hundred fifty days after the department of human services adopts forms and issues written instructions for applying for a prospective payment system rate adjustment for changes to scope of service under section [346-53.63], Hawaii Revised Statutes."

HRS §346-53.64 Federally qualified health center or rural health clinic visit

346-53.64. Federally qualified health center or rural health clinic visit (a) Services eligible for prospective payment system reimbursement are those services that are furnished by a federally qualified health center or rural health clinic that are: (1) Within the legal authority of a federally qualified health center to deliver, as defined in section 1905 of the Social Security Act; (2) Actually provided by the federally qualified health center, either directly or under arrangements; (3) Covered benefits under the medicaid program, as defined in section 4231 of the State Medicaid Manual and the Hawaii medicaid state plan; (4) Provided to a recipient eligible for medicaid benefits; (5) Delivered exclusively by health care professionals, including physicians, physician's assistants, nurse practitioners, nurse midwives, clinical social workers, clinical psychologists, and other persons acting within the lawful scope of their license or certificate to provide services; (6) Provided at the federally qualified health center's practice site, a hospital emergency room, in an inpatient setting, at the patient's place of residence, including long term care facilities, or at another medical facility; and (7) Within the scope of services provided by the State under its fee-for-service medicaid program and its medicaid managed care program, on and after August 1994, and as amended from time to time. (b) Contacts with one or more health professionals and multiple contacts with the same health professional that take place on the same day and at a single location constitute a single encounter, except when one of the following conditions exists: (1) After the first encounter, the patient suffers illness or injury requiring additional diagnosis or treatment; or (2) The patient makes one or more visits for other services such as dental or behavioral health. Medicaid may pay for a maximum of one visit per day for each of these services in addition to one medical visit. (c) A federally qualified health center or rural health clinic that provides prenatal services, delivery services, and postnatal services may elect to bill the managed care organization for all such services on a global payment basis. Alternatively, it may bill for prenatal and postnatal services separately from delivery services and be paid the per visit prospective payment system reimbursement for prenatal and postnatal visits. In this case, it may bill the managed care organization separately for inpatient delivery services that are not eligible for prospective payment system reimbursement. [L Sp 2008, c 8, pt of §2; am L 2015, c 20, §4] Note Section effective upon approval of the Hawaii medicaid state plan by the Centers for Medicare and Medicaid Services. L Sp 2008, c 8, §9. L Sp 2008, c 8, §5 provides: "SECTION 5. The department of health may provide resources to nonprofit, community-based health care providers for direct medical care for the uninsured, including: (1) Primary medical; (2) Dental; (3) Behavioral health care; and (4) Ancillary services, including: (A) Education; (B) Follow-up; (C) Outreach; and (D) Pharmacy services. Distribution of funds may be on a "per-visit" basis, taking into consideration need on all islands."

HRS §346-55.1 Visitation, custody, and support when public assistance paid

346-55.1. Visitation, custody, and support when public assistance paid Whenever public assistance is paid to or for the benefit of any dependent child, the existence or enforcement of a duty of support owed by a noncustodial parent to such child shall not be affected by a failure or refusal by the custodial parent to implement any right as to custody or visitation granted by a court to the noncustodial parent. [L 1983, c 66, §1]

HRS §346-56 State reimbursement

346-56. State reimbursement The department of human services shall comply with all federal requirements pertaining to methods and standards of administration and shall make such rules and regulations and follow such procedures as may be required for the receipt from the federal government of grants or grants-in-aid for public assistance and such administrative costs as are provided in connection therewith. [L 1975, c 145, pt of §1(3); am L 1987, c 339, §4]

HRS §346-57 Loans to applicants for federal supplemental security income

346-57. Loans to applicants for federal supplemental security income Notwithstanding any laws to the contrary, the department of human services may, out of its operating funds, make loans to any person eligible for public assistance as provided in this chapter who is an applicant for benefits under the federal supplemental security income program or its successor agency subject to the following conditions: (1) The Federal Bureau of Supplemental Security Income has denied applicant's request for advance payment or finding of presumptive eligibility for supplemental security income; (2) The loan or loans shall be for a period not to exceed the action of the Federal Bureau of Supplemental Security Income approving or disapproving assistance under its program; (3) The loan or loans shall bear no interest; (4) The loan or loans shall not exceed the amount of assistance otherwise available to the applicant under this chapter; (5) The loan or loans shall be repaid by the applicant out of the retroactive supplemental security income payments, provided that nothing herein shall restrict the federal government from making direct payments to the State for such loan or loans, and provided further that the loan or loans shall be discharged and no repayment shall be required from an applicant whose application for federal supplemental security income assistance has been disapproved; (6) The applicant shall not be eligible for financial assistance by the department, provided that the applicant shall become eligible for such assistance upon disapproval of the application for federal supplemental security income assistance. [L 1975, c 145, pt of §1(3); am L 1979, c 52, §5; gen ch 1985; am L 1987, c 339, §4]

HRS §346-57.5 Interim assistance reimbursement special fund

346-57.5. Interim assistance reimbursement special fund (a) There is established in the state treasury the interim assistance reimbursement special fund, to be administered by the department, into which shall be deposited: (1) Moneys received from the federal government pursuant to section 346-57; (2) Appropriations made by the legislature to the fund; (3) Any interest that accrues upon the balance in the fund; and (4) Any other revenues designated for the fund. (b) Moneys in the interim assistance reimbursement special fund shall be used for: (1) State-funded financial assistance payments; and (2) Programs that support and assist recipients to qualify for supplemental security income. (c) All unencumbered and unexpended moneys in excess of $3,000,000 in the interim assistance reimbursement special fund shall lapse to the credit of the general fund. Upon dissolution of the special fund, any unencumbered and unexpended moneys remaining on balance in the fund shall lapse to the credit of the general fund. (d) Moneys in the interim assistance reimbursement special fund may be used for general assistance to households without minor dependents; provided that these moneys shall not be considered by the director in determining the general assistance allowance as set forth in section 346-53(b). (e) The department shall submit a report to the legislature detailing the amount of, and reason for, any expenditure from the interim assistance reimbursement special fund within ten business days of the expenditure. [L 2015, c 196, §2]

HRS §346-59 Medical care payments

346-59. Medical care payments (a) The department shall adopt rules under chapter 91 concerning payment to providers of medical care. The department shall determine the rates of payment due to all providers of medical care, and pay such amounts in accordance with the requirements of the appropriations act and the Social Security Act, as amended. Payments to critical access hospitals for services rendered to medicaid beneficiaries shall be calculated on a cost basis using medicare reasonable cost principles. (b) Rates of payment to providers of medical care who are individual practitioners, including doctors of medicine, dentists, podiatrists, psychologists, osteopaths, optometrists, and other individuals providing services, shall be based upon the Hawaii medicaid fee schedule. The amounts paid shall not exceed the maximum permitted to be paid individual practitioners or other individuals under federal law and regulation, the medicare fee schedule for the current year, the state limits as provided in the appropriation act, or the provider's billed amount. The appropriation act shall indicate the percentage of the medicare fee schedule for the year 2000 to be used as the basis for establishing the Hawaii medicaid fee schedule. For any subsequent adjustments to the fee schedule, the legislature shall specify the extent of the adjustment in the appropriation act. (c) In establishing the payment rates for other noninstitutional items and services, the rates shall not exceed the current medicare payment, the state limits as provided in the appropriation act, the rate determined by the department, or the provider's billed amount. (d) Payments to health maintenance organizations and prepaid health plans with which the department executes risk contracts for the provision of medical care to eligible public assistance recipients may be made on a prepaid basis. The rate of payment per participating recipient shall be fixed by contract, as determined by the department and the health maintenance organization or the prepaid health plan, but shall not exceed the maximum permitted by federal rules and shall be less than the federal maximum when funds appropriated by the legislature for such contracts require a lesser rate. For purposes of this subsection, "health maintenance organizations" are entities approved as such, and "prepaid health plans" are entities designated as such by the Department of Health and Human Services; and "risk" means the possibility that the health maintenance organization or the prepaid health plan may incur a loss because the cost of providing services may exceed the payments made by the department for services covered under the contract. (e) The department shall prepare each biennial budget request for a medical care appropriation based upon the most current Hawaii medicaid fee schedule available at the time the request is prepared. The director shall submit a report to the legislature on or before January 1 of each year indicating an estimate of the amount of money required to be appropriated to pay providers at the maximum rates permitted by federal and state rules in the upcoming fiscal year. [L 1976, c 150, §2; am L 1979, c 220, §1; am L 1983, c 252, §1; am L 1986, c 107, §1; am L 1987, c 290, §2; am L 1988, c 308, §1; am L 1990, c 263, §§2, 3; am L 2000, c 226, §§4, 9; am L 2001, c 29, §§2, 4; am L 2002, c 16, §28; am L 2004, c 148, §2]

