1. (a)

   1. (1) Hearing aid services may be considered as part of an individual’s employment plan when the individual requires amplification to manage the required communication on the job.

   2. (2) The technology involved with hearing aids changes rapidly, and it is important that counselor and client understand the:

      1. (A) Employment-related communication requirements; and
      2. (B) Available options when providing amplification.

   3. (3)

      1. (A) The Access and Accommodations Program can provide recommendations as to listening devices and expertise regarding medical evaluations and reports.
      2. (B) To make a referral to Access and Accommodations, see Appendix B (Special Programs, Access and Accommodations) and Appendix E (Forms, Access and Accommodations).

2. (b)

   1. (1) To determine eligibility, the counselor will utilize medical reports issued within the past year by a licensed otologist, otolaryngologist, or ENT.
   2. (2) A report from the individual’s primary care physician may be utilized at the counselor’s discretion and with the approval of the manager.

   3. (3)

      1. (A) In all events, the individual must have an audiological or hearing aid evaluation performed or approved by a licensed audiologist or hearing instrument specialist with national board certification.
      2. (B) This evaluation must not be more than one (1) year old at the time of the eligibility determination.
      3. (C) A hearing instrument specialist must have three (3) years of experience and must have passed the NBC-HIS National Certification (see http://www.nbc-his.com) in order to be an approved vendor.

3. (c)

   1. (1) In order for an individual to be eligible for hearing aid services, the audiological or hearing aid evaluation must document significant improvement (with the addition of hearing aids) in speech reception, speech recognition, and discrimination awareness as to environmental sounds.

   2. (2) The evaluation must demonstrate unaided hearing loss of forty-one decibels (41 dB) or greater as measured by the speech reception threshold (SRT) or pure tone average (PTA), measured at:

      1. (A) One-half kilohertz (0.5 kHz);
      2. (B) One kilohertz (1 kHz);
      3. (C) Two kilohertz (2 kHz); and
      4. (D) Three kilohertz (3 kHz).

   3. (3) Thus, hearing loss must be at least moderate on the following hearing-loss scale, listed in decibels:

      1. (A) Normal: 10 to 15;
      2. (B) Slight: 16 to 25;
      3. (C) Mild: 26 to 40;
      4. (D) Moderate: 41 to 55;
      5. (E) Moderately severe: 56 to 70;
      6. (F) Severe: 71 to 90; and
      7. (G) Profound: 91+.

4. (d)

   1. (1) If hearing aids are indicated, the evaluation must:

      1. (A) Specify the suitable type of aid (analog or digital);
      2. (B) Provide the make and model; and
      3. (C) State whether the individual would benefit from monaural or binaural aids.
   2. (2) Hearing aid adjustments will be included as part of the Arkansas Rehabilitation Services purchase, subject to informed choice and the individual’s employment plan.
   3. (3) The evaluation must also include information on warranties, service plans, accessories, and other recommended services, if any.
   4. (4) All hearing aids should include a telecoil unless the audiologist or hearing instrument specialist can provide justification for why the client preferred an aid without telecoil connectivity.

5. (e) Procedures — Hearing aid services.

   1. (1) Preliminary and diagnostic.

      1. (A) Documentation of the action to be taken will be made in the case note.
      2. (B)

6. (i) Counselor will utilize medical reports issued within the past year by a licensed otologist, otolaryngologist, or ENT.

   1. (ii) A report from the individual’s primary care physician may be utilized at counselor discretion and supervisory approval.

      1. (iii) To the extent such diagnostic services are not covered by medical insurance available to the individual, Arkansas Rehabilitation Services may purchase the services.

      2. (C)

         1. (i) Counselor will utilize audiological or hearing aid evaluation issued within the past year from a state-licensed audiologist or nationally certified hearing instrument specialist.
         2. (ii) To the extent such evaluations are not covered by medical insurance available to the individual, Arkansas Rehabilitation Services may purchase the evaluations.
      3. (D) The Arkansas Rehabilitation Services hearing aid order form will be completed by the audiologist or hearing instrument specialist in order to provide the client and counselor a written estimate of hearing aid cost, make, model, type, warranty, service plan, and related information.
      4. (E) Counselor will meet with individual to discuss the medical reports and audiological/hearing aid evaluation.

