BILL ANALYSIS
SENATE HEALTH AND HUMAN SERVICES
COMMITTEE ANALYSIS
Senator Deborah V. Ortiz, Chair
BILL NO: AB 1914
A
AUTHOR: Kehoe
B
AMENDED: April 17, 2002
HEARING DATE: June 19, 2002
1
FISCAL: Appropriations
9
1
CONSULTANT:
4
Matosantos / bjs
SUBJECT
Hearing aids.
SUMMARY
Provides one hearing aid assessment within a 12-month
period as a Medi-Cal benefit. Codifies Medi-Cal
regulations relating to the coverage of hearing aids.
ABSTRACT
Existing law:
1.Establishes the Medi-Cal program, administered by the
Department of Health Services, to provide comprehensive
health care benefits to qualified low-income, aged,
blind, and disabled individuals.
2.Establishes a Medi-Cal schedule of covered benefits,
which includes hearing aids as a covered benefit, subject
to utilization controls.
3.Licenses and regulates hearing aid dispensers to fit and
sell hearing aids, and defines the practice of fitting
and selling hearing aids as those practices used for the
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purpose of selection and adaptation of hearing aids,
including the testing of hearing in connection with
fitting and selling hearing aids.
4.Specifies that hearing tests conducted by hearing aid
dispensers include those that are specifically covered in
the hearing aid dispenser licensing examination.
Prohibits hearing aid dispensers from conducting
diagnostic hearing tests when conducting tests in
connection with the fitting and selling of hearing aids.
5.Licenses and regulates audiologists and defines the
practice of audiology to include, among other things, the
application of methods and procedures of measurement,
testing and appraisal of auditory functions, and
identifying and rehabilitating auditory disorders,
including hearing aid recommendation and evaluation
procedures.
6.Prohibits an individual from fitting or selling hearing
aids unless he or she is a licensed hearing aid
dispenser, with the exception that a licensed audiologist
may conduct hearing aid fitting procedures as long as the
audiologist does not directly or indirectly engage in the
sale of hearing aids.
This bill:
1.Provides one hearing aid assessment within a 12-month
period as a Medi-Cal benefit. Specifies that only the
first valid claim for a hearing aid assessment shall be
reimbursed unless additional assessments are deemed
medically necessary.
2.Codifies existing Medi-Cal regulations. Specifically, it
codifies the following:
a. Provides hearing aids as a covered benefits when
supplied by a hearing aid dispenser on prescription of
an otolaryngologist, or the attending physician where
there is no otolaryngologist available in the
community.
b. Requires an audiological evaluation, performed by
or under the supervision of the attending physician or
by a licensed audiologist.
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c. Requires a complete ear, nose and throat
examination performed by a physician or an
otolaryngologist prior to prescription of a hearing
aid.
1.Requires, prior to coverage, a hearing aid assessment to
be performed by the dispensing practitioner;
2.Requires coverage to be based on the results of the
examination, evaluation and assessment required by this
bill.
FISCAL IMPACT
According to the Assembly Appropriations Committee
analysis, minor costs, if any, to Medi-Cal to authorize
reimbursement to hearing aid dispensers for a hearing aid
assessment. These services are currently reimbursed by
Medi-Cal if performed by an audiologist or physician. If
both an audiologist and dispenser perform an assessment in
a 12-month period, Medi-Cal would pay for only one
assessment, unless additional assessments are medically
necessary. All hearing aid services would remain subject
to Medi-Cal utilization review controls.
BACKGROUND AND DISCUSSION
This measure codifies existing regulations governing the
provision of hearing aids under the Medi-Cal program. It
also provides reimbursement of an annual hearing aid
assessment and includes hearing aid dispensers within the
group of professionals that can conduct a reimbursable
hearing aid assessment. Supporters of the bill argue that
hearing aid dispensers currently administer hearing aid
assessments under their scope of practice and should
receive reimbursement for assessments performed on Medi-Cal
beneficiaries.
Persons with hearing loss generally have a medical
evaluation by a licensed physician to assure that medical
conditions affecting hearing are treated before purchase of
a hearing aid. Following this initial evaluation, a
physician, an audiologist or a hearing aid dispenser tests
the ability of the patient to hear with and without a
hearing aid. Currently, Medi-Cal provides reimbursement
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for evaluations only when a physician or audiologist
performs the evaluation.
Hearing aid dispensers are currently licensed to perform
hearing aid assessments for reimbursement on non-Medi-Cal
patients. According to Hearing Healthcare Providers the
following entities accept hearing tests conducted by
dispensers: Blue Cross, Blue Shield, CalPERS, PERS Care,
Operating Engineers, Workers Compensation, Public Utilities
Commission, United Health Care, Cal-Optima, St. Jude & St
Joseph Mission Network, Scan, Allnet, Family/General
Practice Physicians, and Ear, Nose and Throat Physicians.
