Medicaid Reimbursement of Hearing Services for Infants and Young Children

Abstract

As newborn hearing-screening programs have expanded, more and more infants and young children need hearing services. Medicaid is one of the primary sources of funding for such services and, by law, must establish payment rates that are sufficient to enlist enough providers to provide services. In this study we compared 2005 Medicaid reimbursement rates for hearing services for infants and young children in 15 states with the payment rates for the same services by Medicare and commercially available health insurance. On average, Medicaid rates for the same services were only 67% as high as Medicare and only 38% as high as commercial fees. Furthermore, most Medicaid rates declined from 2000 to 2005, and many states did not have billing codes for a significant number of the hearing services needed by infants and young children. These factors likely contribute to infants and young children with hearing loss not being able to get the hearing services they need to benefit from early identification of hearing loss. These data also raise questions about the extent to which states are meeting the federal requirement that Medicaid payments be sufficient to enlist enough providers so that care and services are adequately available to the general population in the geographic area.

Evaluation of the Universal Newborn Hearing Screening and Intervention Program

“…Compounding this problem is the difficulty involved in evaluating infants, because it necessitates specialized equipment and often requires extra time for testing. As noted elsewhere in this supplemental issue, 14 pediatric audiologists are generally reimbursed poorly for diagnostic services, and payment rates by both public and private insurance systems do not reflect the time-intensive nature of pediatric audiology services.…”

“…14,17 Children with no insurance are less likely to have a usual provider who can act as their medical home. Cost or lack of insurance was also identified as a major barrier to audiology evaluations in one-third of the states.…”

Ensuring Financial Access to Hearing Aids for Infants and Young Children

“…26 As discussed in detail elsewhere in this supplemental issue, 27 access to appropriate hearing aids and related professional services is nonetheless limited for children covered by Medicaid because of low reimbursement rates in many states, coverage restrictions and limits, limited availability of pediatric audiologists, restrictions caused by definitions of medi-cal necessity, and difficulties experienced by providers in obtaining timely authorization and reimbursement.…”

Programa de tamizaje universal e intervención precoz (PTUIP) en hipoacusia sensorioneural bilateral congénita: Tarea pendiente desde la perspectiva de políticas públicas de salud en Chile

“…En la mayoría de los programas de tamizaje universal se ha implementado una estrategia en dos pasos, por ser costo efectiva y más certera 34 . Lo habitual es la realización de OEA en todos los niños como primer paso, y la realización de PEAT-A en los niños que no pasen las OEA, y en casos de niños con factores de riesgo conocidos para hipoacusia 35 .…”