Chapter 17-1720 of Title 17, Hawaii - Benefits Package

Oct 3, 2026

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Chapter 17-1720 of Title 17, Hawaii Administrative Rules amends and compiles the “Benefits Package” requirements under the Department of Human Services, Med-QUEST Division. The chapter establishes general provisions, the scope and content of covered services, and a structured standard benefits package based on a twelve-month benefit period. It defines covered services across medical inpatient care, outpatient services, behavioral health, home and community based services, institutional care, and dental services, including exclusions, limitations, and references to statutory and regulatory authorities.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages20

Reading Time50 min

AccessFree to download

Subchapter 1 General Provisions

§17-1720-1 Purpose

§§17-1720-2 to 17-1720-4 (Reserved)

Subchapter 2 Scope and Content of Services

§17-1720-5 Purpose

§17-1720-6 Covered Services

§§17-1720-7 to 17-1720-9 (Reserved)

Subchapter 3 Standard Benefits Package

§17-1720-10 Standard Benefits Package

§§17-1720-11 to 17-1720-13 (Reserved)

Subchapter 4 Specialized Behavioral Health

§17-1720-14 Specialized Behavioral Health Services

§§17-1720-15 to 17-1720-17 (Reserved)

Subchapter 5 Home and Community Based Services

§17-1720-18 Home and Community Based Services

§§17-1720-19 to 17-1720-21 (Reserved)

Subchapter 6 Institutional Care Services

§17-1720-22 Institutional Care Services

§§17-1720-23 to 17-1720-25 (Reserved)

Subchapter 7 Dental Services

§17-1720-26 Dental Services

§§17-1720-27 to 17-1720-30 (Reserved)

Subchapter 8 Exclusions and Limitations

§17-1720-31 Exclusions and limitations

§17-1720-32 to 17-1720-34 (Reserved)

7. Chapter 17-1720, of Title 17, Hawaii Administrative Rules, entitled “Benefits Package” is amended and compiled to read as follows: “HAWAII ADMINISTRATIVE RULES TITLE 17 DEPARTMENT OF HUMAN SERVICES SUBTITLE 12 MED-QUEST DIVISION CHAPTER 1720 BENEFITS PACKAGE Subchapter 1 General Provisions §17-1720-1 Purpose §§17-1720-2 to 17-1720-4 (Reserved) Subchapter 2 Scope and Content of Services §17-1720-5 Purpose §17-1720-6 Covered Services §§17-1720-7 to 17-1720-9 (Reserved) Subchapter 3 Standard Benefits Package §17-1720-10 Standard Benefits Package §§17-1720-11 to 17-1720-13 (Reserved) Subchapter 4 Specialized Behavioral Health Services §17-1720-14 Specialized Behavioral Health Services §§17-1720-15 to 17-1720-17 (Reserved) Subchapter 5 Home and Community Based Services §17-1720-18 Home and Community Based Services §§17-1720-19 to 17-1720-21 (Reserved) Subchapter 6 Institutional Care Services §17-1720-22 Institutional Care Services §§17-1720-23 to 17-1720-25 (Reserved) Subchapter 7 Dental Services §17-1720-26 Dental Services §§17-1720-27 to 17-1720-30 (Reserved) Subchapter 8 Exclusions and limitations §17-1720-31 Exclusions and limitations §§17-1720-32 to 17-1720-34 (Reserved) Historical Note: This chapter is based substantially upon repealed subchapter 7 of chapter 17-1721.1 and repealed subchapter 8 of chapter 17-1727. The source note for subchapter 7 of chapter 17-1721.1 is: [Eff 01/31/09; am 06/25/12; R 09/30/13] The source note for subchapter 8 of chapter 17-1727 is: [Eff 08/01/94; am 01/29/96; am 03/30/96; am 11/25/96; am 06/19/00; am 02/16/02; am 01/31/09; am 09/10/09; am 06/25/12; am 04/12/13; R 09/30/13] SUBCHAPTER 1 GENERAL PROVISIONS §17-1720-1 Purpose . This chapter describes covered services , exclusions and limitations provided to an [~~ enrolled individual~~ ] enrollee by a participating health plan . [Eff 09/30/13; am and comp ] (Auth: HRS §346-14; 42 C .F .R . §§430 .25, 438 . 6, 440 .210) (Imp: HRS §346-14; 42 C .F .R .§§430 .25, 438 . 6, 440 .210) §§17-1720-2 to 17-1720-4 (Reserved) . SUBCHAPTER 2 SCOPE AND CONTENT OF SERVICES §17-1720-5 Purpose . This [~~ chapter~~ ] subchapter describes covered services provided by a participating health plan to an [~~ enrolled individual~~. ] enrollee .[Eff 09/30/13; am and comp ] (Auth: HRS §346-14; 42 C .F .R . §§430 .25, 438 . 6, 440 .210) (Imp: HRS §346-14; 42 C .F .R . §§430 .25, 438 . 6, 440 .210) §17-1720-6 Covered services. (a) The [~~benefits~~ ] services minimally required to be provided by each participating health plan are described in section 17- 1720-10 and shall be known as the standard benefits package [~~ as described in section 17-1720-10~~] . (b) The standard benefits package [~~ as defined in section 17-1720-10~~] is based on a twelve-month [~~benefits~~ ]benefit period. [~~Benefits~~ ] Service limits are pro-rated for any [~~benefits~~ ] benefit period [~~ other than twelve-month period~~. ] less than twelve-months . If an enrollee [~~ individual~~ ] changes health plans during a [~~benefits~~ ]benefit period, the remaining unused [~~benefits~~ ] service limits will be covered by the new health plan for the duration of the [~~benefits~~ ]benefit period. (c) Based on clinical eligibility and medical necessity, [~~ an enrolled individual may be provided~~ ] a participating health plan may provide services described in section 17-1720-14 [~~by the health plan ~~. ] to an enrollee . (d) Based on level of care eligibility, the [~~ enrolled individual~~ ] enrollee shall be provided services described in sections 17-1720-18 or 17-1720-22 by the health plan . (e) A health plan may, at the health plan’s option , or as otherwise required by the contract between the health plan and the department , or the state plan, provide medically necessary services which exceed the requirements of the standard benefits package . [Eff 09/30/13; am and comp ] (Auth: H

FAQs

What is the purpose of Chapter 17-1720?

Chapter 17-1720 describes covered services, exclusions, and limitations provided to an enrollee by a participating health plan, and sets the chapter’s governing framework under the Med-QUEST Division.

How is the standard benefits package period defined?

The standard benefits package is based on a twelve-month benefit period, and service limits are prorated for benefit periods shorter than twelve months.

What kinds of services does the chapter address?

The chapter covers medically necessary services including medical inpatient days, outpatient services, specialized behavioral health services, home and community based services, institutional care services, and dental services, along with exclusions and limitations.

Oct 3, 2026

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