Current through Register No. 40, October 3, 2024
With the exception of those items specified in
He-W 567.06,
the following hearing aid services and items shall be covered:
(a) When provided by an audiologist or
hearing aid dealer:
(1) The hearing aid
evaluation or a hearing aid consultation, which shall be limited to one service
every 2 years since the last date of service for recipients age 21 or over and
as needed for recipients under age 21;
(2) The ear mold(s);
(3) The least costly hearing aid(s) or pocket
talker as determined by the audiologist or hearing aid dealer to achieve
appropriate access to speech in all of the recipient's communication
settings;
(4) The dispensing or
fitting of the hearing aid(s) or pocket talker, including real ear verification
for conventional hearing aids, adjustment, and instruction;
(5) Follow-up to include verification of
hearing aid or pocket talker performance, if not completed at the fitting, and
monitoring of hearing thresholds, as needed; and
(6) The audiogram;
(b) Monaural hearing aids:
(1) For recipients under 21 years of age
when:
a. The audiogram indicates a unilateral
hearing loss of one or more thresholds of 25 decibels (dB) hearing level (HL)
or poorer at any frequency from 1000 hertz (Hz) to 4000 Hz; and
b. The audiologist or hearing aid dispenser
deems the loss communicatively significant; and
(2) For recipients 21 years of age or over
when the audiogram indicates a bilateral hearing loss with an average threshold
of 35 dBHL or poorer for 1000 Hz, 2000 Hz, 3000 Hz, and 4000 Hz by pure tone
air conduction;
(c)
Binaural hearing aids:
(1) For recipients
under 21 years of age when:
a. The audiogram
indicates a bilateral hearing loss of one or more thresholds of 25 dBHL or
poorer at any frequency from 1000 Hz to 4000 Hz; and
b. The audiologist or hearing aid dispenser
deems the loss communicatively significant; and
(2) For recipients 21 years of age or over,
when:
a. A prior authorization has been
requested and obtained from the department in accordance with
He-W
567.07 in advance of the hearing aid(s) being
rendered; and
b. One of the
following applies:
1.The coverage criteria for monaural hearing aids per He-W
567.05(b), and one of the following criteria have been met:
(i) The recipient is attending post-secondary
school at any educational level for the purpose of obtaining employment or is
receiving vocational training, as documented in accordance with
He-W 567.08(d)
; or
(ii) The recipient is employed and is likely
to be determined as unable to meet the audiometric requirements of the job
without the use of binaural hearing aids, as documented in accordance with
He-W 567.08(c)
; or
2.The recipient meets the definition of statutory blindness
per
He-W 567.01(i)
and as documented in accordance with
He-W 567.08(b)
, and an audiogram indicates a unilateral
hearing loss with an average threshold of 35 dBHL or poorer for 1000 Hz, 2000
Hz, 3000 Hz, and 4000 Hz by pure tone air conduction;
(d) Hearing
aid batteries for the life span of the hearing aid(s);
(e) Replacement of hearing aids:
(1) If there is an increase in the
recipient's hearing loss, as established by the most recent audiogram, which
makes the existing hearing aid ineffective;
(2) If an audiologist or hearing aid dealer
determines that the hearing aid can no longer be repaired, or that it is not
cost effective to do so; or
(3) If
the replacement is due to loss and is coverable under He-W 546 for recipients
under age 21;
(f)
Hearing aid repairs, which shall not require:
(1) A physician referral; or
(2) An initial purchase by
medicaid;
(g) Frequency
modulation (FM) systems for recipients under age 21, when a hearing aid on its
own does not meet the recipient's personal amplification needs, or when a
traditional hearing aid is not an appropriate option, as determined by an
audiologist;
(h) Pocket talkers, to
accommodate hearing loss and enhance communications, when:
(1) The audiogram indicates that a recipient
has a bilateral hearing loss with an average threshold of 35 dBHL or poorer for
1000 Hz, 2000 Hz, 3000 Hz, and 4000 Hz by pure tone air conduction;
and
(2) A hearing aid is not
already covered by medicaid;
(i) Replacement of a pocket talker:
(1) With hearing aid(s) or a more effective
pocket talker if there is an increase in the recipient's hearing loss, as
established by the most recent audiogram, which makes the existing pocket
talker ineffective; or
(2) Once
every 5 years; and
(j)
Replacement of a headset, earbuds, or neckloop for a pocket talker once every
year if an audiologist determines that such accessories are
malfunctioning.
Source. (See Revision Note at chapter heading He-W 500);
ss by #6157, eff 12-29-95, EXPIRED: 12-29-03
New. #9480, eff 5-23-09; ss by
#9739, eff 6-25-10; amd by #10342, eff
6-1-13
