California Code of Regulations
Title 22 - Social Security
Division 3 - Health Care Services
Subdivision 1 - California Medical Assistance Program
Chapter 3 - Health Care Services
Article 4 - Scope and Duration of Benefits
Section 51319 - Hearing Aids
Current through Register 2024 Notice Reg. No. 12, March 22, 2024
(a) Hearing aids are covered only when supplied by a hearing aid dispenser on prescription of an otolaryngologist, or the attending physician where there is no otolaryngologist available in the community, plus an audiological evaluation including a hearing aid evaluation which must be performed by or under the supervision of the above physician or by a licensed audiologist.
(b) Prior to prescribing a hearing aid, the otolaryngologist or attending physician shall perform a complete ear, nose and throat examination.
(c) Prior authorization is required for the purchase or trial period rental of hearing aids, and for hearing aid repairs which exceed a cost of $25.00 per repair service. Claims for individual repair services shall not be cumulative for the purposes of determining the need for prior authorization.
(d) Requests for authorization for hearing aids must include the results of the following tests:
(e) Test results shall be presented in a format acceptable to the Medi-Cal consultant and shall include proposed hearing aid specifications.
(f) Authorization for hearing aids may be granted only when:
(g) Replacement of a hearing aid may be authorized only if:
(h) Eyeglass hearing aids are covered when the requirements of this section and Section 51317 are met at the same time.
(i) Initial hearing aid batteries supplied with the hearing aid are covered when supplied with a hearing aid that has been prior authorized. Replacement hearing aid batteries are not covered.
1. New
subsection (g) filed 1-18-74; effective thirtieth day thereafter (Register 74,
No. 3). For prior history, see Register 72, No. 40.
2. Amendment of
subsection (f) filed 5-15-79 as an emergency; designated effective 5-15-79
(Register 79, No. 20).
3. Editorial correction (Register 79, No.
26).
4. Certificate of Compliance filed 9-12-79 (Register 79, No.
37).
5. Amendment filed 9-4-80; effective thirtieth day thereafter
(Register 80, No. 36).
6. Editorial correction of subsection (f)(2)
(Register 80, No. 40).
7. Amendment of subsection (c)(1) and new
subsection (h) filed 9-1-82 as an emergency; effective upon filing (Register
82, No. 37). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 12-30-82.
8.
Certificate of Compliance transmitted to OAL 12-28-82 and filed 1-21-83
(Register 83, No. 4).
9. Amendment of subsection (h) filed 3-1-84;
effective thirtieth day thereafter (Register 84, No. 9).
10.
Amendment filed 6-22-87; operative 7-22-87 (Register 87, No.
27).
11. Amendment of subsection (c)(1), new subsection (c)(2) and
subsection renumbering filed 4-4-2003 as an emergency; operative 4-4-2003
(Register 2003, No. 14). A Certificate of Compliance must be transmitted to OAL
by 8-4-2003 or emergency language will be repealed by operation of law on the
following day.
12. Certificate of Compliance as to 4-4-2003 order
transmitted to OAL 7-28-2003 and filed 9-4-2003 (Register 2003, No.
36).
Note: Authority cited: Sections 14105 and 14124.5, Welfare and Institutions Code; and Section 57(c), Chapter 328, Statutes of 1982. Reference: Sections 14053, 14132 and 14133, Welfare and Institutions Code; and Section 53, Chapter 328, Statutes of 1982.