Section 7 AAC 115.530 - Hearing services and items(a) The department will pay a hearing services provider for providing a hearing service or hearing item, if that hearing service or hearing item is (1) prescribed by an audiologist, otologist, otolaryngologist, or a physician, except as provided in 7 AAC 115.520(a) (2); and(2) identified by the prescriber in (1) of this subsection as(A) medically necessary to alleviate a disability caused by a hearing impairment; and(B) the least costly alternative that fits the recipient's medical need.(b) The department will pay for a hearing service or hearing item subject to the following conditions and limits: (1) a hearing services provider must include a manufacturer's warranty of no less than one year from the original purchase date of all hearing items;(2) the department will pay for no more than one hearing aid, per ear, per recipient, per three calendar years; the department will not pay for the following hearing aid supplies included with a hearing aid purchased under this paragraph: (E) a bone-conduction receiver with headband;(3) the department will pay one fitting fee per ear, per purchase or rental of a hearing aid; each fitting fee paid under this paragraph includes payment for a minimum of three follow-up visits by the recipient to the hearing services provider to have the hearing aid checked for proper functioning;(4) the department will pay one dispensing fee per ear, per purchase or rental of a hearing aid for the life of that hearing aid under normal use or for the duration of the rental contract; the dispensing fee covers the following: (c) For a recipient under 21 years of age, the department will pay (1) separately for an unlimited number of ear mold impressions and ear molds;(2) for an unlimited number of repairs of a hearing aid if (A) the hearing aid warranty is no longer in effect; and(B) the hearing services provider has not already been paid a dispensing fee under (b)(4) of this section;(3) no more than two replacements of a lost hearing aid if (A) the hearing aid warranty is no longer in effect;(B) the hearing aid was lost no more than three years after the original date of purchase; and(C) a written explanation of how the hearing aid was lost is submitted by the hearing services provider with the provider's claim for payment; the written explanation must be signed by the recipient or, if the recipient is a minor, recipient's parent or guardian;(4) for no more than two replacements of a broken hearing aid if (A) the hearing aid warranty is no longer in effect;(B) the hearing aid was broken no more than three years after the original date of purchase; and(C) the hearing services provider has certified in writing that the hearing aid cannot be repaired or that the cost of repairs would exceed the maximum payment rate for repairing the hearing aid.(d) For a recipient 21 years of age or older, the department will pay (1) separately for no more than two ear mold impressions and two ear molds, per ear, per three calendar years;(2) no more than two repairs of a hearing aid if(A) the hearing aid warranty is no longer in effect; and(B) the hearing services provider has not already been paid a dispensing fee under (b)(4) of this section;(3) no more than one replacement of a lost hearing aid if (A) the hearing aid warranty is no longer in effect;(B) the hearing aid was lost no more than three years after the original date of purchase; and(C) a written explanation of how the hearing aid was lost is submitted by the hearing services provider with the provider's claim for payment; the written explanation must be signed by the recipient;(4) for no more than one replacement of a broken hearing aid if (A) the hearing aid warranty is no longer in effect;(B) the hearing aid was broken no more than three years after the original date of purchase; and(C) the hearing services provider has certified in writing that the hearing aid cannot be repaired or that the cost of repairs would exceed the maximum payment rate for repairing the hearing aid.(e) If the department is paying for the replacement of a hearing aid under this section and the hearing aid manufacturer's warranty is in effect, the department will pay the deductible fee up to the maximum amount set in 7 AAC 145.340. The hearing services provider must submit a copy of the manufacturer's warranty with each claim to document the amount of the deductible.(f) The department will pay a hearing services provider for any type of monaural or binaural hearing aid that is worn in or behind the ear.(g) The department will pay for batteries, subject to the following limits: (1) 20 hearing aid batteries per month up to 160 per year, per recipient; if the batteries are for a recipient's hearing aid that the department did not purchase, the hearing services provider must record in the recipient's record the manufacturer's serial number and the purchase date of the hearing aid;(2) 30 cochlear implant alkaline batteries per month;(3) 55 cochlear implant zinc air batteries per month.