HAR §17-400.1-11. Administration of funds

(a) The division administrator shall be responsible for all funds under the jurisdiction of the division, in all of its programs and organizational subdivisions, regardless of their source or designation. (b) Any charge for services not covered by approved fee schedules shall be authorized by authorized staff of the division in accordance with this section, section 17-400.1-10 and applicable State fiscal policies and procedures governing purchase of services. (c) Payment for services must be authorized in writing, by authorized staff of the division either simultaneously with or before the services are rendered. In an emergency situation, verbal authorization by authorized staff of the division will be permitted if there is prompt documentation and the authorization is confirmed in writing and forwarded to the provider of the services immediately thereafter. (d) Services shall be provided by qualified vendors who meet the requirements of section 17-400.1- 10(g) and are duly licensed to practice their profession in accordance with State licensure laws. (1) Physicians must be licensed by the State board of medical examiners; (2) Specialists must be licensed to practice in the State and certified by the American 400.1-28 §17-400.1-11 board in the particular medical specialty; (3) Dentists must be licensed by the State board of dental examiners; (4) Psychologists must be licensed by the State and certified by the appropriate certifying body; and (5) Other duly authorized medically-oriented resource persons, such as osteopaths, must be licensed and certified by the appropriate governing bodies. (e) When board certified or licensed service providers are not available, the division’s medical consultant shall assist in making a selection of a service provider guided by available objective standards of competence, such as the following: (1) Completion of training and experience requirements for admission to board examinations; (2) Recognition as a competent specialist by State or county medical societies; (3) Acceptance as a specialist by the workers’ compensation board; (4) Membership on the clinical teaching staff of a medical school; or (5) Similar objective standards of competence as described in (1) through (4). (f) New schedules or changes in existing fee schedules shall be authorized only by the division administrator and are subject to the public hearing process before purchase of services. (1) The 1970 relative value studies (RVS) of the Hawaii medical association and the conversion factors approved by the division and distributed under internal communication memo entitled “VRSBD Medical Fee Schedule – RVS Conversion Factors” shall be the division’s fee schedule for all medical diagnostic and treatment (restoration) services purchased by the division. Where there is no procedure code or fee that adequately covers a particular situation or 400.1-29 §17-400.1-11 is indicated “by report” in the RVS, the physician must provide a brief description of the services plus the charge, for review and approval by authorized staff of the division. A change of physicians or vendors may be necessary in instances where agreement on charges cannot be reached. (2) The dental fee schedule approved by the division and distributed under internal communication memo entitled “VRSBD Dental Fee Schedule” shall be the schedule used for all dental services purchased by the division. (3) The division’s list of allowed psychological services distributed under internal communication memo entitled “VRSBD Psychological Fee Schedule” shall be the division’s fee schedule for psychological services purchased by the division. (4) The sign language interpreter services fee schedule approved by the division and distributed under internal communication memo entitled “VRSBD Interpreters for the Deaf and Deaf-Blind” shall be the schedule for all sign language interpreter services purchased by the division. The division’s maximum rates for interpreter services shall be determined by the division in consideration of: (A) The current guidelines issued by the Disability and Communication Access Board; and (B) The Certification levels of the National Registry of Interpreters for the Deaf, the National Association of the Deaf, and the Hawaii Quality Assurance System. (5) When health insurance is available for applicants or eligible individuals, the division shall only pay the difference between the amount indicated on the 400.1-30 §17-400.1-11 division’s applicable fee schedule and the amount covered by the health insurance. If the amount covered by the health insurance equals or exceeds the amount indicated on the division’s applicable fee schedule, the division’s share shall be zero. (A) In arranging for the purchase of services, the division shall inform the vendor of the above arrangements in determining the division’s share in the cost. (B) Regardless of the amount of the division’s share in the cost, the division shall ensure that the vendor agrees not to bill the applicant or eligible individual for any remaining difference in charges resulting from the differences in the amounts covered by insurance, the division’s fee schedule, and the vendor’s charges for the service. (C) A change of physician or vendor may be necessary in instances where agreement on charges cannot be reached. (6) No payment shall be made to vendors for services canceled by the division. Vendors shall be notified in writing of the cancellation. (7) The division may pay up to fifty per cent of the amount authorized in instances when the applicant or eligible individual fails to keep an appointment. Exact amount of payment shall be individually adjusted. Factors such as prolonged procedures, e.g., psychiatry-psychological evaluations, and repeated “no shows” should be considered in setting the final payment amounts. (8) When a request is made to a vendor for special reports such as narrative reports, reviews of medical records, or copies of medical files necessary to establish or 400.1-31 §17-400.1-11 clarify an applicant’s or eligible individual’s status, a charge adequate to cover the value of the additional service may be authorized within the limits set by the division administrator. The cost allowed will vary with the complexity, extensiveness, and time required by a vendor to prepare the report. (9) Payments to hospitals shall be the usual and customary rates as published by the hospital for procedures that are not covered by the division’s fee schedules. Payments shall not be authorized for private rooms unless it is a medical necessity, authorized by the physician and approved by the division’s medical consultant. [Eff AUG 13 2007 ] (Auth: HRS §§347-4, 348-7; 29 U.S.C. §721; 34 C.F.R. §§361.50, 361.51) (Imp: HRS §§347-4, 348-3, 348-6; 29 U.S.C. §721; 34 C.F.R. §§361.50, 361.51) §17-400.1-12 Interagency cooperation and collaboration. (a) The division, in consultation with other appropriate agencies, and with the Governor’s