Hawaii - Personal Emergency Response System — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

The Hawaii Department of Human Services, Med-QUEST Division (MQD) funds Personal Emergency Response Systems (PERS) primarily through the QUEST Integration Section 1115 demonstration waiver and the Department of Health's Developmental Disabilities Division (DOH-DDD) 1915(c) waiver. PERS is defined as a 24-hour emergency assistance service utilizing electronic devices to enable individuals at high risk of institutionalization to secure immediate help in the event of an emotional, physical, or environmental emergency.

Approval to bill for this service requires securing a provider contract with one or more of the QUEST Integration managed care health plans or obtaining a formal recommendation from DOH-DDD before submitting the Medicaid enrollment application through the Hawaii Outreach, Knowledge, and Update (HOKU) portal. Because Hawaii does not issue a specific facility or agency license for PERS providers, the state relies on these waiver-specific network contracting and approval processes to vet equipment standards and response center capabilities.

1. Service Definition and Scope

In Hawaii, PERS is an electronic device system connected to a person's phone and programmed to signal a response center when a portable help button is activated. The service includes the training, installation, repair, maintenance, and response needs associated with the equipment.

The service is strictly limited to individuals who live alone, or who are alone for significant parts of the day, have no regular caregiver for extended periods, and would otherwise require extensive routine supervision.

• Target Population: Individuals living in non-licensed settings who live alone or lack a regular caregiver for extended periods.
• Equipment Types: Allowable items include 24-hour answering/paging systems, beepers, med-alert bracelets, intercoms, and life-lines.
• Service Components: Covers the installation, training, equipment rental, maintenance, and 24-hour monitoring response.
• Setting Restrictions: PERS services will only be provided to a member residing in a non-licensed setting.

2. Regulatory and Oversight Agencies

Medicaid services in Hawaii are administered by the Med-QUEST Division, which oversees the managed care plans delivering the QUEST Integration waiver. The Department of Health manages the waiver specifically for individuals with intellectual and developmental disabilities.

Providers must interact with both the state agencies for enrollment and the managed care organizations for actual service authorization and contracting.

• Department of Human Services, Med-QUEST Division (MQD): Administers the state Medicaid program and oversees the QUEST Integration 1115 waiver (https://medquest.hawaii.gov).
• Department of Health, Developmental Disabilities Division (DOH-DDD): Operates the 1915(c) Medicaid I/DD Waiver and reviews provider applications for that population (https://health.hawaii.gov/ddd).
• Hawaii Outreach, Knowledge, and Update (HOKU): The mandatory state Medicaid provider enrollment portal (https://medquest.hawaii.gov/en/plans-providers/hoku.html).
• QUEST Integration Health Plans: The designated managed care organizations that contract directly with HCBS providers (https://medquest.hawaii.gov/en/about/quest-integration.html).

3. Gatekeeping Prerequisites: Who Can Even Apply

Hawaii does not utilize a Certificate of Need program for HCBS or PERS providers. However, structural prerequisites exist depending on which waiver population the provider intends to serve.

Providers cannot simply enroll in Medicaid and begin billing; they must be accepted into the network of a designating entity.

• Managed Care Contracting: To serve the general aging and disabled population, providers must secure a network contract with at least one QUEST Integration health plan (e.g., HMSA, AlohaCare, Ohana Health Plan).
• DOH-DDD Recommendation: To serve the I/DD population, applicants must pass a DOH-DDD review and receive a formal recommendation before DHS-MQD will execute a Provider Agreement.
• Business Registration: Applicants must be registered to do business in Hawaii with the Department of Commerce and Consumer Affairs (DCCA).
• HCBS Final Rule Compliance: Providers must demonstrate compliance with the HCBS Final Rule prior to the delivery of any waiver services.

4. Licensure and Certification Requirements

Hawaii does not issue a specific state license for PERS agencies through the Department of Health's Office of Health Care Assurance (OHCA). Instead, providers are certified through the waiver approval process.

The state requires that the equipment and the response centers meet specific manufacturing and operational standards to ensure participant safety.

• Facility Licensure Exemption: PERS is an unlicensed service; no OHCA license is required to operate as a PERS provider.
• Equipment Standards: All PERS devices must meet applicable industry standards of manufacture, design, and installation.
• Maintenance Requirements: Repairs and maintenance to the equipment must be performed by the manufacturer’s authorized dealers whenever possible.
• Response Center Standards: The monitoring center must be staffed 24 hours a day by trained professionals capable of dispatching emergency assistance.

5. Medicaid Provider Enrollment

All providers wishing to service Medicaid members in Hawaii must enroll through the Hawaii Outreach, Knowledge, and Update (HOKU) portal. Paper applications are no longer accepted for initial enrollment.

Providers applying to serve the DOH-DDD waiver population have additional form and fee requirements that must be routed through the Developmental Disabilities Division first.

