11-102

DEPARTMENT 	OF 	HEALTH
STATE 	OF 	HAWAII
TITLE 	11
STATE 	HEALTH 	PLANNING AND 	DEVELOPMENT AGENCY
CHAPTER 	102
REVIEWS 	OF 	THE 	APPROPRIATENESS 	OF 	INSTITUTIONAL
AND 	HOME 	HEALTH 	SERVICES
Sec. 	11-102-1
Sec. 	11-102-2
Sec. 	11-102-3
Sec. 	11-102-4
Sec. 	11-102-5
Sec. 	11-102-6
Sec. 	11-102-7
Sec. 	11-102-8
Sec. 	11-102-9
Sec. 	11-102-10
Sec. 	11-102-11
Sec. 	11-102-12\
Sec. 	11-102-13
Sec. 	11-102-14
Sec. 	11-102-15
Sec. 	11-102-16
Sec. 	11-102-17
Sec. 	11-102-18
Sec. 	11-102-19
Sec. 	11-102-20
Sec. 	11-102-21
General 	Provisions
Scope
Review of 	the 	appropriateness
of 	institutional 	and 	home
health 	services
Construction 	of 	rules
Computation 	of 	time
Definitions
The 	agency's 	address 	and
business 	hours
Filing 	of 	documents
Agency 	records
Public 	hearings
Appearances 	at 	public 	hearings
Criteria 	for 	Agency 	Reviews
Criteria
Special 	criteria 	for 	health
maintenance 	organizations
Additional 	criteria 	for 	health
maintenance 	organizations
Review Procedures
Written 	notification 	to
affected 	persons
Method 	of 	notification
Review 	schedule
Date 	of 	notification
Information 	for 	reviews
Request 	for 	a 	public 	hearing
Notification 	of 	status 	and
findings
Required 	findings
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Sec. 	11-102-22
Sec. 	11-102-23
Sec. 	11-102-24
Sec. 	11-102-25
Sec. 	11-102-26
Sec. 	11-102-27
Agency 	findings 	made 	public
Public 	hearing 	for 	purposes 	of
reconsideration
Administrative 	appeals
Exceptions 	to 	use 	of 	procedures
Agency 	reports
Technical 	advisory 	committees
and 	experts
GENERAL 	PROVISIONS
Sec. 	11-102-1 	Scope. 	The 	rules 	in 	this
chapter 	govern 	procedure 	before 	the 	state 	health
planning 	and 	development 	agency. 	They 	are 	adopted
by 	the 	State 	pursuant 	to 	section 	323D-62, 	Hawaii
Revised 	Statutes, 	to 	carry out 	the 	provisions 	of
the 	Public 	Health 	Service Act, 	titles 	XV 	and 	XVI
as 	amended, 	and 	the 	implementing 	federal 	regu-
lations 	relating 	to 	reviews 	by 	the 	state 	health
planning 	and 	development 	agency 	of 	the 	appropri-
ateness 	of 	those 	institutional 	health 	services 	and
home 	health 	services 	offered 	in 	the 	State 	and 	with
respect 	to 	which 	goals 	have 	been 	established 	in
the 	state 	health 	plan, 	and 	to 	provide 	for 	the
efficient 	administration 	of 	the 	reviews. 	(Auth:
HRS 	Sec. 	323D-62) 	(Imp: 	HRS 	Sec. 	323D-12) OCT 	O3198n
Sec. 	11-102-2 	Review of the 	appropriateness 	of
institutional 	and home 	health 	services. 	The
agency 	shall, 	in 	accordance 	with 	these 	rules,
review 	periodically on 	an 	areawide 	basis, 	but 	not
less 	often 	than 	every 	five 	years, 	the 	appropri-
ateness 	of 	those 	institutional 	health 	services 	and
home 	health 	services 	offered 	in 	the 	State 	and with
respect 	to 	which 	goals 	have 	been 	established 	in
the 	state 	health 	plan, 	make 	public 	findings 	as 	to
the 	appropriateness 	of 	each 	service, 	and make
recommendations 	for 	remedial 	action when 	a 	service
is 	found 	inappropriate. 	The 	agency may, 	at 	the
same 	time, 	make 	findings 	as 	to 	the 	appropri-
ateness 	of 	that 	service 	in 	particular 	institutions.
(Auth: 	HRS 	Sec. 	323D-62) 	(Imp: 	HRS 	Sec. 	323D-12)
sti. 1f:8flo2-3 	Construction 	of 	rules. 	(a) 	The
rules 	shall 	be 	liberally 	construed 	to 	promote
reviews 	of 	the 	appropriateness 	of 	those 	institu-
tional 	health 	services 	and home 	health 	services
102-2

offered 	in 	the 	State 	and with 	respect 	to 	which
goals have 	been 	established 	in 	the 	state 	health
plan, 	in order 	for 	the 	agency 	to 	evaluate 	the
current 	health 	care 	system 	in 	the 	State 	and 	to
make 	recommendations, 	where 	necessary, 	for 	remem-
dial 	action.
