17-1733.1

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1733.1-1
HAWAII ADMINISTRATIVE RULES
TITLE 17
DEPARTMENT OF HUMAN SERVICES
SUBTITLE 12
MED-QUEST DIVISION
CHAPTER 1733.1
COVERAGE OF INDIVIDUALS WITH
BREAST AND CERVICAL CANCER
Subchapter 1 	General Provisions
§17-1733.1-1 	Purpose
§17-1733.1-2 	General requirements
§§17-1733.1-3 to 17-1733.1-7 	(Reserved)
Subchapter 2 	Eligibility Requirements
§17-1733.1-8 	Purpose
§17-1733.1-9 	Basic requirements
§17-1733.1-10 	Categorical requirements
§17-1733.1-11 	Non-financial eligibility
requirements and date of coverage
§17-1733.1-12 	Income and asset requirements
§17-1733.1-13 	Eligibility review
§§17-1733.1-14 to 17-1733.1-18 	(Reserved)
Subchapter 3 	Freedom of Choice, Enrollment,
Benefits and Disenrollment
§17-1733.1-19 	Purpose
§17-1733.1-20 	Freedom of choice
§17-1733.1-21 	Enrollment into a participating
health plan
§17-1733.1-22 	Benefits
§17-1733.1-23 	Disenrollment from a health plan

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1733.1-2
§§17-1733.1-24 to 17-1733.1-28 	(Reserved)
Historical Note: 	This chapter is based substantially
upon repealed chapter 17-1733. 	[Eff 02/16/02; am
05/10/03; am 01/31/09; am 06/11/09; R 09/30/13]
SUBCHAPTER 1
GENERAL PROVISION
§17-1733.1-1 	Purpose. 	The purpose of this
chapter is to establish coverage for an individual who
is eligible for the Centers for Disease Control and
Prevention (CDC) breast and cervical cancer early
detection program (BCCEDP) and was found through that
program to have cancer or a precancerous condition of
the breast or cervix, requires treatment, and meets the
eligibility requirements of this chapter.
[Eff 	09/30/13] 	(Auth: 	HRS §346-14; 42 CFR §435.213)
(Imp: 	HRS §346-14; 42 CFR §435.213)
§17-1733.1-2 	General requirements. 	The
confidentiality, administrative appeal, fraud, medical
assistance recovery, application processing,
eligibility review, and adverse action notice
provisions described in subtitle 12 shall pertain to
an individual who applies or is eligible for coverage
under this chapter. 	[Eff 	09/30/13] 	(Auth: HRS
§§346-14, 346-44; 42 C.F.R. §§431.200, 431.206,
431.221, 431.230, 431.300, 435.116, 435.201, 435.907,
435.916, 455.) (Imp: 	HRS §§346-14, 346-44; 42 C.F.R.
§§431.200, 431.206, 431.221, 431.230, 431.300,
435.116, 435.201, 435.907, 435.916, 455.1)
§§17-1733.1-3 to 17-1733.1-7 	(Reserved).
SUBCHAPTER 2

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1733.1-3
ELIGIBILITY REQUIREMENTS
§17-1733.1-8 	Purpose. 	This subchapter describes
the eligibility requirements for participation in
accordance with this chapter. 	[Eff 	09/30/13] 	(Auth:
HRS §346-14; 42 CFR §435.213) (Imp: 	HRS §346-14; 42
CFR §435.213)
§17-1733.1-9 	Basic requirements. 	An individual
shall meet the basic eligibility requirements, which
include but are not limited to, citizenship, qualified
non-citizen status, state residency, verification of
identity, not residing in a public institution and the
provision of a social security number, as described in
chapter 17-1714.1. 	[Eff 	09/30/13] 	(Auth: 	HRS
§§346-14, 346-29; 42 C.F.R. §§435.110, 435.400,
435.910) (Imp: 	HRS §§346-14, 346-29; 42 C.F.R.
§§435.110, 435.400, 435.910)
§17-1733.1-10 	Categorical requirements. 	(a) 	An
individual shall meet the following requirements:
(1) 	Under age sixty-five;
(2) 	Eligible and screened for breast or cervical
cancer or a precancerous condition of the
breast or cervix by an authorized CDC BCCEDP;
(3) 	Require treatment for breast or cervical
cancer or a precancerous condition of the
breast or cervix;
(4) 	Not otherwise covered under creditable
coverage; and
(5) 	Not eligible under any other Medicaid
coverage group.
(b) 	A new period of eligibility may be
established for an individual who is screened by an
authorized CDC BCCEDP with a recurrence or a new
occurrence of breast or cervical cancer or a
precancerous condition of the breast or cervix that
requires treatment and meets the provisions of
subsection (a). 	[Eff 	09/30/13] 	(Auth: 	HRS §346-14;
42 C.F.R. §§435.213) (Imp: 	HRS §346-14; 42 C.F.R.
§§435.213)

