DAR File No. 37899

Health, Family Health and Preparedness, Children with Special Health Care Needs

Rule R398-3

Children's Hearing Aid Pilot Program

Notice of Proposed Rule

(New Rule)

DAR File No.: 37899
Filed: 08/05/2013 06:19:53 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

This rule will govern administration of the Children's Hearing Aid Pilot Program.

Summary of the rule or change:

This rule includes the process to identify children who are financially eligible for services and the process to review and pay for services provided to a child.

State statutory or constitutional authorization for this rule:

• Section 26-10-11

Anticipated cost or savings to:

the state budget:

Costs include staff time to administer the account and volunteer time from committee members to serve an advisory role, develop application process and review applications from treatment providers, and process payment requests from providers. As this is a new program, there are no records to indicate cost burden or savings.

local governments:

None anticipated--Funds will be disbursed to audiologists for hearing aids to eligible children.

small businesses:

Cost--Time for audiologists to prepare applications to receive funds for eligible children. As this is a new program, there are no records to indicate cost burden or savings.

persons other than small businesses, businesses, or local governmental entities:

Cost to families--Time to identify audiologist and obtain testing for hearing aids. Savings to families--Hearing aids will be provided free to families up to the full amount appropriated. The agency estimates approximately 25 children will receive hearing aids through the current amount appropriated. As this is a new program, there are no records to indicate cost burden or savings.

Compliance costs for affected persons:

Cost to audiologists and families--Time to complete application processes involved. As this is a new program, there are no records to indicate cost burden or savings.

Comments by the department head on the fiscal impact the rule may have on businesses:

This will provide some additional payment for hearing aid providers.

David Patton, PhD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Family Health and Preparedness, Children with Special Health Care Needs
44 N MARIO CAPECCHI DR
SALT LAKE CITY, UT 84113

Direct questions regarding this rule to:

• Rebecca Giles at the above address, by phone at 801-538-6259, by FAX at , or by Internet E-mail at rgiles@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

10/01/2013

This rule may become effective on:

10/08/2013

Authorized by:

David Patton, Executive Director

R398. Health, Family Health and Preparedness, Children with Special Health Care Needs.

R398-3. Children's Hearing Aid Pilot Program.

R398-3-1. Definitions.

a. "UDOH" is Utah Department of Health.

b. "Hearing aid" is any traditional non-surgical device providing acoustic amplification.

c. "CHAPP" is Children's Hearing Aid Pilot Program.

d. "CSHCN" is the Bureau of Children with Special Health Care Needs.

e. "L&D" is loss and damage, referring to warranty or insurance coverage for hearing aids.

f. "Managing audiologist" is a non-UDOH licensed audiologist with expertise in pediatric audiology who is responsible for the provision of hearing aids and follow-up care to eligible children.

 

R398-3-2. Purpose and Authority.

The purpose of this rule is to set forth the process to identify children who are financially eligible to receive services under the pilot program and describe how the department will review and pay for services provided to a child under the pilot program.

This rule is authorized by Section 26-10-11(5) which provides that the department shall make rules regarding implementation of the hearing aid pilot program.

 

R398-3-3. Process to Identify Children Who Are Financially Eligible for Services.

(1) Participant financial eligibility

a. Children younger than three years old, with hearing loss who do not yet own a hearing aid or for whom current amplification is no longer appropriate may be eligible for hearing aids under this pilot program.

b. Participant must complete and submit CSHCN Financial Form (PFR) with application to the managing audiologist.

c. Upon request, the family must provide a copy of the most recent federal income tax filing to CHAPP to verify family income as reported by the child's parents. If the federal income tax filing is unavailable, the parents may submit the prior three months' check stubs to extrapolate annual income.

d. Family must be at or below 300% of Federal Poverty Level.

e. This is a one-time benefit per child.

 

R398-3-4. Process to Review and Pay for Services Provided to a Child.

(1) Applications

a. Participant application

i. Must be completed by parent or guardian.

ii. Child shall participate in a Part C Early Intervention program.

iii. Application must be submitted to managing audiologist with:

1. Proof of denial for Medicaid or evidence that family is ineligible for Medicaid.

2. Proof of denial for coverage by current insurance provider.

i. Family/guardian shall provide coverage for all out-of-warranty repairs.

ii. If L&D is claimed during the warranty period, the family shall provide supplemental hearing aid insurance including L&D.

iii. Child will receive hearing aids directly from managing audiologist.

a. Audiologist qualifications and application

i. Hearing aid must be dispensed by a licensed audiologist.

ii. A separate application must be submitted for each child.

(2) Review of applications

a. All applications will be reviewed for completeness and eligibility by the Advisory Committee chair or UDOH designee.

b. Eligibility shall be communicated to the managing audiologist.

(3) Payment process

a. Within 30 days of hearing aid fitting, the managing audiologist will submit the Payment Request Cover Sheet with all supporting documentation.

b. UDOH will review documentation to assure that managing audiologist has submitted all items listed in payment request.

c. Payments will go directly to the managing audiologist.

 

KEY: hearing aids

Date of Enactment or Last Substantive Amendment: 2013

Authorizing and Implemented or Interpreted Law: 26-10-11