New York Codes, Rules and Regulations
Title 18 - DEPARTMENT OF SOCIAL SERVICES
Chapter II - Regulations of the Department of Social Services
Subchapter E - Medical Care
Article 3 - Policies and Standards Governing Provision of Medical and Dental Care
Part 505 - Charges For Professional Health Services
Section 505.31 - Audiology, hearing aid services and products
Universal Citation: 18 NY Comp Codes Rules and Regs ยง 505.31
Current through Register Vol. 46, No. 39, September 25, 2024
(a) Definitions.
(1)
Hearing aid services
means services that are provided in compliance with article 37 of the General
Business Law. These services include the selecting, fitting and dispensing of
hearing aids, hearing aid checks following dispensing, and hearing aid repairs.
Hearing aid products means hearing aids, earmolds, batteries,
special fittings and replacement parts.
(2)
Audiology services mean
audiometric examinations or testing, hearing aid evaluations, conformity
evaluations and hearing aid prescriptions or recommendations if
indicated.
(3)
Qualified
audiologist means an audiologist that is licensed and currently
registered to practice audiology in the State by the State Education
Department.
(4)
Qualified
hearing aid dealer means any person, partnership, association or
corporation engaged in the selecting, fitting and dispensing of hearing aids
and currently registered in the State by the Department of State pursuant to
article 37-A, section 789 of the General Business Law.
(b) Standards. All audiology services and hearing aid services and products must meet the requirements set forth in this Part and must be provided in accordance with the New York State Department of Health's regulations governing the provision of audiology services, audiometric screening and hearing aid services.
(c) Recommendation requirements.
(1) All
recommendations for hearing aids must be in writing and comply with article
37-A of the General Business Law.
(2) The written recommendation must indicate
the need for a hearing aid and include the results of pure tone speech
audiometry or equivalent testing conducted in a sound treated room or test
suite meeting the American National Standard Institute's
specifications.
(3) A prescription
for a specific hearing aid requires a pure tone and sound field speech
audiometry. The tests must be conducted by or under the direction and personal
supervision of an otolaryngologist or qualified audiologist. When a specific
device is prescribed, the hearing aid dealer must dispense as
written.
(4) When a general
recommendation is made, the hearing aid dealer must perform tests and
procedures necessary to determine the specific hearing aid which will be of
maximum benefit to aid or improve the impaired hearing.
(5) Hearing aids must be dispensed within six
months of the date of the recommendation.
(d) Source of recommendation.
(1) All written recommendations for hearing
aids for children under 21 years of age must be from speech and hearing centers
approved to provide services under the Physically Handicapped Children's
Program. The written recommendation must be signed by a qualified
otolaryngologist or qualified audiologist. For persons under 21 residing in New
York State Developmental Centers, the recommendation for a hearing aid may be
from the developmental center.
(2)
Written recommendations for hearing aids for persons 21 years of age and older
must be from a qualified otolaryngologist, a speech and hearing center approved
to provide services under the Physically Handicapped Children's Program, a
qualified audiologist, or a facility approved pursuant to Article 28 of the
Public Health Law and certified to render speech and hearing or audiology
services.
(e) Prior approval requirements.
(1)
Prior approval of the local Physically Handicapped Children's Program medical
director is required for all hearing aid services furnished to persons under 21
years of age.
(2) Prior approval
from the New York State Department of Health is required for hearing aids,
dispensing and administrative fees as defined by regulations of the New York
State Department of Health, and special fittings when the source of the
recommendation is not a speech and hearing center approved to provide services
under the Physically Handicapped Children's Program. Batteries not listed in
the department's provider manual and repairs costing $70 or more require prior
approval from the New York State Department of Health regardless of the source
of the order.
(f) Written statements required.
(1)
Audiology services, except for conformity evaluations (hearing aid checks),
must be supported by a written referral by a licensed physician. The written
referral must be maintained with the recipient record.
(2) A statement of recipient rights and
obligations must be provided to the recipient by the hearing aid dealer at the
time the hearing aid is dispensed. The hearing aid dealer must also place a
copy of the statement in the recipient's record. The statement must explain the
30 day trial period and the recipient's right to return to the dealer for all
necessary adjustments and calibrations of the hearing aid during the 30 day
trial period and to return an unsatisfactory hearing aid.
(g) Review of claims.
