PROPOSED RULES
SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)
Original Notice.
Preproposal statement of inquiry was filed as WSR 99-19-088.
Title of Rule: Repealing WAC 388-86-04001 Hearing aids; and new WAC 388-544-1010 Definitions, WAC 388-544-1100 Hearing aid services -- General, WAC 388-544-1200 Hearing aid services -- For adults, WAC 388-544-1300 Hearing aid services -- For children, and WAC 388-544-1400 Hearing aid services -- Noncovered services.
Purpose: To clarify the language and hearing aid policy in compliance with Governor's Executive Order 97-02.
Statutory Authority for Adoption: RCW 74.08.090.
Statute Being Implemented: RCW 74.08.090.
Summary: The new rule sections explain more clearly the differences in eligibility and services for children and adults.
Name of Agency Personnel Responsible for Drafting: Kevin Sullivan, 925 Plum Street, P.O. Box 45533, Olympia, WA 98504-5533, (360) 725-1344; Implementation: Audrey Jasperson, 623 8th Avenue S.E., P.O. Box 45510, Olympia, WA 98504-5510, (360) 728-1841; and Enforcement: Pam Colyar, 805 Plum Street S.E., P.O. Box 45506, Olympia, WA 98504-5506, (360) 725-1582.
Name of Proponent: Department of Social and Health Services, Medical Assistance Administration, governmental.
Rule is not necessitated by federal law, federal or state court decision.
Explanation of Rule, its Purpose, and Anticipated Effects: The new rule sections explain the differences in eligibility and services for children and adults. It clarifies the language and hearing aid policy in compliance with the Governor's Executive Order 97-02. This rewrite should make the hearing aid policy easier to read and understand.
Proposal Changes the Following Existing Rules: WAC 388-86-04001 is being repealed and replaced with new WAC 388-544-1010, 388-544-1100, 388-544-1200, 388-544-1300, and 388-544-1400, which more clearly defines the differences in hearing aid eligibility for children and adults.
No small business economic impact statement has been prepared under chapter 19.85 RCW. This rule amendment does not affect small businesses.
RCW 34.05.328 does not apply to this rule adoption. The rule does not meet the definition of a "significant legislative rule" as defined in RCW 34.05.328 (5)(c)(iii).
Hearing Location: Blake Office Building East, 4500 10th Avenue S.E., Rose Room, Lacey, WA 98503, on October 3, 2000, at 10:00 a.m.
Assistance for Persons with Disabilities: Contact Kelly Cooper, Rules Coordinator, by September 26, 2000, phone (360) 664-6094, TTY (360) 664-6178, e-mail coopeKD@dshs.wa.gov.
Submit Written Comments to: Identify WAC Numbers, Kelly Cooper, Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 664-6185, by October 3, 2000.
Date of Intended Adoption: Not sooner than October 4, 2000.
August 17, 2000
Marie Myerchin-Redifer, Manager
Rules and Policies Assistance Unit
2821.3HEARING AID SERVICES"Expedited prior authorization" (EPA) means a process designed by MAA to eliminate the need for written prior authorization (see definition for "prior authorization"). MAA establishes authorization criteria and identifies these criteria with specific codes. If the provider determines the client meets the criteria, the provider creates the authorization number using the specific MAA-established codes.
"FM systems" means a hearing device that uses a frequency modulated radio signal. FM systems are sometimes referred to as radio frequency (RF) aids.
"Limitation extension" (LE) means prior authorization from MAA to exceed the service limits (quantity, frequency, or duration) set in WAC or in MAA billing instructions.
"Maximum allowable fee" means the maximum dollar amount that MAA will reimburse a provider for specific services, supplies, and equipment.
"Prior authorization" means MAA and/or department of health approval for certain medical services, equipment, or supplies, before the services are provided to clients, as a precondition for provider reimbursement. Expedited prior authorization and limitation extension are forms of prior authorization.
[]
(1) MAA covers only the hearing aid services listed in this chapter, subject to the exceptions, restrictions, and limitations listed in this chapter.
(2) MAA evaluates requests for services listed as noncovered or subject to limitations or restrictions according to the provisions in WAC 388-501-0165.
(3) MAA reimburses providers at the maximum allowable rates established by MAA.
