DEPARTMENT OF HUMAN SERVICES

Amendments to Chapter 17-1722.3Hawaii Administrative Rules

November 5, 2014

SUNNARY

1. A new subchapter 1.5 is added.

§17-1722.3-5.2

SUBCHAPTER 1.5

EMERGENCY ADMINISTRATIVE RULES RELATING TO STATEMEDICAL ASSISTANCE FOR CERTAIN LAWFULLY PRESENT NON-

CITIZENS

§17-1722.3-5.1 Definitions. The followingdefinitions shall apply to this subchapter:

“Current beneficiary” means a non-pregnant adultnon-citizen who is receiving, at the time thissubchapter is adopted, State medical assistancebenefits that exceed the benefits provided undersection 17-1722.3-18.

“Exchange” means the Hawaii health insuranceexchange established under the Affordable Care Act.

“New ABD Beneficiary” means an aged, blind ordisabled non-citizen who applies for benefits undersection 17-1722.3-5.6 and is determined eligible forbenefits under section 17-1722.3-5.7.

“Qualified health plan” means a qualified healthplan or a qualified health plan issuer, as those termsare defined in 45 C.F.R. §155.20, and as the contextmay dictate. [Eff NOV 052014 1 (Auth: HRS §91-3,91-4, 346-14) (Imp: HRS §346-14)

§17-1722.3-5.2 Basis for emergencyadministrative rules. (a) This subchapter is adoptedas an emergency rule under section 91-3 (b), HawaiiRevised Statutes, because the department finds that itmust amend this chapter upon less than 30 days’ noticeof hearing in order to avoid imminent peril to publichealth or safety.

(b) Certain lawfully present non-pregnant adultnon-citizens who are ineligible for federal medicalassistance due to their immigration status are inreceipt of State medical assistance benefits thatexceed the Basic Health Hawaii benefits defined underthis chapter because of an injunction order issued bythe United States District Court for the District of

3124

§17-1722.3-5.2

Hawaii in the case of Korab v. McManaman, Civil No.10-00483 JMS/KSC.

(c) The injunction order was vacated effectiveNovember 3, 2014. Therefore, the department isrequired by its current administrative rules toterminate the State medical assistance benefitsreceived by the current beneficiaries and toredetermine their eligibility for the Basic HealthHawaii program.

(d) The Affordable Care Act requires most Hawaiiresidents, including lawfully present non-citizens, tohave minimum levels of health coverage. Basic HealthHawaii does not provide the coverage required underthe Affordable Care Act. Therefore, the departmentintends to repeal this chapter upon expiration ofthese emergency rules.

(e) Current beneficiaries who are not aged,blind or disabled, are at risk of losing State medicalassistance coverage before they can be enrolled in aqualified health plan through the Exchange. Thosewith household income of less than one hundred percentof the federal poverty level get less financial helpwith paying their insurance premium than other people.These emergency rules temporarily continue theircurrent benefits while they are transitioning fromState funded medical assistance to enrollment in aqualified health plan purchased through the Exchange,and temporarily provide help with paying the share ofpremiums dues to their qualified health plan until apermanent premium assistance program is established bythe department.

(f) Current beneficiaries who are aged, blind ordisabled have greater and more frequent healthcareneeds, and will be more severely impacted if theypurchase insurance through the Exchange since thatcoverage will impose copayments for many services thatare currently provided at no cost, excludes manyservices that are important to aged, blind anddisabled individuals, such as medical transportation,long term care, and home and community based services.These individuals will also get less financial helpwith paying the premiums if their household income is

312

§17-1722.3-5.3

less than one hundred percent of the federal povertylevel. These emergency rules temporarily continuetheir current benefits until a new State medicalassistance program for certain lawfully present non-pregnant adult non-citizens who are aged, blind ordisabled is established by the State, and allow newABD beneficiaries to apply for this benefit.

(g) These emergency rules ensure that currentbeneficiaries and new ABD beneficiaries have access toneeded health care, including services that are notavailable through the Exchange, without the burden andconfusion of being terminated or excluded fromexisting benefits before appropriate replacementcoverage is in place. [Eff NUV 052014 ] (Auth:HRS §9l-3, 91-4, 346-14) (Imp: HRS §346-14)

§17-1722.3-5.3 Purpose. (a) This subchapterprovides temporary and emergency relief by:

(1) Continuing the same health coverage tocurrent beneficiaries that they arereceiving at the time this subchapter isadopted, pending repeal of this chapter;

(2) Providing new ABD beneficiaries with Statemedical assistance that is equivalent tofederal medical assistance benefits, pendingadoption of administrative rules creating anew State funded medical assistance programfor certain non-citizens who are aged,blind, and disabled;

(3) Transitioning certain current beneficiariesto qualified health plans purchased throughthe Exchange; and

(4) Providing premium assistance to certain non-pregnant adult non-citizens who are notaged, blind or disabled, who are determinedeligible for and purchase a qualified healthplan through the Exchange, pending adoptionof administrative rules establishing apremium assistance program.

