17-1744

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HAWAII ADMINISTRATIVE RULES
TITLE 17
DEPARTMENT OF HUMAN SERVICES
SUBTITLE 12
MED-QUEST DIVISION
CHAPTER 1744
COVERAGE OF MEDICARE PREMIUMS
Subchapter 1 	General Provisions
§17-1744-1 	Purpose
§17-1744-2 	Definitions
Subchapter 2 	Supplemental Medical Insurance
(SMI)
§17-1744-3 	Referral of recipients for medicare
coverage
§17-1744-4 	Effective date of medicare part B (SMI)
premium coverage
Subchapter 3 	Recipients of Financial or Regular
Medical Assistance
§17-1744-5 	Coverage of medicare premiums for
financial or regular medical
assistance recipients
§17-1744-6 	(Reserved)
Subchapter 4 	Coverage of Medicare Premiums for
Qualified Medicare Beneficiaries
(QMBs)
§17-1744-7 	Coverage of medicare premiums for
QMBs
§17-1744-8 	Effective date of coverage for medicare
premiums for QMBs
§17-1744-9 	(Reserved)

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Subchapter 5 	Coverage of Medicare Premiums for
Qualified Disabled and Working
Individuals (QDWIs)
§17-1744-10 	Coverage of medicare premiums for
QDWIs
§17-1744-11 	Effective date of coverage of medicare
part A (HIB) premiums for QDWIs
§17-1744-12 	(Reserved)
Subchapter 6 	Coverage of Medicare Premiums for
Specified Low Income Medicare
Beneficiaries (SLMBs)
§17-1744-13 	Coverage of medicare premiums for SLMBs
§17-1744-14 	Effective date of coverage of medicare
part B (SMI) premiums for SLMBs
§17-1744-15 to 17-1744-20 	(Reserved)
Subchapter 7 	Premium Payment and Discontinuance
§17-1744-21 	Premium payments
§17-1744-22 	Suspended and discontinued payments
Historical Note: 	This chapter is based substantially
upon chapter 17-1300. [Eff 06/29/92; R 08/01/94 	]
SUBCHAPTER 1
GENERAL PROVISIONS
§17-1744-1 	Purpose. 	This chapter describes the
coverage of Medicare premiums for four groups of
medical assistance recipients. 	These groups are:
(1) 	Aged or disabled recipients of financial or
medical assistance who are eligible for all
benefits covered under the medical assistance
program;
(2) 	Qualified Medicare beneficiaries (QMBs) are
only eligible for coverage of premiums,
deductibles and coinsurance amounts, under
Medicare part A and B;

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(3) 	Qualified disabled working individuals
(QDWIs) who under the medical assistance
program are only eligible for coverage of
Medicare hospital insurance (part A)
premiums; and
(4) 	Specified low income Medicare beneficiaries
(SLMBs) who under the medical assistance
program are only eligible for coverage of
Medicare supplementary medical insurance
(part B) premiums. 	[Eff 08/01/94;
am 12/26/05] 	(Auth: 	§346-14) 	(Imp: 42
C.F.R. §431.625; 42 U.S.C. §§1395i-2a and
1396a(a)(10)(E); Pub. L. 108-173)
§17-1744-2 	REPEALED. 	[R 09/30/13]
SUBCHAPTER 2
SUPPLEMENTARY MEDICAL INSURANCE (SMI)
§17-1744-3 	Referral of recipients for medicare
coverage. 	(a) 	All recipients who are eligible but not
enrolled for medicare coverage shall be referred to the
Social Security Administration for enrollment through
the SMI buy-in process. 	Among those who are eligible
for medicare are those who meet the requirement of five
years of residency in the United State, and who:
(1) 	Are sixty-five years of age or older;
(2) 	Have received at least twenty four months of
RSDI disability benefits; or
(3) 	Are end-stage renal disease (ESRD) patients.
(b) 	All recipients who are enrolled in medicare
part A (HIB), but not in part B (SMI), shall be
referred to the Social Security Administration for part
B enrollment through the SMI buy-in process. 	The
exception to the preceding are the qualified disabled
working individuals (QDWI) who are only eligible for
coverage of part A premiums under the medical
assistance program.
(c) 	Recipients who are enrolled in medicare part
B, but not in part A, shall be informed of the
qualified medicare beneficiary (QMB) program and a part
A buy-in referral shall be made, if applicable.

