1. (1) Only in-state and borderline out-of-state (within 30-mile radius of state line)audiology and hearing aid providers who meet enrollment requirements are eligible to participate in the Alabama Medicaid program.

   1. (a) Name
   2. (b) Address
   3. (c) Specialty provider type
   4. (d) Social Security Number
   5. (e) Tax ID Number

   6. (f) Copy of current State license

      Hearing Aid Dealers - must hold a valid current license issued by the Alabama Board ofHearing Aid Dealers, as issued by the state in which the business is located. Licensed Hearing aid dealers desiring to participate in the Alabama Medicaid Program are required to enter into a contractual agreement with the Alabama Medicaid Agency. The dealer should request a contract agreement from the Associate Director of the Hearing Services Program, Alabama Medicaid Agency.

   Audiology providers: Must hold a valid current state license issued by the state in which they practice. Since licenses are reviewed annually, Medicaid will review reference sources such as the Board of Examiners for Speech Pathology and Audiology for determining an audiologist's professional qualifications.

   Medicaid's fiscal agent is responsible for enrollment of audiologists. Licensed Audiologists desiring to participate in the Alabama Medicaid Program should furnish the following information in a written enrollment request to Medicaid's Fiscal Agent.

Author: Carol Akin, Associate Director, Clinic/Ancillary Services

Statutory Authority: State Plan; 42 C.F.R. Title XIX, Social Security Act; 42 C.F.R. §441.56.

History: Rule effective October 1, 1982. Amended effective May 9, 1984; July 9, 1984. Emergency rule effective October 1, 1990; March 18, 1991. Amended effective June 12,1991. Amended: Filed January 7, 2001; effective February 11, 2002.