Section 17-1736-15 - Requirements for participation in the program by providers(a) Except for payments authorized to out-of-state providers in emergency situations and to Qualified Medicare Beneficiaries (QMB) only providers, or as authorized under section 17-1736-13, payments under the medical assistance program for goods, care, and services shall be made only to providers approved by DHS to participate in the Hawaii medical assistance program.(b) An individual, institution, or organization shall meet all of the following requirements in order to become and retain eligibility as a provider under the medical assistance program: (1) The provider shall be licensed or approved as follows:(A) The provider, if an individual, shall be licensed to practice the provider's profession in accord with state law. Permits, temporary licenses, provisional licenses, expired or unrenewed licenses, or any form of license or permit which requires supervision of the licensee shall not serve to qualify the licensee as an approved provider of service under the Hawaii medical assistance program;(B) The provider, if a medical or health related institution, shall be certified by the state department of health under applicable public health rules of the state and standards of the federal government. The following shall apply regarding Medicare certification for participation in Medicaid: (i) Hospitals are required to be Medicare certified;(ii) Facilities that provide SNF services are required to be Medicare certified;(iii) Facilities that provide SNF and ICF services, but are not Medicare certified, may participate as an ICF; and(iv) Facilities that provide ICF services only are unable to obtain Medicare certification, therefore, participation as an ICF is allowed.(C) The provider of any other health care services shall comply with standards and all licensure, certification and other requirements as applicable;(2) The provider shall comply with the non-discrimination provisions of Title VI of the Civil Rights Act of 1964 ( 42 U.S.C. §2000 d) by not discriminating against program beneficiaries on the basis of race, color, national origin, or mental or physical handicap; and(3) The provider shall accept Medicaid's established rates of payments whether based on DHS's fee schedule, negotiated rate, reasonable cost reimbursement, or other adopted rates, whichever is applicable, as payment in full for goods, care, or services furnished. The provider shall not require any participation in payment by the Medicaid recipient for goods, care, or services furnished by the provider. The provider shall not demand or receive any additional payment from any Medicaid recipient with the exception of the department's proviso for cost sharing of medical care costs.Haw. Code R. § 17-1736-15
[Eff 08/01/94; am 02/07/05] (Auth: HRS § 346-14) (Imp: HRS § 346-59; 42 C.F.R. §§440.40, 442.12, 442.101, 447.15, 482.1, 483.1; Pub. L. No. 100-360 §301)