Section 182-547-0850 - Coverage-Clients age twenty-one and older(1)Nonrefurbished, monaural hearing aids. The medicaid agency covers one new nonrefurbished monaural hearing aid, which includes the ear mold, every five years for clients age twenty-one and older. (a) The client must have an average decibel loss of forty-five or greater in the better ear, based on a pure-tone audio-metric evaluation by a licensed audiologist or a licensed hearing aid specialist at 1000, 2000, 3000, and 4000 hertz (Hz) with effective masking as indicated.(b) The hearing aid must meet the client's specific hearing needs and carry a manufacturer's warranty for a minimum of one year.(2)Binaural hearing aids. The agency covers binaural hearing aids. Prior authorization (PA) is required.(3)Replacement. The agency covers the following replacements if the need for replacement is not due to the client's carelessness, negligence, recklessness, deliberate intent, or misuse under WAC 182-501-0050(7): (a) One replacement hearing aid, including the ear mold, in a five-year period when the warranty is expired and the client's hearing aid(s) is:(ii) Broken and cannot be repaired.(b) One replacement ear mold, per year, when the client's existing ear mold is damaged or no longer fits the client's ear.(4)Repair of hearing aids. The agency covers two repairs, per hearing aid, per year, when the cost of the repair is less than fifty percent of the cost of a new hearing aid. To receive payment, all of the following must be met:(a) All warranties are expired; and(b) The repair is under warranty for a minimum of ninety days.(5)Repair or replacement of external components of cochlear implant devices and bone-anchored hearing aids. The agency covers the following repair or replacement of external components of cochlear implant devices and bone-anchored hearing aids. PA is required. (a) Repair or replacement of external components of cochlear implant devices. If the client has bilateral cochlear implant devices, both devices are eligible for repair and replacement of external components; and(b) Repair or replacement of external components of bone-anchored hearing aids, whether implanted or worn with a headband. If the client has bilateral bone-anchored hearing aids, both devices are eligible for repair and replacement of external components.(6)Rental of hearing aids. The agency covers rental hearing aid(s) for up to two months while the client's own hearing aid(s) is being repaired. For rental hearing aid(s) only, the agency pays separately for an ear mold(s).(7)Second hearing aid. The agency pays for a second hearing aid when the client either meets the following clinical criteria or a limitation extension is requested and approved: (a) The client tries one hearing aid for a ninety-day period, but the hearing aid does not adequately meet the client's hearing need; and(b) One of the following reasons is documented in the client's record. The client is: (i) Unable to or has difficulty with conducting job duties with only one hearing aid;(ii) Unable to or has difficulty with functioning in the school environment with only one hearing aid;(iii) Unable to live safely in the community with only one hearing aid; or(8)Batteries. The agency covers batteries for hearing aids, external sound processors for cochlear implant devices, and bone-anchored hearing aid sound processors.Wash. Admin. Code § 182-547-0850
Adopted by WSR 19-20-043, Filed 9/25/2019, effective 11/1/2019