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Hawaii Medicaid EQRO

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External Quality Review Organization Services

HSAG performs the following EQRO services:

  • Review of Health Plan Compliance with Managed Care Standards, Review of Corrective Action Plans, and Re-evaluation of Corrective Actions
  • Validation of Performance Improvement Projects
  • Validation of Performance Measures and HEDIS® Report Validation
  • Administration of Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Surveys
  • Administration of Provider Satisfaction Surveys
  • Development of an Annual Report of External Quality Review Activity Results
  • Technical Assistance to the State and the Health Plans

Click here to navigate to the HSAG website to learn more about HSAG’s EQRO services, or contact Elizabeth Marsh, Director, at emarsh@hsag.com.

Peer Review Services

Long-Term-Care Level of Care (LOC) and At-Risk Determinations

HSAG conducts LOC determinations on requests submitted by the QUEST Integration health plans and community providers for Medicaid members requiring nursing facility (NF) level of care or who are at risk of deteriorating to the NF LOC. HSAG maintains an electronic data base of requests and determinations in “HILOC”—a secure Web application available to Hawaii Medicaid health plans and their contracted Medicaid providers.

Pre-Admission Screening and Resident Review (PASRR) Compliance Reviews

HSAG conducts reviews on a quarterly sample of admissions to Medicaid-certified nursing facilities in the state of Hawaii for compliance with the PASRR process. HSAG maintains ePASRR—a secure Web application for submission of Level I PASRR forms, Level II evaluations, and Level II determinations by Adult Mental Health Division (AMHD) and Developmental Disabilities Division (DDD).

For more information about the Hawaii PRO services, contact Elizabeth Marsh, Director, at emarsh@hsag.com.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).