(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.
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Source Note: The provisions of this §354.1233 adopted to be effective February 14, 1985, 10 TexReg 406; amended to be effective September 1, 1986, 11 TexReg 3648; transferred effective September 1, 1993, as published in the Texas Register September 7, 1993, 18 TexReg 5978; amended to be effective September 1, 1995, 20 TexReg 6207; amended to be effective September 3, 1996, 21 TexReg 7986; transferred effective September 1, 2001, as published in the Texas Register May 24, 2002, 27 TexReg 4561; amended to be effective September 1, 2003 28 TeReg 7288; amended to be effective October 1, 2005, 30 TexReg 6042; amended tobe effective December 2, 2008, 33 TexReg 9667; amended to be effective November 20, 2018, 43 TexReg 7517 |