HRS §346-59.1 Coverage for telehealth

346-59.1. Coverage for telehealth (a) The State's medicaid managed care and fee-for-service programs shall not deny coverage for any service provided through telehealth that would be covered if the service were provided through in-person consultation between a patient and a health care provider. (b) [Repeal and reenactment on December 31, 2025. L 2023, c 107, §8.] Reimbursement for services provided through telehealth via an interactive telecommunications system shall be equivalent to reimbursement for the same services provided via in-person contact between a health care provider and a patient; provided that reimbursement for the diagnosis, evaluation, or treatment of a mental health disorder delivered through an interactive telecommunications system using two-way, real-time audio-only communication technology shall meet the requirements of title 42 Code of Federal Regulations section 410.78. Nothing in this section shall require a health care provider to be physically present with the patient at an originating site unless a health care provider at the distant site deems it necessary. (c) There shall be no geographic restrictions or requirements for telehealth coverage or reimbursement under this section. (d) There shall be no restrictions on originating site requirements for telehealth coverage or reimbursement under this section. (e) Services provided by telehealth pursuant to this section shall be consistent with all federal and state privacy, security, and confidentiality laws. (f) Notwithstanding any other law to the contrary, the provisions of this section shall comply with the applicable federal requirements related to utilization, coverage, and reimbursement for telehealth services. (g) [Repeal and reenactment on December 31, 2025. L 2023, c 107, §8.] For the purposes of this section: "Distant site" means the location of the health care provider delivering services through telehealth at the time the services are provided. "Health care provider" means a provider of services, as defined in title 42 United States Code section 1395x(u), a provider of medical and other health services, as defined in title 42 United States Code section 1395x(s), other practitioners licensed by the State and working within their scope of practice, and any other person or organization who furnishes, bills, or is paid for health care in the normal course of business, including but not limited to primary care providers, mental health providers, oral health providers, physicians and osteopathic physicians licensed under chapter 453, advanced practice registered nurses licensed under chapter 457, psychologists licensed under chapter 465, and dentists licensed under chapter 448. "Interactive telecommunications system" has the same meaning as the term is defined in title 42 Code of Federal Regulations section 410.78(a). "Originating site" means the location where the patient is located, whether accompanied or not by a health care provider, at the time services are provided by a health care provider through telehealth, including but not limited to a health care provider's office, hospital, critical access hospital, rural health clinic, federally qualified health center, a patient's home, and other nonmedical environments such as school-based health centers, university-based health centers, or the work location of a patient. "Telehealth" means the use of telecommunications services, as defined in section 269-1, to encompass four modalities: store and forward technologies, remote monitoring, live consultation, and mobile health; and which shall include but not be limited to real-time video conferencing-based communication, secure interactive and non-interactive web-based communication, and secure asynchronous information exchange, to transmit patient medical information, including diagnostic-quality digital images and laboratory results for medical interpretation and diagnosis, for the purpose of delivering enhanced health care services and information while a patient is at an originating site and the health care provider is at a distant site. Except as provided through an interactive telecommunications system, standard telephone contacts, facsimile transmissions, or e-mail text, in combination or alone, do not constitute telehealth services. [L 2016, c 226, §2; am L 2023, c 107, §2]