(b) 	The 	captions 	of 	the 	rules 	are 	for
reference 	only 	and 	are 	not 	to 	be 	construed 	in 	any
way 	as 	a 	part of 	the 	rules. 	(Auth: 	HRS 	Sec.
323D-62) 	(Imp: 	HRS 	Sec. 	323D-12) 	OCT 	G3 1980
Sec. 	11-102-4 	Computation 	of 	time. 	(a) 	In
computing 	any 	period 	of 	time 	prescribed 	or 	allowed
by 	these 	rules, 	the 	day 	of 	the 	act, 	event 	or
default 	after which 	the 	designated 	period 	of 	time
begins 	to 	run 	shall 	not be 	included. 	The 	last 	day
of 	the 	period 	so 	computed 	shall 	be 	included 	unless
it 	is 	a 	Saturday, 	a 	Sunday or 	a 	holiday, 	in which
event 	the 	period 	runs 	until 	the 	end 	of 	the 	next
day which 	is 	not 	a 	Saturday, 	a 	Sunday 	or 	a 	holiday.
When 	the 	period 	of 	time 	prescribed 	or 	allowed 	is
less 	than 	seven days, 	intermediate 	Saturdays,
Sundays 	and 	holidays 	shall 	be 	excluded 	in 	the
computation. 	As 	used.in this 	rule, 	"holiday"
includes 	any day 	designated 	as 	such 	pursuant 	to
section 	81, 	Hawaii 	Revised 	Statutes.
(b) 	Whenever 	any 	person 	in 	a 	proceeding 	held
under 	these 	rules 	has 	the 	right 	or 	is 	required 	to
do 	some 	act within 	a 	prescribed 	period of 	time
after 	the 	agency provides 	notification 	to 	the
person by mail, 	two 	days 	shall 	be 	added 	to 	the
prescribed 	time. 	(Auth: 	HRS 	Sec. 	323D-62) 	(Imp:
HRS 	Sec. 	323D-12) 	T O3 	Q
Sec. 	11-102-5 	Definitions. 	Except 	for 	the
terms 	"institutional 	health 	services" 	and
"expenditure minimum," 	terms 	used 	in. this 	chapter
shall 	have 	the meaning 	given 	them 	in 	the 	state
health 	planning 	and 	development 	agency's 	certifi-
cate 	of 	need 	rules. 	In 	addition, 	as 	used 	in 	this
chapter 	and 	in 	proceedings 	brought under 	this
chapter, 	unless 	the 	context 	clearly 	requires
otherwise:
·"Affected 	persons" 	include 	the 	person 	or
persons whose 	service 	is 	being 	reviewed 	by 	the
agency, 	health care 	facilities 	and 	health main-
tenance 	organizations 	located 	in 	the 	State which
provide 	institutional 	health 	services, 	any 	agency
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which 	establishes 	rates 	for 	health 	care 	facilities
or 	health maintenance 	organizations 	in 	the 	State,
and 	those members 	of 	the 	public who 	are 	to 	be
served 	by 	the 	service 	subject 	to 	review.
A finding 	of 	"appropriateness" 	means 	a
finding 	that 	the 	service meets 	the 	needs 	of 	a
population 	in accordance 	with 	the 	criteria 	set
forth 	in Sec. 	11-102-11 	and 	Sec. 	11-102-12.
"Areawide review" 	means 	the 	review of 	a
specific 	insititutional 	health 	service 	as 	deliv-
ered 	by 	all 	the 	institutions 	providing 	the 	service
in 	the 	State:
(1) 	Which 	shall 	culminate 	in 	findings 	by
the 	agency 	regarding 	the 	appropriateness
of 	the 	service 	over 	the 	entire 	State,
and
(2) 	Which may 	result 	in recommendations
regarding 	the 	appropriateness 	of 	the
s~rvice. in 	a 	particular 	institution.
"Existing 	institutional 	health 	services" 	or
"services" 	means 	institutional 	health 	services:
(1) 	Being 	offered 	in 	the 	State 	at 	the 	time
of 	review 	for 	appropriateness, 	or
(2) 	Offered 	at 	any 	time 	in 	the 	twelve months
prior 	to 	the 	review and 	also 	planned 	to
be 	offered 	at 	any 	time 	in 	the 	twelve
months 	following 	the 	review, 	or
(3) 	Which will 	be 	offered during 	the 	twelve
months 	following 	the 	review.
"Expenditure minimum" 	means 	$75,000 	for 	the
twelve months 	prior 	to 	the 	review, 	unless 	other-
wise 	adjusted. 	The 	agency may, 	at 	its 	discretion,
periodically 	adjust 	the 	expenditure minimum 	to
reflect 	any change 	in 	an 	index 	designated 	by 	the
secretary 	for 	purposes 	of making 	the 	adjustment.
"Institutional 	health 	services" 	mean 	health
services 	which:
(1) 	Are 	provided 	through private 	or 	public
hospitals, 	rehabilitation 	facilities,
and 	nursing 	homes, 	and
(2) 	Entail 	annual 	operating 	costs 	of 	at
least 	the 	expenditure minimum.
102-4

"Person" 	means 	an 	individual 	or 	a 	natural
person, 	a 	trust 	or 	estate, 	a 	society, 	a 	firm, 	an
assembly, 	a 	partnership, 	a 	corporation, 	a 	profes-
sional 	corporation, 	an 	association, 	the 	State, 	any
political 	subdivision 	of 	the 	State, 	a 	county, 	a
state 	agency 	or 	any 	instrumentality 	of 	the 	State,
a 	county 	agency or 	any 	instrumentality 	of 	a
county. 	(Auth: 	HRS 	Sec. 	323D-62) 	(Imp: 	HRS 	Sec.
323D-12; 	44 	Fed. 	Reg. 	71771 	and 	71772 	Secs.
123. 601 	and 	123. 605) 	Qr.T 	Q o 10	u 	u 	,)RO
Sec. 	11-102-6 	The agency's 	address 	and bu.si-
ness 	hours. 	(a) 	The 	agency's 	offices 	are 	located
at 	600 	Kapiolani 	Boulevard, 	Honolulu, 	Hawaii 	or
such 	other 	address 	at which 	the 	agency may 	be
located 	from 	time 	to 	time. 	Unless 	otherwise
specifically directed, 	.all. communications 	to 	the
agency may be mailed 	to 	the 	state 	health 	planning
and development 	agency, 	P.O. 	Box 	3378, 	Honolulu,
Hawaii 	98601 	or may 	be 	hand 	carried 	to 	the 	agency's
offices.
(b) 	The 	agency's 	offices 	are 	open 	from 	7:45
a.m. 	to 	4:30 	p.m. 	of 	each workday 	unless 	otherwise
provided by 	statute 	or 	executive 	order. 	(Auth:
HRS 	Sec. 	3 23D-62) 	(Imp: 	HRS 	Sec. 	3 23D-12) r.T 	O~	l,; I 	t?
Sec. 	11-102-7 	FiTing 	of documents. 	(a) 	All
documents, 	submittals, 	reports, 	memoranda, 	and
other 	papers 	required 	o~ 	permitted 	to 	be 	filed
with 	the 	agency may be mailed 	or 	hand 	carried 	to
the 	agency's 	offices within 	the 	time 	limit, 	if
any, 	for 	the 	filing.
(b) 	The 	agency 	shall 	promptly 	stamp 	the 	time
and 	date 	upon 	the 	papers 	filed 	with 	the 	agency.
(c) 	The date 	on which 	the 	papers 	are 	actually
received 	by 	the 	agency 	shall 	be 	deemed 	the 	date 	of
filing.
(d) 	All 	papers 	filed 	with 	the 	agency 	shall
be 	plainly 	legible.
(e) 	All 	papers 	filed 	with 	the 	agency 	by 	any
person 	shall be 	signed 	in 	ink 	by 	the 	person or 	an
authorized 	agent 	or 	attorney. 	The 	signature 	of
the 	person 	signing 	the 	document 	constitutes 	a
certification 	that 	the 	person 	has 	read 	the 	docu-
ment; 	that 	to 	the 	best 	of 	the 	person's 	know-
ledge, 	information, 	and 	belief, 	every 	statement
102-5
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con tai_n_e~in_-tha_document----i-s-"t;-1~~:1ae--a-n€1.-ne-s-t-ateme---1-----------------------':'~~
is misleading; 	and 	that 	the 	document 	is 	not
interposed 	for 	delay.
(f) 	All 	papers 	filed 	with 	the 	agency 	by 	any
person 	shall 	state on 	the 	first 	page 	the 	name 	and
mailing ~ddress 	of 	the 	pe~son.
(g) 	Except 	as 	otherwise 	specifically provided
by a 	particular 	rule, 	regulation, 	or 	order 	of 	the
agency, 	only 	an 	original 	of 	all 	papers 	shall 	be
filed 	with 	the .agency. 	(AJJii;.{l,! 	cJWS 	~ec. 	323D-62)
(Imp: 	HRS 	Sec. 	323D-12) 	Ul,;I 	·i.19td}
Sec. 	11-102-8 	Agency records. 	(a) 	The
administrator 	of 	the 	agency 	shall 	have 	charge of
the 	agency's 	official 	records 	and 	shall 	be 	respon-
sible 	for 	the maintenance 	and 	custody 	of 	the
agency's 	files 	and 	records, 	including 	the 	papers,
transcripts 	of 	testimony 	and 	exhibits 	filed 	in
proceedings, 	decisions, 	rules 	and 	regulations, 	and
approved 	forms.