• Enrollment Portal: All applications and updates must be submitted electronically through the HOKU system.
• Application Form: DOH-DDD waiver providers must submit the Medicaid Application/Change Request Form (DHS 1139).
• Application Fee: A $500 application fee is required for new DOH-DDD provider applications, which is forwarded to DHS-MQD.
• Temporary ID: DHS-MQD issues a temporary identification number to facilitate mandatory fingerprinting requirements during enrollment.

6. Staffing, Training and Background Checks

While PERS is primarily an equipment-based service, the personnel installing the equipment and staffing the response center must meet state qualifications.

Agencies must ensure that any staff interacting with participants or handling their emergency data pass required background screenings.

• Response Center Staff: Must be trained professionals capable of handling emotional, physical, or environmental emergencies.
• Criminal History Checks: Required for staff interacting with participants, verified via state and federal background checks.
• Registry Screening: Staff must be screened against state abuse registries prior to hire and periodically thereafter.
• Orientation Training: DOH-DDD providers must complete New Employee Orientation and receive at least two additional continuing education topics annually.

7. Documentation, Policies and Records

Providers must maintain detailed participant records and agency policies that align with DOH-DDD and MQD standards. Records must be available for state or federal audits.

Agencies are also required to ensure language access for participants who have limited English proficiency.

• Participant Records: Must include emergency contacts, service dates, equipment installation details, and the names of family or care providers.
• Agency Policies: Providers must maintain written policies for emergency protocols, participant rights, and confidentiality of records.
• Language Access: Providers must offer interpreter services, and may utilize the State Procurement Office cooperative purchasing program for discounted telephonic interpretation.
• Service Verification: Records must trace to verified service delivery, including participant name, date of service, and equipment type.

8. Billing, Rates and Claims

Billing for PERS is routed through the QUEST Integration health plans or the state's fiscal agent, depending on the specific waiver authorizing the service.

Providers must obtain prior authorization before installing equipment or initiating monthly monitoring billing.

• Prior Authorization: Services must be authorized in advance, often utilizing the DHS 1144 form or the specific MCO's authorization portal.
• Claim Format: Claims are typically submitted on CMS 1500 forms or electronic 837P equivalents using the provider's NPI.
• MCO Reimbursement: Rates for the 1115 waiver are negotiated directly with the QUEST Integration health plans.
• Traceable Claims: All claims must be traceable to documented service delivery, including the duration of delivery and the type of service provided.

9. Approval Sequence and Timeline

The approval sequence depends on the target waiver. For the I/DD waiver, the process begins with DOH-DDD. For QUEST Integration, it begins with HOKU enrollment and MCO contracting.

Providers should expect the process to take several months from initial application to final MCO contract execution.

• Step 1: Submit the initial application to DOH-DDD (for the I/DD waiver) or directly register in HOKU (for QUEST Integration).
• Step 2: DOH-DDD conducts a review or site visit to verify HCBS Final Rule compliance and agency readiness.
• Step 3: DOH-DDD submits a formal recommendation to DHS-MQD for approval.
• Step 4: The provider pays the $500 fee (if applicable), completes fingerprinting, and finalizes the HOKU enrollment.
• Step 5: The enrolled provider executes network contracts with the QUEST Integration health plans.

10. Common Denials and Survey Findings

Applications and ongoing claims are frequently denied when providers fail to adhere to the strict setting and caregiver requirements of the PERS service definition.

State audits also target missing documentation or failure to maintain active business registrations.

• Licensed Setting Violation: Claims are denied if PERS is billed for a member residing in a licensed setting, such as an Adult Residential Care Home.
• Caregiver Presence: Services are denied if the member does not live alone or has a regular caregiver available for extended periods.
• Incomplete HOKU Profiles: Applications are rejected for missing DCCA business registration documents or unpaid application fees.
• HCBS Non-Compliance: Providers face sanctions if they cannot demonstrate that their services comply with the HCBS Final Rule integration requirements.

11. Key Contacts and Resources

Providers should direct enrollment questions to the HOKU helpdesk and waiver-specific questions to either MQD or DOH-DDD.

The state provides online manuals and provider bulletins to communicate policy updates.

• Med-QUEST Division (MQD): Oversees Medicaid and the QUEST Integration waiver (https://medquest.hawaii.gov).
• DOH Developmental Disabilities Division: Manages the 1915(c) waiver and initial provider reviews (https://health.hawaii.gov/ddd).
• HOKU Provider Portal: The mandatory system for Medicaid enrollment and updates (https://medquest.hawaii.gov/en/plans-providers/hoku.html).
• Hawaii State Procurement Office: Resource for accessing discounted telephonic interpretation services (http://spo.hawaii.gov/for-vendors/non-profits/cooperative-purchasing-program/).

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