HRS §346-59.2 Comprehensive breast and cervical cancer control program

346-59.2. Comprehensive breast and cervical cancer control program (a) There is established the comprehensive breast and cervical cancer control program, to be administered by the department of human services in collaboration with the department of health, to assist women who have been diagnosed with breast or cervical cancer by the Hawaii comprehensive breast and cervical cancer control program, but who are not eligible for federally-funded medicaid coverage as provided by the Breast and Cervical Cancer Prevention and Treatment Act of 2000. (b) Under the comprehensive breast and cervical cancer control program, the department of human services shall provide state-funded medical assistance, as appropriated by the legislature, to women who are diagnosed with breast or cervical cancer through the Hawaii comprehensive breast and cervical cancer control program, but who are not eligible for federal medicaid coverage; provided that the person either: (1) Is a resident alien of Hawaii who is not eligible for medicaid; or (2) Would be eligible under medicaid except that the person has health care coverage that specifically does not provide coverage for cancer treatment. (c) The department of health shall work collaboratively with the department of human services to assist in and support the screening, education, and outreach process regardless of a woman's eligibility for medicaid coverage. (d) Under the comprehensive breast and cervical cancer control program, the department of health shall provide state-funded medical assistance, as funded by the legislature, to: (1) Screen women for breast and cervical cancer; (2) Educate women regarding the risks associated with breast and cervical cancer; and (3) Provide outreach to women who are at risk for breast and cervical cancer. [(e)] The department of health and the department of human services shall submit an annual report to the legislature no later than twenty days prior to the convening of each regular session on the expenditure of all funds for the comprehensive breast and cervical cancer control program. [L 2001, c 278, §2; am L 2008, c 52, §§2, 4]

HRS §346-59.4 Medical assistance to other children

346-59.4. Medical assistance to other children The department shall provide state-funded medical assistance, of up to two hundred per cent of the federal poverty level for Hawaii, to persons less than nineteen years of age who are: (1) Legal permanent residents who arrived after August 22, 1996; (2) Persons who are permanently residing under color of law; and (3) Nonimmigrants from the Trust Territories of the Pacific Islands who are citizens of: (A) The Marshall Islands; (B) The Federated States of Micronesia; or (C) Palau, as defined by the Compact of Free Association Act of 1985, P.L. 99-239, or the Compact of Free Association between the United States and the Government of Palau, P.L. 99-658, who are otherwise eligible for benefits under the State's medicaid program and the State's children health insurance program, but are ineligible due to restricted eligibility rules imposed by title XXI of the Social Security Act, the Personal Responsibility and Work [Opportunity] Reconciliation Act of 1996, the Compact of Free Association Act of 1985, P.L. 99-239, the Compact of Free Association between the United States and the Government of Palau, P.L. 99-658, or any other provision of federal law denying medical assistance to nonimmigrants who are citizens of the Marshall Islands, the Federated States of Micronesia, or Palau. [L 2000, c 224, §2; am L 2007, c 236, §§4, 14; am L Sp 2009, c 8, §2; am L 2015, c 20, §5]

HRS §346-59.5 Enforcement of contracts

346-59.5. Enforcement of contracts (a) The director may monitor a health plan's performance during any contract period. (b) In addition to any other administrative or judicial remedy, the director may impose civil or administrative monetary penalties not to exceed the maximum amount established by federal statutes and regulations if the health plan: (1) Fails to provide medically necessary items and services that are required under law or under contract; (2) Imposes upon beneficiaries excess premiums and charges; (3) Acts to discriminate among enrollees; (4) Misrepresents or falsifies information; (5) Violates marketing guidelines; or (6) Violates other contract provisions and requirements. (c) The director may appoint temporary management to oversee compliance efforts if a health plan continues to engage in violations of contract, law or rules, or if there is a substantial risk to the health of enrollees. (d) Pursuant to chapter 91, the director may adopt and enforce such rules as may be necessary to carry out the purposes of this section. (e) The director shall notify the insurance commissioner whenever a sanction under this section is contemplated. [L 1998, c 94, §1]

