HAR §17-659-11. Program eligibility requirements

(a) An individual shall be between 18 and 65 years of age. (b) The household shall not include the minor dependents of any eligible adult for whom the adult provides care and supervision. (c) A dependent adult applying for assistance shall meet the requirements specified in section 17-659-14. (d) A medical determination of physical impairment, mental impairment, or a combination of physical and mental impairment is required at the time of application and when §17-659-11 659-7 the medical or psychiatric board determines a re- examination is needed. An applicant who claims both a physical and a mental impairment shall be asked to designate the primary disability. (1) A determination and certification of physical impairment shall only be made by a board of licensed physicians. (2) A determination and certification of mental impairment shall only be made by a board of licensed psychologists or licensed physicians whose specialty is in psychiatry. (3) A determination and certification of a combination of physical and mental impairment shall be made by both the medical and the psychiatric boards. (4) The director shall appoint licensed physicians or licensed psychologists designated and paid by the department to the medical or psychiatric board. Such members of each board shall be appointed for the period contracted with the department unless otherwise specified. (5) The director shall appoint the department’s medical and psychiatric consultants to the medical or psychiatric board. Such members of each board shall be appointed for the duration of their employment with the department unless otherwise specified. (6) A minimum of three members of each board must participate in the review of a disability. (A) The board members involved in the review of an individual’s physical or mental impairment shall include the department’s designated examining physician or psychologist. (B) A minimum of two board members must agree on each determination and certification of physical or mental impairment. (e) The individual shall provide the department a current medical report. (f) The department shall authorize payment for the individual to obtain a medical determination of §17-659-11 659-8 physical impairment, mental impairment, or a combination of physical and mental impairment. (g) Assistance shall be approved only for the period of the disability when an individual is determined disabled by the medical or psychiatric board. Assistance shall end when a determination is made by the medical or psychiatric board that the individual no longer meets the department’s definition of disabled. (h) When the medical or psychiatric board determines the applicant is not disabled, the applicant shall be provided a notice informing the applicant that additional medical evidence may be submitted within ten calendar days prior to the denial of the application. The notice shall refer the applicant to free legal services for assistance and permit the applicant to request extensions of time, as necessary. (1) If the applicant does not respond, the application shall be denied on the eleventh calendar day or the first work day following the eleventh calendar day if the tenth calendar day fell on a weekend or a holiday. (2) Additional medical evidence submitted within ten calendar days shall be reviewed by the appropriate medical or psychiatric board for a determination and certification of a physical impairment, mental impairment, or a combination of both physical and mental impairment. (3) Additional medical evidence that is not submitted within ten calendar days but is submitted before a disposition of the application is made shall be reviewed by the appropriate medical or psychiatric board for a determination and certification of a physical impairment, mental impairment, or a combination of both physical and mental impairment. (i) For applicants, a presumptive determination of disability may be made by the department for one month's eligibility provided: (1) The disabling condition is readily observable or may be reasonably inferred from prior medical history; and §17-659-11 659-9 (2) Eligibility for subsequent months shall be established in accordance with this section. (j) The disabled person shall be required to accept and pursue medical treatment as determined by the authorized examiner. (1) The department shall provide the disabled person with a legible copy of the recommended treatment; (2) When a determination of mental impairment is made, the person shall accept and pursue treatment; (3) When a determination of physical impairment is made, the person shall accept and pursue medical treatment; (4) The individual with a primary diagnosis of substance abuse shall be required to receive treatment in a residential treatment facility or shall obtain treatment on an outpatient basis provided the treatment is received in a planned manner. Residential treatment facilities and outpatient clinics or providers shall be certified by medicare or medicaid, accredited by the state department of health’s alcohol and drug abuse branch, licensed by the state department of health’s hospital and medical facilities branch or be licensed providers of medical services; (5) An individual’s compliance to treatment shall be evaluated; and (6) Refusal or failure to pursue medical, psychological or psychiatric treatment for the identified disability shall result in disqualification unless the department determines the refusal or failure is due to good cause. Good cause shall include but is not limited to the following: (A) Mental illness or mental deficiency precludes understanding of the department’s requirements; (B) Treatment is contrary to the client’s religious beliefs; (C) Treatment is not available. Treatment is considered not available when the providers of a health plan the individual is enrolled §17-659-11 659-10 in are unable to provide treatment; treatment is considered available even if the individual does not have health coverage or a health plan; (D) Personal emergency. A personal emergency is defined as: (i) a life threatening circumstance affecting the individual, the individual’s spouse, parent or child that is verified by a licensed physician or licensed psychologist; or (ii) the individual suffers a natural disaster that is verified with the police department, fire department or other applicable agency; or (E) Circumstances which threaten the safety of the individual. These circumstances shall be verified with a licensed physician, a licensed psychologist, the police department, or other applicable agency. [Eff 3/19/93; am 7/24/95; am 12/15/95; am 11/22/96; am 9/26/97; am 7/16/99; am 5/31/02; am and comp 3/27/09 ] (Auth: HRS §§346-14, 346-71) (Imp: HRS §§346-31, 346- 71)