Section 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 licensed 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 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 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 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 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.Haw. Code R. § 17-400.1-11
[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 )