HRS §431N-5
Health director must make rules for the program
The state health director must create rules to run this health care program. The rules will cover who can join, what care is covered, how payments work, and how to appeal. They also set rules for health care providers and for removing people who drop other insurance to join.
state agencies
The statute, as written — Rulemaking authority
The director of health shall adopt rules in accordance with chapter 91 which are necessary to carry out this chapter. The rules shall include, but need not be limited to: (1) Establishment of guidelines for the purchase of health care coverage from health care contractors by the department; (2) Establishment of specific health care services to be covered, limited, and excluded by the program, including preventive services, outreach, and education strategies designed to reach gap group individuals; (3) Establishment of eligibility requirements for participation in the program; (4) Development and implementation of an identification and notification process for eligible program participants; (5) Establishment of a payment schedule based on the person's ability to pay; (6) Establishment of program participation criteria for health care contractors; (7) Establishment of monitoring and evaluative guidelines for the program; (8) Establishment of appeal procedures for denial of eligibility, disqualification from program participation, assessment of civil penalties, or other negative action; and (9) Establishment of procedures to exclude or remove from the program persons who drop individual or group coverage to obtain insurance.
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