Kaiser Permanente is one of Hawaii’s QUEST Integration plans. It is built differently from the others: its QUEST manual says Kaiser "provides most services through its own hospital and clinics" and through Hawaii Permanente Medical Group, with contracted outside providers accounting for "only 2% of all services." For a Kaiser QUEST child, ABA is the Med-QUEST EPSDT benefit — the manual names intensive behavioral therapy "including applied behavioral analysis (ABA)" for children with ASD — but an outside ABA agency needs a Kaiser authorization through Authorization and Referral Management (ARM). Kaiser publishes no ABA-specific policy, code list or hour rules that we could find, so most plan-level fields are marked unverified.
Kaiser’s commercial HMO plans in Hawaii are also under Luke’s Law through HRS § 432D-23 (under 14, $25,000 a year for ABA). This guide covers the QUEST line.
Kaiser’s QUEST manual: when services from an outside provider are needed, "an authorization request is submitted and processed through Kaiser Permanente’s Authorization and Referral Management Department (ARM)," and the Kaiser Physician-in-Charge makes the final review of out-of-plan requests, "including Behavioral Health." Referrals are authorized "for specific services, including frequency and duration of treatment," and anything beyond needs a new authorization. PA "must be obtained before service is rendered," and "No retroactive requests will be processed," except for newborns, state retroactive enrollments, certain discharges, and "when members transition to Kaiser from another QUEST health plan" — which matters for ʻOhana families moving on January 1, 2027.[1][4][2]
The benefit follows Med-QUEST’s memo: under 21, the memo’s diagnosing providers, a treatment plan with standardized goal measurement, 26-week periods, supervision at 1–2 hours per 10 RBT hours, Medicaid secondary to other coverage. The memo lists Kaiser’s Health Coordination line as (808) 432-5330.[1][4][2]
The questions that decide whether a family can start with Kaiser Permanente Hawaii (QUEST Integration), and what they have to bring. Each maps onto something intake should ask on the first call.
Under 21 — EPSDT; Kaiser’s manual describes the ABA benefit for children with ASD, and the MQD memo sets the under-21 limit.[1][4]
Yes for outside providers: external referrals are "generated in Kaiser’s electronic medical record" for ARM to review, and the authorization names the services, frequency and duration.[1]
The federal managed-care limit applies: 7 calendar days standard (rating periods from January 1, 2026; extendable by 14) and 72 hours expedited. Kaiser’s manual says each authorization step is tracked against "the allowable timeframes as described in the QUEST contract." No retro authorizations except narrow exceptions.[6][1]
Medicaid is secondary to all other insurance (MQD memo). Kaiser’s manual does not set out ABA-specific COB. TRICARE pays after other coverage except Medicaid; CHAMPVA pays last.[4][7][10][11]
Ask the plan: Kaiser Permanente QUEST office (808) 432-5330.
No recency window in the MQD memo; no Kaiser rule found.[4]
Ask the plan: Kaiser Permanente QUEST office (808) 432-5330.
MQD memo list: developmental-behavioral or developmental pediatrician, neurologist, pediatrician, psychiatrist, psychologist, or other licensed practitioner with ASD expertise. No Kaiser variation published.[4]
Ask the plan: Kaiser Permanente QUEST office (808) 432-5330.
MQD memo: "evidence-based assessments," no instrument named. No Kaiser requirement published.[4]
Ask the plan: Kaiser Permanente QUEST office (808) 432-5330.
MQD memo QI-2527 applies (audio-video, modifier 95/GT/GQ); it lists Kaiser’s community-provider portal as the contact for plan rules. No Kaiser ABA telehealth rule found.[5]
Ask the plan: Kaiser customer service / MCSA department 800-966-5955.
Coverage decides whether Kaiser Permanente Hawaii (QUEST Integration) pays. These decide whether the claim survives: how sessions must be staffed and supervised, what may be billed concurrently, the per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.
No Kaiser-specific rule published; the MQD memo sets it: 1–2 hours of case supervision per 10 RBT hours, at least one direct, direct supervision at least 5% of BCaBA and RBT hours.[4]
Ask the plan: Kaiser Permanente QUEST office (808) 432-5330, or the Kaiser contracted-provider agreement.
The MQD memo allows 97153 and 97155 concurrently when both codes’ criteria are met and they carry different modifiers. No Kaiser billing rule published.[4]
Ask the plan: Kaiser claims / Community Medical Services (808) 432-7529.
Kaiser authorizes specific services with frequency and duration; no published ABA unit cap. The MQD memo sets no cap.[1][4]
Ask the plan: The ARM authorization itself.
Not published by Kaiser or the MQD memo.[1]
Ask the plan: Kaiser contracted-provider agreement or Community Medical Services (808) 432-7529.
Per the MQD memo: clinic, home or community named in the treatment plan; school ABA by DOE under the IEP; nothing outside Hawaii. No Kaiser-specific rule published.[4]
Ask the plan: Kaiser Permanente QUEST office (808) 432-5330.
Per the MQD memo: payment to the licensed practitioner or employing agency, with HO/HN/HM modifiers. Kaiser’s own contracted-provider billing rules were not found.[4]
Ask the plan: Kaiser claims / Community Medical Services (808) 432-7529.
Yes — its QUEST manual describes EPSDT intensive behavioral therapy, including ABA, for children with an ASD diagnosis, under the Med-QUEST benefit for members under 21.
Only with a Kaiser authorization through Authorization and Referral Management, naming the services, frequency and duration. Kaiser does not process retro authorizations except in narrow cases, including members transferring from another QUEST plan.
Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed September 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.
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