Department of Human Services

Complete Revised and Submitted 1115 Application

• Cover Letter
• Final Application
• Table of contents
• • Attachment A  –  Quality Assurance Monitoring Info
  • Attachment B  –   Interim Evaluation Report
  • Attachment C  –   Hawaii Med-QUEST Quality Strategy Approved
  • Attachment D  –   CMS 416 Forms
  • Attachment E  –   Benefit Specifications and Provider Qualifications
  • Attachment F  –   Behavioral Health Protocol
  • Attachment G  –  Budget Neutrality
  • Attachment H  –  Email Notice
  • Attachment I   –  Abbreviated Public Notice and Proof of Publication
  • Attachment J   –  Full Public Notice
  • Attachment K  –  Tribal Notice