(b) 	All 	documents 	filed 	with 	or 	presented 	to
the 	agency 	shall 	be 	retained 	in 	the 	agency's 	files
for 	the 	period 	required 	by 	law.
(c) 	All 	public 	records 	of 	the 	agency, 	as
such public 	records 	are 	defined 	in 	chapter 	92,
Hawaii 	Revised 	Statutes, 	including 	all 	written
materials 	pertinent 	to 	any agency 	review, 	shall 	be
available 	for 	inspection by 	any 	person, 	in 	the
manner 	provided 	in 	chapter 	92, 	Hawaii 	Revised
Statutes, 	unless 	the 	records 	are 	accorded 	confi-
dential 	treatment 	pursuant 	to 	law. 	All 	requests
for 	inspection 	or 	copying 	of 	the 	agency's 	public
records 	shall 	be 	submitted 	in writing 	to 	the
agency and 	shall 	indicate 	the material 	to 	be
inspected 	or 	copied. 	Copies 	of 	the 	agency's
public 	records 	shall 	be 	furnished 	by 	the 	agency 	to
any person upon 	request 	and 	upon 	payment 	of 	the
statutory 	fee. 	(Auth: 	HRS 	Sec. 	323D-62) 	(Imp:
HRS 	Sec. 	323D-12) 	T 	3
Sec. 	11-102-9 	Public hearings. 	The 	agency
shall 	not 	impose 	any 	fee 	for 	a 	public 	hearing 	held
under 	these 	rules. 	The 	agency 	shall 	provide
written 	notification 	of 	the 	public 	hearing 	to 	the
person 	requesting 	the 	public 	hearing, 	other
affected 	persons, 	any 	person who 	submitted written
testimony 	to 	the 	agency 	during 	the 	appropriateness
review, 	and 	to 	any 	other 	persons 	at 	their 	request.
102-6

The 	agency shall 	comply with 	the 	provisions 	for
notice 	of 	public 	hearings 	in 	chapters 	91 	and 	92,
Hawaii 	Revised 	Statutes, 	and 	with 	the 	applicable
federal 	requirements. 	The 	agency 	shall 	keep 	a
record 	of 	the 	public 	hearing, 	which may 	be 	in 	the
form 	of 	written minutes 	or 	a 	transcript 	or 	a
recording 	of 	the 	hearing. 	(Auth: 	HRS 	Sec. 	323D-
62) 	(Imp: 	HRS 	Sec. 	323D-12) (I ~ 7000	1r·,	
•,,.. ·~0~
Sec. 	11-102-10 Appearances 	at 	public 	hearings.
At 	any 	public 	hearing 	held 	under 	these 	rules, 	any
person 	shall 	have 	the 	right 	to 	appear 	at 	the
hearing 	and 	to 	present 	relevant 	oral 	or written
testimony, 	arguments, 	and 	evidence. 	Any 	person
shall 	have 	the 	right 	to 	be 	represented 	by 	or with
counsel 	or 	another 	person 	chosen 	as 	a 	represen-
tative. 	The 	agency may 	at 	any 	time 	require 	any
person 	appearing 	before 	the 	agency 	in 	a 	represen-
tative capacity 	to 	show authority 	and 	qualifi-
cation 	to 	act 	in 	such 	capactiy. 	(Auth: 	HRS 	Sec.
323D-62) 	(Imp: 	HRS 	Sec. 	323D-12) 	OCT 	O3 1980
CRITERIA FOR AGENCY 	REVIEWS
Sec. 	11-102-11. Criteria. 	(a) 	The 	criteria
which 	the 	agency 	shall 	consider 	in 	its 	deter-
minations 	on 	appropriateness 	include 	at 	least 	the
following:
(1) 	The 	relationship 	of 	the 	health 	services
being 	reviewed 	to 	the 	state 	health 	plan
and 	the 	annual 	implementation 	plan.
(2) 	The 	relationship 	of 	the 	services
reviewed 	to 	the 	long-range development
plan, 	if 	any, 	of 	the 	person 	providing
the 	services.
(3) 	The 	need 	that 	the 	population 	served 	has
for 	the 	services, 	and 	the 	extent 	to
which 	low income 	persons, 	racial 	and
ethnic minorities, 	women, 	handicapped
persons, 	and 	other 	underserved 	groups
have 	access 	to 	those 	services.
(4) 	The 	availability 	of 	less 	costly or more
effective 	alternative methods 	of
providing 	the 	services.
102-7
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( 5) 	The 	rel a tionshiJ;L_o_f_the_s-er_vices--------------
______________._=.__!__-=r:':e=v:::-1::•e~w-::.·~e~d~t::--:o::---t:;:-h=-e existing 	heal th 	care .
system of 	the 	area 	in which 	the 	services
are 	provided.
