HAR §17-1738-6
HAR §17-1738-6. Limitation of services
Cite as Haw. Code R. § 17-1738-6
(a)
Reimbursement for case assessment and case planning
shall be limited to no more than one each for a
recipient in a calendar year unless the recipient
requires a reassessment due to a major change in level
of functioning due to health, socio-emotional or
environmental factors, in which case a second
assessment or case plan may be reimbursed.
(b) Reimbursement for ongoing monitoring and
service coordination shall be limited to one claim for
each recipient per month, and shall be only for the
services rendered by or under the supervision of the
recipient's designated case manager.
(c) Ongoing monitoring or service coordination
shall not be available to recipients who are inpatients
in acute hospitals, or residents of nursing or ICF-MR
facilities.
(d) Case management services are not reimbursable
UNOFFICIAL
1738-6
when rendered to a recipient who, on the date of
service, is enrolled in a health maintenance
organization.
(e) Recipients receiving services under Home &
Community-Based Waiver Services shall be eligible to
receive non-duplicative case management services as
targeted case management services under section
17-1738-5.
(f) The following activities are considered
necessary for the proper and efficient administration
of the medicaid state plan, and are not reimbursable:
(1) Medicaid eligibility determinations and
re-determinations;
(2) Medicaid pre-admission screening;
(3) Prior authorization for medicaid services;
(4) Medicaid utilization review;
(5) EPSDT administration; and
(6) Activities associated with the lock-in
provisions of section 17-1741-8.
[Eff 08/01/94; am 02/10/97; am 12/27/97 ]
(Auth: HRS §346-14; 42 C.F.R. §431.10)
(Imp: 42 U.S.C. §1396n)