Haw. Code R. § 17-1735.2-4 - Requirements of participating health plans

(a) Health plans participating in the medical assistance program shall abide by the provisions of their respective contracts with the department as well as federal and state statutes and regulations.

(b) The requirements of each participating health plan shall include, but are not limited to, the following:

(1) Provision of all services required by the contract between the respective plan and the department;

(2) Provision of a primary care provider for each eligible individual who is enrolled in the health plan;

(3) Provision of a case management system to ensure that health services identified by an eligible individual's primary care provider as medically necessary are received;

(4) Development and maintenance of a sufficient network of health care providers to ensure the provision of required health services are provide to an eligible individual in a timely manner;

(5) Maintenance of adequate support staff and systems to administer and conduct business functions;

(6) Development and maintenance of required information systems;

(7) Development and maintenance of a quality assurance program;

(8) Development and maintenance of a grievance and appeal system for a dissatisfied eligible individual;

(9) Development and maintenance of a toll-free telephone hotline in the State to confirm enrollment, respond to inquiries from an eligible individual, and provide information to the general public; and

(10) Maintenance of a medical records system to enable the provision of information pertinent to the care and management of an eligible individual to the department.

Notes

Haw. Code R. § 17-1735.2-4

[Eff 09/30/13] (Auth: HRS § 346-14) (Imp: HRS § 346-14; 42 C.F.R. §430.25)