a. Provide physician services to assist with the review of medical claims for individuals eligible under emergency medical assistance to determine the emergency period (using Form 1149A) as well as the disability determinations (using Form 1180), referred to as the Aging and Disability Resource Center (ADRC) referral and determination/re-determination. CSO may assign comparable medical reviews for eligibility for other programs or benefits. The physician will use Hawaii Administrative Rules on which to make determinations that conditions were met for coverage by Hawai’i Medicaid. b. The physician will review cases assigned by CSO and will access files electronically using MQD’s designated secure internet site, or another mutually agreed upon method. c. While reviewing the case files, the physician will ensure confidentiality of protected health information and ensure files are secured to prevent access by others unauthorized to view files. A Business Associate Agreement (BAA) will be required to be signed between the contracted physician and MQD. d. Upon completion of review, the files will be returned promptly to MQD/CSO by placing it in MQD’s designated secure internet site, or another mutually agreed upon method. e. The assigned cases will be reviewed and a determination made no more than seven (7) days from date of receipt/placement in folder in secure site. f. Physician services shall NOT exceed $150,000.00 per year, inclusive of all expenses and taxes.