(b) Certain non-citizens who are eligible forfederal medical assistance, including but not limited

2 A

§17-1722.3-5.3

to pregnant women and children who are citizens ofCOFA nations, continue to be eligible for federalmedical assistance and are not affected by theseemergency administrative rules. [Eff NOV 052014 1(Auth: HRS §91-3, 91-4, 346-14) (Imp: HRS §346-14)

§17-1722.3-5.4 Effect of this subchapter. (a)This subchapter shall supersede any contraryadministrative rules contained in this chapter, unlessotherwise specifically noted in this subchapter.

(b) This subchapter shall apply to currentbeneficiaries, applicants under sections 17-1722.3-5.6and l7-l722.3-5.7,’new ABD beneficiaries, andindividuals eligible for premium assistance undersection 17-1722.3-5.14. [Eff NOV 052014 1 (Auth:HRS §91-3, 91-4, 346-14) (Imp: HRS §346-14)

§17-1722.3-5.5 Continuation of eligibility forcurrent beneficiaries. Current beneficiaries shallcontinue to remain eligible for benefits under section17-1722.3-5.9 provided they continue meet theapplicable eligibility requirements, other thancitizenship and non-citizen status, of chapter17-1715.1 (Former Foster Care Children Group), 17-1717(Parents and Other Caretaker Relatives Group),17-1717.1 (Transitional Medical Assistance), 17-1718(Adults Group), 17-1719 (Aged, Blind and DisabledGroup), 17-1730.1 (Medically Need Spenddown) or17-1735.1 (Fee For Service) . [Eff NOV 052014 ](Auth: HRS §91-3, 91-4, 346-14) (Imp: HRS §346-14)

§17-1722.3-5.6 Open application period. Withinfifteen calendar days after the effective date of thissubchapter, the department shall publish notice of anopen application period for new ABD beneficiaries asprovided under, and subject to the requirements of,section l71722.310. [Eff NOV 135 2014 1 (Auth:HRS §9l-3, 91-4, 346-14) (Imp: HRS §346-14)

31 2A

§17-1722.3-5.8

§17-1722.3-5.7 Eligibility requirements for newaged, blind, and disabled beneficiaries. To bedetermined eligible for benefits under section 17-1722.3-5.9, an individual who applies during an openapplication period must:

(1) Meet the requirements set forth in chapter17-1719 (Aged, Blind and Disabled Group),with the exception of citizenship and non-citizen status under section 17-1714.1-28;

(2) Be a qualified non-citizen, a nonimmigrantunder the INA (including citizens of COFAnations), or a non-citizen paroled into theUnited States under section 212(d) (5) of theINA for less than one year;

(3) Not be eligible for federal medicalassistance(A) Solely due tcitizenship or non-

citizen status; or(B) Under chapters:

(i) 17-1715, Children Group;(ii) 17-1716, Pregnant Women Group; or(iii) 17-1719, Aged, Blind and Disabled

Group.(4) Not be eligible for health coverage as an

active military enlistee, a retired militarypersonnel, or a dependent of an active orretired military enlistee.[Eff NOV 052014 1 (Auth: HRS §9l-3,91-4, 346-14) (Imp: HRS §346-14)

§17-1722.3-5.8 Enrollment into a participatinghealth plan. (a) All current beneficiaries and newABD beneficiaries, except for adults identified insection 17-1735.1-2(a), shall be enrolled in a healthplan as provided under chapter 17-1720.1.

(b) Current beneficiaries and new ABDbeneficiaries who are adults identified in section17-1735.1-2(a) shall not be enr11ed in a health planand will receive services on a fee-for-service basis.[Eff NOV 052014 1 (Auth: HRS §91-3, 91-4, 346-14)(Imp: HRS §346-14)

§17-1722.3-5.9

§17-1722.3-6.9 Benefits. (a) All currentbeneficiaries and new ABD beneficiaries shall beprovided a standard benefits package by aparticipating health plan and other services whenappropriate as described in chapter 17-1720.

