WSR 14-24-075
PROPOSED RULES
HEALTH CARE AUTHORITY
(Washington Apple Health)
[Filed November 26, 2014, 2:33 p.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 14-17-064.
Title of Rule and Other Identifying Information: WAC 182-547-0800 Hearing aids—Coverage—Clients twenty years of age and younger and 182-531-0375 Audiology services.
Hearing Location(s): Health Care Authority (HCA), Cherry Street Plaza Building, Sue Crystal Conference Room 106A, 626 8th Avenue, Olympia, WA 98504 (metered public parking is available street side around building. A map is available at http://www.hca.wa.gov/documents/directions_to_csp.pdf or directions can be obtained by calling (360) 725-1000), on January 6, 2015, at 10:00 a.m.
Date of Intended Adoption: Not sooner than January 7, 2015.
Submit Written Comments to: HCA Rules Coordinator, P.O. Box 45504, Olympia, WA 98504-5504, delivery 626 8th Avenue, Olympia, WA 98504, e-mail arc@hca.wa.gov, fax (360) 586-9727, by 5:00 p.m. on January 6, 2015.
Assistance for Persons with Disabilities: Contact Kelly Richters by December 29, 2014, TTY (800) 848-5429, (360) 725-1307, or e-mail kelly.richters@hca.wa.gov.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: Revisions to these sections are necessary to:
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Add bilateral cochlear implants as a covered benefit for clients twenty years of age and younger. The agency uses health technology assessment in determining coverage for new or existing technology when coverage is not mandated by federal or state law. This policy decision complies with a recent health technology assessment decision made by the health technology clinical committee (HTCC).
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Change repair policy to state, "The agency pays for repairs of hearing aids that are less than five years old…".
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Change requirement that repair warranty be for a minimum of six months rather than ninety days.
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Change payment for rental hearing aids from two months to thirty days.
Reasons Supporting Proposal: The bilateral cochlear implant policy decision complies with a recent health technology assessment decision made by HTCC. The changes to the repair policy and rental of hearing aids align with industry standards. Changes to the repair and rental policy were in response to stakeholder's comments during external review.
Statutory Authority for Adoption: RCW 41.05.021, 41.05.160.
Statute Being Implemented: RCW 41.05.021, 41.05.160.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: HCA, governmental.
Name of Agency Personnel Responsible for Drafting: Wendy Barcus, P.O. Box 42716, Olympia, WA 98504-2716, (360) 725-1306; Implementation and Enforcement: Jean Gowen, P.O. Box 45506, Olympia, WA 98504-5506, (360) 725-2005.
No small business economic impact statement has been prepared under chapter 19.85 RCW. The agency has analyzed the proposed rules and concludes they do not impose more than minor costs for affected small businesses.
A cost-benefit analysis is not required under RCW 34.05.328. RCW 34.05.328 does not apply to HCA rules unless requested by the joint administrative rules review committee or applied voluntarily.
November 26, 2014
Kevin M. Sullivan
Rules Coordinator
AMENDATORY SECTION (Amending WSR 11-14-075, filed 6/30/11, effective 7/1/11)
WAC 182-531-0375 Audiology services.
(1) The ((department)) agency covers, with prior authorization, ((the implantation of a unilateral)) cochlear devices for clients twenty years of age and younger with the following limitations:
(a) The client meets one of the following:
(i) Has a diagnosis of profound to severe bilateral, sensorineural hearing loss;
(ii) Has stimulable auditory nerves but has limited benefit from appropriately fitted hearing aids (e.g., fail to meet age-appropriate auditory milestones in the best-aided condition for young children, or score of less than ten or equal to forty percent correct in the best-aided condition on recorded open-set sentence recognition tests);
(iii) Has the cognitive ability to use auditory clues;
(iv) Is willing to undergo an extensive rehabilitation program;
(v) Has an accessible cochlear lumen that is structurally suitable for cochlear implantation;
(vi) Does not have lesions in the auditory nerve and/or acoustic areas of the central nervous system; or
(vii) Has no other contraindications to surgery; and
(b) The procedure is performed in an inpatient hospital setting or outpatient hospital setting.
(2) The ((department)) agency covers ((osseointegrated bone anchored hearing aids (BAHA))) BAHAs for clients twenty years of age and younger with prior authorization.
(3) The ((department)) agency covers replacement parts and batteries for BAHAs and cochlear devices for clients twenty years of age and younger only. See WAC ((388-547-0800)) 182-547-0800.
(4) The ((department)) agency considers requests for removal or repair of previously implanted ((bone anchored hearing aids (BAHA))) BAHAs and cochlear devices for clients twenty one years of age and older only when medically necessary. Prior authorization from the ((department)) agency is required.
(5) For audiology, the ((department)) agency limits:
(a) Caloric vestibular testing to four units for each ear; and
(b) Sinusoidal vertical axis rotational testing to three units for each direction.
AMENDATORY SECTION (Amending WSR 13-20-013, filed 9/20/13, effective 10/21/13)
WAC 182-547-0800 Hearing aids—Coverage—Clients twenty years of age and younger.
(1) The agency covers new, nonrefurbished, monaural or binaural hearing aid(s), which includes the ear molds, for eligible clients twenty years of age and younger. In order for the provider to receive payment, the hearing aid must meet the client's specific hearing needs and ((be under)) carry a manufacturer's warranty for a minimum of one year.
(2) The agency pays for the following replacements as long as the need for replacement is not due to the client's carelessness, negligence, recklessness, or misuse in accordance with WAC 182-501-0050(8):
(a) Hearing aid(s), which includes the ear molds, when:
(i) The client's hearing aid(s) are:
(A) Lost;
(B) Beyond repair; or
(C) Not sufficient for the client's hearing loss; and
(ii) All warranties are expired.
(b) Ear mold(s) when the client's existing ear mold is damaged or no longer fits the client's ear.
(3) The agency pays for repairs of hearing aids that are less than five years old as follows:
(a) A maximum of two repairs, per hearing aid, per year, when the repair is less than fifty percent of the cost of a new hearing aid. To receive payment, all of the following must be met:
(i) All warranties are expired; and
(ii) The repair ((is under)) warranty is for a minimum of ((ninety days)) six months.
(b) A rental hearing aid(s) for up to ((two months)) thirty days while the client's own hearing aid is being repaired. In the case of a rental hearing aid(s), the agency pays separately for an ear mold(s).
(4) The agency pays for ((unilateral)) cochlear implant and ((osseointegrated hearing aids ())BAHA(())) replacement parts when:
(a) The manufacturer's warranty has expired;
(b) The part is for immediate use, not a back-up part; and
(c) The part needs to be replaced due to normal wear and tear and is not related to misuse or abuse of the item (see WAC 182-502-0160)((; and
(d) The part is not an external speech processor)).
(5) The agency covers ((one)) cochlear implant external speech processors, including maintenance and repair.
(6) The agency covers ((one)) BAHA speech processors, including maintenance and repair.
(7) The agency covers batteries for hearing aids, cochlear implant external speech processors, and BAHA speech processors.