(1) The identity of the physician,
audiologist, speech and hearing center approved to provide services under the
Physically Handicapped Children's Program, or the facility approved pursuant to
Article 28 of the Public Health Law and certified to render speech and hearing
or audiology services which ordered the hearing aid service or product must be
recorded by the hearing aid dealer on the claim for payment by entering in the
license or MMIS provider ID number of the orderer where indicated.
(2) The identity of the referring physician
must be recorded on the claim for payment for audiology services by entering
the license or MMIS provider ID number of the physician where
indicated.
(3) Written statements
referring persons for audiology services and recommendations or prescriptions
for hearing aid services and products must be maintained by the provider
submitting the claim for audit by the department or other authorized agency for
six years from the date of payment.
(4) Hearing aid dealers must also maintain at
each of their business locations the records specified in 19 NYCRR
191.13.
(5) The financial liability
of the referring or ordering provider for any audiology services or hearing aid
services or products determined on audit not to be medically necessary is set
forth in Part 518 of this Title.
(h) Payment.
(1) Hearing aid services and products
payment.
(i) Payment for hearing aid services
and products is limited to providers enrolled in the medical assistance program
as hearing aid dealers, speech and hearing centers approved by the Physically
Handicapped Children's Program to provide speech and hearing services, or
facilities approved pursuant to Article 28 of the Public Health Law and
certified to render speech and hearing or audiology services.
(ii) Hearing aids must be provided for a
trial period of at least 30 days.
(iii) The dispensing and administrative fees,
as defined by regulations of the New York State Department of Health, are
reimbursable to for-profit hearing aid dealers only.
(iv)
(a)
Payment for hearing aids must not exceed the lower of:
(1) the maximum reimbursable amount for the
item, as shown in the fee schedule for hearing aid/audiology services and as
determined by the department based on the average cost of products
representative of that item; or
(2)
the usual and customary price charged to the general public for the same or
similar items.
(b) When
there is no maximum reimbursable amount listed in the fee schedule for hearing
aid/audiology services, payment for hearing aids must not exceed the lower of:
(1) the acquisition cost, net of any
discounts or rebates, supported by a copy of the invoice, which must include
the brand, model, and serial number of the dispensed hearing aid; or
(2) the usual and customary price charged to
the general public for the same or similar items.
(v) Reimbursement for dispensing
and administrative fees, batteries, earmolds, and replacement parts is based on
the fee schedule for hearing aid/audiology services. The fee schedule for
hearing aid/audiology services is available at the Medicaid fiscal agent's
website.
(2) Audiology
payment.
(i) Payment is available for
audiology services for those providers enrolled in the medical assistance
program as audiologists, speech and hearing centers approved by the Physically
Handicapped Children's Program to provide speech and hearing services,
facilities approved under article 28 of the Public Health Law and certified to
render speech and hearing or audiology services, or audiology services which
are part of the development of, or furnished pursuant to, an individualized
education program or an interim or final individualized family services plan
and which are provided by audiologists employed by, or under contract to, a
school district, an approved pre-school, a county in the State or the city of
New York, an approved early intervention program, or a municipality in the
State.
(ii) Reimbursement to
qualified audiologists or hearing aid dealers that employ qualified
audiologists for audiology services is based on the fee schedule for hearing
aid/audiology supplies and services. The fee schedule for hearing aid/audiology
supplies and services is available from the department and is also contained in
the MMIS Provider Manual (Hearing Aid/Audiology Services). Copies of the manual
may be obtained by writing Computer Sciences Corporation, Health and
Administrative Services Division, 800 North Pearl St., Albany, NY 12204. Copies
may also be obtained from the Department of Social Services, 40 North Pearl
St., Albany, NY 12243. The manual is provided free of charge to every provider
of audiology services at the time of enrollment in the MA program.
(iii) Reimbursement to facilities approved
under article 28 of the Public Health Law and certified to render speech and
hearing or audiology services is limited to the rates set by the New York State
Department of Health for speech and hearing or audiology services.
(iv) Payment is available for audiology
services which are part of the development of, or furnished pursuant to, an
individualized education program and are provided by audiologists employed by,
or under contract to, a school district, an approved pre-school, or on behalf
of a county in the State or the city of New York. Reimbursement for such
services must be made in accordance with the provider agreement.
(v) Payment for audiology services which are
part of the development of, or furnished pursuant to, an interim or final
individualized family services plan and are provided by audiologists employed
by, or under contract to, an approved early intervention program or a
municipality in the State. Reimbursement for such services must be made in
accordance with the provider agreement.
Disclaimer: These regulations may not be the most recent version. New York may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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