assurance, if necessary, will effect an interagency agreement or other mechanism for interagency coordination between the division and any appropriate public entity, including the State entity responsible for administering the State medicaid program, a public institution of higher education, and a component of the statewide workforce investment system, to ensure the provision of vocational rehabilitation services described in section 17-401.1-6 other than those services exempted in section 17-401.1-13(b), that are included in the IPE of an eligible individual, including the provision of such VR services during any pendency of any interagency dispute described in paragraph (2)(C). (1) The above requirements of paragraph (a) may be met through: (A) A State statute or regulation; 400.1-32 §17-400.1-12 (B) A signed agreement between the respective officials of the public entities that clearly identifies the responsibilities of each public entity for the provision of the services; or (C) Another appropriate mechanism as determined by the division. (2) The interagency agreement or other mechanism for interagency coordination must include the following: (A) An identification or description of a method for defining the financial responsibility of the public entity for providing the VR services other than those exempted in section 17-401.1- 13(b), and a provision stating the financial responsibility of the public entity for providing those services. (B) Information specifying the conditions, terms, and procedures under which the division must be reimbursed by the other public entities for providing VR services based on the terms of the agreement or other mechanism. (C) Information specifying procedures for resolving interagency disputes under the agreement or other mechanism, including procedures under which the division may initiate proceedings to secure reimbursement from other public entities or otherwise implement the provisions of the agreement or mechanism. (D) Information specifying policies and procedures for public entities to determine and identify interagency coordination responsibilities of each public entity to promote the coordination and timely delivery of VR services other than those exempted in section 17-401.1-13(b). 400.1-33 §17-400.1-12 (b) If a public entity, other than the division, is obligated under Federal law (such as the Americans with Disabilities Act, section 504 of the Act, or section 188 of the Workforce Investment Act) or State law, or assigned responsibility under State policy or an interagency agreement established under this subsection, to provide or pay for any services considered to be VR services (e.g., interpreter services under section 17-401.1-24), other than those exempted in section 17-401.1-13(b): (1) The public entity must fulfill that obligation or responsibility through: (A) The terms of the interagency agreement or other requirements of this section; (B) Providing or paying for the service directly or by contract; or (C) Other arrangement. (2) If the public entity fails to provide or pay for VR services for an eligible individual as established under this subsection, the division must provide or pay for those services to the individual and may claim reimbursement for the services from the public entity that failed to provide or pay for those services. The public entity must reimburse the division pursuant to the terms of the interagency agreement or other mechanism in accordance with the procedures established in the agreement or other mechanism pursuant to paragraph (a)(2)(C). [Eff AUG 13 2007] (Auth: HRS §§347-4, 348-7; 29 U.S.C. §721; 34 C.F.R. §361.53(d) and (e)) (Imp: HRS §§347-4, 348-7; 29 U.S.C. §721; 34 C.F.R. §361.53(d) and (e)) §17-400.1-13 Coordination of services with the State department of education. (a) The division shall implement the following plans, policies, and procedures for coordination of services with the State department of education to facilitate the transition of students with disabilities from the receipt of 400.1-34 §17-400.1-13 educational services in school to the receipt of vocational rehabilitation services under the division: (1) The development and approval of an individualized plan for employment in accordance with section 17-401.1-10 as early as possible during the transition planning process but, at the latest, by the time each student determined to be eligible for VR services leaves the school setting or, if the division is operating under an order of selection pursuant to section 17-401.1-5, before each eligible student able to be served under the order leaves the school setting. (2) A formal interagency agreement with the State department of education which at a minimum, provides for: (A) Consultation and technical assistance to assist the department of education in planning for the transition of students with disabilities from school to post-school activities, including VR services; (B) Transition planning between personnel of the division and the department of education for students with disabilities that facilitate the development and completion of their individualized education programs (IEPs) under the Individual’s with Disabilities Education Act (IDEA); (C) The roles and responsibilities, including financial responsibilities, of each agency, including provisions for determining State lead agencies and qualified personnel responsible for transition services; and (D) Procedures for outreach to and identification of students with disabilities who are in need of transition services as early as 400.1-35 §17-400.1-13 possible during the transition planning process, and including, at a minimum, a description of the purpose of the VR services program, eligibility requirements, application procedures, and scope of services that may be provided to eligible individuals. [Eff AUG 13 2007] (Auth: HRS §§347-4, 348-7; 29 U.S.C. §721; 34 C.F.R. §361.22) (Imp: HRS §§347-4, 348-7; 29 U.S.C. §721; 34 C.F.R. §361.22) §17-400.1-14 Cooperation with WIA One-Stop centers. (a) The division shall carry out the following functions as a required partner in the One- Stop service delivery system of the statewide workforce investment system under Title I of the Workforce Investment Act of 1998: (1) Make available to participants through the One-Stop service delivery system the core services that are applicable to the program administered by the division under this part, which consists of: (A) Eligibility determination; (B) Outreach, intake and orientation; (C) Skills assessment; (D) Job search, placement assistance, career counseling; (E) Information on: (i) Employment statistics information. (ii) Performance and cost data on eligible training providers. (iii) Local area performance outcomes. (iv) Availability of supportive services. (v) Filing claims on unemployment compensation. (F) Assistance in establishing eligibility for welfare-to-work and financial aid for training and education; and (G) Follow up services for 12 months after 400.1-36