Current through Register Vol. 49, No. 13, September 23, 2024
Subpart
1.
Definitions.
The terms used in this part have the meanings given
them.
A. "Audiologic evaluation" means
an assessment of communication problems caused by hearing loss that is
performed by an audiologist or an otolaryngologist.
B. "Audiologist" has the meaning given in
part
9505.0390, subpart
1, item A.
C. "Hearing aid" means a monaural hearing
aid, a set of binaural hearing aids, or other device worn by the recipient to
improve the recipient's access to and use of auditory information.
D. "Hearing aid accessory" means chest
harnesses, tone and ear hooks, carrying cases, and other accessories that are
not included in the cost of the hearing aid but that are necessary to the
recipient's use of the hearing aid.
E. "Hearing aid services provider" means:
(1) a person who has a certificate from the
commissioner of health as a dispenser of hearing instruments as specified in
Minnesota Statutes, chapter 153A;
(2) an audiologist;
(3) an otolaryngologist; or
(4) a provider, as specified in part
9505.0175, subpart 38, who employs
dispensers of hearing instruments, audiologists, or otolaryngologists.
A hearing aid services provider who is not an audiologist or
an otolaryngologist must not perform an audiologic evaluation.
F. "Hearing aid services" means
the services provided by a hearing aid services provider that are necessary to
dispense hearing aids and provide hearing aid accessories and
repairs.
G. "Otolaryngologist"
means a physician specializing in diseases of the ear and larynx who is board
eligible or board certified by the American Board of Otolaryngology.
Subp. 2.
Covered hearing aid
services.
To be eligible for medical assistance payment, the hearing
aid services must meet the requirements of items A to E and the other
requirements of this part.
A. A
physician's examination must determine that the recipient does not have medical
or surgical conditions that contraindicate fitting the recipient with a hearing
aid.
B. The physician who examines
the recipient must refer the recipient for an audiologic evaluation to
determine if the recipient has a communication disorder caused by a hearing
loss and if a hearing aid is medically necessary for the recipient.
C. The audiologist or otolaryngologist who
conducts the audiologic evaluation required under item B must order a specific
hearing aid based on the findings of the audiologic evaluation.
D. The hearing aid services provider must
provide the hearing aid that is recommended by the audiologist or
otolaryngologist.
E. The
audiologist or otolaryngologist must inform the recipient of the need to
schedule a follow-up visit and must request that the recipient schedule a
follow-up visit to determine the effectiveness of the hearing aid within 30
days of providing the aid or within the time period specified in the contract
obtained through the competitive bidding process under part
9505.0200, whichever is
longer.
Subp. 3.
Eligibility for replacement hearing aid.
A recipient is not eligible to receive a replacement hearing
aid through medical assistance within five years after a hearing aid was
provided to the recipient under subpart
2 unless prior authorization
is obtained from the commissioner. The criteria for prior authorization of a
replacement hearing aid are listed in items A and B:
A. the recipient's present hearing aid is no
longer effective because the recipient has had an increase in hearing loss;
or
B. the recipient's hearing aid
has been misplaced, stolen, or damaged due to circumstances beyond the
recipient's control so that it cannot be repaired. The recipient's degree of
physical and mental impairment must be considered in determining whether the
circumstances were beyond the recipient's control. If the recipient's hearing
aid was misplaced, stolen, or irreparably damaged more than two times in a
five-year period, a recipient must not receive a replacement hearing
aid.
Subp. 4.
Condition for payment; availability of hearing aid through contract
purchase.
If the department seeks competitive bids under part
9505.0200 for the provision of
hearing aids and if at least one of the hearing aids available to a recipient
is consistent with the results of the audiologic evaluation, then medical
assistance payment for the recipient's hearing aid is limited to a hearing aid
available under part
9505.0200.
Subp. 5.
Hearing aid services provider
payment.
A hearing aid services provider must receive one payment for
fitting a new hearing aid for a recipient plus providing at least three
batteries of the type necessary to operate the hearing aid. A hearing aid
services provider must not request payment until after the hearing aid is
dispensed. The payment also covers the following hearing aid services during
the hearing aid warranty period:
A.
instructing and counseling the recipient on the use and care of the hearing
aid;
B. providing the recipient a
copy of the manufacturer's warranty applicable to the recipient's hearing aid;
and
C. returning the hearing aid to
the manufacturer for repair.
Subp.
6.
Replacement batteries.
Medical assistance payment is available to pay for
replacement batteries only in the quantity necessary to operate the hearing aid
for a period of not more than 90 days, beginning with the date the hearing aid
is provided to the recipient.
Subp.
7.
Hearing aid services to resident of long-term care
facility.
For a resident of a long-term care facility to be eligible
for medical assistance payment, the resident's hearing aid services must result
from:
A. a request by the
recipient;
B. a referral by a
registered nurse, licensed practical nurse, or consulting nurse who is employed
by the long-term care facility; or
C. a referral by the recipient's family,
guardian, or attending physician.
For purposes of this subpart, "long-term care facility" means
a residential facility certified by the Department of Health as a nursing
facility or an intermediate care facility for the developmentally
disabled.
Subp.
8.
Other covered hearing aid services.
Medical assistance payment is also available to pay for the
hearing aid services in items A and B:
A. ear molds if the ear molds are not
provided by the manufacturer as part of the hearing aid under the contract with
the state, or if the earmolds are not customarily provided with the hearing
aid; and
B. hearing aid
accessories.
Subp. 9.
Trial period for audiologist's or otolaryngologist's evaluation of
hearing aid.
A. A hearing aid services
provider must allow a recipient at least a 30-day trial or the period required
by the contract between the state and the hearing aid manufacturer, whichever
is longer, to allow an audiologist or otolaryngologist to determine whether the
hearing aid meets the recipient's needs. The trial period consists of
consecutive days beginning with the date the hearing aid is provided to the
recipient. The hearing aid services provider must tell the recipient of the
beginning and ending dates of the trial period.
B. If the audiologist or otolaryngologist
determines that the hearing aid does not meet the recipient's needs, the
audiologist or otolaryngologist must tell the recipient of the availability of
further audiologic services as set forth in part
9505.0390, subpart
4, and order any necessary
changes during the trial period.
Subp. 10.
Hearing aid services not
covered.
Medical assistance payment is not available to pay for the
following hearing aid services:
A. a
hearing aid that is not medically necessary for the recipient;
B. replacement batteries, other than as
specified in subpart
6, provided regardless of the
recipient's need;
C. charges for
picking up and delivering a hearing aid that are billed on a separate claim for
payment;
D. repairs to a hearing
aid during the warranty period and other hearing aid services that the contract
between the state and the hearing aid manufacturer specifies must be provided
within the contract price;
E.
purchase without prior authorization of a hearing aid not covered by a contract
obtained through the competitive bidding process under part
9505.0200;
F. hearing aid services billed on a separate
claim for payment when the payment for the service is included in the
dispensing fee for the hearing aid;
G. hearing aid drying kits, battery chargers,
swim molds, or adapters for telephones, television, or radio;
H. canal hearing aids;
I. routine cleaning, checking, and other
maintenance of hearing aids without request or referral from the recipient, the
recipient's family, guardian, or attending physician; and
J. hearing aids prescribed or hearing aid
services ordered by a physician if the hearing aids or the hearing aid services
are provided by a person or entity that commits a felony listed in United
States Code, title 42, section 1320a-7b, subject to the exceptions listed in
Code of Federal Regulations, title 42, part 1001, section 952.
Statutory Authority: MS s
256B.04
