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Notice #: 0001120160-01
Public Notices

2nd Notice

QUEST Integration Renewal Application

The State of Hawaii, Department of Human Services (the State) is proposing to request approval from the federal Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS) to extend the “QUEST Integration” (Project Number 11-W-0001/9) Demonstration under Section 1115(a) of the Social Security Act for an additional five years in order to further transform and improve the healthcare delivery system for low-income Hawai’i residents. The State will request approval of a five-year extension of the 1115 Demonstration Project beginning January 1, 2019 and continuing through December 31, 2023.

The State previously issued public notice on February 17, 2018 and is reissuing notice to provide some additional information related to the financing approach, to share the interim evaluation results of the demonstration, to provide documentation of the annual post award forum, and to confirm our process for tribal consultation. The draft application has also been updated to provide more description of the state’s objectives for the 1115 Demonstration Project.

Program Description, Goals, and Objectives
Originally implemented as the QUEST program in 1994, QUEST Integration is the current version of Hawaii’s Section 1115 demonstration project to provide comprehensive benefits to its Medicaid enrollees through a competitive managed care delivery system. The provision of benefits through managed care has saved billions of dollars in State and federal funds and has enabled the State to use some of these savings to provide State-funded medical coverage to individuals not otherwise eligible for Medicaid.

Under the demonstration renewal, the State will request approval from the federal government to continue to deliver services through managed care under existing waiver authorities. The State also seeks to build on the state’s history of providing the most vulnerable residents with effective, efficient, evidence-based health care. Toward that end, the State is building the Hawai’i ‘Ohana Nui Project Expansion (HOPE) program, a five-year initiative to develop and implement a roadmap to achieve this vision of healthy families and healthy communities.

The QUEST Integration Demonstration will be a vehicle to put the HOPE initiative into place. Under the renewal, MQD will continue the current programs and provide beneficiaries with access to the same single Medicaid benefit package that it offers currently, of which access to certain services is based on clinical criteria and medical necessity. The demonstration will also include coverage of community integration services (supportive housing services) (this request is currently under separate review with CMS, but would ultimately be included in the demonstration.)

The goal of the HOPE initiative and the new QUEST Integration demonstration is to achieve the Triple Aim of better health, better care, and sustainable costs for our community. Within five years, MQD anticipates that the investments in healthy families and healthy communities will translate to improved health and well-being through decreased onset of preventable illnesses, improved early detection and optimal management of conditions, and a continued sustainable growth rate in Medicaid spending. More specifically, the goals include:
Improve health outcomes for demonstration populations;
Maintain a managed care delivery system that achieves appropriate utilization of the health care system and a slower rate of expenditure growth; and
Support strategies and interventions targeting the social determinants of health.

To test those goals, MQD proposes the following evaluation hypotheses:
Increasing utilization of primary care, preventive services, and health promotion will reduce prevalence of risk factors for chronic illnesses and lower the total cost of care for targeted beneficiaries.
Improving care coordination (e.g., by establishing team-based care and greater integration of behavioral and physical health) will improve health outcomes and lower the total cost of care for high-needs, high-cost individuals.
Implementing alternative payment methodologies (APMs) at the provider level and value-based purchasing (VBP) reimbursement methodologies at the MCO level will increase appropriate utilization of the health care system, which in turn will reduce preventable healthcare costs.
Providing community integration services and similar initiatives for vulnerable and at-risk adults and families will result in better health outcomes and lower hospital utilization.

For further details on the program descriptions, goals, and objective, please refer to the State’s full public notice, the draft Demonstration renewal proposal, the Hawai’i ‘Ohana Nui Project Expansion (HOPE) Program Vision Document, the Potential Initiatives Under HOPE document and relevant documents located in the following link:

First Comment Period (CLOSED)
The State’s first public notice and comment period for the QUEST renewal began on February 17, 2018 and ended on March 23, 2018. On February 15, 2018, the State issued a full public notice document with a comprehensive description of the proposed draft Demonstration Project. On February 17, 2018, the State published an abbreviated public notice in the newspapers of widest circulation in each city with a population of 100,000 or more. Both the full and abbreviated public notices were consistent with 42 C.F.R. 431.408. On February 20, 2018 and March 1, 2018, the State used an electronic mailing list to notify potentially interested parties of the opportunity to review the public notice and provide comments.

As required, the State held two in-person public hearings to solicit public input and comment about the demonstration extension application:

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

Hawai’i Department of Human Services
1390 Miller Street, Conference Room 1 & 2
Honolulu, Hawai’i

March 6, 2018 from 8:00 am to 12:00 pm via teleconference at:

Oahu Kakuhihewa State Office Building
601 Kamokila Boulevard, Room 167B
Kapolei, Hawai’i

Hawai’I Hilo State Office Building
75 Aupuni Street, Basement
Hilo, Hawai’i

Kauai Lihue State Office Building
3060 Eiwa Street, Basement
Lihue, Hawai’i

Maui Wailuku Judiciary Building
2145 Main Street, First Floor
Wailuku, Hawai’i

Commenters were allowed to appear by video chat at these hearings. The notice included contact information for individuals who could not attend and who would need accommodations in order to participate in the public forum. The State did not receive any calls, emails, or other forms of communication requesting accommodations.

Second Comment Period (OPEN)
The State invites the public to comment on the renewal application and documents relevant to the renewal application a second time. Copies of the draft demonstration renewal proposal and the attachments are on the Department’s website at

Written requests for a copy of the draft demonstration renewal proposal, relevant documents and any corresponding comments or questions may be sent 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 July 31, 2018 and August 30, 2018. All comments must be submitted before or on the closing date in order to be considered.

Special accommodations (i.e., interpreter, large print or taped materials) will be arranged if requested no later than seven (7) working days before the comment period ends by calling 808-692-8058.

(SA1120160 7/31/18)