No. 39451 (Amendment): Rule R398-3. Children's Hearing Aid Pilot Program

(Amendment)

DAR File No.: 39451
Filed: 06/17/2015 10:09:00 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this filing is to update the rule from changes of the program going from a pilot program to a full program and includes minor administrative corrections.

Summary of the rule or change:

On 05/14/2013, H.B. 157 (from the 2015 General Session) became Section 26-10-11 as the Children's Hearing Aid Pilot program. On 07/01/2015, the pilot program will be superseded by the full program of Children's Hearing Aid Program. This rule is being updated with the full program information including minor administrative updates.

State statutory or constitutional authorization for this rule:

• Section 26-10-11

Anticipated cost or savings to:

the state budget:

The bureau will incur a minimal cost to reprint the rule and to notify audiologist and the Utah School of the Deaf and Blind.

local governments:

The proposed rule does not affect local government.

small businesses:

The proposed rule clarifies statutory changes to a full program and updates requirements already in place and therefore should not have an additional fiscal impact.

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

The proposed rule clarifies statutory changes to a full program and updates requirements already in place and therefore should not have an additional fiscal impact.

Compliance costs for affected persons:

The proposed rule clarifies statutory changes to a full program and updates requirements already in place and therefore should not have an additional fiscal impact.

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

There is no impact on businesses because it does not propose additional requirements that are not currently in rule.

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:

• Joyce McStotts at the above address, by phone at 801-584-8239, by FAX at 801-584-8488, or by Internet E-mail at [e-mail]

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:

08/14/2015

This rule may become effective on:

08/21/2015

Authorized by:

David Patton, Executive Director

RULE TEXT

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.

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

b.[c.] ["CHAPP"]"CHAP" is Children's Hearing Aid [Pilot ]Program.

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

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

e.[f.] "Managing audiologist" is a non- Department[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]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 [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]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[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[Proof of denial for 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[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 or their designee.

 

KEY: hearing aids

Date of Enactment or Last Substantive Amendment: [October 15, 2013]2015

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

 

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