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

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

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

Legislation in United StatesStateAgeFreqAmount Who pays CT <12yrs 2 yrs $1000./HA Individual and Grp. KY <18yrs 3 yrs $1400./HA Group and state. No self funded coverage LA <18 yrs 3yrs$1400./HA Any health insurance MDMinors 3 yrs. $1400./HA Any health insurance MN <18yrs HL 3 yrs not listed Fully insured no self funded coverage MO* Initial HA for infants initial Not listed Any health Insurance OK <18yrs 4 yrs No limit Any health plan, No self pay or ERISA

Proposed Legislation in United StatesStateAgeFreqAmount Who pays MO <19yrs 3yrs$1250./HA Every Health Carrier offering health benefit plans that are delivered, issued for delivery, continued or renewed after 1/1/2005

Connecticut: PROVIDES Pays up to $1000. for hearing aids every 2 years Pays up to $1000. for hearing aids every 2 years Pays up to age 12 Pays up to age 12 However, Children with a HL of >40dB are already funded for hearing aids through IDEA Part C monies 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

Hearing Aid Legislation In Kentucky Trish Freeman Pam Ison Michelle King

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

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

KCDHH Study Group Once members were identified, the study group met to: 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 network as mechanism for generating grassroots action when needed

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

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

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. 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.

SB 152 PRO/CON: PROVIDES Hearing Aids/earmolds Hearing Aids/earmolds Related Services Related Services Up to age 18 Up to age 18 Up to $1,400 per impaired ear every 36 months 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

What the law means Coverage – for some Coverage – for some Those outside of state jurisdiction are: 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. The law only affects new or re-issued policies.

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

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

Louisiana PROVIDES Pays up to $1400. for hearing aids every 3yrs Pays up to $1400. for hearing aids every 3yrs Pays up to age 18 Pays up to age 18 However, Children are covered if are on Medicaid (approx. 35% of 1,359 Hearing Impaired in LA) 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. 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. PROVIDES 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.

Barriers to overcome in Louisiana Hearing aid dealers wanted to join the legislation 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.

Barriers to overcome in Louisiana Opposition from the insurance lobbyist 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.

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

SETTING THE STAGE DEMOGRAPHICS CUSHION HISTORY

BUILDING UNHS  Model  Reimbursement  Legislation  Awareness

BUILDING LEGISLATIVE SUPPORT  Awareness and education  State agency support  Voter interest  Special interest lobbying

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

FROM UNHS TO EHDI  Community awareness  Amplification  Habilitation

2001: Reducing Barriers to Amplification  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

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

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

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

Oklahoma Provides HAs to children <18 yrs. (previous bill was for <13 years) 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) 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. 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.

Grassroots efforts work!

advocacy/state/issues/ha_reimbursement.htm