La. Admin. Code tit. 50 § XV-8701

Current through Register Vol. 50, No. 11, November 20, 2024

Section XV-8701 - Prior Authorization

A. Hearing aids and related services are only covered for EPSDT recipients up to the age of 21. Approval is granted only when there is significant hearing loss as documented by audiometric or electrophysiologic data from a licensed audiologist and medical clearance and prescription from an ear specialist (otologist).

B. The audiologist must furnish a report, including an audiogram (if applicable) and all test results, indicating the degree and type of hearing loss. A hearing loss greater than 20 decibels with an average hearing level in the range 250-2000 Hz is considered significant. Additional required medical and social information shall include:

1. the recipient's age;

2. expected benefit of the hearing aid;

3. previous and current use of a hearing aid;

4. additional disabilities expected to influence the use of a hearing aid; and

5. referrals made on the recipient's behalf to early intervention programs, special education programs or other habilitative services.

C. Hearing aid repairs, batteries, and ear molds shall not require prior authorization. Limitations on the purchase of ear molds are established as follows:

1. one ear mold will be allowed every 90 days for EPSDT recipients from birth through age 4; and

2. one ear mold per year will be allowed for EPSDT recipients from age 5 up to 21.

La. Admin. Code tit. 50, § XV-8701

Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 27:547 (April 2001), repromulgated for LAC codification, LR 29:180 (February 2003).

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.