HOME HEALTH SERVICES PROVIDER IN HAWAII

DELIVERING SKILLED NURSING, THERAPEUTIC, AND PERSONAL SUPPORT SERVICES IN THE COMFORT OF PARTICIPANTS’ HOMES

Home Health Services in Hawaii provide clinical, therapeutic, and supportive care to individuals who require medical oversight but prefer to remain at home rather than receive institutional care. These services are authorized under Hawaii’s Medicaid State Plan, Home and Community-Based Services (HCBS) waiver programs, and Medicare, helping individuals recover, manage chronic conditions, and maintain independence.

1. GOVERNING AGENCIES

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

Role: Oversees Medicaid provider enrollment, service authorization, and reimbursement for Home Health Services

Agency: Hawaii Department of Health (DOH) — Office of Health Care Assurance (OHCA)

Role: Licenses and inspects Home Health Agencies for regulatory compliance

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight ensuring Home Health Services meet Medicaid and Medicare standards of care

2. HOME HEALTH SERVICE OVERVIEW

Home Health Services deliver a combination of skilled medical care and personal support directly to the participant’s home.

Approved providers may deliver:

• Skilled Nursing (e.g., wound care, medication administration, chronic disease monitoring)

• Physical Therapy (PT) services (mobility training, strength rehabilitation)

• Occupational Therapy (OT) services (ADL skill-building, adaptive equipment use)

• Speech-Language Pathology (SLP) services (speech, swallowing therapy)

• Medical Social Work (MSW) services (psychosocial assessments, counseling)

• Home Health Aide services (basic personal care under nurse supervision)

All services must be based on a physician’s order and follow an individualized Plan of Care (POC) developed in collaboration with the participant, family, and healthcare team.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

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

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

• Obtain Home Health Agency License through DOH’s Office of Health Care Assurance (OHCA)

• Obtain Medicare certification (optional but strongly recommended for dual Medicaid/Medicare billing)

• Maintain general liability, professional liability, and malpractice insurance

• Employ licensed clinical staff including RNs, PTs, OTs, SLPs, MSWs, and HHAs

4. MED-QUEST/DHS PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

• Submit application for Home Health Agency licensing through OHCA

• Prepare for the Pre-Licensure Survey including facility readiness, staffing, policies, and patient care protocols

Application and Documentation Submission:

• Submit Articles of Incorporation, proof of EIN/NPI, clinical staff credentialing, operational policies, quality assurance plans, and emergency preparedness protocols

Licensure and Certification Surveys:

• Undergo OHCA licensure survey

• Undergo CMS Certification Survey if Medicare participation is desired

Approval & Medicaid Enrollment:

• Upon licensing (and certification if applicable), complete Medicaid enrollment through Hawaii’s Med-QUEST Division

• Configure billing codes for Skilled Nursing Visits, Therapy Visits, Home Health Aide Services, and Medical Social Work Services

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Business License (Hawaii DCCA)

• IRS EIN confirmation

• NPI confirmation

• Home Health Agency License (OHCA)

• Medicare Certification (optional but encouraged)

• Proof of general, professional, and malpractice insurance

• HCBS-Compliant Policy & Procedure Manual including:

  • Participant intake, physician order processing, and care plan development

  • Skilled nursing, therapy, and personal care delivery protocols

  • Emergency preparedness, infection control, and incident response procedures

  • HIPAA confidentiality, participant rights, and grievance handling procedures

  • Staff credentialing, background screening, and competency verification

  • Medicaid billing, service authorization tracking, and audit readiness systems

6. STAFFING REQUIREMENTS

Role: Administrator / Director of Nursing (DON)

Requirements: Active Hawaii RN license; experience managing home health operations; background screening clearance

Role: Registered Nurses (RNs) and Licensed Practical Nurses (LPNs)Requirements: Active Hawaii nursing licensure; CPR certification; home care experience preferred

Role: Physical Therapists (PTs), Occupational Therapists (OTs), Speech-Language Pathologists (SLPs)

Requirements: Active Hawaii professional licensure in applicable disciplines

Role: Medical Social Workers (MSWs)Requirements: Master’s degree in social work; Hawaii licensure preferred

Role: Certified Home Health Aides (HHAs)

Requirements: Completion of a state-approved Home Health Aide program; CPR certification recommended

All staff must complete:

• HIPAA confidentiality and participant rights training

• Infection control, emergency response, and abuse prevention training

• Annual continuing education in clinical best practices and Medicaid compliance

7. MEDICAID WAIVER PROGRAMS

Home Health Services are authorized under:

• Medicaid State Plan (Home Health Benefit)

• Community Care Services (CCS) Program

• Developmental Disabilities/Intellectual Disabilities (DD/ID) Waiver (for specific skilled services)

Approved providers may deliver:

• Intermittent skilled nursing care

• Short-term therapy services

• Personal care support through Home Health Aides under RN supervision

• Social work services addressing psychosocial barriers to health

8. TIMELINE TO LAUNCH

Phase: Business Formation, Licensing, and Facility Preparation

Timeline: 2–4 months

Phase: Staff Hiring, Clinical Program Development, and Training

Timeline: 2–3 months

Phase: OHCA Licensing and CMS Certification (optional)Timeline: 3–6 months

Phase: Med-QUEST Enrollment and Medicaid Readiness Review

Timeline: 60–90 days

9. CONTACT INFORMATION

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

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

Hawaii Department of Health (DOH) — Office of Health Care Assurance (OHCA)

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

Centers for Medicare & Medicaid Services (CMS)

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

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — HAWAII HOME HEALTH SERVICES PROVIDER

WCG supports home health agencies, clinical organizations, and healthcare entrepreneurs in launching Medicaid-compliant Home Health Services under Hawaii’s HCBS waiver programs and Medicaid State Plan benefits.

Scope of Work:

• Business registration and EIN/NPI setup

• Home Health Agency licensing and Medicare certification support

• Medicaid provider enrollment assistance

• Development of Home Health Services Policy & Procedure Manual

• Staff credentialing templates and participant intake/care planning forms

• Medicaid billing setup and claims management

• Website, domain, and email setup

• Care coordination, clinical documentation, and emergency planning templates

• Quality assurance and clinical outcome monitoring systems

• Community networking and hospital discharge referral strategies

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