Section 17-1416-15 - Presumptive eligibility(a) Any applicant not determined eligible or ineligible by the thirtieth day from the date of application shall be determined presumptively eligible for the social service for which the individual applied effective the thirty-first day from the date of application.(b) A determination of presumptive eligibility shall not constitute a final disposition. The application shall be processed and disposition of the application shall be made as soon as possible. The applicant shall remain presumptively eligible until the application is either approved or denied. The applicant shall be informed of the decision.(c) On the thirty-first day from the date of application, the department shall send a written notice of presumptive eligibility to all applicants who have not been notified of approval or denial.(d) The cost of services for which the application was made shall be authorized for services received beginning the thirty-first day until presumptive eligibility is no longer effective when: (1) The applicant submits to the department a bill or receipt for payment within thirty days of the date indicated on the bill or receipt; and(2) The amount paid does not exceed the department's rate of payment for the kind of service received.(e) The following conditions shall apply in order to terminate presumptive eligibility when the applicant is determined eligible: (1) Presumptive eligibility shall end on the day the disposition is made. The applicant shall be notified of full eligibility; and(2) The cost of services for which the application was made shall be authorized from the date of application according to the department's rate of payment, if the client submits a bill or receipt for services received during that time.(f) The following conditions shall apply in order to terminate presumptive eligibility when the applicant is determined ineligible: (1) On the day the department determines the applicant ineligible, the department shall mail the applicant notice to this effect;(2) Presumptive eligibility shall terminate three days from the date the notice is mailed;(3) The cost of services for which the individual applied and received during presumptive eligibility shall be authorized if the applicant submits a bill or receipt for payment within thirty days of the date indicated on the bill or receipt. Payment shall be made according to the rate of payment for the kind of service rendered;(4) If a fair hearing is requested, no payments shall be made for service received after presumptive eligibility terminated and while the fair hearing request is pending;(5) If a fair hearing decision is in the applicant's favor, the applicant shall be determined eligible from the date of application. Costs for services received from the date of application shall be paid at the department's rate of payment for that particular service when: (A) The services are the kind of services for which the individual applied; and(B) The applicant submits a bill or receipt to the department; and(6) If a fair hearing decision is adverse to the applicant, the applicant shall remain ineligible and responsible for costs incurred prior to as well as after the period of presumptive eligibility.Haw. Code R. § 17-1416-15
[Eff 6/29/92; comp 10/28/95] (Auth: HRS § 346-14) (Imp: HRS § 346-14; 42 U.S.C. §1397 c )