Ala. Admin. Code r. 560-X-19-.01

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-19-.01 - Hearing Services - General

(1) Audiological function tests and hearing aids are limited to Medicaid eligible individuals who are eligible for treatment under the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program. Hearing aids are provided through hearing aid dealers who are contracted to participate in the Alabama Medicaid Hearing Aid Program.

An eligible individual with hearing problems may be referred to a private physician or to Crippled Children's Service for medical evaluation. Audiological function tests must be referred by a physician before testing.

(2) Medical Examination:

(a) A hearing aid will not be approved for any Medicaid eligible recipient prior to a medical examination and recommendation for a hearing evaluation by a licensed physician, within sixty (60) days of the time of hearing aid fitting. This is mandatory.

(b) The medical examination should, if possible, be given by a physician specializing in diseases of the ear. If a physician of this type is not available or accessible, referral may be made to Crippled Children Service for otological evaluation, medical clearance and medical approval for the use of earmolds.

(c) Children under six (6) years of age shall be examined by an otologist or otolaryngologist before an aid is fitted.

(d) The examining physician referring the patient to a hearing aid dealer will be required to furnish the dealer with appropriate medical evaluation statements and recommendations, according to program requirements.

(3)Otologic Evaluations: Eligible recipients are authorized one otologic evaluation per calendar year, which shall include one of the following:

a. Basic comprehensive audiometry,

b. Evoked response audiometry,

c. Conditioning play audiometry. Prior authorization is not required for additional evaluations within the current benefit period.

(4)Special Audiological Function Tests. Special audiological function tests are those services not included in a comprehensive evaluation. These services are reported separately using discriptors from the audiological series of the CPT manual. Prior authorization is not required.

Author:

Ala. Admin. Code r. 560-X-19-.01

Rule effective October 1, 1982. Amended effective June 8, 1985. Emergency rule effective December 1, 1986. Amended effective March 12, 1987. Emergency rule effective October 1, 1990; March 18, 1991. Amended effective June 12, 1991.

Statutory Authority: State Plan; 42 C.F.R. Title XIX, Social Security Act; 42 C.F.R. §441.56.