Utah Administrative Code

The Utah Administrative Code is the body of all effective administrative rules as compiled and organized by the Office of Administrative Rules (see Subsection 63G-3-102(5); see also Sections 63G-3-701 and 702).

NOTE: For a list of rules that have been made effective since December 1, 2017, please see the codification segue page.

NOTE TO RULEFILING AGENCIES: Use the RTF version for submitting rule changes.


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

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

As in effect on December 1, 2017

Table of Contents

R398-3-1. Definitions.

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

b. "CHAP" is Children's Hearing Aid Program.

c. "CSHCN" is the Department's Bureau of Children with Special Health Care Needs.

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

e. "Managing audiologist" is a non-Department 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 program and describe how the department will review and pay for services provided to a child under the 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 program.

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

(1) Participant financial eligibility

a. Children younger than six 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 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 CHAP 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 per ear 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. If a child is under three years of age, the 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. Evidence of non-coverage by current insurance provider.

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

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

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

a. Audiologist qualifications and application

i. Hearing aid must be fit 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 or their designee.

KEY

hearing aids

Date of Enactment or Last Substantive Amendment

August 21, 2015

Authorizing, Implemented, or Interpreted Law

26-10-11


Additional Information

Contact

For questions regarding the content or application of rules under Title R398, please contact the promulgating agency (Health, Family Health and Preparedness, Children with Special Health Care Needs). A list of agencies with links to their homepages is available at https://www.utah.gov/government/agencylist.html.