Hawaii - Adult Companion Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

Adult Companion Services in Hawaii are funded through the Department of Human Services (DHS) Med-QUEST Division (MQD) QUEST Integration managed care program and the Department of Health Developmental Disabilities Division (DDD) 1915(c) I/DD Waiver. Agencies seeking reimbursement must secure a Provider Services Agreement with DOH/DDD and contract directly with QUEST Integration health plans before MQD will issue an active Medicaid provider number.

The service provides non-medical care, supervision, and socialization to adults, often delivered in conjunction with Community Care Foster Family Home (CCFFH) settings or as a standalone waiver support. Approval requires registering as a business with the Department of Commerce and Consumer Affairs (DCCA), obtaining a General Excise Tax (GET) license, and passing DOH/DDD readiness reviews to verify compliance with waiver standards.

1. Service Definition and Scope

In Hawaii, Adult Companion Services consist of non-medical care, supervision, and socialization provided to an adult participant. The service is designed to assist individuals with intellectual and developmental disabilities, or those in community care settings, to remain safely in the community.

This service explicitly excludes medical or healthcare-related tasks. Staff members may not perform medication administration, tube feedings, or other activities requiring nursing oversight, which must be performed by qualified professionals such as an RN or LPN.

• Target Population: Adults aged 21 and older with substantial complex health management or developmental support needs.
• Covered Activities: Socialization, supervision, and non-medical care outlined in the Individualized Service Plan (ISP).
• Excluded Activities: Medication administration, tube feedings, and any healthcare-related services requiring clinical training.
• Delivery Settings: Participant's own home, certified Adult Foster Homes (AFH), Developmental Disabilities Domiciliary Homes (DD Doms), or Community Care Foster Family Homes (CCFFH).

2. Regulatory and Oversight Agencies

The Hawaii Department of Health (DOH) Developmental Disabilities Division (DDD) operates the I/DD Waiver and conducts provider readiness and certification reviews. The Department of Human Services (DHS) Med-QUEST Division (MQD) serves as the state Medicaid agency, overseeing provider enrollment and the QUEST Integration managed care plans.

Because Hawaii utilizes a managed care delivery system for most Medicaid services, providers must also interact with designated QUEST Integration health plans for credentialing, contracting, and claims submission.

• Department of Health Developmental Disabilities Division (DDD): Operates the waiver and approves provider agreements (https://health.hawaii.gov/ddd/).
• Department of Human Services Med-QUEST Division (MQD): Manages Medicaid enrollment and oversight (https://medquest.hawaii.gov).
• Department of Commerce and Consumer Affairs (DCCA): Registers businesses operating in Hawaii (https://cca.hawaii.gov).
• Department of Taxation: Issues the required General Excise Tax (GET) license for businesses (https://tax.hawaii.gov).

3. Gatekeeping Prerequisites: Who Can Even Apply

Hawaii requires all prospective waiver providers to establish a formal business presence in the state before applying. An applicant must be a registered business in the State of Hawaii through the Department of Commerce and Consumer Affairs (DCCA) and possess a tax license for General Excise Tax (GET).

Furthermore, access to Medicaid reimbursement is gated by the requirement to enter into a Provider Services Agreement with DOH/DDD and subsequently secure network contracts with QUEST Integration managed care organizations. Standalone enrollment without DOH/DDD approval or MCO contracting is not permitted.

• Business Registration: Must be a registered business in the State of Hawaii through the DCCA.
• Tax Licensure: Must possess a General Excise Tax (GET) license from the Hawaii Department of Taxation.
• DOH/DDD Provider Agreement: Must be approved by DOH/DDD and enter into a formal contract with the State to provide waiver services.
• Managed Care Contracting: Must secure network agreements with QUEST Integration health plans to receive authorizations and payment.

4. Licensure and Certification Requirements

Hawaii does not issue a distinct, standalone facility license for Adult Companion Services. Instead, agencies are certified as DOH/DDD Waiver Providers. The agency must demonstrate adherence to staffing qualifications, training, education, and certification standards stated in the Medicaid Waiver Standards.

When companion services are provided within a residential setting like a Community Care Foster Family Home (CCFFH), the home itself must be certified under Hawaii Administrative Rules (HAR) Title 17, Subtitle 9, Chapter 1454-43, which limits occupancy and dictates physical environment standards.

• Agency Certification: Must be approved as a DOH/DDD Waiver Provider with a Medicaid provider agreement.
• CCFFH Certification: If operating a foster home, must maintain certification under HAR Chapter 1454-43.
• Capacity Limits: CCFFH settings are limited to up to three adults receiving services, with a maximum of two residents per bedroom.
• Telehealth Allowances: Certain participant-specific training and monitoring may be conducted via HIPAA-compliant telehealth.

5. Medicaid Provider Enrollment

After securing DOH/DDD approval, agencies must enroll with the Med-QUEST Division (MQD) to obtain a Medicaid provider number. Enrollment is processed through MQD's Provider Relations Section and must comply with 42 CFR Part 455 requirements, including revalidation every five years.

Providers must submit their DOH/DDD approval, DCCA registration, and GET license alongside their Medicaid application. MQD verifies that the provider has no current limitations or exclusions before issuing the provider ID.

