Regulation .04 Covered Services.
Regulation .04 Covered Services.LinkCopy Citation
The Program covers the following medically necessary services:
A.
Audiology services, as follows:
(1)
For participants who are at risk for or have a hearing impairment, audiology assessments using procedures appropriate for the participant’s developmental age and abilities; and
(2)
Hearing aid evaluations and routine follow-up for participants with an identified hearing impairment, who currently use or are being considered for hearing aids; and
B.
Hearing amplification services, as follows:
(1)
Unilateral or bilateral hearing aids which are medically necessary and are:
(a)
Not used or rebuilt, and which meet the current standards set forth in 21 CFR §§801.420 and 801.421, which are incorporated by reference;
(b)
Recommended and fitted by an audiologist in conjunction with written medical clearance from a physician who has performed a medical examination within the past 6 months;
(c)
Sold on a 30-day trial basis; and
(d)
Fully covered by a manufacturer’s warranty for a minimum of 2 years, at no cost to the Program;
(2)
Hearing aid accessories and services, as listed below:
(a)
Ear molds;
(b)
Batteries;
(c)
Routine follow-ups and adjustments;
(d)
Repairs after all warranties have expired;
(e)
Replacement of unilateral or bilateral hearing aids every 5 years when determined to be medically necessary; and
(f)
Other hearing aid accessories determined to be medically necessary;
(3)
Cochlear implants and related services, as listed below:
(a)
Unilateral or bilateral implantation of cochlear implant or implants which are medically necessary including the cost of the device;
(b)
Post-operative evaluation and programming of the cochlear implant or implants;
(c)
Aural rehabilitation services; and
(d)
Repair or replacement of cochlear implant device components subject to the limitations in Regulation .05 of this chapter; and
(4)
Auditory osseointegrated device or devices and related services, as listed below:
(a)
Unilateral or bilateral implantation of auditory osseointegrated devices which are medically necessary including the cost of the device;
(b)
Non-implantable or softband device or devices which are medically necessary;
(c)
Evaluation and programming of the auditory osseointegrated device or devices; and
(d)
Repair or replacement, or both, of auditory osseointegrated device components subject to the limitations in Regulation .05 of this chapter.