(6) 	The 	availability 	of 	resources, 	including
health manpower, 	management 	personnel,
and 	funds 	for 	capital 	and 	operating
needs 	for 	the 	provision 	of 	the 	services
reviewed 	and 	the 	availability 	of
alternative 	uses 	of 	these 	~esources
for 	the 	provision of 	other 	health
services.
(7) 	The 	special 	needs 	and 	circumstances 	of
those 	entities 	which 	provide 	a 	substan-
tial 	portion 	of 	their 	services 	or
resources 	or 	both 	to 	people 	who 	live
outside 	the 	State.
(8) 	The 	special 	needs 	and 	circumstances 	of
biomedical 	and 	behavioral 	research
projects 	which 	are designed 	to meet 	a
national 	need 	and 	for 	which 	local 	condi-
tions 	offer 	special 	advantages.
(9) 	The 	contribution 	of 	the 	existing 	insti-
tutional 	health 	services 	in meeting 	the
health 	related 	needs 	of members 	of
medically underserved 	groups 	and 	groups
which 	have 	traditionally 	experienced
difficulties 	in obtaining 	equal 	access
to 	health services, 	including 	low 	income
persons, 	racial 	and 	ethnic minorities,
women, 	and 	handicapped 	persons, 	partic-
ularly 	those 	needs 	identified 	in 	the
annual 	implementation plan 	as 	deserving
of 	priority.
(10) 	The 	special 	circumstances 	of 	health
service 	institutions 	with 	respect 	to
the 	need 	for 	conserving 	energy.
(11) 	The 	effect 	of 	competition 	on 	the 	supply
of 	the 	health 	services 	being 	reviewed,
pu~suant 	to 	the 	applicable 	federal
requirements.
(12) 	Improvements 	or 	innovations 	in 	the
financing 	and 	delivery 	of 	health 	services
which 	foster 	competition, 	in 	accordance
102-8

with 	the 	applicable 	federal 	requirements,
and which 	serve 	to 	promote 	quality
assurance 	and 	cost 	effectiveness.
(13) 	The 	quality 	of 	care 	provided 	by 	the
services 	or 	facilities 	in 	the 	past.
(b) 	Criteria 	adopted 	for 	reviews 	in 	accor-
dance with 	this 	section may vary 	according 	to 	the
type 	of 	health 	service 	being 	reviewed 	and 	the
purpose 	of 	the 	review. 	(Auth: 	HRS 	Sec. 	323D-62)
(Imp: 	HRS 	Sec. 	323D-12; 	44 	Fed. 	Reg. 	71773 	Sec.
123.607) 	T O3 •
Sec. 	11-102-12 Special 	criteria for 	health
maintenance 	organizations. 	Notwithstanding 	Sec.
11-102-11, 	in 	the 	case 	of 	areawide 	reviews 	which
result 	in 	institution-specific 	findings 	regarding
services 	provided by 	or 	through 	health mainte-
nance 	organizations, 	the 	criteria 	for 	agency
review 	shall 	be 	limited 	to 	the 	following:
(1) 	The 	needs 	of 	enrolled ma~bers 	and
reasonably 	anticipated 	new members
of 	the 	health maintenance 	organization
for 	the 	existing 	institutional 	health
services 	provided by 	the 	organization.
(2) 	Whether 	the 	services 	could 	be 	obtained
from 	non-·heal th maintenance 	organi-
zation 	providers 	or 	other 	health
maintenance 	organization providers
in 	a 	reasonable 	and 	cost-effective
manner which 	is 	consistent with 	the
basic method 	of 	operation 	of 	the
health maintenance 	organization.
(3) 	Any other.~actors 	which 	the 	agency may
propose 	fn 	writing 	and 	the 	secretary
may, 	in 	accordance with 	Sec. 	11-102-13,
approve. 	(Auth: 	HRS 	Sec. 	323D-62)
(Imp: 	HRS 	Sec. 	323D-12; 	44 	Fed. 	Reg.
71773 	Sec. 	123.607) 	0 3
Sec. 	11-102-13 Additional 	criteria 	for
health maintenance 	organizations. 	Where 	the
agency 	proposes 	under 	Sec. 	11-102-12(3) 	that 	it 	be
permitted 	to 	base 	areawide 	reviews 	resulting 	in
institution-specific 	findings 	of 	services 	provided
by 	or 	through health maintenance 	organizations 	on
102-9

criteria 	not 	set 	forth 	in 	Sec. 	11-102-12, 	the
agency 	shall 	do 	so 	in 	a 	written 	request 	to 	the
secretary. 	Unless 	the 	secretary 	has 	approved 	the
additional 	criteria 	proposed 	by 	the 	agency, 	the
agency 	shall 	base 	its 	review 	solely on 	the 	criteria
in Sec. 	11-102-12. 	(Auth: 	HRS 	Sec. 	323D-62)
(Imp: 	HRS 	Sec. 	323D-12; 	44 	Fed. 	Reg. 	71773 	Sec.
