Texas Medicaid & Healthcare Partnership

Texas Health & Human Services Commission

Texas Department of Assistive and Rehabilitative Services (DARS)

Medicaid Rules and Fees

Sometime in 2007, the Medicaid division of the Texas Health and Human Services Commission is expected to initiate a rulemaking proceeding to change the rules and reimbursement fees applicable to the sale of hearing instruments to Medicaid patients by approved providers. THAA has been in constant contact throughout the year with the Medicaid staff in charge of developing both of these rulemakings, and will notify members when these proceedings begin.

Currently, licensed dispensers who are approved to fit and dispense hearing instruments to qualified Medicaid patients, receive a reimbursement from the state for a monaural fitting based on the Manufacturers Suggested Retail Price of the hearing instrument minus 18%. It is not known at this time what the proposed new reimbursement fees will be, but they are expected to be less MSRP minus 18%.

The Medicaid staff working on the new hearing aid reimbursements fees hopes to have proposed rates forwarded to management soon. Following approval by management, a rate hearing will be scheduled. Notice of that hearing has to be published in the Texas Register. The Medicaid staff has agreed to forward the proposed rates to THAA as soon as they are known

Changes to the rules governing the sale and reimbursement of hearing aids must first be approved by the Medical Care Advisory Council and the Health and Human Services Commission Council before they are published in the Texas Register for a 30-day public comment period. The Medicaid staff does not anticipate submitting proposed rule changes to MCAC or HHSC until November of 2007. At this time, THAA expects the proposed rule changes will be the same as those the association has been discussing with the Medicaid staff all year. These changes are summarized below:

1. Binaural fittings will be reimbursed for all qualified patients. Today, only legally blind qualified patients receive reimbursement for binaural fittings.
   
   
2. Reimbursement for hearing aid batteries will be allowed.
   
   
3. Medicaid will not pay for repairs or replacement of lost, destroyed, or inappropriate hearing instruments.
   
   
4. Medicaid will not pay separately for shipping and handling charges assessed for procurement of the hearing instrument.
   
   
5. Hearing aid providers will no longer be required to dispense hearing aids manufactured in the United States. Providers will only be required to consider U. S. manufacturers whose price and quality are comparable to foreign manufacturers.
   
   
6. Hearing aids will be limited to eligible recipients whose air conduction puretone average in the better ear is 25dB or greater, instead of the current 45dB or greater requirement.

When both of these proceedings are formally initiated, THAA will inform members in an email update and through this page of the site.