Current through August 30, 2024
(a) The department
will pay a hearing services provider for providing a hearing service or hearing
item, if that hearing service or hearing item is
(1) prescribed by an audiologist, otologist,
otolaryngologist, or a physician, except as provided in
7 AAC 115.520(a) (2); and
(2) identified by the prescriber in (1) of
this subsection as
(A) medically necessary to
alleviate a disability caused by a hearing impairment; and
(B) the least costly alternative that fits
the recipient's medical need.
(b) The department will pay for a hearing
service or hearing item subject to the following conditions and limits:
(1) a hearing services provider must include
a manufacturer's warranty of no less than one year from the original purchase
date of all hearing items;
(2) the
department will pay for no more than one hearing aid, per ear, per recipient,
per three calendar years; the department will not pay for the following hearing
aid supplies included with a hearing aid purchased under this paragraph:
(A) a single cord;
(B) a Y-cord;
(C) a harness;
(D) a new receiver;
(E) a bone-conduction receiver with
headband;
(3) the
department will pay one fitting fee per ear, per purchase or rental of a
hearing aid; each fitting fee paid under this paragraph includes payment for a
minimum of three follow-up visits by the recipient to the hearing services
provider to have the hearing aid checked for proper functioning;
(4) the department will pay one dispensing
fee per ear, per purchase or rental of a hearing aid for the life of that
hearing aid under normal use or for the duration of the rental contract; the
dispensing fee covers the following:
(A)
repair;
(B) replacement
parts;
(C) periodic
cleaning;
(D) labor.
(c) For a recipient
under 21 years of age, the department will pay
(1) separately for an unlimited number of ear
mold impressions and ear molds;
(2)
for an unlimited number of repairs of a hearing aid if
(A) the hearing aid warranty is no longer in
effect; and
(B) the hearing
services provider has not already been paid a dispensing fee under (b)(4) of
this section;
(3) no
more than two replacements of a lost hearing aid if
(A) the hearing aid warranty is no longer in
effect;
(B) the hearing aid was
lost no more than three years after the original date of purchase;
and
(C) a written explanation of
how the hearing aid was lost is submitted by the hearing services provider with
the provider's claim for payment; the written explanation must be signed by the
recipient or, if the recipient is a minor, recipient's parent or
guardian;
(4) for no
more than two replacements of a broken hearing aid if
(A) the hearing aid warranty is no longer in
effect;
(B) the hearing aid was
broken no more than three years after the original date of purchase;
and
(C) the hearing services
provider has certified in writing that the hearing aid cannot be repaired or
that the cost of repairs would exceed the maximum payment rate for repairing
the hearing aid.
(d) For a recipient 21 years of age or older,
the department will pay
(1) separately for no
more than two ear mold impressions and two ear molds, per ear, per three
calendar years;
(2) no more than
two repairs of a hearing aid if
(A) the
hearing aid warranty is no longer in effect; and
(B) the hearing services provider has not
already been paid a dispensing fee under (b)(4) of this section;
(3) no more than one replacement
of a lost hearing aid if
(A) the hearing aid
warranty is no longer in effect;
(B) the hearing aid was lost no more than
three years after the original date of purchase; and
(C) a written explanation of how the hearing
aid was lost is submitted by the hearing services provider with the provider's
claim for payment; the written explanation must be signed by the
recipient;
(4) for no
more than one replacement of a broken hearing aid if
(A) the hearing aid warranty is no longer in
effect;
(B) the hearing aid was
broken no more than three years after the original date of purchase;
and
(C) the hearing services
provider has certified in writing that the hearing aid cannot be repaired or
that the cost of repairs would exceed the maximum payment rate for repairing
the hearing aid.
(e) If the department is paying for the
replacement of a hearing aid under this section and the hearing aid
manufacturer's warranty is in effect, the department will pay the deductible
fee up to the maximum amount set in
7 AAC 145.340. The hearing services provider must submit
a copy of the manufacturer's warranty with each claim to document the amount of
the deductible.
(f) The department
will pay a hearing services provider for any type of monaural or binaural
hearing aid that is worn in or behind the ear.
(g) The department will pay for batteries,
subject to the following limits:
(1) 20
hearing aid batteries per month up to 160 per year, per recipient; if the
batteries are for a recipient's hearing aid that the department did not
purchase, the hearing services provider must record in the recipient's record
the manufacturer's serial number and the purchase date of the hearing
aid;
(2) 30 cochlear implant
alkaline batteries per month;
(3)
55 cochlear implant zinc air batteries per month.