123 • 607 > 0CT 	O3 1980
REVIEW PROCEDURES
Sec. 	11-102-14 Written 	notification 	to
affected 	persons. 	The 	agency 	shall 	provide
written 	notification 	to 	affected 	persons 	of 	the
beginning 	of 	an 	appropriateness 	review. 	The
written 	notification 	shall 	include 	a 	review
schedule. 	(Auth: 	HRS 	Sec. 	323D-62) 	(Imp: 	HRS
Sec. 	323D-12; 	44 	Fed. 	Reg. 	71772 	Sec. 	123.605)
Sec. 	11-102-15 	Method 	of 	notification. 	The
agency may 	provide 	written 	notification 	to 	members
of 	the 	public 	through 	newspapers 	of 	general
circulation 	and 	other 	public 	information 	channels.
The 	agency 	shall 	send 	written 	notification 	to 	all
other 	affected 	persons 	by mail, 	which may 	be 	part
of 	a 	newsletter. 	(Auth: 	HRS 	Sec. 	323D-62) 	(Imp:
HRS 	Sec. 	323D-12; 	44 	Fed. 	Reg. 	71772 	Sec. 	123.605)
Sec. 	11-102-16 	Review 	schedule. 	The 	agency
shall 	prepare 	review 	schedules 	which 	provide 	that
no 	areawide 	review 	shall, 	to 	the 	extent 	practi-
cable, 	take 	longer 	than 	one hundred 	eighty 	days
from 	the 	date 	that 	the 	agency 	provides 	written
notification 	to 	affected 	persons 	of 	the 	beg·inning
of 	the 	review 	to 	the 	date 	when 	the 	agency 	files
its written 	findings. 	(Auth: 	HRS 	Sec. 	323D-62)
(Imp: 	HRS 	Sec. 	323D-12; 	44 	Fed. 	Reg. 	71772 	Sec.
123.605)
Sec. 	11-102-17 Date of 	notification. 	The
date 	of 	notification 	is 	the 	date 	on which 	the
agency 	sends 	written 	notification 	to 	affected
persons 	or 	the 	date 	on which 	the 	written 	noti-
fication 	appears 	in 	a 	newspaper 	of 	general 	circu-
lation 	in 	the 	State, 	whichever 	is 	later. 	(Auth:
HRS 	Sec. 	323D-62) 	(Imp: 	HRS 	Sec. 	323D-12)
Sec. 	11-102-18 	Information 	for· 	reviews.
Persons 	subject 	to 	a 	review 	shall 	submit 	to 	the
agency 	any 	information which 	the 	agency may
102-10

require 	concerning 	the 	subject 	of 	the 	review 	in
the 	form 	and manner :which 	the 	agency 	shall
prescribe 	and 	publish. 	The 	information 	require-
ments may vary 	according 	to 	the 	purpose 	for 	which
the 	particular 	review 	is 	being 	conducted 	or 	the
type 	of 	health 	service 	being 	reviewed. 	The 	agency
shall 	require 	no 	information 	of 	a 	person 	subject
to 	review which 	is 	not 	prescribed 	and published 	as
being 	required 	in accordance with 	the 	applicable
federal 	requirements. 	Information 	requirements
shall be 	limited 	to 	information which 	is
reasonably 	needed 	for 	the 	review 	and 	the 	agency
shall 	use 	existing 	information 	sources 	to 	the
maximum extent 	feasible. 	The 	agency 	shall
prescribe 	and 	publish 	the 	period 	of 	time 	within
which 	persons 	subject 	to-a 	review 	shall 	submit 	to
the 	agency 	the 	information 	required 	by 	the 	agency.
(Auth: 	HRS 	Sec. 	323D-62.) 	(iimp: 	HRS 	Sec. 	323D-12;
44 	Fed. 	Reg. 	71772 	Secs. 	123.603 	and 	123.605)
Sec. 	11-102-19 	Request 	for 	a 	public 	hearing.
Upon 	the 	request 	of 	any 	affected 	person 	or 	the
agency, 	the 	agency 	shall 	hold 	a 	public 	hearing 	in
the 	course. of 	the 	appropriateness 	r.eview. 	To 	be
effective, 	the 	request 	for 	a 	public 	hearing 	shall
be 	in writing 	and 	shall 	include.a 	statement 	of 	the
affected 	person's 	or 	the 	agency's 	interest 	and
reasons 	for 	requesting 	a 	public 	hearing, 	and 	shall
be 	filed 	with 	the 	agency 	at 	least 	forty-five 	days
prior 	to 	the 	date 	in 	the 	review 	schedule 	when 	the
agency 	shall 	file 	its 	written 	findings. 	(Auth:
HRS 	Sec. 	323D-62) 	(Imp: 	HRS 	Sec. 	323D-12; 	44 	Fed.
