Legislative Updates

 

Governor's Committee for People with Disabilities Legislative Report 1/12/2021:

Medicaid Audiologist Reimbursement for Hearing Aid Fitting,   

Dispensing, and Evaluation

 

The reimbursement fee for audiologists enrolled in Medicaid includes all necessary follow-up appointments for clients for as long as they have hearing aids. Reports of difficulties with reimbursement for hearing aid reimbursement began in 2013. Audiologists also reported reduction in rates for other services, such as hearing aid fitting and evaluations. That same year the Texas Academy of Audiology (TAA) conducted a survey and found 73 percent of respondents accepting Medicaid were “unlikely or definitely not” going to remain Medicaid providers if reimbursement rates dropped below $400.

 

In 2014, 37 percent of TAA survey respondents reported they had discontinued dispensing hearing aids through Medicaid and 20 percent reported having limited or considering limiting the number of Medicaid patients accepted per month. They also reported a 92 percent decrease in children and 91 percent decrease in infants served. By 2017, TAA reported an overall 80% decrease in the number of patients receiving services.

 

The pre-approval process for receiving hearing aids through Medicaid is quite lengthy, involving an audiologist, otolaryngologist (colloquially known as an ENT), primary care physician, and other staff resources. TAA reports many are ultimately denied even after receiving prior authorization. Limited or no access to hearing aids can have significant consequences, especially for children in crucial developmental periods. According to TAA the current reimbursement rates cover barely half of the actual cost to providers.

 

Note that these figures do not include the cost of having staff conduct preauthorization.

 

Recommendation 6.14:

The HHSC Rate Analysis Division should proactively engage with audiologists and other stakeholders to review the

Medicaid rates for hearing aid fitting and related procedures to ensure the rate is sufficient:

a. Evaluate the reimbursement process to implement timely payment and reimbursement to providers;

b. Compare Medicaid rates to other state agency rates for hearing aid dispensing, fitting, maintenance, evaluation, etc. including Texas

Workforce Commission Vocational Rehabilitation Services rates.

 

Cost for three years of proper follow up and fitting for one child with hearing aids: $3500. Medicaid reimbursement rates for same services: $1750.

 

Recommendation 6.15: HHSC should evaluate the adequacy of its

Medicaid provider network throughout the state to ensure sufficient

geographical coverage and timeliness of audio logical services.