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(d) 	The recipient's consent for SMI buy-in shall
not be required. 	However, the recipient shall be
informed that the department is enrolling the recipient
for coverage. 	[Eff 08/01/94 	] 	(Auth: HRS §346-14)
(Imp: 	42. C.F.R. §431.625)
§17-1744-4 	Effective date of medicare part B
(SMI) premium coverage. 	(a) 	For financial assistance
applicants who are aged, blind, disabled or AFDC-
related and are also SMI enrollees, the effective date
of SMI premium coverage, through buy-in enrollment,
shall be the first month for which financial assistance
is approved.
(b) 	For supplemental security income (SSI)
beneficiaries who are approved for medical assistance
only and are SMI enrollees, the effective date of SMI
premium coverage, through the buy-in process, shall be
the effective date of medical assistance coverage.
(c) 	For applicants newly approved for medical
assistance only under federally funded assistance
groups with the exception of QMBs, SLMBs, and QDWIs,
the effective date of coverage of SMI premiums shall be
the first day of the second month after the month in
which eligibility for medical assistance is determined.
(d) 	For all aged, blind, disabled, and AFDC-
related recipients of financial or medical assistance,
who subsequently become eligible for SMI, the effective
date of coverage of SMI premiums through the buy-in
process shall be the effective date of SMI coverage.
[Eff 08/01/94 	] (Auth: 	HRS §346-14) 	(Imp: 	42
C.F.R. §431.625; 42 U.S.C. §§1395i-2a and
1396(a)(10)(E))
SUBCHAPTER 3
RECIPIENTS OF FINANCIAL OR REGULAR MEDICAL ASSISTANCE
§17-1744-5 	Coverage of medicare premiums for
financial or regular medical assistance recipients. (a)
Financial and medical assistance recipients, other than
QMBs and QDWIs, are only entitled to coverage of
premiums for medicare part B (SMI).
(b) 	Financial and medical assistance recipients,
other than QMBs and QDWIs, are not eligible for

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coverage of premiums for medicare part A (HIB).
(c) 	The effective dates of medicare part B
coverage, through the buy-in process, are described in
section 17-1744-4.
(d) 	A recipient shall not withdraw from SMI
coverage while the recipient is enrolled under the
department's buy-in arrangement. 	[Eff 08/01/94 	]
(Auth: 	HRS §346-14) 	(Imp: 	42 C.F.R. §431.625)
§17-1744-6 	(Reserved).
SUBCHAPTER 4
COVERAGE OF MEDICARE PREMIUMS FOR QUALIFIED MEDICARE
BENEFICIARIES (QMBs)
§17-1744-7 	Coverage of medicare premiums for
QMBs. 	(a) 	Qualified medicare beneficiaries shall be
entitled to coverage of premiums for medicare part B
(SMI) and for medicare part A (HIB), provided premiums
for part A (HIB) are required of the QMBs.
(b) 	Premiums for medicare part A (HIB) shall not
be covered for QMBs, who have insured status in the
Social Security system and are thus provided part A
(HIB) coverage at no cost.
(c) 	Premiums for medicare part A (HIB) and part B
(SMI) for QMBs shall be paid through the respective
buy-in programs for part A and part B. 	[Eff
08/01/94 	] 	(Auth: 	HRS §346-14) 	(Imp: 	42 U.S.C.
§1396 (a)(10)(E))
§17-1744-8 	Effective date of coverage of medicare
premiums for QMBs. 	Coverage of medicare part A (HIB)
and part B (SMI) premiums for QMBs shall begin
effective the month after the month in which
determination of QMB eligibility is made. [Eff
08/01/94 	] 	(Auth: HRS §346-14) 	(Imp: 	42 U.S.C.
§1396(a)(10)(E))
§17-1744-9 	(Reserved).