HRS §346-59.6 Medicaid overpayment recovery

346-59.6. Medicaid overpayment recovery The director shall recover medicaid overpayments made to providers. Medicaid overpayments shall be recovered due to a provider's ineligibility, noncovered service, noncovered drug, lack of prior authorization when a service requires one, incorrect payment allowance identified through any post payment review, or claims processing error. The director may recover overpayments through recoupment, tax offset under sections 231-51 to 231-59, and circuit court judgment. Nothing in this section shall limit the director's authority to recover overpayments through all other lawful means. [L 1998, c 293, §1; am L 2001, c 55, §16]

HRS §346-59.7 Enforcement of decisions regarding medicaid overpayment recovery; judgment rendered thereon

346-59.7. Enforcement of decisions regarding medicaid overpayment recovery; judgment rendered thereon (a) The director may file in the circuit court in the jurisdiction in which the medicaid overpayment occurred a certified copy of: (1) A decision of the director assessing a medicaid overpayment against a provider from which no appeal has been taken within the time allowed therefor; (2) A decision of the director assessing a medicaid overpayment against a provider from which an appeal has been taken but in which no order has been made by the director, the administrative appeals officer, or the court that the appeal shall operate as a supersedeas or stay; (3) A decision of the administrative appeals officer assessing a medicaid overpayment against a provider from which no appeal has been taken within the time allowed therefor; or (4) A decision of the administrative appeals officer assessing a medicaid overpayment against a provider from which an appeal has been taken but in which no order has been made by the administrative appeals officer or the court that the appeal shall operate as a supersedeas or stay. The court shall render a judgment in accordance with the decision and notify the parties thereof. The judgment shall have the same effect, and all proceedings in relation thereto shall thereafter be the same, as though the judgment had been rendered in an action duly heard and determined by the court, except that there shall be no appeal therefrom. (b) In all cases in which an appeal from the decision has been taken within the time provided, but in which the director, the administrative appeals officer, or the court has not issued an order that the appeal shall operate as a supersedeas or stay, the decree or judgment of the circuit court shall provide that the decree or judgment shall become void if the decision or award of the director or administrative appeals officer, as the case may be is later set aside. (c) As used in this section, the term "administrative appeals officer" means the director's designated subordinate appointed to contested case hearings pursuant to chapter 91, and this chapter. [L 1998, c 293, §2]

