COMMUNITY INTEGRATION SERVICES PROVIDER IN HAWAII

PROMOTING INCLUSION, PARTICIPATION, AND SOCIAL CONNECTIONS FOR INDIVIDUALS IN THEIR COMMUNITIES

Community Integration Services in Hawaii assist individuals with disabilities, chronic health conditions, or aging-related needs in developing the skills, supports, and opportunities needed to participate fully in community life. These services are authorized under Hawaii’s Medicaid Home and Community-Based Services (HCBS) waiver programs, fostering greater independence, socialization, and quality of life.

1. GOVERNING AGENCIES

Agency: Hawaii Department of Human Services (DHS) — Med-QUEST Division

Role: Oversees Medicaid provider enrollment, service authorization, and reimbursement for Community Integration Services

Agency: Hawaii Department of Health (DOH) — Developmental Disabilities Division (DDD)

Role: Administers HCBS waiver Community Integration Services for individuals with intellectual and developmental disabilities (IDD)

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight, ensuring Community Integration Services meet Medicaid HCBS standards for community-based, person-centered support

2. COMMUNITY INTEGRATION SERVICE OVERVIEW

Community Integration Services focus on helping participants build skills and access opportunities that allow them to live, work, and thrive in their communities.

Approved providers may deliver:

• Assistance with locating and participating in community activities (e.g., classes, volunteer opportunities, recreation, religious events)

• Skills training in navigating community resources and using public transportation

• Development of social skills and peer interactions

• Support with joining clubs, hobby groups, sports teams, or civic organizations

• Advocacy training to support personal choices and community engagement

• Education on public services (e.g., libraries, parks, senior centers)

Services must align with goals identified in the participant’s Individualized Service Plan (ISP) and support meaningful community membership, not just presence in public spaces.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register your business with the Hawaii Department of Commerce and Consumer Affairs (DCCA)

• Obtain EIN from the IRS and NPI (Type 2)

• Enroll as a Medicaid provider with Hawaii’s Med-QUEST Division

• Complete DDD Provider Certification if serving DD/ID Waiver participants

• Maintain general liability and professional liability insurance

• Develop policies for person-centered planning, safety in community settings, and participant support

4. MED-QUEST/DHS PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

• Submit Provider Enrollment Application for Community Integration Services through Hawaii’s Med-QUEST Division

• Identify planned community engagement activities and geographic service areas

Application and Documentation Submission:

• Submit Articles of Incorporation, proof of EIN/NPI, insurance certificates, operational policies, and participant intake procedures

• Provide sample community engagement plans, service tracking forms, and risk management protocols

Program Readiness Review:

• DHS and DOH review provider readiness, including participant safety systems, community participation strategies, and Medicaid documentation compliance

Approval & Medicaid Enrollment:

• Upon approval, configure billing codes for Community Integration Services (typically hourly or session-based billing)

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Business License (Hawaii DCCA)

• IRS EIN confirmation

• NPI confirmation

• Proof of general and professional liability insurance

• HCBS-Compliant Policy & Procedure Manual including:

  • Participant intake, assessment, and community participation planning

  • Community activity safety procedures and emergency response plans

  • Daily documentation and service authorization tracking

  • HIPAA confidentiality, participant rights, and grievance handling procedures

  • Staff credentialing, background checks, and competency documentation

  • Medicaid billing, quality assurance monitoring, and audit readiness documentation

6. STAFFING REQUIREMENTS

Role: Community Integration Program Manager / Supervisor

Requirements: Experience in disability services, social work, recreation therapy, or human services; background screening clearance

Role: Community Support Workers / Direct Support Professionals (DSPs)

Requirements: High school diploma or GED; CPR/First Aid certification preferred; background screening clearance

All staff must complete:

• Person-centered planning, community integration, and social inclusion training

• HIPAA confidentiality, participant rights, and abuse prevention training

• Emergency preparedness and incident management training

• Annual training refreshers on Medicaid compliance and community-based support best practices

7. MEDICAID WAIVER PROGRAMS

The following Hawaii Medicaid Waivers authorize Community Integration Services:

• Developmental Disabilities/Intellectual Disabilities (DD/ID) Waiver

• Community Care Services (CCS) Program (where social and community integration goals are identified)

Approved providers may deliver:

• Skills training for independent community navigation

• Supervised participation in social, recreational, or volunteer activities

• Peer support and self-advocacy skill development

• Transportation support (if tied to community activity participation)

8. TIMELINE TO LAUNCH

Phase: Business Formation and Initial Credentialing Setup

Timeline: 1–2 weeks

Phase: Med-QUEST Provider Application and Readiness Review

Timeline: 60–90 days

Phase: Staff Hiring, Credentialing, and Community Activity Setup

Timeline: 30–45 days

Phase: Medicaid Enrollment and Billing System Configuration

Timeline: 45–60 days

9. CONTACT INFORMATION

Hawaii Department of Human Services (DHS) — Med-QUEST Division

Website: https://medquest.hawaii.gov/

Hawaii Department of Health (DOH) — Developmental Disabilities Division (DDD)

Website: https://health.hawaii.gov/ddd/

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.cms.gov/

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — HAWAII COMMUNITY INTEGRATION SERVICES PROVIDER

WCG supports community-based organizations, direct support agencies, and inclusion-focused programs in launching Medicaid-compliant Community Integration Services under Hawaii’s HCBS waiver programs.

Scope of Work:

• Business registration and EIN/NPI setup

• Medicaid provider enrollment support

• Development of Community Integration Services Policy & Procedure Manual

• Staff credentialing templates and participant community assessment forms

• Medicaid billing setup and claims management

• Website, domain, and email setup

• Community activity planning, safety procedures, and service documentation templates

• Participant intake, social goal planning, and community partnership development

• Quality assurance programs for service delivery and participant satisfaction tracking

Continue To Our Client Portal To Get Started

Our Client Portal offers a wealth of resources that you can explore related to various programs and state requirements.