THE EVER-CHANGING LAWS AND RULES GOVERNING AUDIOLOGY

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1 THE EVER-CHANGING LAWS AND RULES GOVERNING AUDIOLOGY Update on SuperHEAROs working on legislation that affects Audiology Presented at the 18th Annual Conference of Texas Academy of Audiology October 19-21, 2017 San Marcos, TX

2 TODAY S AGENDA Federal Legislation Update TX Medicaid Dick Danielson Angela Shoup Angela Garcia Texas Legislation Updates Matt Lyon Brad Shields Texas Dept of Licensing and Regulation Brian Francis

3 FEDERAL AUDIOLOGY LEGISLATIVE UPDATES Dick Danielson, PhD Baylor College of Medicine NASA/Johnson Space Center

4 FEDERAL AUDIOLOGY LEGISLATIVE UPDATES FROM THE 115TH CONGRESS Adam Finkel Kate Thomas American Academy of Audiology Government Relations office

5 FEDERAL LEGISLATIVE ISSUES Early Hearing Detection and Intervention Act (S. 652, H.R. 1539) SIGNED! (10/18/2017) Medicare Telehealth Parity Act (H.R. 2550) Access to Frontline Health Care Act (H.R. 2042) Hearing Aid Assistance Tax Credit Act (S. 48) Over-the-Counter Hearing Aid Act (S. 670, H.R. 1652): FDA Reauthorization Act (H.R. 2430) SIGNED (8/21/2017)

6 TEXAS MEDICAID UPDATES Angela Shoup, PhD UT Southwestern Medical Center Ashley Garcia, AuD The Children s Hospital of San Antonio

7 THANK YOU, TAA SUPER HEROES FOR YOUR DEDICATION TO TEXAS PATIENTS AND FAMILIES

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9 HEARING DEVICES POLICY Review of allowable procedure codes and provider types, Review of hearing aid trial period guidelines. Review peer state guidelines for hearing device reimbursement. Review of date of service requirements for claims submitted for hearing aid devices, hearing aid accessories, ear impressions, ear molds, and replacement batteries. Medical necessity for replacement batteries. Review peer state guidelines for replacement batteries. Extend age range for L8692 from 5 years or older to all ages. Amend hearing aid documentation requirements to allow NPs and PAs under physician delegation to perform examinations to determine medical necessity for a hearing aid. Amend the Hearing Evaluation, Fitting, and Dispensing Report (Form 3503) to specify that NPs/CNSs and PAs under physician delegation may recommend a client for a hearing evaluation and may also complete the required physician examination report if they have performed an examination to determine medical necessity for a hearing aid.

10 OTOLOGY AND AUDIOMETRY SERVICES MEDICAL POLICY Allow reimbursement of 92540, 95940, 95941, 92520, and to audiologists. End date diagnosis restrictions for Add age ranges to procedure codes to match policy language. Add procedure codes to the medical policy that are not currently in any table.

11 Accessing Audiology Services and Hearing Devices in Medicaid Managed Care: Overcoming Challenges Patient Related Clinic point of contact for families Up to date parent contact information Hearing aid referral information letter Insurance Plan Related Case manager assignments Formal Medicaid complaints (template) Access to Care Issue Provider Related Identification of providers actively accepting Medicaid in surrounding areas Specific amplification recommendations Collaborative ENT/Audiology management

12 PARENT SAMPLE LETTER Dear Parent, Your child has been diagnosed with a hearing loss that needs to be treated with hearing aids. If you would prefer a closer location, you are responsible for contacting your insurance company to locate a provider. We are referring you to: Easter Seals of Central Texas Audiology Coordinator Gladys Gautier ggautier@eastersealstx.org Audiologist Nora Bowers, Au.D. STEP 1. REFERRAL To schedule an appointment for hearing aids they will need the following: Formal Audiology/Hearing Aid referral from your pediatrician to assist with authorization. An informal referral will automatically be sent from The Children s Hospital of San Antonio Audiology/ENT Clinic. Please contact your child s pediatrician to request a formal referral. Insurance information. Signed HIPAA Form. Completed Physicians Examination Report. if your child is followed by the ENT department it will be included with the informal referral. If your child is followed by an outside ENT, please have them fill out the required form and fax to (512) Audiogram (Hearing test) or Auditory Brainstem Response (ABR) from your audiologist. The Children s Hospital of San Antonio Audiology Clinic will include this with the informal referral. STEP 2. INTAKE CALL You will receive a call to verify insurance and to collect history and demographic information in order to file through insurance. STEP 3. APPOINTMENT AND FITTING Once authorization has been received. The appointment will occur as follows: Initial Visit Hearing Aid Evaluation 2nd Visit Hearing Aid Fitting (approximately 5 weeks later) 3rd Visit Hearing Aid Follow Up (2 weeks later) Please see Medicaid Transportation Brochure for information regarding travel reimbursement. If you have any questions regarding your test results or medical clearance, please contact our clinic If you have any questions regarding your hearing aid appointment or status of referral, please contact Gladys at If prompted to voic please leave your name, your child s name and date of birth, and reason for calling.

13 TEXAS LEGISLATIVE ISSUES Matt Lyon TAA Gov t Affairs Liaison Brad Shields, TAA Lobbyist

14 FINALLY. Let your legislators hear from you as an audiologist and as a citizen Contribute to the PAC