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SUBCHAPTER 5
COVERAGE OF MEDICARE PREMIUMS FOR QUALIFIED DISABLED
AND WORKING INDIVIDUALS (QDWIs)
§17-1744-10 	Coverage of medicare premiums for
QDWIs. 	(a) 	The medical assistance coverage for
qualified disabled and working individuals (QDWIs), who
are identified and referred to the State by the Social
Security Administration, shall only be limited to
coverage of medicare part A (HIB) premiums.
(b) 	QDWIs shall not be entitled to coverage of
medicare part B (SMI) premiums.
(c) 	Premiums for medicare part A (HIB) for QDWIs
shall not be made through the part A buy-in program. 	A
special group premium payor arrangement shall be
established for the purpose of paying medicare Part A
(HIB) premiums for QDWIs. 	[Eff 08/01/94 	] 	(Auth:
HRS §346-14) 	(Imp: 	42 U.S.C. §1395i-2a)
§17-1744-11 	Effective date of coverage of
medicare part A (HIB) premiums for QDWIs. 	The
effective date of coverage of medicare part A premiums
for QDWIs shall be the effective date of enrollment in
medicare part A as allowed under 42 U.S.C. §1395i-2(a)
and determined by the Social Security Administration.
[Eff 08/01/94 	] 	(Auth: HRS §346-14) 	(Imp: 	42
U.S.C. §1395i-2a)
§17-1744-12 	(Reserved)
SUBCHAPTER 6
COVERAGE OF MEDICARE PREMIUMS FOR SPECIFIED LOW INCOME
MEDICARE BENEFICIARIES (SLMBs)
§17-1744-13 	Coverage of medicare premiums for
SLMBs. 	(a) 	Specified low income medicare
beneficiaries shall be entitled to coverage of premiums
for medicare part B (SMI) only.

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(b) 	Premiums for medicare part B (SMI) for SLMBs
shall be paid through the buy-in program for part B.
[Eff 08/01/94 	] 	(Auth: 	HRS §346-14) 	(Imp: 	42
U.S.C. §1396(a)(10)(E))
§17-1744-14 	Effective date of coverage of
medicare part B (SMI) premiums for SLMBs. 	Coverage of
medicare part B (SMI) premiums for SLMBs shall begin in
the first month of SLMB eligibility. 	[Eff
08/01/94 	] 	(Auth: HRS §346-14) 	(Imp: 42 U.S.C.
§1396(a)(10)(E))
§§17-1744-15 to 17-1744-20 (Reserved)
SUBCHAPTER 7
PREMIUM PAYMENT AND DISCONTINUANCE
§17-1744-21 	Premium payments. 	(a) 	The
department shall pay the full amount of monthly
medicare premiums for which an individual, under the
medical assistance program, is eligible.
(b) 	Buy-in coverage and other coverage of
medicare premiums shall be noted in each enrollee's
case record. 	[Eff 08/01/94 	] (Auth: 	HRS §346-l4)
(Imp: 	42 C.F.R. §43l.625)
§l7-1744-22 	Suspended and discontinued payments.
A recipient is ineligible for continued buy-in coverage
effective the month financial or medical payment is
suspended or discontinued except when medical
assistance coverage is suspended because of the
recipient's admission to a hospital, skilled nursing,
or intermediate care facility which is not a medical
institution for mental disease or tuberculosis. [Eff
08/01/94 	] 	(Auth: 	HRS §346-l4) (Imp: 	42 C.F.R.
§43l.625) 	(Auth: 	HRS §346-14) 	(Imp: 	42 U.S.C.
§1396(a)(10)(E)