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Notice #: 0001073202-01
Public Notices

Statement of Public Notice
Section 1115(a) Renewal of Section 1115 Demonstration

The State of Hawai’i, Department of Human Services (the State), hereby notifies the public that it intends to seek a five-year renewal of its Section 1115 Demonstration Project from the Centers for Medicare & Medicaid Services (CMS). The State is providing this abbreviated notice pursuant to CMS requirements in 42 C.F.R. §431.408(a)(2)(ii).

The State is proposing to request approval from the federal Department of Health and Human Services (DHHS), Centers for Medicare and Medicaid Services (CMS) to extend and amend the QUEST Integration Demonstration under Section 1115(a) of the Social Security Act for an additional five years, and to amend Medicaid State Plan, as appropriate, in order to incorporate specific measures that will further transform and improve the current health delivery system for eligible Hawai’i residents. The State will request approval of a five-year extension of the 1115 Demonstration (Waiver) to be effective January 1, 2019, and continuing through December 31, 2024.

For over two decades, Hawai’i’s demonstration has efficiently and effectively delivered comprehensive benefits to a large number of beneficiaries, including expansion populations, through competitive managed care delivery systems. Under the renewal, "QUEST Integration" continues to build on this success by delivering services through managed care, while integrating the demonstration’s programs and benefits to have a more patient-centered care delivery system and alignment of the demonstration with applicable requirements. All eligible beneficiaries will continue to be enrolled under "QUEST Integration", and access to services will be determined by clinical criteria and medical necessity. The renewal continues to incorporate the simplified Medicaid eligibility structure under the Affordable Care Act into Hawaii’s demonstration.

Under the "QUEST Integration" renewal, the State requests approval from the federal government to continue to deliver services through managed care under existing waiver authorities in order to continue to implement and deliver coordinated care system services while slowing growth in costs, and will ask for new flexibilities to continue to build on the state’s history of providing the most vulnerable residents with effective, efficient, evidence-based health care, and to implement the following strategies:

Invest in primary care, prevention, and health promotion.
Improve outcomes for High-Need and High-Cost individuals.
Promote payment reform and financial alignment.
Support locally driven initiatives to improve population health.

In addition, the Med-QUEST (MQD) will improve the health care delivery system by supporting the following foundational building blocks:

Health Information Technology – Use data and analytics to transform and drive clinical care.
Workforce Strategy – Increase workforce capacity and flexibility.
Continuous Improvement – Performance measurement and evaluation.


Goals Healthy Families and Healthy Communities and
Achieving the Triple Aim – Better Health, Better Care, Sustainable Costs

Strategies 1. Invest in primary care, 2. Improve outcomes for 3. Payment 4. Support locally driven
prevention, and health High-Need, High-Cost Reform and initiatives to improve
promotion Individuals Alignment population health

Foundational 1. Use health information technology to drive transformation
Building 2. Increase workforce capacity
Blocks 3. Performance measurement and evaluation

The waiver renewal goals and strategies will continue as documented in the current waiver. Hawai’i will request flexibility to make the following, but not limited to these targeted changes, in the waiver renewal:

Increase the proportion of health care spending on primary care in order to promote the health system’s orientation toward high-value care.
Continue to promote further developments in value-based purchasing and alternative payment methodologies.
Promote best practices that address the needs of HNHC individuals (i.e. care coordination, palliative care, Dr. Ornish’s Program for Reversing Health Disease).
Promote primary care and pay for value. Hawai’i will request to advance the use of value-based payments to Managed Care Organizations (MCOs). MQD will request to provide new performance incentive payments to primary care providers.
Cover additional evidence-based services that further integrate physical and behavioral health services such as the Collaborative Care Model.
Promote increased investments in health related and flexible services.
MCOs will be encouraged to invest in services that improve quality and outcomes, and MCOs that reduce costs through the use of these services can receive financial incentives to offset those cost reductions.
Support workforce development efforts such as Project ECHO, a teaching program for providers.

For further details on the program descriptions, goals, and objective, please refer to the "Medicaid Innovation Initiative" located in the following link:

The draft renewal application and the State’s full public notice, which describe the demonstration and the proposed renewal in more detail, can be found at Hard copies are available for review at the Department of Human Services, Med-QUEST, Policy and Program Development Office at 601 Kamokila Blvd., Room 518, Kapolei, HI 96707.


We invite comments on this proposal. Please submit any comments or questions to Ms. Edie Mayeshiro by mail to P.O. Box 700190, Kapolei, HI, 96709-0190 or by email at

Comments will be accepted for consideration between February 17, 2018, and
March 19, 2018 (30 days from the date of this notice).

Public Hearings

The State will hold two public hearings to solicit comments from interested parties on the proposed renewal:

1. March 2, 2018, from 8:00 am to 12:00 pm:

Department of Human Services
1390 Miller Street, Conference Rooms 1 & 2
Honolulu, Hawaii

2. March 6, 2018, from 8:00 am to 12:00 pm:

Oahu Kakuhihewa Videoconference Center
Kakuhihewa State Office Building
601 Kamokila Boulevard, Room 167B
Kapolei, Hawaii

Hawaii Hilo Videoconference Center
Hilo State Office Building
75 Aupuni Street, Basement
Hilo, Hawaii

Kauai Lihue Videoconference Center
Lihue State Office Building
3060 Eiwa Street, Basement
Lihue, Hawaii

Maui Wailuku Videoconference Center
Wailuku Judiciary Building
2145 Main Street, First Floor
Wailuku, Hawaii

If you require special assistance or auxiliary aids and/or services to participate in the public hearing (e.g., sign or foreign language or wheelchair accessibility), please contact:

Oahu Emelinia Mauricio (808) 692-8058
Hawaii Calvin Unoki (808) 933-0339, extension 101
Kauai Iris Venzon (808) 241-3575, extension 101
Maui Agriffa Kristia Braquit (808) 243-5780, extension 101

at least 72 hours prior to the hearing for arrangements. The prompt submission of requests helps to ensure the availability of qualified individuals and appropriate accommodations.
(SA1073202 2/17/18)