Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 354 - MEDICAID HEALTH SERVICES
Subchapter A - PURCHASED HEALTH SERVICES
Division 15 - HEARING AID SERVICES
Section 354.1233 - Requirements for Hearing Aid Services
Universal Citation: 1 TX Admin Code ยง 354.1233
Current through Reg. 49, No. 38; September 20, 2024
(a) Hearing aid services. Providers of hearing aid services must comply with:
(1) all applicable federal and state laws and
regulations;
(2) recognized
professional standards;
(3) the
provisions in Division 1 of this subchapter (relating to Medicaid Procedures
for Providers);
(4) the provisions
in Division 11 of this subchapter (relating to General
Administration);
(5) the
conditions, specifications, and limitations established by the Texas Health and
Human Services Commission (HHSC); and
(6) applicable requirements of their
licensing authority.
(b) Reimbursement.
(1) Physicians. Physicians
shall be reimbursed for all services covered by the Texas Medicaid Program,
including examinations and hearing evaluations. Physicians may delegate
examinations to nurse practitioners, clinical nurse specialists, or physician
assistants.
(2) Audiologists.
Audiologists shall be reimbursed for hearing aid evaluations and for the
fitting and dispensing of hearing aids.
(3) Fitters and dispensers. Hearing aid
fitters and dispensers shall be reimbursed for the fitting and dispensing of
hearing aids.
(c) Hearing aid evaluations. Hearing aid evaluations must be recommended by a physician, or, under physician delegation, a nurse practitioner, clinical nurse specialist, or physician assistant, based upon examination of the recipient. Reimbursement for hearing aid evaluations will be made only to physicians or licensed audiologists. The recipient must have a medical necessity for a hearing aid as stated in §354.1231 of this division (relating to Benefits and Limitations). The recipient must not have any medical contraindications to the ability to use or wear a hearing aid.
(1)
A physician, nurse practitioner, clinical nurse specialist, or physician
assistant who recommends a hearing aid evaluation must be licensed in the state
where and when the examination is conducted.
(2) The physician, nurse practitioner,
clinical nurse specialist, or physician assistant must indicate on the
Physician Examination Report form if the recipient needs a hearing aid
evaluation based on the examination of the recipient. Medicaid reimbursement
for a hearing aid evaluation shall be based on the physician's, nurse
practitioner's, clinical nurse specialist's, or physician assistant's
recommendation that the hearing aid evaluation is necessary.
(3) Providers must administer hearing aid
evaluations using appropriate procedures as specified within their scope of
practice and recognized professional standards.
(4) Reimbursement for home visit hearing aid
evaluations shall be made if the recipient's physician has documented that the
recipient's medical condition prohibits traveling to the provider's place of
business.
(5) Providers of hearing
aid evaluations must have a report in the recipient's record. Providers must
include in the report hearing aid evaluation test data.
(6) Hearing aid evaluations performed by
fitters and dispensers are not reimbursable. If a fitter or dispenser performs
a hearing evaluation on a recipient, the recipient shall not be billed for the
hearing evaluation.
(d) Hearing aids. Providers must offer each recipient eligible for a hearing aid a new instrument that meets the recipient's hearing need.
(1) Warranty. Providers must ensure that each
hearing aid purchased through the Texas Medicaid Program is a new and current
model that meets the performance specifications of the manufacturer and the
hearing needs of the recipient. Providers must also ensure that each hearing
aid is covered by at least a standard 12-month manufacturer's warranty,
effective from the dispensing date.
(2) Required package. Providers must dispense
each hearing aid purchased through the Texas Medicaid Program with all
necessary tubing, cords, connectors, and a one-month supply of batteries. The
instructions for care and use of the hearing aid must be included with the
hearing aid package.
(3) Thirty-day
trial period. Providers must allow each eligible recipient thirty days to
determine if the recipient is satisfied with a hearing aid purchased through
the Texas Medicaid Program. The trial period consists of thirty consecutive
days from the dispensing date. Providers must inform recipients of the trial
period and present the beginning and ending date of the trial period to the
recipient in writing.
(A) During the trial
period, providers may dispense additional hearing aids, as medically necessary,
until the recipient is satisfied with the result of the hearing aid or the
provider determines that the recipient cannot benefit from the dispensing of an
additional hearing aid. A new trial period begins with the dispensing date of
each hearing aid.
(B) Providers may
charge a rental fee for hearing aids returned during the trial period.
(i) If a rental fee is charged, providers
must assess the rental fee according to the rules and regulations established
by the Texas Department of Licensing and Regulation.
(ii) The maximum rental fee for eligible
Medicaid recipients shall be $2 per day. This fee shall not be a covered
benefit of the Texas Medicaid Program. Recipients shall be responsible for
paying any rental fee assessed them for instruments returned during the 30-day
period. Providers must keep in the recipient's file the signed certification
acknowledging responsibility to pay hearing aid rental fees.
(iii) Providers must comply with all
procedures and directions of the Texas Medicaid Program regarding forms and
certifications required during the 30-day trial period. Providers must allow
thirty days to elapse from the hearing aid dispensing date before completing a
"30-day trial period certification statement." The certification statement must
be maintained by the provider in the recipient's file.
(4) Post-fitting checks. The
fitter and dispenser must perform a post-fitting check of the hearing aid
within five weeks of the initial fitting. The post-fitting check is part of the
dispensing procedure and is not reimbursed separately.
(5) First revisit. The first revisit shall
include a hearing aid check. Providers must make counseling available as needed
within six months of the post-fitting check.
(6) Second revisit. The purpose of the second
revisit is to make any necessary adjustments to the hearing aid. Provider must
conduct a second revisit as needed.
Disclaimer: These regulations may not be the most recent version. Texas 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.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
