Government Affairs - Florida Academy of Audiology (FLAA)

Statement on Consumer-Administered Hearing Tests and Direct-To-Consumer Hearing Aid Sales

The Academy of Doctors of Audiology (ADA), the American Academy of Audiology (AAA), the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), the American Speech-Language-Hearing Association (ASHA), and International Hearing Society (IHS) have issued a joint position statement on Consumer-Administered Hearing Tests and Direct-to-Consumer Hearing Aid Sales.

Please click here to view the statement.

2011 Session Dates

posted December 20, 2011

Below are the committee weeks as they are currently scheduled. Of course we won’t know how each week looks until it gets closer. Generally they start short and get progressively longer.

Legislative Committee Weeks in Tallahassee
– The week of December 6
– The week of January 10
– The week of January 24
– The week of February 7
– The week of February 14
– The week of February 21

The actual schedule for each week will be distributed as early as possible prior to the notice deadline. Although some weeks may be more heavily scheduled, most will begin no earlier than Monday afternoon and run through Thursday afternoon.

Regular Session convenes on Tuesday, March 8, 2011.

Government Affairs Update

Just a short update on what’s been going on.

Legislative Session is over for 2010. We were concerned that our licensure might come up for sunset but it didn’t. We will continue to watch for this in the next legislative session.
As of now, we have avoided the 21.3% reduction on Medicare Part B payments. Both the House and the Senate passed an amended version of H.R. 4851 thus extending the 20009 rates through May 31, 2010. It is thought that Congress will look for a more long-term solution to this Medicare Part B reimbursement issue in June.
In the Senate, on April 14th, a bipartisan bill was introduced, S.3199, the Early Hearing Detection and Intervention (EHDI) Act of 2010. Encourage your Senator to support this bill which would authorize funding for early hearing loss detection and intervention activities for 2010 through 2015,
We are still working on direct access. The ADA Advocacy Committee is in the process of offering assistance to drat and disseminate communications in support of Direct Access.
The House of Representatives adopted a Health Reform Reconciliation bill which amends the Senate’s overall health reform bill. The FDA Class 1 medical device tax exemption was dropped, however, a specific hearing aid exemption was retained. Therefore, hearing aids are excluded from the tax.

We will keep you posted on any issues in the next Advocate.

Code Alert!

The AMA’s Current Procedural Terminology (CPT) coding system, the coding system we use for the majority of our insurance billing, has a few updates relevant to audiology for 2010. They have bundled some of the impedance codes, as well as some of the ENG codes. The bundled codes are as follows.

92550 will be reported when you perform tympanometry and acoustic reflex testing instead of reporting 92567 (tympanometry) and 92568 (acoustic reflexes). 92570 will be reported if you perform tympanometry, reflexes and acoustic reflex decay. If you just perform tympanometry, you will continue to code 92567. The code 92569, acoustic reflex decay, will be eliminated, as that is typically not reported in isolation.

For ENG testing, you will now use code 92540 if you perform Spontaneous and Gaze tests (92541), Positional testing (92542), Optokinetic testing (92544) and Tracking (92545). The individual codes will remain in place should you only perform one of the procedures on a given day. Also, based on a Medicare Correct Coding Initiative (CCI) edit, you may only bill one of the individual codes on any given date of service. Calorics will continue to be billed using code 92543, one unit of service for each caloric performed, up to a maximum of four units of servcice. Utilizing the new codes, a typical ENG will be billed as 92540 and 92543×4.

As can be expected, the new codes result in significant reductions in reimbursement from Medicare. This is in addition to the reductions already budgeted to take place in 2010. For example, in the 2010 Florida Area 03 fee schedule, tympanometry alone (92567) will pay $16.03, acoustic reflexes (92568) will pay $17.04. The bundled code for tympanometry and reflexes (92550) will only pay $21.02. If reflex decay testing is included, the total reimbursement for code 92570 is only $32.27.

The bundled ENG code 92540 results in more drastic cuts in reimbursement. If codes 92541, 92542, 92544 and 92545 were billed separately, the total would be $187.42. While already a significant cut from 2009 rates, the bundled code results in an even lower payment of only $96.82. Remember, Medicare law REQUIRES you to use bundled codes.

A new code for Epley Maneuver was introduced in 2009: code 95992. That is good news, bad news, bad news and good news.

