Transcript hearing aids

Providing a ‘Sound Start’ for
Infants Needing Amplification
Early Hearing Detection and Intervention
(EHDI) Conference 2004
Karen M. Ditty
Michelle King
Toni Maxon
Ilene Briskin
States with Insurance mandates for
Hearing Aids:
Connecticut (October, 2001)
 Kentucky (July, 2002)
 Louisiana (January, 2004)
 Maryland (2001)
 Minnesota (August, 2003)
 Missouri (current & pending)
 Oklahoma (November, 2003)

Requirements vary between states
for:
ages covered
 amount of coverage
 benefit period
 provider qualifications
 type of hearing loss
 no states require a similar benefit for adults

Legislation in United States
State
Age
Freq
Amount
Who pays
CT
<12yrs
2 yrs
$1000./HA
Individual and Grp.
KY
<18yrs
3 yrs
$1400./HA
Group and state . No self
funded coverage
LA
<18 yrs
3yrs
$1400./HA
Any health insurance
MD
Minors
3 yrs. $1400./HA
Any health insurance
MN
<18yrs HL
loss @birth
3 yrs
Fully insured no self
funded coverage
MO* Initial HA
for infants
OK <18yrs
not listed
initial Not listed
Any health Insurance
4 yrs
Any health plan, No self
pay or ERISA
No limit
Proposed Legislation in United States
State
MO
Age
<19yrs
Freq
3yrs
Amount
$1250./HA
Who pays
Every Health Carrier
offering health benefit
plans that are delivered,
issued for delivery,
continued or renewed
after 1/1/2005
Connecticut:
PROVIDES
 Pays up to $1000. for
hearing aids every 2 years
 Pays up to age 12
 However, Children with a
HL of >40dB are already
funded for hearing aids
through IDEA Part C
monies
DOESN’T PROVIDE
 Benefit does not really
cover cost of digital
hearing aids
Hearing Aid Legislation
In Kentucky
Trish Freeman
Pam Ison
Michelle King
The Path to Hearing Aid
Insurance Legislation
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Get all interested parties involved
Research current legislation: Is there one you can
model?
Identify key person to serve as “watchdog” and
primary contact for sponsors
Find a message that resonates and repeat it over
and over in various ways
Be prepared for opposition and to make
concessions
Be persistent: don’t give up when you get
discouraged
KY Origin: Parent Advocate

Proposed hearing aid legislation idea to
KCDHH board and asked to form study
group
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Key goal was to bring together
representatives from all major players in
the deaf/HOH community
KCDHH Study Group

Once members were identified, the study group met
to:
 plan strategy for getting bill introduced and passed
 draft language of bill that would be acceptable to
all parties modeled after MD.
 identify potential bill sponsors and co-sponsors
 develop talking points
 establish email network as mechanism for
generating grassroots action when needed
Steps Taken to Generate
Grassroots Support
Flyers – parents – community partners
 Newsletter articles
 Letters to Editor
 Media Coverage
 Flyers to Legislators
 Email Network

 Committee

Testimony
Meetings with Key Legislators
2002 Legislative Session
 Bill
introduced and passed this session:
 SB152: An act relating to health
insurance coverage for hearing aids
SB 152
AN ACT relating to health insurance coverage
for hearing aids and related services.
Create a new section of Subtitle 17A of
KRS Chapter 304 to require all health benefit
plans to provide coverage for hearing aids
and related services for persons under 18
years of age; amend KRS 18A.225 to require
all health benefit plans for state employees to
provide coverage for hearing aids and related
persons for dependents under 18 years of
age.
SB 152 PRO/CON:
PROVIDES
 Hearing Aids/earmolds
 Related Services
 Up to age 18
 Up to $1,400 per
impaired ear every 36
months
DOESN’T PROVIDE
 Batteries, cords
 For 18 and older
 for 40% of all insured
in KY because selffunded plans don't
have to follow the
mandate
What the law means
Coverage – for some
 Those outside of state jurisdiction are:
 Self-funded insurance
 ERISA is covered by the Department
of Labor, Federal Employee Program,
and Medicare.
 The law only affects new or re-issued
policies.