   2. (2) Comparable benefits and selection of vendor.

      1. (A)

         1. (i) If the reports and evaluation conclude that hearing aids are indicated for the individual’s hearing loss, the counselor will discuss potential hearing aid vendors and comparable benefits.
         2. (ii) If hearing aids are not indicated, hearing aid services will not be provided (subject to further medical and audiological evaluation of the individual, as needed).

      2. (B)

         1. (i) Services are based on financial need and comparable benefits will be utilized.
         2. (ii) Counselor will verify whether the individual is covered by medical insurance that pays for hearing aids in whole or in part.
         3. (iii) Arkansas Rehabilitation Services will authorize purchase of the hearing aids recommended by the audiologist/hearing instrument specialist only after the counselor has reviewed written documentation of the amount of coverage or lack of coverage.
         4. (iv) Any available coverage will be used as the required comparable benefit.
         5. (v) Social Services Block Grants to defray the cost of hearing aids must also be considered.

      3. (C)

         1. (i) For purposes of informed choice, the counselor will refer to the Arkansas Rehabilitation Services approved vendor list and discuss possible vendors with the individual.
         2. (ii) If the evaluation from the audiologist/hearing instrument specialist recommends a type or brand of hearing aid that cannot be purchased from an approved vendor, the counselor may consider securing a W-9 from a new vendor that can fill the order.
         3. (iii) Regardless of the vendor selected, Arkansas Rehabilitation Services will issue payment based on the criteria below.

   3. (3) Payment for hearing aids.

      1. (A)

         1. (i) Invoices for hearing aids must be itemized.
         2. (ii) Each line item must correspond to the recommendations for the individual in the audiology/hearing aid evaluation.

      2. (B)

         1. (i) Line items for devices not recommended for the individual in the audiology/hearing aid evaluation may be rejected if inconsistent with the individual’s employment plan.
         2. (ii) Nonitemized or bundled invoices will be rejected and returned to the vendor.

      3. (C)

         1. (i) Each line item for a hearing aid or related device must include the appropriate billing code from the L or V sections of the HCPCS.
         2. (ii) Arkansas Rehabilitation Services may request further documentation to support a given L or V code, and may refuse payment if the vendor cannot provide the documentation requested.

      4. (D)

         1. (i) Used devices, if provided, must be disclosed on the invoice as “refurbished”, “used”, or “rebuilt”.
         2. (ii) Failure to disclose a refurbished device or to follow the Food and Drug Administration procedures may result in removal of the vendor from the Arkansas Rehabilitation Services approved vendor list.

      5. (E)

         1. (i) Counselor will verify that the individual received the device and is able to use it.
         2. (ii) Document in the ECF.
         3. (iii) Counselor will key required information into the case management system for Arkansas Rehabilitation Services purchase authorization.
      6. (F) Arkansas Rehabilitation Services will issue payment for new hearing aids and related devices according to the current Arkansas Workers’ Compensation fee schedule for the appropriate L or V code.
      7. (G) For used hearing aids and related devices, Arkansas Rehabilitation Services will pay seventy percent (70%) of the price indicated for the appropriate L or V code in the Arkansas Workers’ Compensation fee schedule.
      8. (H) For hearing aids and related devices (new or used) not covered by Arkansas Workers’ Compensation, Arkansas Rehabilitation Services will pay up to fifty percent (50%) of the total charges billed.
      9. (I) For individuals with insurance coverage for hearing aids and related devices, Arkansas Rehabilitation Services will issue payment after that coverage has been applied.
      10. (J) Counselor may refer client for assistive technology assessment if client still experiences vocational difficulties with hearing aids.

Codification Notes: “ECF” means electronic case file. "ENT" means ears, nose, and throat. "HCPCS" means Healthcare Common Procedure Coding System. "NBC-HIS" means National Board for Certification in Hearing Instrument Sciences.