1. (a)

   1. (1) Individuals requesting assistance from Arkansas Rehabilitation Services for cochlear implant surgery as a method of treatment to provide a sense of sound to a person who is profoundly deaf or severely hard of hearing must meet the following:

      1. (A) Complete psychological exam to determine emotional and mental stability of the individual;
      2. (B) Documented evidence from the individual or employer that the procedure would remove any significant vocational impediment;
      3. (C) Documented evidence from medical personnel in regard to the type and severity of the hearing loss;
      4. (D) Documented counseling with medical personnel in regard to after effects and adjustment to the procedure; and
      5. (E) Documented post-operative aural rehabilitation plan.
   2. (2) Refer required documentation to manager, Deputy Chief of Field Services, and Chief of Field Services for approval.
   3. (3) Reports and recommendations will be obtained from the attending physician, audiologist, and other required healthcare team members and attached to the ECF.

   4. (4)

      1. (A) Follow general Arkansas Rehabilitation Services guidelines for bill payment processes such as using Healthcare Common Procedure Coding System (HCPCS) codes.
      2. (B) Arkansas Rehabilitation Services is the payer of last resort.

2. (b) Procedures — Cochlear implants.

   1. (1) Medical clearance provided by ENT.

   2. (2)

      1. (A) Evaluation conducted by either an ENT or licensed audiologist to assess the type and severity of client’s hearing loss as measured by the PTA or SRT.
      2. (B) PTA is calculated using only:

3. (i) One-half kilohertz (0.5 kHz);

   1. (ii) One kilohertz (1 kHz);

      1. (iii) Two kilohertz (2 kHz); and

         1. (iv) Three kilohertz (3 kHz).
   2. (3) Medical consultant reviews the client’s case.
   3. (4) ENT recommendations, psych report recommendations, medical consultant recommendations, client’s vocational goals, and client’s financial details will be considered by the counselor while considering client’s eligibility for services.

   4. (5)

      1. (A) If client is cleared to proceed with cochlear implant surgery, the Arkansas Rehabilitation Services Hearing Aid Order Form must be submitted by the ENT or audiologist.

      2. (B) Document that counseling was conducted by either the ENT or licensed audiologist about:

         1. (i) Realistic expectation;
         2. (ii) Surgery;
         3. (iii) Typical costs; and
         4. (iv) Expected follow-up care.
      3. (C) Aural rehabilitation plan must be documented as well.
   5. (6) Surgery occurs (typically outpatient).
   6. (7) Itemized invoice sent to counselor.

   7. (8)

      1. (A) For reimbursement, the counselor will follow guidelines related to reimbursement based on HCPCS policies and all other reimbursement policies of Arkansas Rehabilitation Services.
      2. (B) Arkansas Rehabilitation Services is the payer of last resort.
   8. (9) Follow-up care provided by ENT and audiologist as needed.
   9. (10) Aural rehabilitation plan implemented.

   10. (11)

       1. (A) Counselor support continues.
       2. (B) Refer client for assistive technology assessment.

Codification Notes: “ECF” means electronic case file. "ENT" means ear, nose, and throat. "PTA" means pure-tone average. "SRT" means speech reception threshold.