HRS §346-59.9 Psychotropic medication

346-59.9. Psychotropic medication (a) This section shall apply only to the medicaid managed care and fee-for-service programs administered by the department when the department or the department's contracted health plan is the primary insurer. When the department is the secondary insurer, the department and its contracted health plans shall be responsible only for the secondary insurer's share of any psychotropic medication covered by the primary insurer. (b) The department and its contracted health plans shall not impose any restriction or limitation on the coverage for, or a recipient's access to, antipsychotic medication. (c) The department and its contracted health plans shall not impose any restriction or limitation on the coverage for, or a recipient's access to, antidepressant medication other than: (1) Requiring that an individual must have two failed attempts on a generic antidepressant medication to receive coverage for a new brand-name antidepressant prescription; and (2) Requiring that if an individual does not have two failed attempts on a generic antidepressant medication, that individual shall receive coverage for a brand-name antidepressant medication with prior authorization by the contracted health plan; provided that while a prior authorization request for a brand-name antidepressant medication submitted by the prescriber is pending, a supply of the prescribed medication sufficient to last until the request is resolved shall be covered if requested by the prescriber. For purposes of this subsection, a "failed attempt" means that the prescribed generic antidepressant medication up to the maximum FDA-approved dosage is not effective in treating the individual, or the individual's compliance is compromised due to the side effects caused by the medication. (d) The department and its contracted health plans shall not impose any restriction or limitation on the coverage for, or a recipient's access to, anti-anxiety medication other than: (1) Requiring that an individual must have two failed attempts on a generic anti-anxiety medication to receive coverage for a new brand-name anti-anxiety prescription; and (2) Requiring that if an individual does not have two failed attempts on a generic anti-anxiety medication, that individual shall receive coverage for a brand-name anti-anxiety medication with prior authorization by the contracted health plan; provided that while a prior authorization request for a brand-name anti-anxiety medication submitted by the prescriber is pending, a supply of the prescribed medication sufficient to last until the request is resolved shall be covered if requested by the prescriber. For purposes of this subsection, a "failed attempt" means that the prescribed generic anti-anxiety medication up to the maximum FDA-approved dosage is not effective in treating the individual, or the individual's compliance is compromised due to the side effects caused by the medication. (e) The department and its contracted health plans shall not require any individual stable on a brand-name antidepressant medication on or before July 1, 2010, to transfer to a different antidepressant medication, generic or brand-name, unless the individual's condition becomes unstable and requires the medication to be replaced. (f) The department and its contracted health plans shall not require any individual stable on a brand-name anti-anxiety medication on or before July 1, 2010, to transfer to a different anti-anxiety medication, generic or brand-name, unless the individual's condition becomes unstable and requires the medication to be replaced. (g) The department and its medicaid managed care contracted health plans shall have the authority to investigate fraud, abuse, or misconduct. (h) All psychotropic medications covered by this section shall be prescribed by a psychiatrist, a physician, or an advanced practice registered nurse with prescriptive authority under chapter 457 and duly licensed in the State. (i) As used in this section: "Anti-anxiety medication" means those medications included in the United States Pharmacopeia's anxiolytic therapeutic category. "Antidepressant medication" means those medications included in the United States Pharmacopeia's antidepressant therapeutic category. "Antipsychotic medication" means those medications included in the United States Pharmacopeia's antipsychotic therapeutic category. "Psychotropic medication" means only antipsychotic, antidepressant, or anti-anxiety medications approved by the United States Food and Drug Administration for the treatment of mental or emotional disorders. [L 2005, c 239, pt of §2, §5; am L 2006, c 311, pt of §2, §3; am L 2007, c 39, §§1, 2; am L 2010, c 205, §§2, 9; am L 2012, c 120, §2; am L 2015, c 20, §§6, 7; am L 2022, c 126, §2]

HRS §346-60 Group therapy; reimbursement for services

346-60. Group therapy; reimbursement for services (a) The department shall establish rules pursuant to chapter 91 to permit payment to providers of group therapy services to recipients under this chapter. (b) For the purposes of this section, "group therapy" shall be defined as psychotherapeutic treatment delivery in which a patient receives treatment as a member of a group of patients receiving similar treatment, involving interaction both between the patient and the practitioner and among patients, and which is supervised by a practitioner licensed under chapters 453 or 465. [L 1976, c 236, §2]

HRS §346-61 Optometric services, choice

346-61. Optometric services, choice Whenever visual or optometric services within the lawful scope of practice of a duly licensed optometrist are included in any program, financed with public funds or administered by any public agency, for aid to the indigent, the aged, the legally blind, or any other group or class, the recipient of the aid shall be entitled to choose whether the services are to be performed by a duly licensed physician or by a duly licensed optometrist. Visual or optometric services as used herein include eye and/or visual examination or a correction of any vision or muscular anomaly and the supplying of ophthalmic materials, including contact lenses and subnormal vision aids. [L 1977, c 36, pt of §1]

