FINAL BILL REPORT

E2SSB 5179

C 159 L 18

Synopsis as Enacted

Brief Description: Requiring coverage for hearing instruments under public employee and medicaid programs.

Sponsors: Senate Committee on Ways & Means (originally sponsored by Senators Bailey, Keiser, Palumbo, Hasegawa and Conway).

Senate Committee on Health Care

Senate Committee on Ways & Means

House Committee on Health Care & Wellness

House Committee on Appropriations

Background: Washington State Medicaid is an umbrella of programs, including the medical program commonly known as Apple Health with 1.9 million enrollees. The program currently only covers hearing aids for children under the age of 20 and for clients of the Developmental Disability Administration age 21 and over. The program covers new, non-refurbished hearing aids that meet the client's specific hearing needs and they must be under warranty for a minimum of one year. Replacements are covered if the hearing aid is lost, beyond repair, or not sufficient for the client's hearing loss.

The Public Employees Benefits Board (PEBB) program covers over 300,000 employees and retirees with medical and dental benefits. The comprehensive medical benefit packages for employees and retirees currently include coverage for an annual hearing exam, and hearing aids are covered with an $800 benefit every three calendar years. Hearing aids can cost several thousands of dollars per hearing aid.

The regulation of health care professionals that engage in hearing and speech services falls under RCW 18.35, which requires that the fitting and dispensing of hearing instruments be performed by a licensed hearing aid specialist or a licensed audiologist.

Summary: Beginning January 1, 2019, health plans offered to Medicaid enrollees and to PEBB covered employees must include coverage for hearing instruments. Subject to amounts appropriated for this purpose, for PEBB covered employees, coverage must include a new hearing instrument every five years, and services and supplies such as the initial assessment, fitting, adjustment, and auditory training.

For Medicaid enrollees, coverage must include, when medically necessary, a new hearing instrument every five years, a new hearing instrument when alterations to the existing hearing instrument cannot meet the needs of the patient, and services and supplies such as the initial assessment, fitting, adjustment, and auditory training. If specific funding is not provided in the Omnibus Appropriations Act, this provision will be null and void.

The hearing instrument must be recommended and dispensed by a licensed audiologist, hearing aid specialist, or physician or osteopathic physician specializing in otolaryngology.

Votes on Final Passage: