Haw. Code R. § 16-23-104 - Health care providers

(a) Frequency and extent of treatment shall not be more than the nature of the injury and the process of recovery requires. Authorization is not required for the initial fifteen treatments of the injury during the first sixty calendar days, except for naturopathic, chiropractic and acupuncture treatments which are governed by section 431:10C-103.6, HRS.

(b) A bill for no more than four hours for psychometric, projective, and other psychological testing and the resultant reports shall not be subject to prior authorization.

(c) Conservative care extending beyond one hundred twenty calendar days from the date of first treatment may be subject to prior authorization.

(d)

(1) If the injury is the result of an accident on or after January 1, 1998, chiropractic and acupuncture visits shall be limited to the number of and costs for treatments in section 431:10C-103.6, HRS.

(2) A "visit" shall include all examinations or chiropractic manipulative treatments involving one or more regions, spinal, and authorized physiotherapy modalities and procedures or acupuncture treatments provided on the same date.

(3) The Hawaii state chiropractic guidelines are those guidelines in effect on January 25, 1997 (light green cover).

(4) Payments to a chiropractor or an acupuncturist for visits shall conform to paragraph (1) and shall not be reduced or revised by an insurer or its agent(s).

(5) Chiropractic treatments shall not exceed the scope of practice permitted by chapters 431 and 442, HRS.

(e) If the injury is the result of an accident occurring on or after January 1, 1998, for physical medicine and rehabilitation, treatments may include up to four procedures, up to four modalities, or a combination of up to four procedures and modalities, and the visit shall not exceed sixty minutes per injury. When treating more than one injury, treatments may include up to six procedures, up to six modalities, or a combination of up to six procedures and modalities, and the entire visit shall not exceed ninety minutes.

(f) If the injury is the result of an accident occurring on or after January 1, 1998, an insurer or its agent(s) shall not reduce payments to health care providers under this section through the withholding of moneys for the payments of taxes. This subsection shall not exempt an insurer or its agent from complying with the Internal Revenue Code.

Notes

Haw. Code R. § 16-23-104

[Eff and comp 6/1/93; am and comp 1/1/98; am and comp 1/8/99; am and comp 11/11/12] (Auth: HRS §§ 431:2-201, 431:10C-214, 431:10C-308.5, 431:10C-B) (Imp: HRS §§ 431:10C-308.5, 431:10C-B)