Providing a ‘Sound Start’ for Infants Needing Amplification

1. Providing a ‘Sound Start’ for Infants Needing Amplification Early Hearing Detection and Intervention (EHDI) Conference 2004 Karen M. Ditty Michelle King Toni Maxon Ilene Briskin

2. States with Insurance mandates for Hearing Aids: • Connecticut (October, 2001) • Kentucky (July, 2002) • Louisiana (January, 2004) • Maryland (2001) • Minnesota (August, 2003) • Missouri (current & pending) • Oklahoma (November, 2003)

3. Requirements vary between states for: • ages covered • amount of coverage • benefit period • provider qualifications • type of hearing loss • no states require a similar benefit for adults

4. Legislation in United States

5. Proposed Legislation in United States

6. PROVIDES Pays up to $1000. for hearing aids every 2 years Pays up to age 12 However, Children with a HL of >40dB are already funded for hearing aids through IDEA Part C monies DOESN’T PROVIDE Benefit does not really cover cost of digital hearing aids Connecticut:

7. Hearing Aid LegislationIn Kentucky Trish Freeman Pam Ison Michelle King

8. The Path to Hearing Aid Insurance Legislation • Get all interested parties involved • Research current legislation: Is there one you can model? • Identify key person to serve as “watchdog” and primary contact for sponsors • Find a message that resonates and repeat it over and over in various ways • Be prepared for opposition and to make concessions • Be persistent: don’t give up when you get discouraged

9. KY Origin: Parent Advocate • Proposed hearing aid legislation idea to KCDHH board and asked to form study group • Key goal was to bring together representatives from all major players in the deaf/HOH community

10. KCDHH Study Group • Once members were identified, the study group met to: • plan strategy for getting bill introduced and passed • draft language of bill that would be acceptable to all parties modeled after MD. • identify potential bill sponsors and co-sponsors • develop talking points • establish email network as mechanism for generating grassroots action when needed

11. Steps Taken to Generate Grassroots Support • Flyers – parents – community partners • Newsletter articles • Letters to Editor • Media Coverage • Flyers to Legislators • Email Network • Committee Testimony • Meetings with Key Legislators

12. 2002 Legislative Session • Bill introduced and passed this session: • SB152: An act relating to health insurance coverage for hearing aids

13. SB 152 AN ACT relating to health insurance coverage for hearing aids and related services.      Create a new section of Subtitle 17A of KRS Chapter 304 to require all health benefit plans to provide coverage for hearing aids and related services for persons under 18 years of age; amend KRS 18A.225 to require all health benefit plans for state employees to provide coverage for hearing aids and related persons for dependents under 18 years of age.

14. PROVIDES Hearing Aids/earmolds Related Services Up to age 18 Up to $1,400 per impaired ear every 36 months DOESN’T PROVIDE Batteries, cords For 18 and older for 40% of all insured in KY because self-funded plans don't have to follow the mandate SB 152 PRO/CON:

15. What the law means • Coverage – for some • Those outside of state jurisdiction are: • Self-funded insurance • ERISA is covered by the Department of Labor, Federal Employee Program, and Medicare. • The law only affects new or re-issued policies.

16. CURRENT STATUS • Some insurances are paying • Health Care Providers must seek verification and follow guidelines • Families must continue to be vigilant advocates for their children’s needs • Continue to push for improved legislation

17. Key Steps to Success • Inspiration • Motivation • Teamwork • Persistence www.lrc.state.ky.us/recarch/02rs/SB152.htm

18. Louisiana • PROVIDES • Allows parents to buy “Up” on digital hearing aids if they choose at their own cost. DOES NOT PROVIDE • self-funded plans do not have to abide by the mandate • Out of state insurance companies do not have to follow mandate. PROVIDES • Pays up to $1400. for hearing aids every 3yrs • Pays up to age 18 • However, Children are covered if are on Medicaid (approx. 35% of 1,359 Hearing Impaired in LA) • Children’s Special Health services provide hearing aids to a many more hearing impaired. Law intended to capture all other deaf and hard of hearing children.

19. Barriers to overcomein Louisiana • Hearing aid dealers wanted to join the legislation • Original plan was to only have Audiologists as providers of hearing aids for infants and children within the legislation • Dealers were included as most insurance carriers required a Masters degree to be providers and many would not qualify.

20. Barriers to overcomein Louisiana • Opposition from the insurance lobbyist • Critical to work on language with the insurance lobbyist so that the bill would not be opposed by the lobbyist. • Defining comprehensive audiometry correctly so that it would be appropriate for the population.

21. MARYLAND’S PLEDGE TO CHILDREN WHO ARE DEAF OR HARD OF HEARING DEBRA DOYLE ALLEN, M.A. ILENE BRISKIN, SC. D.

22. SETTING THE STAGE

23. BUILDING UNHS • Model • Reimbursement • Legislation • Awareness

24. BUILDING LEGISLATIVE SUPPORT • Awareness and education • State agency support • Voter interest • Special interest lobbying

25. 1999: UNIVERSAL NEWBORN HEARING SCREENING • All birthing hospitals to establish UNHS • Insurers to reimburse • Notification to be provided • Existing program and advisory council to be adapted

26. FROM UNHS TO EHDI • Community awareness • Amplification • Habilitation

27. Insurance Mandate For minor children $1400 per ear Licensed audiologist prescribes, fits and dispenses Hearing Aid Loan Bank Children 0-3 years Maryland State Dept. of Education Funding 2001: Reducing Barriers to Amplification

28. FOR MORE INFORMATION… • mlis.state.md.us • 1999: HB 884; UNIVERSAL NEWBORN HEARING SCREENING • 2001: HB 160; HEALTH INSURANCE – HEARING AIDS- COVERAGE FOR CHILDREN • HB 282; STATE DEPARTMENT OF EDUCATION – HEARING AID LOAN BANK PROGRAM – ESTABLISHMENT AND OPERATION

29. Minnesota DOES NOT PROVIDE • Self Insured carriers do not have to pay • Out of state carriers do not have to pay. • Hearing aids not covered unless hearing loss occurred at birth. PROVIDES • Pays for hearing aid for each year every 3 years. (no price limit set) • Pays up to age 18

30. CURRENTLY PROVIDES Hearing Aids Initial hearing aid only PROPOSED LEGISLATION Hearing Aids Related Services Up to age 18 Up to $1,400 per impaired ear every 36 months Missouri:

31. Oklahoma • Provides HAs to children <18 yrs. (previous bill was for <13 years) • Only licensed audiologists could dispense (hearing aid dealers were setting a standard of care of $500./HA) • Modified previous bill, but still needed more work. Stressed importance of being at the capitol to watch the bill as it goes through the process.

32. Grassroots efforts work!http://www.audiology.org/professional/gov/

33. http://capwiz.com/audiology/home/

34. http://www.asha.org/about/legislation-advocacy/grassroots

35. http://www.asha.org/about/legislation-advocacy/state/issues/ha_reimbursement.htmhttp://www.asha.org/about/legislation-advocacy/state/issues/ha_reimbursement.htm