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§17-1733.1-11 	Non-financial eligibility
requirements and effective date of coverage. 	(a) 	An
individual who is determined eligible in accordance
with this chapter shall remain eligible while
receiving required treatment.
(1) 	Breast or cervical cancer shall be medically
reevaluated annually by a treating physician
to verify and confirm the need for continued
treatment at the time of the annual
eligibility review; or
(2) 	A precancerous condition of the breast or
cervix shall be medically reevaluated at six-month
intervals by a treating physician to verify and
confirm the need for continued treatment, and one of
the reevaluations shall coincide with the annual
eligibility review.
(b) 	Eligibility shall be effective retroactively
to the date the individual is screened and initially
diagnosed with breast or cervical cancer or a
precancerous condition of the breast or cervix by the
authorized CDC BCCEDP or ten calendar days immediately
prior to the date the application is received by the
department as described in chapter 1720.1, whichever
occurs first. 	[Eff 	09/30/13] 	(Auth: 	HRS §346-14;
42 CFR §§430.25, 431.40, 435.213, 438.6) (Imp: 	HRS
§346-14; 42 CFR §§430.25, 431.40, 435.213, 438.6)
§17-1733.1-12 	Income and asset requirements. 	An
individual’s household income and assets shall not be
considered in determining eligibility for participation
in this chapter. 	[Eff 	09/30/13] 	(Auth: 	HRS §346-14;
42 C.F.R. §430.25) (Imp: 	HRS §346-14; 42 C.F.R.
§430.25)
§17-1733.1-13 	Eligibility review. 	(a) 	An
individual eligible under the provisions of this
chapter shall receive an annual eligibility review
every twelve months.
(b) 	Eligibility shall be redetermined in
accordance with chapter 17-1712.1 and subchapter 5 of
chapter 17-1714.1. 	[Eff 	09/30/13] 	(Auth: 	HRS

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§346-14; 42 C.F.R. §§435.213, 435.916) (Imp: 	HRS §346-
14; 42 C.F.R. §§435.213, 435.916)
§§17-1733.1-14 to 17-1733.1-18 	(Reserved).
SUBCHAPTER 3
FREEDOM OF CHOICE, ENROLLMENT, BENEFITS AND
DISENROLLMENT
§17-1733.1-19 	Purpose. 	This subchapter
addresses the provisions of freedom of choice,
enrollment, benefits and disenrollment for an
individual eligible in accordance with this chapter.
[Eff 	09/30/13] 	(Auth: 	HRS §346-14; 42 CFR §435.213)
(Imp: 	HRS §346-14; 42 CFR §435.213)
§17-1733.1-20 	Freedom of choice. 	(a) 	An
individual eligible in accordance with this chapter
shall be provided a choice of a health plan and a
provider as described in chapter 17-1720.1.
(b) 	An individual identified in section 17-
1735.1-2(a) shall choose a department approved
provider as described in chapter 17-1736.
[Eff 	09/30/13] 	(Auth: 	HRS §346-14; 42 CFR §§430.25,
431.51, 438.52) (Imp: 	HRS §346-14; 42 CFR §§430.25,
431.51, 438.52)
§17-1733.1-21 	Enrollment into a participating
health plan. 	(a) 	An individual eligible in
accordance with this chapter, with the exception of an
individual identified in section 17-1735.1-2(a), shall
be enrolled in a health plan as described in chapter
17-1720.1.
(b) 	An individual identified in section 17-
1735.1-2(a) shall not be enrolled into a health plan
and services shall be provided on a fee-for-service
basis. 	[Eff 	09/30/13] 	(Auth: 	HRS §346-14; 42

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CFR §§430.25, 431.10, 431.40, 438.50) (Imp: 	HRS §346-
14; 42 CFR §§430.25, 431.10, 431.40, 438.50)
§17-1733.1-22 	Benefits. 	(a) 	An individual
enrolled in a health plan shall be provided a standard
benefits package by a participating health plan and
other services when appropriate as described in
chapter 17-1720.
(b) 	An individual identified in section 17-
1735.1-2(a) shall be provided coverage under the fee-
for-service provisions as described in chapter 17-
1737. 	[Eff 	09/30/13] 	(Auth: 	HRS §346-14; 42 C.F.R.
§§430.25, 431.40, 438.6) (Imp: 	HRS §346-14; 42 C.F.R.
§§430.25, 431.40, 438.6)
§17-1733.1-23 	Disenrollment from a health plan.
An enrollee shall be disenrolled from a health plan
under the provisions as described in chapter 17-
1720.1. 	[Eff 	09/30/13] 	Auth: 	HRS§346-14; 42 CFR
§§430.25, 431.40, 438.56) (Imp: 	HRS §346-14; 42 CFR
§§430.25, 431.40, 438.56)
§§17-1733.1-24 to 17-1733.1-28 	(Reserved).