HRS §346-62 Examination of blind

346-62. Examination of blind The department of human services shall not approve an application for public assistance to a blind person until the applicant has been examined by an ophthalmologist, optometrist, or a qualified physician designated by it to make such examinations. The examining person shall certify to the department the diagnosis, prognosis, and visual acuity of the applicant. Certification shall be in forms prescribed by the department. [L 1977, c 36, pt of §1; am L 1987, c 339, §4]

HRS §346-63 Social services

346-63. Social services (a) The department shall adopt rules to provide social services pursuant to the Social Security Act, as amended, to eligible persons who are residents of the State. Such rules shall include provisions to permit payment for social services received by recipients from individuals, organizations, or other public or private agencies, and to enable the recipients to satisfy statutory requirements of state and federal tax and employment insurance programs. (b) The department may contract for the purchase of social services to be performed for the benefit of eligible recipients from individuals, organizations, and private or public agencies, or to reimburse an eligible recipient for department authorized social services obtained directly from individuals. Persons performing authorized social services obtained directly by the recipient shall not be considered employees of the State. The rate of payment for social services obtained directly by the recipient from an individual who is not self-employed shall reflect the recipient's obligation under state and federal tax and employment insurance laws. [L 1978, c 110, §3]

HRS §346-64.5 Eligibility for chore services

346-64.5. Eligibility for chore services (a) An applicant for chore services shall be eligible when the applicant meets program requirements for chore services and income eligibility standards as established by the department of human services. Income eligibility standards shall include individuals who have been found eligible for medical assistance under the department's medicaid program. (b) For the purposes of this section, "chore services" means essential housecleaning and related activities such as marketing, cooking, and cleaning. [L 1988, c 208, §1]

HRS §346-65 Child abuse and neglect discretionary emergency assistance

346-65. Child abuse and neglect discretionary emergency assistance (a) The department may grant funds to a family for child abuse and neglect discretionary emergency assistance in accordance with this section. The purpose of these grants is to assist children and families when an emergency situation arises or is imminent which may cause child abuse or neglect or has caused children and families to need assistance from the department pursuant to chapter 587A, and the financial assistance may prevent the abuse or neglect, prevent the removal of a child from a family, or would meet the immediate needs of a child who has been removed from a family. (b) Emergency assistance shall be authorized when: (1) A situation arises or is imminent which presents an immediate or imminent threat of child abuse or neglect or has caused children and families to need assistance from the department pursuant to chapter 587A; (2) The family is eligible for public assistance or has no available financial resources; (3) Financial assistance may eliminate or alleviate the situation and remove the immediate or imminent threat of child abuse or neglect; and (4) No other financial resources are available from within the family or from other public or private source which could be used to eliminate or alleviate the situation. (c) Emergency assistance may be used for shelter, respite child care, clothing, transportation, medical costs, utilities, food, repairs, essential equipment, and other goods or services which in the discretion of the department are necessary to eliminate or alleviate the emergency situation. (d) A family shall not be granted more than $1,000 in emergency assistance during one fiscal year; except that under an exceptional situation as determined by the director, a family may be granted not more than $2,000 during one fiscal year. (e) For the purposes of this chapter only, emergency assistance shall not be considered income to the head of household or family nor as part of the family's assistance allowance. [L 1986, c 160, §1; am L 1988, c 327, §4; am L 2010, c 135, §7]

HRS §346-66 Psychological services

346-66. Psychological services When the health care or rehabilitative services authorized under this chapter are services which a psychologist is licensed to render under chapter 465, the department shall not require referral, direction, or prescription of services by another health care practitioner. [L 1987, c 290, §1]

HRS §346-67 Medical foods and low-protein modified food products; treatment of inborn error of metabolism; notice