(b) Current beneficiaries and new ABDbeneficiaries who are adults identified in section17-1735.1-2(a) shall be provided coverage under thefee-for-service provisions as described in chapter17-1737. [Eff NOV 1352014 ] (Auth: HRS §91-3,91-4, 346-14) (Imp: HRS §346-14)

§17-1722.3-5.10 Eligibility review requirements.Eligibility shall be redetermined in accordance withchapter 17-1712.1 ad sbpter 5 of chapter17-1714.1. [Eff NuV 0 D UI’t ] (Auth: HRS §91-3,91-4, 346-14) (Imp: HRS §346-14)

§17-1722.3-5.11 Termination of eligibility. Anindividual’s eligibility for services under thissubchapter shall be terminated for any of thefollowing reasons:

(1) The individual fails to meet any of theeligibility requirements of sections17-1722.3-5.5 and 17-1722.3-5.7;

(2) Death of the individual;(3) The individual no longer resides in the

State;(4) The individual voluntarily terminates

coverage;

(5) The individual is admitted to a publicinstitution as defined in chapter 17-1714.1;

(6) The individual’s whereabouts are unknown;(7) Lack of State funds;(8) The program is terminated; or(9) Expiration of these emergency rules.

[Eff NOV 1352014 ] (Auth: HRS §9l-3,91-4, 346-14) (Imp: MRS §346-14)

3124

§17-1722.3-5.14

§17-1722.3-5.12 Disenroliment from aparticipating health plan. An enrollee under thissubchapter shall be disenrolled from a participatinghealth plan as provided under subchapter 4 of chapter17-1720.1. [Eff NOV 052014 1 (Auth: HRS §91-3,91-4, 346-14) (Imp: HRS §346-14)

§17-1722.3-5.13 Transition of currentbeneficiaries who are not aged, blind, and disabled.(a) The department shall send the individual’sapplication information, which includes household andother applicable information, and may also sendenrollment information, to the Exchange for purposesof calculating the individual’s advance premium taxcredit and cost-share reduction and for enrollment ina qualified health plan through the Exchange.

(b) To ensure continued health insurancecoverage, individuals will need to complete theExchange application process and enroll in a qualifiedhealth plan through the Exchange prior to terminationof Basic Health Hawaii, which will occur no earlierthan March 1, 2015.

(c) The department shall not be responsible foran individual completing the Exchange applicationprocess, enrolling in a qualified health plan throughthe Exchange, or for calculating an individual’sadvance premium tax credit or cost-sharing reduction.[Eff NOV 052014 1 (Auth: HRS §91-3, 91-4, 346-14)(Imp: HRS §346-14)

§17-1722.3-5.14 Premium assistance eligibilityrequirements. In order to receive the premiumassistance described under sections 17-1722.3-5.14 to17-1722.3-5.17, an eligible individual shall:

(1) Have selected or be enrolled in a 94%actuarial value silver level qualifiedhealth plan through the Exchange;

(2) Be determined eligible for advanced premiumtax credit and the maximum cost-sharingreduction by the Exchange; and

3124

§17-1722.3-5.14

(3) Have household income of less than onehundred percent of the federal poverty levelfor the applicable household size asdetermined by the Exchange’and communicatedby the Exchange to the qualified health planselected by the individual.

(4) If the Exchange does not communicate thisinformation to the qualified health plan,then the qualified health plan may contactthe individual to obtain informationnecessary for the qualified health plan todetermine whether the individual’s householdincome is less than one hundred percent ofthe federal poverty level for the applicablehousehold size. [Eff NOV 052014 1 (Auth:HRS §91-3, 346.14) (Imp: HRS §346.14)

§17-1722.3-5.15 Premium assistance benefits.(a) The department shall, upon presentation of aninvoice by a qualified health plan to the department,pay to the eligible individual’s qualified health plan(referred to in this section as “the health plan”) theshare of premium that the eligible individual isrequired to pay to the health plan to receivecoverage.

(b) The department shall pay the eligibleindividual’s share of premium to the health plan onlyupon receipt by the department of an invoice from thehealth plan.

(c) The department shall not make any paymentsdirectly to eligible individuals.

(d) The department shall not pay, and theeligible individual shall be responsible for, anycost-sharing including, but not limited to,deductible, co-payment or co-insurance.