(h) The department will pay a hearing
services provider for the reasonable and necessary costs of delivering a
hearing item, not to exceed the amount set in
7 AAC 145.340, as follows:
(1) the cost on invoice of delivering a
hearing item from the hearing services provider to a recipient who resides
outside the municipality where the business of the hearing services provider is
located if
(A) the hearing item is
unavailable in the municipality in which the recipient resides; and
(B) the hearing services provider submits a
receipt for the delivery cost with the claim for payment;
(2) the cost on invoice of delivering a
hearing item from the manufacturer to the hearing services provider following
the manufacturer's repair of that hearing item if the hearing services provider
submits with the claim for payment a copy of the manufacturer's invoice showing
the cost of delivery to the hearing services provider.
(i) When a damaged hearing item is no longer
covered under the manufacturer's warranty, the department will pay a hearing
services provider separately for the labor necessary to
(1) assess a damaged hearing item;
and
(2) repair a damaged hearing
item.
(j) The department
will pay for the labor, repair, or replacement cost of a hearing item only if
the repair or replacement is necessary for the hearing item to function as
intended. A claim submitted to the department for the labor, repair, or
replacement of a hearing item must include
(1) a statement signed by the recipient or
the recipient's representative that describes the cause for and nature of the
repair;
(2) a description of the
hearing item being repaired and its serial number, if available;
(3) the beginning and end dates of warranty
coverage, if available; and
(4)
documentation for labor charges that includes the amount of time spent on the
repair, rounded up to the nearest quarter hour, and the hourly rate charged for
the repair.
(k) The
department will not pay for labor, repair, or replacement costs if
(1) the hearing item is covered under a
manufacturer's or supplier's warranty;
(2) the hearing item needs repair because of
a manufacturer's defect; or
(3) the
labor, repair, or replacement has already been paid for as a dispensing fee
under (b)(4) of this section.
(l) The department will not pay for hearing
item rental or a rent-to-purchase arrangement if the rental price would be more
expensive than the purchase price. The department will pay a hearing services
provider for hearing item rental or a rent-to-purchase arrangement as follows:
(1) for a rental period that is 30 days or
longer, the department will pay a monthly rental fee that is equal to 10
percent of the allowed purchase price, as calculated under
7 AAC 145.340;
(2) for a rental period that is less than 30
days, the department will pay an amount equal to the monthly rental fee divided
by the number of days in the month, times the number of days in the rental
period;
(3) the department will not
pay a rental fee for a rental period that exceeds 12 months of continuous use;
if the length of need is more than 12 months of continuous use, the prescriber
must administer another hearing assessment and request prior authorization for
the purchase of a new hearing item; the department will pay the difference
between the allowed purchase price and the total monthly rental fees already
paid by the department if the hearing services provider
(A) transfers ownership of the hearing item,
including any warranty, to the recipient for whom it was rented; and
(B) replaces the rented hearing item with a
new hearing instrument if the rented hearing item was previously used by anyone
other than the recipient before it was rented to the recipient;
(4) before the total rental fee
payments equal the allowed purchase price, the department will not separately
pay the cost of labor, repairs, and maintenance; labor, repairs, and
maintenance must be included in the rental fee and must be documented in the
rental agreement;
(5) when total
rental payments reach the allowed purchase price of a new hearing item, the
department will pay the cost of labor, repair, and maintenance after 60 days or
when the warranty expires, whichever is later.
(m) The department will not pay a hearing
services provider separately for the provider's administrative expenses. The
following costs are considered administrative expenses and are included in the
payment for the hearing item:
(1) telephone
responses to questions;
(2)
mileage;
(3) travel
expenses;
(4) travel
time;
(5) equipment set
up;
(6) installation;
(7) office inventory supply;
(8) orientation and training regarding the
proper use of equipment.
(n) The department will not pay for items
identified as assistive listening devices in the Healthcare Common
Procedure Coding System (HCPCS), adopted by reference in
7 AAC 160.900, including the following:
(1) a telephone amplifier;
(2) an alerter;
(3) a television amplifier;
(4) a television caption decoder;
(5) a telecommunications device for the deaf
(TDD);
(6) a device for use with a
cochlear implant.
(o)
The department will not pay a hearing services provider for charges submitted
for adjustments, labor, repairs, or replacement parts for a previously
purchased hearing item when the department has purchased a newer like
item.
(p) Based upon the medical
documentation provided for prior authorization, the department will pay for a
recipient's use of a hearing item on a trial basis when a trial period is not
covered by the manufacturer, if supported by the medical documentation
submitted by the hearing services provider under
7 AAC 115.540.
Authority:AS
47.05.010
AS 47.07.030
AS
47.07.040
