HAR §11-172-32. Medical assistance reimbursement

Medical assistance reimbursement to providers shall only be made for individuals eligible for medical assistance and who are medically determined to need community mental health rehabilitation services. These services must be recommended by a physician or other licensed practitioner to promote the maximum reduction or restoration, or both, of an individual to the individual’s best possible functional level relevant to the individual’s diagnosis of mental illness, or mental illness and abuse of drugs or alcohol. [Eff AUG 06 2005] (Auth: HRS §§ 321-1, 334-9; 42 C.F.R. § 431.10) (Imp: HRS § 321-1, 334-9) §11-172-33 Utilization management information and data. Providers shall submit information and data regarding appropriateness of CMHRS provided, lengths of stay, and quality of CMHRS provided to the department. Upon request, the applicant or provider shall deliver to the department the requested information. The department shall develop and give to the applicant or provider forms for providing this information, and shall review the information to determine compliance with department policies and requirements. The department may establish policies and procedures for conducting reviews under this section. [Eff AUG 06 2005] (Auth: HRS §§ 321-1, 334-9; 42 C.F.R. § 431.10) (Imp: HRS § 321-1, 334-9) SUBCHAPTER 4 MISCELLANEOUS PROVISIONS