The good news is that there is finally a code to accurately report treatment for BPPV that is not a physical therapy, time-based code. The bad news is that Medicare considers it treatment. As such, audiologists are excluded from billing for it. The other bad news is that Medicare has also valued the procedure at $0.00. This means that even if we could bill for it, the reimbursement would be $0.00. The good news is that Medicare excludes us from billing for it. As a result, you can still perform the procedure and have the patient pay out of pocket for your excellent services. You need to inform them that Medicare may cover the procedure if performed elsewhere, and have them sign the Advance Beneficiary Notice (ABN) form. They then have the option of having you perform the service and paying out of pocket.

There are some important ramifications here, as many insurers look to Medicare for what they should cover. You will need to determine if, or what any third party payers that you may be contracted with will pay for canalith repositioning. You will also need to determine if your contract allows you to have the patient pay you out of pocket for non-covered services.

Mean User Gain Setting for CIC Hearing Instruments
By Fred Rahe, Au.D.

Legislation was recently introduced in Florida (Rahe, 2008) that would have essentially deregulated hearing aids with less than 30dB of gain. This provokes the question: how many hearing aids are actually worn with a gain setting of 30dB or less. This is an important question in that if a majority of hearing aids actually utilize less than 30dB gain, the above mentioned legislation would effectively remove consumer protection from a significant portion of the hearing impaired public seeking assistance from hearing aids.

Today’s commercially available hearing aids are digital and can be programmed to a wide degree of gain and output settings. The question to be addressed here is not the capabilities of the instruments, rather the typical setting actually in use.

The prevalence of hearing loss in the United States population has been reported at 16.1%, or 29 million Americans (Agrawal, Platz and Niparko, 2008). The prevalence in older adults has been reported as high as 45.9% (Cruickshanks, et al, 1998). The distribution of range of hearing loss in the over 65 population has been reported as follows: Mild: 39%, Moderate 17.4%, Severe: 2.9% and Profound 0.6% (Arpesella, et al, 2008). In other words, 94% of the hearing impaired elderly have mild or moderate hearing loss, with only 6% having a severe or profound loss.

If one looks at the fitting ranges of basic digital completely-in-the-canal (CIC) hearing instruments from four leading hearing aid manufacturers (Figure 1), they all report being suitable for up to 60-70dB of hearing loss. Therefor, one can conclude that, based on gain capability, CIC instruments would be appropriate for up to 94% of the hearing impaired elderly population. To this end, we believe that user gain settings of CIC instruments would appropriately reflect preferred gain and output settings for up to 94% of hearing aid consumers.

Methods

We elected to look at the user gain settings of CIC hearing aids sent into an all-make repair lab. We believe that looking at instruments sent in for repair will most accurately reflect actual user gain settings. An all make repair lab will remove bias resulting from looking at only one manufacturer. Gain and output measurements were made after the instruments were repaired to factory standards and reprogrammed to user settings. Gain and output strips of 81 randomly selected CIC instruments repaired in a one-month period were analyzed.

Results

The means and standard deviations for the gain, HFASSPL90 and maximum output are seen in Table 1. As can be seen, the average gain for 81 instruments is 17.15, with a standard deviation of 8.22. This means the 65% of the hearing aids had a user gain setting between 8.93 and 25.37dB. The distribution of gain settings followed a normal distribution pattern (Figure 2).

Figure 2: Distribution of user gain settings.

Results for maximum output were a mean of 105.33dB, with a standard deviation of 7.06dB. Results for High Frequency Average SSPL90 were 100.56 and 8.12dB, respectively.

Conclusions

The mean user gain setting of 81 CIC hearing aids was 17.15dB, with a standard deviation of 8.22. This is in agreement with the findings of Cox and Alexander (1991) that found the mean user preferred gain setting in patients with mild to moderately severe hearing loss to be 13.7dB. The findings in the present study are in hearing aids that are suitable, based on manufacturer stated fitting ranges, for over 90% of the elderly hearing impaired population. Clearly, de-regulating hearing aids with less than 30dB of gain would strip the majority of consumers of protection provided by legislation regulating the sale of hearing aids.

Acknowledgements

Thanks to Kurt Eckman at C&K Labs, Inc. for taking the time and effort to provide the hearing aid test strips.

