N.H. Admin. Code § He-W 567.05

Current through Register No. 45, November 7, 2024

Section He-W 567.05 - Covered Services

With the exception of those items specified in He-W 567.06, the following hearing aid services and items shall be covered:

(a) When provided by an audiologist or hearing aid dealer:

(1) The hearing aid evaluation or a hearing aid consultation, which shall be limited to one service every 2 years since the last date of service for recipients age 21 or over and as needed for recipients under age 21;

(2) The ear mold(s);

(3) The least costly hearing aid(s) or pocket talker as determined by the audiologist or hearing aid dealer to achieve appropriate access to speech in all of the recipient's communication settings;

(4) The dispensing or fitting of the hearing aid(s) or pocket talker, including real ear verification for conventional hearing aids, adjustment, and instruction;

(5) Follow-up to include verification of hearing aid or pocket talker performance, if not completed at the fitting, and monitoring of hearing thresholds, as needed; and

(6) The audiogram;

(b) Monaural hearing aids:

(1) For recipients under 21 years of age when:

a. The audiogram indicates a unilateral hearing loss of one or more thresholds of 25 decibels (dB) hearing level (HL) or poorer at any frequency from 1000 hertz (Hz) to 4000 Hz; and

b. The audiologist or hearing aid dispenser deems the loss communicatively significant; and

(2) For recipients 21 years of age or over when the audiogram indicates a bilateral hearing loss with an average threshold of 35 dBHL or poorer for 1000 Hz, 2000 Hz, 3000 Hz, and 4000 Hz by pure tone air conduction;

(c) Binaural hearing aids:

(1) For recipients under 21 years of age when:

a. The audiogram indicates a bilateral hearing loss of one or more thresholds of 25 dBHL or poorer at any frequency from 1000 Hz to 4000 Hz; and

b. The audiologist or hearing aid dispenser deems the loss communicatively significant; and

(2) For recipients 21 years of age or over, when:

a. A prior authorization has been requested and obtained from the department in accordance with He-W 567.07 in advance of the hearing aid(s) being rendered; and

b. One of the following applies:

1.The coverage criteria for monaural hearing aids per He-W 567.05(b), and one of the following criteria have been met:

(i) The recipient is attending post-secondary school at any educational level for the purpose of obtaining employment or is receiving vocational training, as documented in accordance with He-W 567.08(d) ; or

(ii) The recipient is employed and is likely to be determined as unable to meet the audiometric requirements of the job without the use of binaural hearing aids, as documented in accordance with He-W 567.08(c) ; or

2.The recipient meets the definition of statutory blindness per He-W 567.01(i) and as documented in accordance with He-W 567.08(b) , and an audiogram indicates a unilateral hearing loss with an average threshold of 35 dBHL or poorer for 1000 Hz, 2000 Hz, 3000 Hz, and 4000 Hz by pure tone air conduction;

(d) Hearing aid batteries for the life span of the hearing aid(s);

(e) Replacement of hearing aids:

(1) If there is an increase in the recipient's hearing loss, as established by the most recent audiogram, which makes the existing hearing aid ineffective;

(2) If an audiologist or hearing aid dealer determines that the hearing aid can no longer be repaired, or that it is not cost effective to do so; or

(3) If the replacement is due to loss and is coverable under He-W 546 for recipients under age 21;

(f) Hearing aid repairs, which shall not require:

(1) A physician referral; or

(2) An initial purchase by medicaid;

(g) Frequency modulation (FM) systems for recipients under age 21, when a hearing aid on its own does not meet the recipient's personal amplification needs, or when a traditional hearing aid is not an appropriate option, as determined by an audiologist;

(h) Pocket talkers, to accommodate hearing loss and enhance communications, when:

(1) The audiogram indicates that a recipient has a bilateral hearing loss with an average threshold of 35 dBHL or poorer for 1000 Hz, 2000 Hz, 3000 Hz, and 4000 Hz by pure tone air conduction; and

(2) A hearing aid is not already covered by medicaid;

(i) Replacement of a pocket talker:

(1) With hearing aid(s) or a more effective pocket talker if there is an increase in the recipient's hearing loss, as established by the most recent audiogram, which makes the existing pocket talker ineffective; or

(2) Once every 5 years; and

(j) Replacement of a headset, earbuds, or neckloop for a pocket talker once every year if an audiologist determines that such accessories are malfunctioning.

N.H. Admin. Code § He-W 567.05

Source. (See Revision Note at chapter heading He-W 500); ss by #6157, eff 12-29-95, EXPIRED: 12-29-03

New. #9480, eff 5-23-09; ss by #9739, eff 6-25-10; amd by #10342, eff 6-1-13

Amended by Volume XXXVIII Number 23, Filed June 7, 2018, Proposed by #12538, Effective 5/25/2018, Expires 5/25/2028.