SPECIALIZED THERAPIES SERVICES PROVIDER IN HAWAII

Fatumata Kaba
1 day ago
4 min read

PROMOTING FUNCTIONAL INDEPENDENCE AND WELL-BEING THROUGH INDIVIDUALIZED THERAPEUTIC INTERVENTIONS

Specialized Therapies Services in Hawaii offer tailored therapeutic interventions to address participants’ physical, cognitive, communication, and behavioral needs. These services are authorized under Hawaii’s Medicaid Home and Community-Based Services (HCBS) waiver programs, aiming to support individuals with disabilities or chronic conditions in achieving greater independence and improving their 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 Specialized Therapies

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

Role: Administers HCBS waiver services, including specialized therapeutic services for individuals with intellectual and developmental disabilities (IDD)

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight ensuring Specialized Therapies meet Medicaid HCBS standards and person-centered planning principles

2. SPECIALIZED THERAPIES SERVICE OVERVIEW

Specialized Therapies encompass a wide range of targeted interventions designed to enhance the functional abilities, communication skills, physical health, and behavioral regulation of participants.

Approved providers may deliver:

Speech-Language Therapy (improving communication and swallowing function)
Occupational Therapy (enhancing daily living skills, sensory integration, adaptive strategies)
Physical Therapy (improving mobility, strength, balance, and physical endurance)
Behavioral Therapy (addressing behavioral challenges through positive supports)
Feeding Therapy (specialized therapy for eating and swallowing disorders)
Music or Art Therapy (where authorized under waiver programs)

All therapies must be recommended by an assessment, authorized in the participant’s Individualized Service Plan (ISP), and tied to measurable, person-centered outcomes.

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)
Enroll as a Medicaid provider through the Hawaii Med-QUEST Division
Therapists must hold active Hawaii licenses in their respective disciplines (PT, OT, SLP, Psychology, etc.)
Maintain general and professional liability insurance
Develop clinical policies and protocols for service delivery, participant safety, and documentation

4. MED-QUEST/DHS PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

Submit Provider Enrollment Application for Specialized Therapies under Hawaii’s HCBS Waiver Services
Indicate therapy disciplines provided and service areas

Application and Documentation Submission:

Submit Articles of Incorporation, proof of EIN/NPI, clinical staff credentialing, insurance certificates, and sample service models
Provide participant intake forms, therapy assessment templates, care plans, and service tracking forms

Program Readiness Review:

DHS reviews provider readiness, including staff qualifications, service systems, emergency protocols, and Medicaid compliance documentation

Approval & Medicaid Enrollment:

Upon approval, configure billing codes specific to each specialized therapy service authorized under Medicaid

5. REQUIRED DOCUMENTATION

Articles of Incorporation or Business License (Hawaii DCCA)
IRS EIN confirmation
NPI confirmation
Professional licenses for clinical staff (PT, OT, SLP, psychologist, etc.)
Proof of general and professional liability insurance
HCBS-Compliant Policy & Procedure Manual including:
- Participant intake, assessment, and therapy planning protocols
- Delivery of therapeutic interventions and outcome measurement
- HIPAA confidentiality, participant rights, and grievance procedures
- Emergency response protocols and clinical supervision plans
- Staff credentialing, background screening, and continuing education documentation
- Medicaid billing, service authorization tracking, and audit readiness systems

6. STAFFING REQUIREMENTS

Role: Clinical Supervisor / Lead Therapist

Requirements: Active Hawaii license in applicable therapy discipline; supervisory experience preferred; background screening clearance

Role: Licensed Therapists (PTs, OTs, SLPs, Behavioral Therapists)

Requirements: Active Hawaii professional licensure; CPR certification recommended; background screening clearance

Role: Therapy Assistants (where applicable, such as COTAs, PTAs)

Requirements: Certification and/or licensure as required; background screening clearance

All staff must complete:

HIPAA confidentiality and participant rights training
Emergency response and documentation compliance training
Continuing education in clinical best practices and therapy-specific standards
Annual competency evaluations and Medicaid documentation refreshers

7. MEDICAID WAIVER PROGRAMS

The following Hawaii Medicaid Waivers authorize Specialized Therapies Services:

Developmental Disabilities/Intellectual Disabilities (DD/ID) Waiver
Community Care Services (CCS) Program (where authorized for therapies tied to chronic health conditions)

Approved providers may deliver:

Therapy evaluations and individualized therapy planning
Direct delivery of therapy services in homes, centers, or community settings
Coordination with interdisciplinary teams to integrate therapy goals into broader care plans
Progress monitoring and reassessment services

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 Clinical System Development

Timeline: 30–45 days

Phase: Medicaid Enrollment and Billing System Setup

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/

SPECIALIZED THERAPIES SERVICES PROVIDER IN HAWAII

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — HAWAII SPECIALIZED THERAPIES SERVICES PROVIDER

WCG supports therapy providers, rehabilitation centers, and healthcare organizations in launching Medicaid-compliant Specialized Therapies Services under Hawaii’s HCBS waiver programs.

Scope of Work: