Section 354.1233 - Requirements for Hearing Aid Services(a) Hearing aid services. Providers of hearing aid services must comply with: (1) all applicable federal and state laws and regulations;(2) recognized professional standards;(3) the provisions in Division 1 of this subchapter (relating to Medicaid Procedures for Providers);(4) the provisions in Division 11 of this subchapter (relating to General Administration);(5) the conditions, specifications, and limitations established by the Texas Health and Human Services Commission (HHSC); and(6) applicable requirements of their licensing authority.(b) Reimbursement. (1) Physicians. Physicians shall be reimbursed for all services covered by the Texas Medicaid Program, including examinations and hearing evaluations. Physicians may delegate examinations to nurse practitioners, clinical nurse specialists, or physician assistants.(2) Audiologists. Audiologists shall be reimbursed for hearing aid evaluations and for the fitting and dispensing of hearing aids.(3) Fitters and dispensers. Hearing aid fitters and dispensers shall be reimbursed for the fitting and dispensing of hearing aids.(c) Hearing aid evaluations. Hearing aid evaluations must be recommended by a physician, or, under physician delegation, a nurse practitioner, clinical nurse specialist, or physician assistant, based upon examination of the recipient. Reimbursement for hearing aid evaluations will be made only to physicians or licensed audiologists. The recipient must have a medical necessity for a hearing aid as stated in §354.1231 of this division (relating to Benefits and Limitations). The recipient must not have any medical contraindications to the ability to use or wear a hearing aid.(1) A physician, nurse practitioner, clinical nurse specialist, or physician assistant who recommends a hearing aid evaluation must be licensed in the state where and when the examination is conducted.(2) The physician, nurse practitioner, clinical nurse specialist, or physician assistant must indicate on the Physician Examination Report form if the recipient needs a hearing aid evaluation based on the examination of the recipient. Medicaid reimbursement for a hearing aid evaluation shall be based on the physician's, nurse practitioner's, clinical nurse specialist's, or physician assistant's recommendation that the hearing aid evaluation is necessary.(3) Providers must administer hearing aid evaluations using appropriate procedures as specified within their scope of practice and recognized professional standards.(4) Reimbursement for home visit hearing aid evaluations shall be made if the recipient's physician has documented that the recipient's medical condition prohibits traveling to the provider's place of business.(5) Providers of hearing aid evaluations must have a report in the recipient's record. Providers must include in the report hearing aid evaluation test data.(6) Hearing aid evaluations performed by fitters and dispensers are not reimbursable. If a fitter or dispenser performs a hearing evaluation on a recipient, the recipient shall not be billed for the hearing evaluation.(d) Hearing aids. Providers must offer each recipient eligible for a hearing aid a new instrument that meets the recipient's hearing need. (1) Warranty. Providers must ensure that each hearing aid purchased through the Texas Medicaid Program is a new and current model that meets the performance specifications of the manufacturer and the hearing needs of the recipient. Providers must also ensure that each hearing aid is covered by at least a standard 12-month manufacturer's warranty, effective from the dispensing date.(2) Required package. Providers must dispense each hearing aid purchased through the Texas Medicaid Program with all necessary tubing, cords, connectors, and a one-month supply of batteries. The instructions for care and use of the hearing aid must be included with the hearing aid package.(3) Thirty-day trial period. Providers must allow each eligible recipient thirty days to determine if the recipient is satisfied with a hearing aid purchased through the Texas Medicaid Program. The trial period consists of thirty consecutive days from the dispensing date. Providers must inform recipients of the trial period and present the beginning and ending date of the trial period to the recipient in writing.(A) During the trial period, providers may dispense additional hearing aids, as medically necessary, until the recipient is satisfied with the result of the hearing aid or the provider determines that the recipient cannot benefit from the dispensing of an additional hearing aid. A new trial period begins with the dispensing date of each hearing aid.(B) Providers may charge a rental fee for hearing aids returned during the trial period. (i) If a rental fee is charged, providers must assess the rental fee according to the rules and regulations established by the Texas Department of Licensing and Regulation.(ii) The maximum rental fee for eligible Medicaid recipients shall be $2 per day. This fee shall not be a covered benefit of the Texas Medicaid Program. Recipients shall be responsible for paying any rental fee assessed them for instruments returned during the 30-day period. Providers must keep in the recipient's file the signed certification acknowledging responsibility to pay hearing aid rental fees.(iii) Providers must comply with all procedures and directions of the Texas Medicaid Program regarding forms and certifications required during the 30-day trial period. Providers must allow thirty days to elapse from the hearing aid dispensing date before completing a "30-day trial period certification statement." The certification statement must be maintained by the provider in the recipient's file.(4) Post-fitting checks. The fitter and dispenser must perform a post-fitting check of the hearing aid within five weeks of the initial fitting. The post-fitting check is part of the dispensing procedure and is not reimbursed separately.(5) First revisit. The first revisit shall include a hearing aid check. Providers must make counseling available as needed within six months of the post-fitting check.(6) Second revisit. The purpose of the second revisit is to make any necessary adjustments to the hearing aid. Provider must conduct a second revisit as needed.1 Tex. Admin. Code § 354.1233
The provisions of this §354.1233 adopted to be effective February 14, 1985, 10 TexReg 406; Amended to be effective September 1, 1986, 11 TexReg 3648; transferred effective September 1, 1993, as published in the Texas Register September 7, 1993, 18 TexReg 5978; Amended to be effective September 1, 1995, 20 TexReg 6207; Amended to be effective September 3, 1996, 21 TexReg 7986; transferred effective September 1, 2001, as published in the Texas Register May 24, 2002, 27 TexReg 4561; Amended to be effective September 1, 2003 28 TeReg 7288; Amended to be effective October 1, 2005, 30 TexReg 6042; amended tobe effective December 2, 2008, 33 TexReg 9667; Amended by Texas Register, Volume 43, Number 46, November 16, 2018, TexReg 7517, eff. 11/20/2018