(e) The department is not responsible forensuring that the health plan timely submits aninvoice for premium payment to the department. Anycomplaints by an eligible individual regarding thehealth plan billing the individual for the

3124

§17-1722.3-5.18

individual’s share of premium must be directed to thehealth plan. [Eff NUV 052014 ] (Auth: HRS §9l-3,346-14) (Imp: HRS §346-14)

§17-1722.3-5.16 Termination of premiumassistance. An individual’s eligibility for premiumassistance shall be terminated at any time for any ofthe following reasons:

(1) Fails to meet the eligibility requirementsset forth in section 17-1731-5.14;

(2) voluntarily terminates participation in thepremium assistance program;No longer resides in the State;Death of the individual;Whereabouts are unknown;Insufficient State funds; orThe premium assistance benefit under thissubchapter is terminated.[Eff NOV 052014 ] (Auth: HRS §91-3,346-14) (Imp: HRS §346-14)

§17-1722.3-5.17 Administration of premiumassistance. The department may contract with a thirdparty or parties to provide the premium assistancebenefit and to provide administration including, butnot limited to, payment, auditing, and recovery. Thedepartment’s provision of premium assistance shall beadministered at no cost to the eligible individual.[Eff NOV 052014 1 (Auth: I-{RS §9l-3, 346-14) (Imp:

HRS §346-14)

§17-1722.3-5.18 Effective period of theseemergency administrative rules. These emergencyadministrative rules shall take effect upon filingwith the Lieutenant Governor’s office and shall beeffective for no longer than one hundred twentycalendar days. [Eff NOV 052014 1 (Auth: HRS§9l-3, 91-4, 346-14) (Imp: HRS §346-14)

3124

(3)(4)(5)(6)(7)

CD

fm

--

[01

H —a[0

1H

[02

—1

Hto

—-a

to

H —3

Ito

I_fl H

wto

U,

rt 0H to

H -1rt

I

oH —a

Hto

—1

to

HI_

A)

—a toI_

flto •

toU

)H

Ifl

to H CD (Ia CD ii a

DEPARTMENT OF HUMAN SERVICES

Amendments to Chapter 17-1722.3, Hawaii AdministrativeRules, on the Summary page dated November 5, 2014, were adoptedon November 5, 2014, without public hearing pursuant to §91-3(b), Hawaii Revised Statutes.

These amendments shall take effect upon filing with theOffice of the Lieutenant Governor and shall be effective for nomore than one hundred twenty calendar days after such filing,pursuant to §91-4(b) (2), Hawaii Revised Statutes.

APPROVED AS TO FORM:

(1)

U

cUJ

Zb

U

U

PATRICIA McMANAMAN

DirectorDepartment of Human Services

4eY Generaleputy

0%c.I NEIL \ABERCROMBIEGovernorState of Hawaii

Date:

Filed

3124

At

-•-

.:--

....__-t-

•F

-—

3

fr

/--:

Bil

ingu

alan

dSi

gnIn

terp

rete

rS

ervi

ces

for

Pub

lic

Not

ice

and

Hea

ring

Med

-QU

EST

prov

ides

free

bilin

gual

and

sign

lang

uage

inte

rpre

ters

.If

you

need

anin

terp

rete

r,pl

ease

call

1-80

0-31

6-80

05an

dpr

ess

0.T

his

isa

toll

-fre

ete

lephone

num

ber.

You

can

also

get

help

inpe

rson

atth

eM

ed-Q

UE

STof

fice

near

you.

Med-Q

UE

ST

*fl*

0T

1-80

O-3

16-8

0O54

O1W

seM

ed-Q

UE

ST

iJ

IM

ed-Q

UE

STm

eiaw

ora

chon

chia

kuno

npw

orou

sm

epw

omw

nge

ese

kam

o.Ik

apw

een

mei

osup

pwan

gen

chon

chia

kuko

sem

woc

hen

kopw

eko

kkor

iC

huuk

ese

1-80

0-31

6-80

05m

eka

tiki

0.Ei

ewna

mpa

nte

ngew

aes

eka

mo.

Enm

eipw

anto

ngen

ian

gei

anin

nis

non

anep

we

nom

wew

ech

onan

inni

sno

new

eof

esin

Med

-QU

EST

aka

nng

onuk

.Ti

Med

-QU

EST

ket

man

gted

tili

bre

nga

para

ipat

arus

(inte

rpre

ter)

dagi

tise

nias

nga

leng

guah

e(s

ign

lang

uage

)ke

nna

dum

adum

aa

pags

asao

.N

om

asap

ulIl

ocan

oyo

tipar

aipat

arus,

pang

aasi

yota

awag

anti

num

ero

1-80

0-31

6-80

05ke

nit

alm

egti

num

ero

0.D

ayto

ya

num

ero

tite

lepono

ket

awan

baya

dna

.M

abal

in‘

met

nga

pers

onal

kayo

am

apan

dum

awat

titu

long

idia

yop

isin

ati

Med

-QU

EST

nga

asid

egka

daka

yo.

