Haw. Code R. § 17-659-11 - Program eligibility requirements
(a) An individual
shall be between 18 and 65 years of age.
(b) The household shall not include the minor
dependents of any eligible adult for whom the adult provides care and
supervision.
(c) A dependent adult
applying for assistance shall meet the requirements specified in section
17-659-14.
(d) A medical
determination of physical impairment, mental impairment, or a combination of
physical and mental impairment is required at the time of application and when
the medical or psychiatric board determines a reexamination is needed. An
applicant who claims both a physical and a mental impairment shall be asked to
designate the primary disability.
(1) A
determination and certification of physical impairment shall only be made by a
board of licensed physicians.
(2) A
determination and certification of mental impairment shall only be made by a
board of licensed psychologists or licensed physicians whose specialty is in
psychiatry.
(3) A determination and
certification of a combination of physical and mental impairment shall be made
by both the medical and the psychiatric boards.
(4) The director shall appoint licensed
physicians or licensed psychologists designated and paid by the department to
the medical or psychiatric board. Such members of each board shall be appointed
for the period contracted with the department unless otherwise
specified.
(5) The director shall
appoint the department's medical and psychiatric consultants to the medical or
psychiatric board. Such members of each board shall be appointed for the
duration of their employment with the department unless otherwise
specified.
(6) A minimum of three
members of each board must participate in the review of a disability.
(A) The board members involved in the review
of an individual's physical or mental impairment shall include the department's
designated examining physician or psychologist.
(B) A minimum of two board members must agree
on each determination and certification of physical or mental
impairment.
(e) The individual shall provide the
department a current medical report.
(f) The department shall authorize payment
for the individual to obtain a medical determination of physical impairment,
mental impairment, or a combination of physical and mental
impairment.
(g) Assistance shall be
approved only for the period of the disability when an individual is determined
disabled by the medical or psychiatric board. Assistance shall end when a
determination is made by the medical or psychiatric board that the individual
no longer meets the department's definition of disabled.
(h) When the medical or psychiatric board
determines the applicant is not disabled, the applicant shall be provided a
notice informing the applicant that additional medical evidence may be
submitted within ten calendar days prior to the denial of the application. The
notice shall refer the applicant to free legal services for assistance and
permit the applicant to request extensions of time, as necessary.
(1) If the applicant does not respond, the
application shall be denied on the eleventh calendar day or the first work day
following the eleventh calendar day if the tenth calendar day fell on a weekend
or a holiday.
(2) Additional
medical evidence submitted within ten calendar days shall be reviewed by the
appropriate medical or psychiatric board for a determination and certification
of a physical impairment, mental impairment, or a combination of both physical
and mental impairment.
(3)
Additional medical evidence that is not submitted within ten calendar days but
is submitted before a disposition of the application is made shall be reviewed
by the appropriate medical or psychiatric board for a determination and
certification of a physical impairment, mental impairment, or a combination of
both physical and mental impairment.
(i) For applicants, a presumptive
determination of disability may be made by the department for one month's
eligibility provided:
(1) The disabling
condition is readily observable or may be reasonably inferred from prior
medical history; and
(2)
Eligibility for subsequent months shall be established in accordance with this
section.
(j) The
disabled person shall be required to accept and pursue medical treatment as
determined by the authorized examiner.
(1)
The department shall provide the disabled person with a legible copy of the
recommended treatment;
(2) When a
determination of mental impairment is made, the person shall accept and pursue
treatment;
(3) When a determination
of physical impairment is made, the person shall accept and pursue medical
treatment;
(4) The individual with
a primary diagnosis of substance abuse shall be required to receive treatment
in a residential treatment facility or shall obtain treatment on an outpatient
basis provided the treatment is received in a planned manner. Residential
treatment facilities and outpatient clinics or providers shall be certified by
medicare or medicaid, accredited by the state department of health's alcohol
and drug abuse branch, licensed by the state department of health's hospital
and medical facilities branch or be licensed providers of medical
services;
(5) An individual's
compliance to treatment shall be evaluated; and
(6) Refusal or failure to pursue medical,
psychological or psychiatric treatment for the identified disability shall
result in disqualification unless the department determines the refusal or
failure is due to good cause. Good cause shall include but is not limited to
the following:
(A) Mental illness or mental
deficiency precludes understanding of the department's requirements;
(B) Treatment is contrary to the client's
religious beliefs;
(C) Treatment is
not available. Treatment is considered not available when the providers of a
health plan the individual is enrolled in are unable to provide treatment;
treatment is considered available even if the individual does not have health
coverage or a health plan;
(D)
Personal emergency. A personal emergency is defined as:
(i) a life threatening circumstance affecting
the individual, the individual's spouse, parent or child that is verified by a
licensed physician or licensed psychologist; or
(ii) the individual suffers a natural
disaster that is verified with the police department, fire department or other
applicable agency; or
(E) Circumstances which threaten the safety
of the individual. These circumstances shall be verified with a licensed
physician, a licensed psychologist, the police department, or other applicable
agency.
Notes
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