References

Agrawal, Y., Platz, E.A., & Niparko, J.K. (2008) Prevalence of hearing loss and differences by demographic characteristics among US adults, Archives of Internal Medicine, 168, (14), 1522-30.

Arpesella, M., Ambrosetti, U., DeMartini, G., Emanuele, L., Lottaroli, S., Redaelli, T., Sarchi, P., Segagni Lusignani, L., Traverso, A. & Cesarani, A. (2008) Prevalence of hearing loss in elderly individuals over 65 years of age, Ig Sanita Pubbl., 64, (6), 611-21.

Cox, R.M & Alexander, G.C. (1991) Preferred hearing aid gain in everyday environments. Ear and Hearing, 12, (2), 123-6.

Cruickshanks, K.J., Wiley, T.L., Tweed, T.S., Klein, B.E., Klein, R., Mares-Periman, J.A. & Nondahl, D.M. (1998) Prevalence of hearing loss in older adults in Beaver Dam, Wisconson, American Journal of Epidemiology, 148, (9), 879-86.

Rahe, F. A., (2008) Bill to legalize mail order hearing aids fails in Florida. Audiology Advocate, Vol. 10, No. 3, 10.

Attention FLAA Members!

Important information regarding required information on your hearing aid receipts.

It is your responsibility to make sure that the contact information for filing a complaint in your receipt is current. The current required wording, as of 2/5/09 is as follows:

64B20-8.008 Requirements Regarding Certain Information on the Receipt.

(1) The receipt required by Section 468.1245(2), Florida Statutes, shall state that any complaint concerning the hearing aid and guarantee therefor, if not reconciled with the licensee from whom the hearing aid was purchased, should be directed to: Department of Health, Consumer Services Unit, 4052 Bald Cypress Way, Bin C-75, Tallahassee, Florida 32399-3275, (850)245-4339. This information shall be displayed in 10 Point Type or Larger, on the same side of the receipt where the client signs, and no other telephone number of any other agency, society, or bureau shall be displayed on that side of said receipt.

Please be aware that this information can change, and you can not count on the State to notify you of the change. They will fine you if your receipts are not correct, however. If we become aware of any changes, we will update the information on our web site.

You may also check on-line at the Speech and Audiology Licensing Board’s web site:

http://www.doh.state.fl.us//mqa/speech/sa_lic_req.html

Click on consumer information, and follow links for filing a complaint.

You may also go to:

www.flrules.org and look up Rule 64B20-8.0008

Legislative Notice

Direct Access Bill Introduced

The Academy’s efforts on Capitol Hill have led to the introduction of the “Medicare Hearing Health Care Enhancement Act of 2007” (HR 1665 – Direct Access bill) in the U.S. House of Representatives. Sponsored by Representative Mike Ross (D-AR), this bipartisan legislation would allow Medicare beneficiaries the option of going directly to a qualified audiologist for hearing and balance diagnostic tests. Currently, Medicare requires that beneficiaries with hearing loss or balance disorders obtain a physician referral before seeing an audiologist. Senator Tim Johnson (D-SD) intends to introduce the bill in the Senate when he returns to the office. We urge you to Contact your Representative today and encourage them to sign on as a cosponsor for this bill.

Bill to Legalize Mail Order Hearing Aids Fails in Florida

Fred Rahe, Au.D., Vice President Professional Issues

An amendment was introduced in the last days of the 2008 Florida legislative session that would have legalized mail order sale of certain types of hearing aids. While first appearing innocuous enough as legislation to allow for the sale of hunters’ amplifiers, shooter’s compression and other assistive hearing devices, it became clear that it was a veiled attempt to allow for the sale of mail order and over the counter hearing aids. Fortunately, the amendment was not passed.

The amendment was introduced at the request of several manufacturers of mail order hearing aids. The word is that they are already planning on filing the legislation again next year, and have a team of lobbyists lined up to promote the change. We will be monitoring this closely. The legislation as introduced was as follows:

Notwithstanding any provision of law, “hearing aid” does not include and specifically excludes frequency specific enhancement devices used by sportsmen, hunting deafening devices, ear plugs, and other assistive listening devices of 30 decibels or less, which are not specifically and individually fitted for a hearing impaired person.