Section 17b-262-795 - Need for service(a) The department shall pay for the purchase or repair of a medically necessary hearing aid or supply, subject to the conditions and limitations described in sections 17b-262-792 to 17b-262-803, inclusive, of the Regulations of Connecticut State Agencies.(b) All clients who have been identified as having a hearing loss, such as through the performance of a hearing screening, shall receive a medical evaluation by a licensed practitioner, preferably an ear specialist, before a hearing aid is considered to ensure that all medically treatable conditions that affect hearing are identified and treated first. The medical evaluation shall have taken place within the six-month period prior to the date in which the client receives the first hearing aid and may, at the licensed practitioner's discretion, be accompanied by a prescription for a hearing aid.(c) Medical necessity shall be documented by the provider and shall include: (1) An estimate of the client's ability to benefit from the use of a hearing aid as demonstrated by improvement in speech discrimination or environmental awareness of sound;(2) test results showing the client's current hearing level and an estimate of improvement in speech discrimination or environmental awareness of sound;(3) evidence of a medical evaluation signed by a licensed practitioner; and(4) a written prescription signed by a licensed practitioner or an order by an audiologist or hearing aid dealer.(d) In addition the provider shall document: (1) The commitment on the part of the appropriate caregiver to assist the client in the use and care of the hearing aid, if the client is incapable of caring for the hearing aid on his or her own; and(2) the status of any previous hearing aid used by the client.(e) The department shall pay for hearing aids and supplies for a client who lives at home or in a nursing facility, ICF/MR, hospital or chronic disease hospital, except as limited by sections 17b-262-792 to 17b-262-803, inclusive, of the Regulations of Connecticut State Agencies.(f) All hearing aids dispensed to a child under eighteen years of age shall meet the requirements of section 20-406-10 of the Regulations of Connecticut State Agencies.(g) Hearing testing shall meet the requirements of section 20-406-9(f) of the Regulations of Connecticut State Agencies.(h) There shall be a thirty-day trial period for a hearing aid in accordance with section 20-402a of the Connecticut General Statutes; the cancellation fee applies to the total acquisition cost and dispensing fee.(i) An audiometric report to support medical necessity is required for the purchase of all hearing aids.(j) A hearing aid shall be replaced only when the prior hearing aid no longer meets the client's needs, has been lost, stolen or damaged beyond repair.(k) For a hearing aid that has been lost, stolen or damaged beyond repair, the provider shall document:(1) The disposition of the prior hearing aid and statement of circumstances of loss or damage;(2) in the case of damage, a statement from the hearing aid dealer or audiologist that the hearing aid cannot be repaired;(3) the measures to be taken by the client, family or other caregiver, to prevent future loss or damage.(l) For a hearing aid that is no longer meets the client's needs, the provider shall document the significant change in the client's hearing loss to warrant the replacement.Conn. Agencies Regs. § 17b-262-795
Adopted effective July 11, 2011