Medi-Cal does not accept results of evaluations conducted
by dispensers. Supporters argue that Medi-Cal
beneficiaries with hearing problems may have to visit a
physician or audiologist for an evaluation and then go to a
hearing aid dispenser for a hearing aid. Visiting
additional providers can delay the receipt of a hearing
aid, pose added transportation challenges and conflict with
work responsibilities. Furthermore, the lack of
reimbursement for assessments conducted by a licensed
hearing aid dispensers may be a barrier to accessing care
especially in areas where there is a limited number of
audiologists who serve Medi-Cal patients.
Currently, there are 4,161 licensed hearing aid dispensers
in California, 1527 are practicing. There are 2194
licensed audiologists, 1380 of them are practicing. In
2001, Medi-Cal records indicate there were 18,000 hearing
aid evaluations costing $940,000 and 15,000 hearing aids
dispensed at a cost of $9,600,000 in the fee-for-service
segment of Medi-Cal, which makes up approximately 2/3 of
Medi-Cal enrollees.
Medi-Cal regulations require requests for authorization for
hearing aids to include the results of the following tests:
a. Pure tone air conduction threshold and bone
conduction tests of each ear, at 500, 1,000, 2,000,
3,000 and 4,000 Hertz with effective masking as
indicated; and,
b. Speech tests, aided and unaided, including Speech
Reception Threshold (SRT) using Spondee words, a Word
Discrimination Score derived from testing at 40
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decibels above the SRT or at the Most Comfortable
Loudness using standard discrimination words lists
utilizing either recorded or live voice, and Sound
Field Aided and Unaided Speech Scores.
Hearing aid dispensers are permitted under their scope of
practice to conduct testing of hearing in connection with
the fitting and selling of hearing aids. Hearing tests
conducted by hearing aid dispensers include those that are
specifically covered in the hearing aid dispenser licensing
examination. According to the handbooks prepared by the
Hearing Aid Dispensers Bureau which prepare candidates for
the written and practical examinations, hearing aid
dispenser candidates are tested on various assessments and
procedures, including the following:
a. Establishing pure tone air and pure tone bone
thresholds; and,
b. Measuring characteristics of client's hearing with
pure tone and speech audiometric tests, including
establishing unmasked speech reception thresholds for
spondaic words/Spondees, establishing masked speech
reception thresholds, determining masked and unmasked
speech discrimination scores, and establishing most
comfortable listening level for speech and/or pure
tones.
Currently, the Medi-Cal program provides reimbursement for
hearing aid assessments or evaluations performed by
physicians or a licensed audiologist. This measure would
approve reimbursement of hearing aid assessments performed
by licensed hearing aid dispensers acting within their
scope of practice.
The American Academy of Otolaryngology - Head and Neck
Surgery writes in support. They state that hearing aid
dispensers are required and licensed to perform the hearing
aid assessments for many patients, including most HMO and
fee-for-service patients. This bill does not expand the
scope of practice of the dispenser, it simply provides
reimbursement for the same assessments when delivered to
Medi-Cal beneficiaries. The California Medical Association
supports this bill for similar reasons.
Numerous licensed hearing aid dispensers write in support.
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They argue that this measure will increase access to
hearing aids for Medi-Cal beneficiaries particularly in
areas where there is a shortage of audiologist to perform
the required testing. They assert that acceptance by
Medi-Cal of tests performed by hearing aid dispensers could
greatly reduce the time it takes clients to have their
hearing tested.
Previous legislation:
AB 1480 (Aanestad) of 2001, was similar to prior versions
of this bill. It would have permitted hearing aid
dispensers to perform the evaluation necessary for Medi-Cal
coverage of a hearing aid. AB 1480 was held by the
Assembly Appropriations Committee.
AB 1298, (Firebaugh) of 1999, would have required Medi-Cal
coverage for hearing aids to include coverage for any
necessary hearing tests, whether performed by a physician,
a licensed audiologist, or a licensed hearing aid
dispenser, when acting within his or her scope of practice.
AB 1298 was never voted on in the Assembly.
PRIOR ACTIONS
Assembly Floor: 74 - 2 Pass
Assembly Appropriations: 21 - 1 Do Pass
Assembly Health: 14 - 0 Do Pass
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POSITIONS
Support: Hearing HealthCare Providers/California
(sponsor)
American Academy of Otolarynogology - Head
and Neck Surgery
California Medical Association
17 individuals
Oppose: Children's Hospital and Health Center
Oliver Audiology and Hearing Aid Services
San Diego Hearing Center
Tracy Family Hearing Center
2 individuals
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