-4

Med

-QU

ES

Ts

1ItL

IL

f.

I-3F

2L

F1-8

OO

--316-8

OO

5i!

FF

O1O

AI2.O

IK

orea

nN

i5h

)DM

ed-Q

UE

STA

))

JF

21

LIL

f.

4—4,

Med

-QU

EST

kasr

eko

mus

otko

min

kuh

inor

ekm

akin

kain

inka

slu

oin

kasr

ulu

riga

slah

ma

kom

kefa

hkan

.K

omfi

nen

enu

mw

etin

tuta

fku

leng

kas

torn

,nu

nak

Kos

raea

nm

unas

pang

onne

mpu

sein

ge:

1-80

0-31

6-80

05na

kom

tany

a0.

Tac

lofo

nna

cmpu

sein

geko

mku

hin

oerk

mak

inw

angi

nm

ob.

Kom

oaya

paku

inos

unac

eis

kasr

usi

nM

ed-Q

UE

STm

aoa

nap

kura

nnu

yuru

man

.M

ed-Q

UE

STej

Ie!Q

kri

-uko

kro

imej

je!o

kw

ônea

n,ib

oru

o-ka

jin

ak“k

ônna

ankö

npa

”(h

anro

ejar

ronr

on).

LJe

kwãj

aiku

jju

onri

-uko

kjou

jim

kUr

1-80

0-M

arsh

alle

se31

6-80

05im

keee

0.Ej

jeJQ

kw

One

anta

lboo

nnô

mba

in.

Kw

Om

aroñ

inba

rãin

wôt

bökj

ipai

iib

oM

ed-Q

UE

STw

ôpij

eoep

aake

eok.

Med

-QU

EST

am

oou

nger

ache

la

diak

boch

erao

le

iluc

hes

elte

kol

ma

dirr

ekel

Cha

del

mo

olei

uid

ate

koi

bous

bech

ach

im.

Als

ekum

kous

bech

aol

eiui

da

Pal

auan

tekor

em

omke

dong

ra1-

800-

316-

8005

ebe

tir

a0.

Tia

nga

diak

Ioch

erao

la

doud

engu

aer

mor

ngii.

Ng

dirr

ekel

sebe

chem

elng

mai

ang

eseu

era

rech

ader

aM

ed-Q

UE

STse

lkm

eed

erka

uel

obis

.M

ed-Q

uest

kin

saw

ahsk

ida

kaw

ewe

depi

lka

wei

dnm

duen

irai

lm

eso

hte

kak

karo

hnge

was

ade

sign

lang

uage

.M

ako

mw

anah

ne

saw

asen

kaw

ewe,

Poh

npei

anko

mw

kala

ngan

ohek

er1-

800-

316-

8005

ohpa

dik

0.N

embe

uet

soht

epw

eipw

eide

soht

eis

epe

ohng

tele

pon

uet.

Kom

wpu

kak

ahle

saw

assa

hng

aram

aseh

men

sang

Med

-Que

stni

ohpi

sm

eke

ieu

kara

hni

kom

wi.

Med

-QU

EST

em

appi

ida

riy

puiw

one

gird

iini

ma

afw

ege

thin

.F

aanr

aba

t’uf

em

aabw

egth

inng

omm

agdi

liiy

efo

nnu

mba

ni1-

800-

316-

8005

nge

0.Y

apes

eIr

rera

yeto

ll-f

ree

num

ba.

Kur

rayo

gni

ngan

pue

ayuw

koM

ed-Q

UE

STof

fice

uto

obem

.

Med

-QU

EST

cung

cp

thôn

gdi

chvi

ênso

ngng

O’v

àng

ônng

O’k

hiêu

mie

nph

i.N

uq

uvj

cn

thôn

gdch

viên

vui

lông

goi

s61-

800-

316-

8005

vàbm

0.V

ietn

ames

eD

àylà

s6iê

nth

oai

min

phi.

Qu’

vjd

ing

cóth

nh

nhân

viên

tai

van

phôn

gM

ed-Q

UE

STg

nq

uvI

giüp

à.

BH

HLE

PP

ubE

cH

eab

ng

nd

NoO

ce11

/201

4