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Notice #: 0001342253-01
Public Notices



In accordance with the public notice requirement of Title 42, Section 441.304 of the Code of Federal Regulations, the State of Hawaii, Department of Human Services and Department of Health (the State), hereby notifies the public that it intends to request from the Centers for Medicare & Medicaid Services (CMS), an amendment to the Home and Community Based Services (HCBS) Waiver for Individuals with Intellectual and Developmental Disabilities (I/DD Waiver) authorized in Section 1915(c) of the Social Security Act.


The purpose of this posting is to provide public notice and elicit public input regarding the proposed amendments to its current 1915(c) HCBS I/DD Waiver that serves individuals with developmental disabilities or intellectual disabilities who meet institutional level of care, and choose to live in their own home or in the community with appropriate and quality supports designed to promote health, safety and independence.


The purpose of this amendment is to modify the service definition for Personal Assistance/Habilitation (PAB) to include supports provided in a hospital setting; add an exception review to Vehicle Modifications for requests that exceed the limit; update the cost projections for Vehicle Modifications for waiver years 2 through 5; and remove an outdated performance measure from the Financial Accountability Section.

The current waiver service definition for PAB is being modified to include supports provided to a participant while receiving acute-care hospital services to foster communication, provide intensive personal care, and/or promote behavioral stabilization to support successful transitions or to maintain their functional abilities. These are services in the Individualized Service Plan (ISP) that cannot be provided by hospital staff and are not a substitute for services the hospital is obligated to provide pursuant to its conditions of participation in Medicare and Medicaid, Federal or State law, or another applicable requirement. This change will help support participants while they receive acute care services in the hospital to aid in their transition back to the community or maintain their functional abilities.

The current waiver definition for Vehicle Modifications has a limit of $36,000, including a sub-limit of $6,000 for shipping. This amendment will add an exception review to enable the State to consider requests where the lowest bid for the medically necessary conversion with any shipping costs exceeds the limit of $36,000.00 and remove the sub-limit of $6,000 for shipping costs. This change will improve access to this service for participants due to the unique issues in Hawaii with vehicle availability and market fluctuations for shipping vehicles to or from the mainland.

The current Appendix J cost estimates for Vehicle Modification in Waiver Years 2 through 5 will be modified to increase the projected number of users and the average units per user due to anticipated changes in utilization once the exception review is implemented.

The current Appendix I Financial Accountability sub-assurance (a) includes an outdated performance measure that will be deleted because it was replaced by a new performance measure in the approved waiver. This change has no impact on participant access to services.


As required by 42 C.F.R. 441.304, the State must establish and use a public input process for any changes in services or operation of the waiver. The opportunity for public comment shall be held open for a minimum of 30 days prior to implementation of the proposed change or submission of the proposed change to CMS, whichever comes first.

Comments will be accepted for consideration from the date when this notice is published through November 15, 2021. Individuals may submit written comments using the following methods:

By email: (Please identify in the subject line: Waiver Amendment)

By mail:

Department of Health, Developmental Disabilities Division
Attention: Community Resources Branch
3627 Kilauea Avenue, Room 411
Honolulu, Hawaii 96816

A copy of the 1915(c) I/DD Waiver is available online at: under Featured News and for public viewing from the first working day the public notice appears in the Honolulu Star-Advertiser, Hawaii Tribune Herald, West Hawaii Today, The Maui News, and The Garden Island. A printed copy of the waiver application and special accommodations (i.e., interpreter, large print or taped materials) can be arranged if requested by contacting the DDD Community Resources Branch at (808) 733-2135 no later than seven (7) working days before the comment period ends.

(SA1342253 9/30/21)