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UNOFFICIAL 1736-5

§17-1736-11 Purpose. The purpose of this chapter is to establish conditions for provider participation in the fee for service component of Hawaii's medical assistance program. The provisions of this chapter govern provider applications and procedures for approval or denial of those applications, the requirements to be met by a provider before that person or organization is certified or denied provider status, and the requirements that providers keep records to participate in the program. Also described are procedures to be used for suspension or termination of providers from the Hawaii medical assistance program. [Eff 08/01/94 ] (Auth: HRS §346-14) (Imp: 42 C.F.R. §431.10)

§17-1736-12 REPEALED. [R 09/30/13]

§17-1736-13 Application for provider participation. (a) Any provider who wishes to provide care, goods, or services to receive reimbursement from the Hawaii medical assistance program, shall apply in writing to the med-QUEST division of DHS. The provider shall, at the request of the DHS med-QUEST administrator, supply all information requested concerning the provider's education and qualifications as a provider, financial status of the provider's practice, background history of the provider, and if the provider is required to maintain a license, the status of that license. The DHS med-QUEST administrator shall, in the administrator's sound discretion, have the right to approve or deny any application for certification as a provider under the Hawaii medical assistance program. If a provider is denied certification by the DHS med-QUEST administrator, the provider may request a fair hearing as provided by section 17-1736-33. Application forms to request certified provider status shall be furnished by the DHS med-QUEST administration.

(b) Except for providers exempted in subsections (c) and (d), all providers participating or applying to participate in Hawaii's medical assistance program shall have a current and valid written agreement or contract on file with DHS. Failure to maintain such a contract shall constitute grounds for suspension, termination, or withholding payment of claims submitted under the Hawaii medical assistance program until a