17-1713.1

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1713.1-1
HAWAII ADMINISTRATIVE RULES
TITLE 17
DEPARTMENT OF HUMAN SERVICES
SUBTITLE 12
MED-QUEST DIVISION
CHAPTER 1713.1
NOTICES
§17-1713.1-1 	Purpose
§17-1713.1-2 	Notice of eligibility or level of
benefits and services
§17-1713.1-3 	Use of electronic notices
§17-1713.1-4 	Notice content
§17-1713.1-5 	Timely and adequate notice
§17-1713.1-6 	Termination of eligibility
§§17-1713.1-7 to 17-1713.1-11 	(Reserved)
Historical Note: 	This chapter is based substantially
upon repealed chapter 17-1713. 	[Eff 	08/01/94; am
01/29/96; am 03/30/96; am 10/26/01; R 09/30/13]
§17-1713.1-1 	Purpose. 	The purpose of this
chapter is to establish the circumstances, conditions,
and deadlines under which the department shall notify
an individual regarding a determination of eligibility,
level of benefits or services, spenddown or premium
amounts and adverse actions. 	[Eff 	09/30/13] 	(Auth:
HRS §346-14; 42 C.F.R. §§431.206; 431-214, 431.917,
435.918) (Imp: 	HRS §346-14; 42 C.F.R. §§431.206; 431-
214, 431.917, 435.918)
§17-1713.1-2 	Notice of eligibility, or level of
benefits and services. 	(a) 	The department shall
provide an individual with a written notice of any
decision by the department or designee affecting the
individual’s eligibility for benefits and services
approval, denial, termination, or suspension of

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1713.1-2
benefits or services.
(b) 	The notice shall be written in plain language
and be accessible to a person who is limited English
proficient or has a disability.
(c) 	The notice content shall include that an
individual’s information may be transferred to all
applicable insurance affordability programs.
(d) 	Effective January 1, 2015, for MAGI
determinations, the department shall provide a combined
eligibility notice in coordination with the Health
Insurance Exchange. 	[Eff 	09/30/13] 	(Auth: 	HRS §346-
14; 42 C.F.R. §§431.206, 435.917, 435.1200) (Imp: 	HRS
§346-14; 42 C.F.R. §§431.206, 435.917, 435.1200)
§17-1713.1-3 	Use of electronic notices. 	(a) 	An
individual shall be provided a choice to receive
notices and information in electronic format in lieu of
regular mail. 	When an electronic format is requested,
the department shall:
(1) 	Confirm by regular mail the individual’s
election to receive notices electronically;
(2) 	Inform the individual of the right to change
the election, at any time, to regular mail;
(3) 	Post notices to the electronic account within
one business day of notice generation;
(4) 	Send an email or other electronic
communication to alert the individual of the
posting of a notice to their electronic
account. 	No confidential information shall
be contained in the email or electronic
alert;
(5) 	If undeliverable, send the notice by regular
mail within three (3) business days of the
date of the failed electronic communication;
and
(6) 	Provide, upon request, a paper-based notice
sent through regular mail of any notice
posted to the electronic account.
[Eff 	09/30/13] 	(Auth: 	HRS §346-14; 42
C.F.R. §435.918) (Imp: 	HRS §346-14; 42
C.F.R. §435.918)

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§17-1713.1-4 	Notice content. 	(a) 	A notice of
approved eligibility includes, but is not limited to:
(1) 	The basis and effective date of eligibility;
(2) 	The circumstances and procedures under which
reporting is required;
(3) 	If applicable, the amount of medical expenses
which must be incurred to establish
eligibility for medically needy spenddown;
(4) 	Information on the level of benefits and
services approved, including, any premiums,
enrollment fees and cost sharing; and
(5) 	Information on administrative appeal rights
as described in chapter 17-1703.1 to appeal
eligibility or approved level of benefits and
services.
(b) 	A notice to deny or take other action
affecting an individual’s eligibility or level of
benefits and services, based on the individual’s
household income at or below the applicable MAGI
standard shall contain information on the basis for
eligibility other than the MAGI standard and how to
request a determination on a MAGI-excepted basis.
[Eff 	09/30/13] 	(Auth: HRS §346-14; 42 C.F.R.
§§431.210, 435.917) (Imp: 	HRS §346-14; 42 C.F.R.
§§431.210, 435.917)
§17-1713.1-5 	Timely and adequate notice. 	(a)
Prior to the implementation of any adverse action which
affects an individual, a timely and adequate notice
shall be sent.
(b) 	A notice of adverse action shall be
considered timely when sent:
(1) 	At least fifteen (15) calendar days prior to
the effective date of adverse action except
as described in paragraph (c). 	When a new
address is reported to the department by the
individual within the eligible period, a new
notice shall be re-issued; or
(2) 	Five (5) calendar days prior to the effective
date of adverse action when the department
has evidence of probable fraud by the
individual.
(c) 	Adequate notice shall be sent not later than
the date of action when:
(1) 	The department has factual information
confirming the death of an individual;

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(2) 	The department received a clear written
statement signed by the individual or
authorized representative that:
(A) 	Medical assistance is no longer wanted;
or
(B) 	Provides information that necessitates
termination or reduction of services and
indicates the individual understands
that the consequences of supplying the
information is the reduction or
termination of assistance;
(3) 	The individual has been admitted or committed
to a public institution ineligible to receive
medical assistance;
(4) 	The individual is transferred or discharged
from a long-term care facility or qualified
home and community based home;
(5) 	The individual's whereabouts are unknown and
mail sent to the individual has been returned
by the post office indicating no known
forwarding address;
(6) 	The department has verified the individual's
receipt of medical assistance in another
jurisdiction, state, territory or
commonwealth;
(7) 	A change in the level of medical care is
prescribed by the individual’s physician; or
(8) 	Involves an adverse action made in regards to
preadmission screening requirements.
[Eff 	09/30/13] 	(Auth: 	HRS §346-14; 42
C.F.R. §§431.206, 431.211, 431.213, 431.214,
435.917) (Imp: 	HRS §346-14; 42 C.F.R.
§§431.206, 431.211, 431.213, 431.214,
435.917)
§17-1713.1-6 	Termination of eligibility. 	(a)
The department shall terminate an individual’s
eligibility and send notice of the adverse action when:
(1) 	A signed, written request for termination is
received from the eligible individual;
(2) 	The department has verified the death of an
eligible individual;
(3) 	The eligible individual is admitted or
committed to a public institution;
(4) 	The eligible individual is no longer residing
in the state;

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(5) 	The eligible individual's whereabouts are
unknown;
(6) 	The eligible individual, when required to
meet the asset standard, fails to provide the
department with verification to determine the
amount of the assets;
(7) 	The eligible individual, whose eligibility
determination is not based on the MAGI
standard, fails to provide the department
with verification to determine the amount of
income;
(8) 	The eligible individual fails to apply for
and develop potential sources of assets and
income when required;
(9) 	An eligibility redetermination is not
completed because of the eligible
individual’s failure to provide the
department with requested verification or to
provide a completed eligibility
redetermination form when required;
(10) The eligible individual fails to meet any of
the necessary requirements of the eligibility
group; or
(11) The eligible individual fails to cooperate or
provide information to federal or state
personnel who review the decisions regarding
eligibility for assistance.
[Eff 	09/30/13] 	(Auth: HRS §346-14; 42
C.F.R. §§435.903, 435-916) (Imp: 	HRS §§346-
14; 42 C.F.R. §§435.903, 435-916)
§§17-1713.1-7 to 17-1713.1-11 	(Reserved).