CURRENT STATUS
Some insurances are paying
 Health Care Providers must seek
verification and follow guidelines
 Families must continue to be vigilant
advocates for their children’s needs
 Continue to push for improved legislation
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Key Steps to Success
Inspiration
 Motivation
 Teamwork
 Persistence
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www.lrc.state.ky.us/recarch/02rs/SB152.htm
Louisiana
PROVIDES
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Pays up to $1400. for
hearing aids every 3yrs
Pays up to age 18
However, Children are
covered if are on Medicaid
(approx. 35% of 1,359
Hearing Impaired in LA)
Children’s Special Health
services provide hearing
aids to a many more
hearing impaired. Law
intended to capture all
other deaf and hard of
hearing children.
PROVIDES
Allows parents to buy “Up”
on digital hearing aids if they
choose at their own cost.
DOES NOT PROVIDE
self-funded plans do not
have to abide by the mandate
Out of state insurance
companies do not have to
follow mandate.
Barriers to overcome
in Louisiana

Hearing aid dealers wanted to join the
legislation
 Original plan was to only have
Audiologists as providers of hearing aids
for infants and children within the
legislation
 Dealers were included as most insurance
carriers required a Masters degree to be
providers and many would not qualify.
Barriers to overcome
in Louisiana

Opposition from the insurance lobbyist
 Critical to work on language with the
insurance lobbyist so that the bill would
not be opposed by the lobbyist.
 Defining comprehensive audiometry
correctly so that it would be appropriate
for the population.
MARYLAND’S PLEDGE
TO CHILDREN WHO
ARE DEAF OR HARD
OF HEARING
DEBRA DOYLE ALLEN, M.A.
ILENE BRISKIN, SC. D.
SETTING THE STAGE
HISTORY DEMOGRAPHICS
CUSHION
BUILDING UNHS
 Model
 Reimbursement
 Legislation
 Awareness
BUILDING LEGISLATIVE
SUPPORT
 Awareness and education
 State agency support
 Voter interest
 Special interest lobbying
1999: UNIVERSAL NEWBORN
HEARING SCREENING
 All birthing hospitals to
establish UNHS
 Insurers to reimburse
 Notification to be
provided
 Existing program and
advisory council to be
adapted
FROM UNHS TO EHDI
 Community awareness
 Amplification
 Habilitation
2001: Reducing Barriers to
Amplification
 Insurance Mandate
 Hearing Aid Loan
Bank
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For minor children
$1400 per ear
Licensed
audiologist
prescribes, fits
and dispenses
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Children 0-3 years
Maryland State
Dept. of Education
Funding
FOR MORE INFORMATION…
 mlis.state.md.us
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1999: HB 884; UNIVERSAL NEWBORN HEARING
SCREENING
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2001: HB 160; HEALTH INSURANCE – HEARING
AIDS- COVERAGE FOR CHILDREN
HB 282; STATE DEPARTMENT OF
EDUCATION – HEARING AID LOAN
BANK PROGRAM – ESTABLISHMENT
AND OPERATION
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Minnesota
PROVIDES
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Pays for hearing aid for
each year every 3 years.
(no price limit set)
Pays up to age 18
DOES NOT PROVIDE
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Self Insured carriers do
not have to pay
Out of state carriers do not
have to pay.
Hearing aids not covered
unless hearing loss
occurred at birth.
Missouri:
CURRENTLY
PROVIDES
 Hearing Aids
 Initial hearing aid only
PROPOSED
LEGISLATION
 Hearing Aids
 Related Services
 Up to age 18
 Up to $1,400 per
impaired ear every 36
months
Oklahoma
Provides HAs to children <18 yrs. (previous
bill was for <13 years)
 Only licensed audiologists could dispense
(hearing aid dealers were setting a standard
of care of $500./HA)
 Modified previous bill, but still needed
more work. Stressed importance of being at
the capitol to watch the bill as it goes
through the process.
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Grassroots efforts work!
http://www.audiology.org/professional/gov/
http://capwiz.com/audiology/home/
http://www.asha.org/about/legislation-advocacy/grassroots
http://www.asha.org/about/legislationadvocacy/state/issues/ha_reimbursement.htm