[]
This section applies to medical assistance clients eighteen years of age or older:
(1) MAA covers the purchase of one new, nonrefurbished hearing aid for an adult client every five years if all of the following conditions are met:
(a) The client must:
(i) Be eighteen years of age or older;
(ii) Be eligible for the categorically needy program or the medical care services program;
(iii) Have a minimum average fifty decibel hearing loss in the better ear based on auditory screening at one thousand, two thousand, three thousand, and four thousand Hertz (Hz) with effective masking as indicated; and
(iv) Be evaluated by an audiologist.
(b) The client's current hearing aid, if the client has one, is not sufficient for the hearing loss in the better ear; and
(c) The hearing aid must be:
(i) Warranted for one year; and
(ii) Medically necessary, as defined in WAC 388-500-0005.
(2) Reimbursement for hearing aids includes:
(a) A prefitting evaluation;
(b) An ear mold; and
(c) A minimum of three post-fitting consultations.
(3) MAA covers the repair of a hearing aid when the:
(a) Initial one-year warranty has expired;
(b) Repair is warranted for ninety days;
(c) Cost of repair is less than fifty percent of the cost of a new hearing aid; and
(d) Provider has documented the repair and replacement costs.
(4) MAA covers the cost of renting a hearing aid for up to two months while the client's own hearing aid is being repaired.
(5) MAA covers one replacement hearing aid in a five year period when the:
(a) Hearing aid is lost or broken beyond repair;
(b) Client continues to meet the criteria in subsection (1) of this section; and
(c) Provider has documented the necessity for the replacement.
(6) MAA covers replacement of ear molds on the following basis:
(a) Once a year for soft ear molds; and
(b) Once every three years for hard ear molds.
(7) Prior MAA authorization is required for the following services for adults:
(a) Bone conduction hearing aids; and
(b) Binaural hearing aids.
[]
This section applies to medical assistance clients seventeen years of age or younger:
(1) MAA covers the purchase of new, nonrefurbished hearing aids for children if all of the following conditions in subsections (1)(a) and (1)(b) are met:
(a) The child must:
(i) Be seventeen years of age or under;
(ii) Be eligible for any MAA medical program, except medically indigent program (MIP) and family planning only program; and
(iii) Have prior authorization from the child's local department of health's (DOH) children with special health care needs (CSHCN) coordinator to receive a hearing aid.
(b) The hearing aid must be:
(i) Warranted for one year; and
(ii) Medically necessary as defined in WAC 388-500-0005.
(2) Reimbursement for hearing aids includes:
(a) A prefitting evaluation;
(b) An ear mold for in-the-ear (ITE) hearing aids; and
(c) A minimum of three post-fitting consultations.
(3) MAA covers the repair of a hearing aid when the:
(a) Initial one-year warranty has expired;
(b) Client's local CSHCN coordinator authorizes the repair;
(c) Repair is warranted for ninety days;
(d) Cost of repair is less than fifty percent of the cost of a new hearing aid; and
(e) Provider has documented the repair and replacement costs.
(4) When authorized by the client's local CSHCN coordinator, MAA covers the cost of renting a hearing aid while the client's own hearing aid is being repaired.
(5) MAA covers replacement of a hearing aid when the:
(a) Hearing aid is lost or broken beyond repair;
(b) Client's local CSHCN coordinator authorizes the replacement;
(c) Client continues to meet the criteria in subsection (1) of this section; and
(d) Provider has documented the necessity for the replacement.
(6) MAA covers replacement of hard and soft ear molds when authorized by the client's local CSHCN coordinator.
(7) All hearing aid equipment and services for children require prior authorization from the client's local CSHCN coordinator, except FM systems which require prior authorization from MAA.
[]
MAA does not cover any of the following:
(1) The purchase of batteries, ear trumpets, or tinnitus maskers;
(2) Group screenings, except as provided under the early and periodic screening, diagnosis, and treatment (EPSDT) program/healthy kids under WAC 388-534-0100;
(3) Computer-aided hearing devices used only in school;
(4) Hearing aid charges reimbursed by insurance or other payer source;
(5) Digital hearing aids; or
(6) FM systems or programmable hearing aids for adults.
[]
The following section of the Washington Administrative Code is repealed:
| WAC 388-86-04001 | Hearing aids. |