1. (a)

   1. (1) Individuals requesting assistance from Arkansas Rehabilitation Services for a bone-anchored auditory implant (BAAI) as a method of treatment to provide a sense of sound to a person who is hard of hearing must meet the following:

      1. (A) Documented evidence from the individual or employer that the procedure would remove any significant vocational impediment;
      2. (B) Documented evidence from medical personnel in regard to the type and severity of the hearing loss; and
      3. (C) Documented counseling from medical personal in regard to the:

2. (i) Surgery process;

   1. (ii) After effects; and

      1. (iii) Adjustment to the procedure.
   2. (2) Refer required documentation to manager, Deputy Chief of Field Services, and Chief of Field Services for approval only if needed for payment procedures.
   3. (3) Reports and recommendations will be obtained from the attending physician and audiologist and attached to the ECF.
   4. (4) Follow general Arkansas Rehabilitation Services guidelines for bill payment processes such as using HCPCS codes.
   5. (5) Arkansas Rehabilitation Services is the payer of last resort.

   6. (6) Considerations for the BAAI/BAHA technology:

      1. (A) Minimally invasive surgery;
      2. (B) No occlusion of ear canal;
      3. (C) No risk to damage residual hearing during surgery process; and
      4. (D) Able to test the product before undergoing surgery (real-time results) since the BAAI can be worn on a headband.

3. (b) How to qualify (candidacy guidelines).

   1. (1)

      1. (A) Individuals requesting assistance from Arkansas Rehabilitation Services for a bone-anchored auditory implant (BAAI) as a method of treatment must have a PTA or SRT of forty-one decibels (41 dB) or greater.

      2. (B) PTA shall be calculated using only:

         1. (i) One-half kilohertz (0.5 kHz);
         2. (ii) One kilohertz (1 kHz);
         3. (iii) Two kilohertz (2 kHz); and
         4. (iv) Three kilohertz (3 kHz).
   2. (2) Clients must also meet the requirements below based on whether they have conductive or mixed hearing loss or single-sided deafness.

   3. (3) Please refer to the appropriate section below for additional guidelines:

      1. (A)

         1. (i) Conductive.
         2. (ii) Conductive hearing loss with an air-bone gap of more than thirty decibels (30 dB);

      2. (B) Mixed:

         1. (i) Air-bone gap of more than thirty-to-thirty-five decibels (30 – 35 dB); or
         2. (ii)
4. (a) (a) Mild-to-moderate sensorineural loss.

5. (b) (b) “The BAAI sound processor can compensate for some of the sensorineural loss…[with] only modest amplification required – much less than is necessary with conventional hearing aids. The most powerful BAAI processor can compensate for a sensorineural element of up to 65 dB HL (measured at 0.5, 1, 2, and 3 kHz).”; and

   1. (C)

      1. (i) Single-sided deafness (SSD).

         1. (ii) “Candidates with SSD and normal hearing in their good ear may benefit from a BAAI System. The BAAI sound processor picks up sound on the deaf side and sends it via bone conduction to the contralateral cochlea, overcoming the head shadow effect. This gives improved speech understanding and 360° sound awareness.”; and

      2. (D)

         1. (i) BAAI versus CROS for SSD.
         2. (ii) BAAI does not occlude the ear canal.
         3. (iii) CROS system requires hearing device on both ears.
         4. (iv) BAAI only requires hearing device on one (1) side.
         5. (c) Comorbid condition considerations. For some indications, such as chronic otitis media and allergies, implantable bone conduction may be a great solution regardless of the size of the air-bone gap:
   2. (1) Skin allergies may be aggravated by ear molds of some hearing aids;
   3. (2) Congenital malformations. Facial anatomy may limit AC hearing aid placement;
   4. (3) Draining ears. Ear canal remains open at all times with BAAI system;
   5. (4) Ear canal stenosis. Ear canal is bypassed;
   6. (5) Previous ear surgery, especially if they struggle with feedback issues post-surgery with AC aid;

   7. (6) Radical cavity.

      1. (A) At higher risk for ear canal to become occluded.
      2. (B) BAAI bypasses canal; and

   8. (7)

      1. (A) Syndromic hearing losses, e.g., clients with Down syndrome, Goldenhar syndrome, and Treacher Collins syndrome.

      2. (B) For some clients and their caretakers, a BAAI may be a more optimal solution due to maintenance and other considerations.

         1. (d) Procedures — BAAI.
   9. (1) Medical clearance provided by ENT.

   10. (2)

       1. (A) Evaluation conducted by either an ENT or licensed audiologist to assess the type and severity of client’s hearing loss.
       2. (B) All clients must have a hearing loss of forty-one decibels (41 dB) or greater as measured by either their PTA or SRT for Arkansas Rehabilitation Services to purchase hearing aids for them.

       3. (C) PTA is calculated using only:

          1. (i) One-half kilohertz (0.5 kHz);
          2. (ii) One kilohertz (1 kHz);
          3. (iii) Two kilohertz (2 kHz); and
          4. (iv) Three kilohertz (3 kHz).
   11. (3) Medical consultant reviews the client’s case.
   12. (4) ENT recommendations, medical consultant recommendations, client’s vocational goals, Arkansas Rehabilitation Services hearing loss level requirements (measured in decibels), and Arkansas Rehabilitation Services financial requirements will be considered by the counselor while considering client’s eligibility for services.
   13. (5) If client is cleared to proceed with BAAI, the Arkansas Rehabilitation Services Hearing Aid Order Form must be submitted by the ENT or audiologist.

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

       1. (A) Realistic expectation;
       2. (B) Surgery;
       3. (C) Typical costs; and
       4. (D) Expected follow-up care.
   15. (7) Surgery occurs (typically outpatient).
   16. (8) Itemized invoice sent to counselor.

   17. (9)

       1. (A) For reimbursement, 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.
   18. (10) Follow-up care provided by the ENT and audiologist as needed.
   19. (11) Counselor support continues.
   20. (12) Refer client for assistive technology assessment if client still experiences vocational difficulties after BAAI implementation.

Codification Notes: “AC” means air conduction. "BAHA" means bone-anchored hearing aid. "CROS" means contralateral routing of signal. "ENT" means ears, nose, and throat. "HCPCS" means healthcare common procedure coding system. "PTA" means pure-tone average. "SRT" means speech reception threshold.