- (1) These requirements are in addition to those contained in rule provisions generally applicable to Medicaid providers.
- (2) Over-the-counter hearing aids are not a covered benefit.
(3) A prescription hearing aid may be covered under the Medicaid program if all of the following conditions are satisfied:
- (a) the member's physician or mid-level practitioner has referred the member to an audiologist for an audiological evaluation;
- (b) the licensed audiologist has determined a prescription hearing aid would be effective in improving the member's hearing;
- (c) the licensed audiologist's evaluation has concluded that the member requires a prescription hearing aid or aids;
- (d) prior authorization for the prescription hearing aid has been granted by the department or its designated review organization; and
- (e) the prescription hearing aid is provided by a licensed hearing aid dispenser or an audiologist.
- (4) The date of service is defined as the date the prescription hearing aid(s) is ordered by the dispenser.
- (5) For members aged 21 or over, a replacement prescription hearing aid purchased by Medicaid requires prior authorization.
Authorizing statute(s): 53-2-201, 53-6-113, MCA
Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-141, MCA
History: NEW, 1980 MAR p. 973, Eff. 3/14/80; AMD, 1987 MAR p. 895, Eff. 7/1/87; AMD, 1988 MAR p. 596, Eff. 3/25/88; AMD, 1988 MAR p. 758, Eff. 4/15/88; AMD, 1990 MAR p. 1326, Eff. 7/13/90; AMD, 1998 MAR p. 2168, Eff. 8/14/98; AMD, 1999 MAR p. 1379, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 481; AMD, 2009 MAR p. 2485, Eff. 1/1/10; AMD, 2011 MAR p. 2293, Eff. 10/28/11; AMD, 2024 MAR p. 2024, Eff. 8/10/24.