QUEST Integration – Alcohol and Drug/Chemical Dependency Treatment

Original Effective Date:

08/01/1994

Current Effective Date:

09/02/2026

Inpatient Benefits

The QUEST Integration plan provides unlimited benefits for treatment of drug and alcohol abuse at parity with coverage for other medical conditions for all diagnoses related to substance abuse.

Inpatient services must be performed in a qualified treatment facility that has been specifically accredited to render alcohol or drug dependency services by the state of Hawaii (or by the state in which the facility is located). As with other inpatient services, hospitals must also notify HMSA’s Medical Management department to report the admission of a behavioral health or substance abuse patient.

Inpatient Professional Services

The HMSA QUEST Integration plan provides unlimited benefits for treatment of drug and alcohol abuse at parity with coverage for other medical conditions for services provided to a patient who is confined in a hospital and being treated for a mental illness or alcohol or drug dependency.

Qualified Providers

In compliance with the provisions of the Hawaii Revised Statutes (Chapter 431M), HMSA requires that the treating provider possess one of the following certifications:

• Certified Substance Abuse Counselor (CSAC).
• Certified Substance Abuse Program Administrator (CSAPA).
• American Society of Addiction Medicine (ASAM).
• Certification in Addiction Psychiatry.
• American Psychological Association Certificate of Proficiency in the Treatment of Alcohol and Other Psychoactive Substance Use Disorders.
• Licensed Clinical Social Worker (LCSW).
• Advanced Practice Registered Nurse (APRN).

Outpatient Benefits

The QUEST Integration plan provides unlimited benefits for treatment of drug and alcohol abuse at parity with coverage for other medical conditions for all diagnoses related to substance abuse.

Residential Facilities

Adult/pediatric mental health or substance abuse residential treatment facilities provide short-term treatment within structured therapeutic environments. Prior authorization is required.

See Post-acute, Residential Treatment Facility and Community Care Foster Family Home Care for more information.

Benefit Limit

The cost of detoxification services and educational programs to which drinking or drugged drivers are solely referred by the judicial system, or services performed by mutual self-help groups, are not eligible for benefits.

Precertification

The QUEST Integration plan requires precertification in specified situations (see Precertification). Payment for services will not be made unless precertification is obtained through HMSA’s Behavioral Health Services QUEST Integration for the following services:

• All services rendered by providers outside the QUEST Integration network (non-participating).
• All services provided out of state.
• Residential treatment for mental health and substance abuse disorders at residential treatment facilities.

Non-medical services such as interisland travel, lodging, and language translation provided in connection with behavioral health care must be authorized by calling QUEST Integration Provider Services.

Revision History