• MQD Enrollment: Application submitted to the Med-QUEST Division Provider Relations Section.
• Revalidation: Providers must revalidate their Medicaid enrollment at least every 5 years per 42 CFR 455.414.
• Locum Tenens: Temporary provider coverage (up to 60 days) requires written notification to the Health Care Services Branch (HCSB) at least seven days prior.
• NPI Requirement: Must obtain and register a National Provider Identifier (NPI) appropriate for agency-based HCBS.

6. Staffing, Training and Background Checks

Agencies must ensure all direct care staff meet strict baseline qualifications before delivering Adult Companion Services. Staff must be at least 18 years of age, be legally authorized to work in the United States, and pass a comprehensive criminal history check.

Additionally, staff must be specifically trained in the participant's Individualized Service Plan (ISP) or Individual Plan (IP) and demonstrate the ability to perform the assigned non-medical tasks safely.

• Age Requirement: All direct care staff must be at least 18 years of age.
• Background Checks: Staff must pass a criminal history check prior to providing services.
• Work Authorization: Staff must be legally able to work in the United States.
• ISP Training: Staff must be trained in the specific requirements of the participant's Individualized Service Plan (ISP).

7. Documentation, Policies and Records

Providers must maintain detailed records demonstrating compliance with the ISP and waiver standards. DOH/DDD conducts verification of provider qualifications prior to service delivery, during the first month of service for initial evaluation, and every succeeding 12th month thereafter.

Agencies must implement policies for incident reporting, privacy (HIPAA), and service documentation. If a participant receives fewer than one waiver service per month for a period of 120 days, case managers must provide monthly monitoring to prevent discharge.

• Service Documentation: Must maintain timesheets and progress notes aligning with authorized ISP goals.
• Annual Verification: DOH/DDD verifies provider qualifications every 12th month after the initial evaluation.
• Privacy Compliance: Must adhere to HIPAA requirements, especially when utilizing telehealth for ISP training or monitoring.
• Authorized Representatives: Must retain Form DHS 1121 if a participant designates a representative for health information.

8. Billing, Rates and Claims

Payment for Adult Companion Services is based on compliance with billing protocols and completed supporting documentation as required by the Medicaid Waiver Standards. Claims are typically submitted to the participant's QUEST Integration health plan rather than directly to MQD, using standard encounter reporting formats.

Providers must account for Hawaii's General Excise Tax (GET) in their financial operations, as they are required to hold a GET license. Rates are established by MQD and DOH/DDD and are published in the waiver fee schedule.

• Claims Routing: Submitted to the applicable QUEST Integration managed care plan.
• Encounter Reporting: Must comply with the MQD 837 Encounter Reporting Companion Guide standards.
• Prior Authorization: Services must be prior authorized by DOH/DDD based on clinical review and specified in the ISP.
• Tax Compliance: Agencies must manage General Excise Tax (GET) obligations as part of their business operations.

9. Approval Sequence and Timeline

The approval sequence begins with establishing a legal business entity in Hawaii. Applicants must register with the DCCA and obtain a GET license from the Department of Taxation before approaching DOH/DDD.

Once business prerequisites are met, the agency applies to DOH/DDD for a Provider Services Agreement. Following DOH/DDD approval, the agency enrolls with MQD for a Medicaid ID, and finally credentials with QUEST Integration health plans to receive service authorizations.

• Step 1: Register the business with the Hawaii DCCA and obtain a GET license.
• Step 2: Submit an application and undergo readiness review with DOH/DDD.
• Step 3: Sign the Provider Services Agreement with DOH/DDD upon approval.
• Step 4: Submit the Medicaid provider enrollment application to MQD Provider Relations.
• Step 5: Complete credentialing and contracting with QUEST Integration MCOs.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied at the gatekeeping stage because the applicant failed to secure a DCCA business registration or GET license prior to submitting their DOH/DDD application.

During annual DOH/DDD verifications, common survey findings include staff providing services before criminal history checks are fully cleared, or failure to document that staff received participant-specific training on the ISP.

• Missing Business Licenses: Denial of application for lacking DCCA registration or GET license.
• Background Check Violations: Findings issued when staff begin work before criminal history checks are completed.
• ISP Training Gaps: Failure to document that staff were trained on the participant's specific ISP.
• Scope of Practice Violations: Findings issued if companion staff perform prohibited healthcare tasks like medication administration.

11. Key Contacts and Resources

Prospective providers should begin by reviewing the DOH/DDD waiver provider requirements and ensuring their business is properly registered with the state. The Med-QUEST Division provides manuals and companion guides for claims and encounter reporting.

For specific questions regarding the I/DD Waiver provider agreement, agencies must contact the DOH/DDD Provider Resources branch.

• DOH Developmental Disabilities Division: Waiver provider information and applications (https://health.hawaii.gov/ddd/waiver-providers).
• Med-QUEST Division (MQD): Medicaid provider enrollment and manuals (https://medquest.hawaii.gov).
• Hawaii DCCA: Business registration portal (https://cca.hawaii.gov).
• Senior Companion Program (Oahu): For individual companion program inquiries, call (808) 832-0340.

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