Reg. 	71772 	Sec. 	123.6051
Sec. 	11-102-20 	Notification 	of 	status 	and
findings. 	The 	agency 	shall 	provide 	notification
to 	providers 	of 	health 	services 	and 	other 	persons
subject 	to 	the 	agency 	review of 	the 	status 	of 	the
agency's 	review, 	findings 	made 	in 	the 	course 	of
the 	review, 	and 	other 	appropriate 	information
respecting 	the 	review. 	(Auth: 	HRS 	Sec. 	323D-62)
(Imp: 	HRS 	Sec. 	323D-12; 	44 	Fed. 	Reg. 	71772 	Sec.
123.605)
Sec. 	11-102-21 Required 	:findings. 	(a) 	The
agency 	shall 	file 	written 	findings 	stating 	the
basis 	for 	any 	findings 	made 	by 	the 	agency 	in 	the
course 	of 	the 	appropriateness 	review.
(b) 	Where 	the 	agency 	has 	made 	a 	finding 	that
a 	service 	is 	inappropriate, 	the 	agency 	shall, 	to
102-11

the 	extent practicable, 	at 	the 	same 	time,·make
recommendations 	for 	remedial 	action.
(c) 	The 	agency 	shall 	not make 	a 	finding 	that
an 	existing 	institutional 	health 	service 	is
inappropriate unless 	the 	agency 	states 	in writing
that 	the 	service 	has 	not met one 	or more 	of 	the
criteria 	and 	the 	ways 	in which 	the 	service 	failed
to meet 	the 	criteria, 	including 	any 	that 	are
beyond 	the 	control 	of 	the 	person 	or 	persons
providing 	the 	service.
(d) 	Should 	the 	agency 	fail 	to 	use 	criteria
addressing 	all 	six 	of 	the 	characteristics 	of
appropriateness 	in a 	review 	of 	a 	particular 	service,
the 	agency 	shall explain 	this.in ,its 	findings.
The 	six 	characteristics 	of 	appropriateness 	are
availability, 	accessibility, 	acceptability,
continuity, 	cost, 	and 	quality.
(e) 	If 	the 	agency makes 	a 	finding 	regarding
an existing 	institutional 	health 	service 	or 	home
health 	service which 	the 	agency determines 	is 	not
consistent with 	the 	goals 	of 	the 	state 	health 	plan
or 	the 	priorities 	of 	the 	annual .implementation
plan, 	the 	agency 	shall 	submit 	a 	detailed 	statement
of 	the 	reasons 	for 	the 	inconsistency.
(f) 	The 	agency, 	in 	conducting 	an 	areawide
review resulting 	in 	institution-specific 	findings,
shall 	not make 	a 	finding-that 	an 	existing
institutional 	health 	service 	provided by 	or
through 	a 	health maintenance 	organization 	is
inappropriate 	solely 	because 	there 	is 	a 	health
maintenance 	organization 	of 	the 	same 	type, 	as
specified 	in.the 	applicable 	federal 	requirements,
in 	the 	State, 	or 	solely because 	the 	services 	being
reviewed 	are 	not discussed 	in 	the 	state 	health
plan or 	the 	annual 	implementation 	plan. 	(Auth:
HRS 	Sec. 	323D-62) 	(Imp: 	HRS 	Sec. 	323D-12; 	44 	Fed.
Reg. 	71772-71773, 	Secs. 	123.605, 	123.607, 	and
123.608)
Sec. 	11-102-22 	Agency 	findings 	made 	public.
The 	agency 	shall, 	in 	accordance with 	the 	appli-
cable 	federal 	requirements, 	make 	public 	its
findings 	with 	respect 	to 	the 	appropriateness 	of
existing 	institutional 	health 	services 	and 	home
health 	services. 	(Auth: 	HRS 	Sec. 	323D-62) 	(Imp:
HRS 	Sec. 	3230-12; 	44 	Fed. 	Reg. 	71773 	Sec. 	123.608)
102-12

Sec. 	11-102-23 	Public 	hearing 	for pu:r:poses
of reconsider·ation. 	Any 	person 	affected 	by 	the
agency's 	review may, 	for 	good 	cause 	shown, 	request
in writing 	a 	public 	hearing 	for 	purposes 	of
reconsideration of 	the 	agency's 	findings. 	~
request 	for 	a 	public 	hearing 	shall 	be 	deemed 	by
the 	agency 	to 	show good 	cause 	if- 	the 	request.:
(1) 	Presents 	significant, 	relevant 	infor-
mation 	not 	previously 	considered by
the 	agency,
(2) 	Demonstrates 	that 	there 	have 	been
significant changes 	in 	factors 	or
circumstapces 	relied 	upon by 	the
agency 	in making 	its 	findings,
(3) 	Demonstrates 	that 	the 	agency 	has
materially 	failed 	to 	follow 	its 	adopted
rules 	in making 	i t_s 	findings, 	or
(4) 	Provid.es 	such 	other 	bases 	for 	a 	public
hearing 	as 	the 	agency 	determines
constitutes 	good 	cause.
To 	be 	effective, 	the 	written 	request 	for 	a
public 	hearing 	for 	purposes 	of 	reconsideration
shall 	be 	received 	by 	the 	agency within 	thirty days
after 	the 	agency 	files 	its 	written 	findings. 	If
good 	cause 	for 	the 	hearing 	is 	shown, 	the 	agency
shall 	hold 	the 	public 	hearing within 	sixty 	days
after 	receipt 	of 	the 	request. 	The 	agency 	shall
file 	written 	findings 	within 	sixty days 	after 	the
hearing which 	state 	the 	basis 	for 	any 	findings
made 	by 	the 	agency 	in 	the 	course 	of 	the 	recon-
sideration. 	The 	agency 	shall 	provide 	written
notification 	of·the 	findings 	to 	affected 	persons.
(Auth: 	HRS 	Sec. 	323D-62) 	(Imp: 	HRS 	Sec. 	323D-12;
44 	Fed. 	Reg. 	71772 	Sec. 	123.605)
Sec. 	11-102-24 Administrative 	appeals. 	If 	a
decision· of 	the 	agency 	results 	in 	an 	institution-
specific 	finding 	of 	inappropriateness, 	the 	person
providing 	the 	service may 	file 	an 	administrative
appeal 	of 	the 	decision. 	The 	person 	shall 	file 	the
appeal 	with 	the 	agency within 	thirty days 	after
final 	action by 	the 	agency 	on 	the 	reconsideration.
The 	appeal 	shall 	be 	in writing 	and 	shall 	include 	a
statement 	of 	the 	nature 	of 	the 	person's 	interest,
reasons 	for 	the 	submission 	of 	the 	appeal, 	and 	a
clear 	and 	concise 	statement of 	the 	person's
102-13
009

position or contention. 	The 	agency 	shall 	desig-
nate 	a 	person 	from 	within 	the 	agency 	to 	be 	the
hearing 	officer who 	hears 	the 	appeal. 	The 	hearing
officer 	shall 	be 	a 	person who 	did 	not 	participate
in 	the 	decision 	and 	the 	reconsideration. 	The
hearing 	officer may 	require 	the 	person who 	is
appealing 	to 	file 	additional 	information 	and
memoranda 	in 	connection with 	the 	appeal. 	The
hearing 	officer may, 	at 	his 	or 	her 	discretion,
hold 	a 	public 	hearing 	on 	the 	appeal. 	The 	hearing
officer 	shall 	file 	written 	findings 	on 	the 	appeal
within 	ninety 	days 	after 	the 	appeal 	is 	filed 	with
the 	agency. 	The 	decision 	of 	the 	hearing 	officer
on 	the 	appeal shall 	be 	considered·the 	final
decision 	of 	the 	agency. 	(Auth: 	HRS 	Sec. 	323D-62)
(Imp: 	HRS 	Sec;:;,. :323D.;;.12; 	44 	Fed. 	Reg. 	71772 	Sec.
123. 605) (H'T 	!' j
Sec. 	11-,102-25 Exceptions 	to use 	of 	proce-
dures. 	The 	agency, 	may with 	respect 	to 	any 	type
or 	group of 	reviews, 	request 	in writing 	from 	the
secretary an 	exception 	to 	the 	federal 	requirement
that 	the 	agency use 	review 	procedures 	which meet
the 	implementing 	federal 	regulations. 	(Auth: 	HRS
Sec. 	323D-62) 	(Imp: 	HRS 	Sec. 	323D-12; 	44 	Fed.
Reg. 	71773 	Sec. 	123.606) n .T 	O31980
Sec. 	11-102-26 	Agency 	reports. 	The 	agency
shall 	prepare 	and 	publish 	at 	least 	annually 	a
report 	of 	the 	appropriateness 	reviews 	being
conducted, 	including 	a 	statement 	concerning 	the
status 	of 	each 	review, 	and 	of 	the 	reviews
completed by 	the 	agency 	since 	the 	publication 	of
the 	last 	report 	and 	a 	general 	statement 	of 	the
findings 	made 	in 	the 	course 	of 	the 	reviews. 	(Auth:
HRS 	Sec. 	323D-62) 	(Imp: 	HRS 	Sec 	323D-12; 	44 	Fed.
Reg . 	71 7 7 2 	Sec . 	12 3 . 6 0 5 	0 ~ 	•"
Sec. 	11-102-27 	Technical advisory 	c·om:mi ttees
and 	experts. 	The 	agency may 	call 	upon 	technical
committees 	and 	individuals 	who 	have 	special
expertise 	to 	provide 	technical 	assi~tance 	to 	the
ag~ncy. 	(Auth 	HRS 	Sec. 	323D-62) 	(Imp: 	HRS 	Sec.
323D-12) 	3 	n
102-14