Med-QUEST reopens public comment on revised §1115 Demonstration waiver renewal application

On July 31, 2018, the State of Hawaii, Department of Human Services Med-QUEST Division reopened its public comment period for its “Quest Integration” §1115 Waiver Renewal Application. The new comment period will end Thursday August 30, 2018.

DHS previously solicited comments on the draft application in March 2018, but revised the application in July 2018, to include additional information related to the financing approach, to share the interim evaluation results of the demonstration, to provide documentation of the annual post award forum, and to confirm the process for tribal consultation – all requested by CMS.  As a result, per CMS rules a new public comment period is required.

Since its implementation, CMS has renewed Hawaii’s wavier five times. The current waiver demonstration began in October 2013, and will expire December 31, 2018. It seeks to streamline eligibility, consolidate programs into a single QUEST Integration model, further integrate behavioral health services, cognitive rehabilitation, and habilitation.

Of particular note in the revised waiver application is the newly included Interim Evaluation Report. The evaluation groups the goals of the demonstration into three categories for measurement: 1) access to care and beneficiary engagement, 2) improving health, ensuring high-quality care, and managing costs, and 3) health plan and provider accountability.

The evaluation report concludes QUEST Integration:

  1. Improved access to care and beneficiary engagement by aligning with the Affordable Care Act and improving ratings from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys;
  2. Showed mixed results in improving health care outcomes and quality of care, with declining scores in several adult measures, scores below the national average three of four measures in behavioral health, and variation in scores for the Child Core Set Measures;
  3. Delivered similarly mixed results in the Pay for Performance Program (P4P), improving the state aggregate score on 7 out of 9 measures, but only meeting the target for 2 out of 9 measures from 2014 through 2016; and
  4. Performed weakly in provider surveys reflecting workforce shortages that impact service and care coordination.

The revised waiver proposes to continue the current QUEST program, while adopting  policies to invest in primary care, prevention, and health promotion, improve outcomes for high-need, high-cost individuals, engage in payment reform and alignment, and support community driven initiatives to improve population health in line with the Hawai‘i ‘Ohana Nui Project Expansion (HOPE) initiative. The evaluation report findings will be incorporated to help inform the direction and the design of the HOPE initiative in the next renewal period. Check here for a list of potential initiatives under the HOPE program

Any questions or comments on the revised waiver application may be submitted to Ms. Edie Mayeshiro, Medical Assistance Program Officer, MQD Policy Program Development Office, by mail to P.O. Box 700190, Kapolei, HI, 96709-0190 or by email at, by August 30, 2018.