(h) The department will pay a hearing services provider for the reasonable and necessary costs of delivering a hearing item, not to exceed the amount set in 7 AAC 145.340, as follows: (1) the cost on invoice of delivering a hearing item from the hearing services provider to a recipient who resides outside the municipality where the business of the hearing services provider is located if (A) the hearing item is unavailable in the municipality in which the recipient resides; and(B) the hearing services provider submits a receipt for the delivery cost with the claim for payment;(2) the cost on invoice of delivering a hearing item from the manufacturer to the hearing services provider following the manufacturer's repair of that hearing item if the hearing services provider submits with the claim for payment a copy of the manufacturer's invoice showing the cost of delivery to the hearing services provider.(i) When a damaged hearing item is no longer covered under the manufacturer's warranty, the department will pay a hearing services provider separately for the labor necessary to (1) assess a damaged hearing item; and(2) repair a damaged hearing item.(j) The department will pay for the labor, repair, or replacement cost of a hearing item only if the repair or replacement is necessary for the hearing item to function as intended. A claim submitted to the department for the labor, repair, or replacement of a hearing item must include (1) a statement signed by the recipient or the recipient's representative that describes the cause for and nature of the repair;(2) a description of the hearing item being repaired and its serial number, if available;(3) the beginning and end dates of warranty coverage, if available; and(4) documentation for labor charges that includes the amount of time spent on the repair, rounded up to the nearest quarter hour, and the hourly rate charged for the repair.(k) The department will not pay for labor, repair, or replacement costs if (1) the hearing item is covered under a manufacturer's or supplier's warranty;(2) the hearing item needs repair because of a manufacturer's defect; or(3) the labor, repair, or replacement has already been paid for as a dispensing fee under (b)(4) of this section.(l) The department will not pay for hearing item rental or a rent-to-purchase arrangement if the rental price would be more expensive than the purchase price. The department will pay a hearing services provider for hearing item rental or a rent-to-purchase arrangement as follows: (1) for a rental period that is 30 days or longer, the department will pay a monthly rental fee that is equal to 10 percent of the allowed purchase price, as calculated under 7 AAC 145.340;(2) for a rental period that is less than 30 days, the department will pay an amount equal to the monthly rental fee divided by the number of days in the month, times the number of days in the rental period;(3) the department will not pay a rental fee for a rental period that exceeds 12 months of continuous use; if the length of need is more than 12 months of continuous use, the prescriber must administer another hearing assessment and request prior authorization for the purchase of a new hearing item; the department will pay the difference between the allowed purchase price and the total monthly rental fees already paid by the department if the hearing services provider (A) transfers ownership of the hearing item, including any warranty, to the recipient for whom it was rented; and(B) replaces the rented hearing item with a new hearing instrument if the rented hearing item was previously used by anyone other than the recipient before it was rented to the recipient;(4) before the total rental fee payments equal the allowed purchase price, the department will not separately pay the cost of labor, repairs, and maintenance; labor, repairs, and maintenance must be included in the rental fee and must be documented in the rental agreement;(5) when total rental payments reach the allowed purchase price of a new hearing item, the department will pay the cost of labor, repair, and maintenance after 60 days or when the warranty expires, whichever is later.(m) The department will not pay a hearing services provider separately for the provider's administrative expenses. The following costs are considered administrative expenses and are included in the payment for the hearing item:(1) telephone responses to questions;(7) office inventory supply;(8) orientation and training regarding the proper use of equipment.(n) The department will not pay for items identified as assistive listening devices in the Healthcare Common Procedure Coding System (HCPCS), adopted by reference in 7 AAC 160.900, including the following: (1) a telephone amplifier;(3) a television amplifier;(4) a television caption decoder;(5) a telecommunications device for the deaf (TDD);(6) a device for use with a cochlear implant.(o) The department will not pay a hearing services provider for charges submitted for adjustments, labor, repairs, or replacement parts for a previously purchased hearing item when the department has purchased a newer like item.(p) Based upon the medical documentation provided for prior authorization, the department will pay for a recipient's use of a hearing item on a trial basis when a trial period is not covered by the manufacturer, if supported by the medical documentation submitted by the hearing services provider under 7 AAC 115.540.Eff. 2/1/2010, Register 193Authority:AS 47.05.010
AS 47.07.030
AS 47.07.040