346-67. Medical foods and low-protein modified food products; treatment of inborn error of metabolism; notice (a) Public assistance recipients in this State who receive medical assistance pursuant to this chapter shall be allowed coverage for medical foods and low-protein modified food products for the treatment of an inborn error of metabolism; provided that the medical food or low-protein modified food product is: (1) Prescribed as medically necessary for the therapeutic treatment of an inborn error of metabolism; and (2) Consumed or administered enterally under the supervision of a physician or osteopathic physician licensed under chapter 453. The department shall adopt rules pursuant to chapter 91 to effectuate this subsection. (b) All health maintenance organizations and prepaid health plans with which the department executes risk contracts for the provision of medical care to eligible public assistance recipients shall provide notice to their members regarding the coverage required by this section. The notice shall be in writing and prominently placed in any literature or correspondence sent to members and shall be transmitted to members within calendar year 2000 when annual information is made available to members, or in any other mailing to members, but in no case later than December 31, 2000. (c) For the purposes of this section: "Inborn error of metabolism" means a disease caused by an inherited abnormality of the body chemistry of a person that is characterized by deficient metabolism, originating from congenital defects or defects arising shortly after birth, of amino acid, organic acid, carbohydrate, or fat. "Low-protein modified food product" means a food product that: (1) Is specially formulated to have less than one gram of protein per serving; (2) Is prescribed or ordered by a physician or osteopathic physician as medically necessary for the dietary treatment of an inborn error of metabolism; and (3) Does not include a food that is naturally low in protein. "Medical food" means a food that is formulated to be consumed or administered enterally under the supervision of a physician or osteopathic physician and is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements, based on recognized scientific principles, are established by medical evaluation. [L 1999, c 86, §1; am L 2009, c 11, §45]

HRS §346-68 Bridge to hope program; transitional benefits

346-68. Bridge to hope program; transitional benefits (a) There is created within the department a post-secondary education benefits program, to be known as the bridge to hope program, for heads of households in the first-to-work program. (b) To receive assistance under this program, the participant shall: (1) Be enrolled as a student each term in an approved course of study including, but not limited to, vocational education; (2) Maintain passing grades or better throughout the course of study; and (3) Meet work activity requirements as defined by the department. (c) Internships, externships, practicums, or any other work training required by the course of study shall count toward the recipient's work requirement. (d) The department shall adopt rules in accordance with chapter 91 to carry out the purpose of this section. [L 2000, c 276, §2; am L 2008, c 82, §2]

HRS §346-69 Welfare safety net program; department of human services

346-69. Welfare safety net program; department of human services The department of human services may create a welfare safety net program entitled "Keeping Hope Alive" to assist working families that will be disqualified from receiving further public assistance as a consequence of reaching the five-year time limit set by the federal Personal Responsibility and Work Opportunity [Reconciliation] Act of 1996. [L 2001, c 150, §4]

HRS §346-70 Medical assistance for other pregnant women

346-70. Medical assistance for other pregnant women (a) The department may provide state-funded medical assistance to a pregnant woman age nineteen years of age or older whose countable family income does not exceed one hundred and eighty-five per cent of the federal poverty level for a family of applicable size, including the expected unborn children. The pregnant woman shall be: (1) A legal immigrant who entered the United States on or after August 22, 1996; and (2) Otherwise eligible for benefits under the State's medicaid program but is prohibited from participating in any medical assistance program under title XIX of the Social Security Act for a period of five years beginning on the date of her entry into the United States, due to restricted eligibility rules imposed by title XIX of the Social Security Act and the Personal Responsibility and Work [Opportunity] Reconciliation Act of 1996. (b) Once determined eligible for medical assistance under this section, the pregnant woman shall continue to be eligible throughout her pregnancy and through the last day of the calendar month in which the sixty-day period following childbirth ends. (c) Assets shall not be evaluated for eligibility purposes. (d) The director shall adopt rules pursuant to chapter 91 to determine eligibility for medical assistance. [L 2004, c 160, §2]

Source: Hawaii State Legislature (capitol.hawaii.gov), via Internet Archive capturesURL: http://www.capitol.hawaii.gov/hrscurrent/Vol07_Ch0346-0398/HRS0346/HRS_0346-.htmFetched: 11/10/2026