1. The Maryland Hearing Aid Loan Bank A Bridge To Early Intervention Paul K.Farrell, Sue Griebler, Ilene Briskin

2. 1972 Parent-Infant Pilot Program (0-4) in 2 counties 1975PL 94-142 1979Birth Mandate State 1985Program to Identify Hearing Impaired Infants 1987Maryland Infants & Toddler Program 2000Maryland Universal Newborn Hearing Screening 2002Maryland Hearing Aid Loan Bank History of Maryland Early Identification of Hearing Loss & Intervention

3. 1985: HIGH RISK REGISTRY Identify Risk Factors Identify Risk Factors –NICU more than 48 hours –Anatomical malformation –Asphyxia –Bacterial meningitis –Low birthweight –Perinatal infection –Family history –Hyperbilirubinanemia Program for Hearing Impaired Infants at the Maryland State Department of Health and Mental Hygiene (DHMH) Program for Hearing Impaired Infants at the Maryland State Department of Health and Mental Hygiene (DHMH) Advisory Council Advisory Council

4. MARYLANDS PATH TO UNIVERSAL NEWBORN HEARING SCREENING

5. COLLABORATION American Academy of Pediatrics American Academy of Pediatrics A.G. Bell Association A.G. Bell Association Advisory Council Advisory Council Educational Audiology Assoc. Educational Audiology Assoc. Johns Hopkins Hospital Johns Hopkins Hospital Md. Academy of Audiology Md. Academy of Audiology Md. Hospital Assoc. Md. Hospital Assoc. Md. Speech, Language, Hearing Association Md. Speech, Language, Hearing Association University of Maryland Hospital University of Maryland Hospital The Maryland Department of Health and Mental Hygiene The Maryland State Dept. of Education CUSHION (Coalition for the Universal Screening of Hearing in Our Newborns) CUSHION (Coalition for the Universal Screening of Hearing in Our Newborns)

6. Awareness & Legislative Support Legislators Legislators –High Risk registry –Public Policy days –Constituent lobbying and testimony –Professional lobbying –Informational materials Insurers Insurers State agency support State agency support Other citizens and related advocacy organizations Other citizens and related advocacy organizations

7. FINANCIAL CONCERNS Maryland Health Care Commission Maryland Health Care Commission Insurance Industry Insurance Industry Fiscal note: Cost/Benefit study Fiscal note: Cost/Benefit study

8. 1999: UNIVERSAL NEWBORN HEARING SCREENING All birthing hospitals establish UNHS All birthing hospitals establish UNHS Insurers reimburse Insurers reimburse Notification provided Notification provided Existing program & Advisory Council expanded and administered by DHMH Existing program & Advisory Council expanded and administered by DHMH

9. From Universal Newborn Hearing Screening to the Hearing Aid Loan Bank Community awareness Community awareness –Public Service Announcement Amplification legislation Amplification legislation –Grant support –Modified prior legislative approach Habilitation: In process Habilitation: In process

10. 2001: REDUCING BARRIERS TO AMPLIFICATION MEDICAL ASSISTANCE MEDICAL ASSISTANCE INSURANCE MANDATE INSURANCE MANDATE –For minor children –$1400 per ear –Licensed audiologist prescribes, fits and dispenses –Exceptions »Out of state employers and insurers »ERISA plans HEARING AID LOAN BANK HEARING AID LOAN BANK –Maryland State Dept. of Education –Children 0-3 years –Funding –Licensed audiologist prescribes, fits and dispenses –First earmolds provided

11. Mission The Hearing Aid Loan Bank will provide access to amplification as soon as possible following a diagnosis of hearing loss in an infant or toddler. This is essential to emerging language and healthy social/emotional development that are the foundation for school readiness and success.

12. Getting Started The basics: Getting off the ground The basics: Getting off the ground How does the loaner program work? How does the loaner program work? Who qualifies for the program? Who qualifies for the program? Hearing Aid Loan Period Hearing Aid Loan Period Budget Outline Budget Outline Hearing Aids and Earmolds Hearing Aids and Earmolds Manufacturer support Manufacturer support

13. The Basics: Getting off the ground Application Application Policies & Procedures Policies & Procedures Audiologist Survey Audiologist Survey Brochure Brochure Purchasing Purchasing Public Awareness Public Awareness Family Satisfaction Survey Family Satisfaction Survey

14. How the Loan Bank Works Universal Newborn Hearing Screening Protocol Confirmation Of Hearing Loss By Hospital/Community Audiologist Referral to Local Infants & Toddlers program Referral to Loan Bank Permanent Hearing Aids Or Cochlear Implant LITP Service Coordinator Audiology Services

16. Who qualifies for the program? Uninsured Uninsured Underinsured Underinsured Experience delays in acquiring hearing aids Experience delays in acquiring hearing aids Uncertain audiologic diagnosis Uncertain audiologic diagnosis Families accessing use of alternative technology, i.e, cochlear implant Families accessing use of alternative technology, i.e, cochlear implant

17. How to Apply for Hearing Aids Referring Audiologist Information: All audiometric data (e.g. OAE/ABR,BOA) All audiometric data (e.g. OAE/ABR,BOA) A recommendation for suitable amplification A recommendation for suitable amplification Medical Clearance for hearing aids from childs physician Medical Clearance for hearing aids from childs physician Parent/Legal Guardian Information: Statement indicating the reason the parent or guardian has no immediate access to hearing aids Statement indicating the reason the parent or guardian has no immediate access to hearing aids Statement indicating insurance coverage, or a lack of coverage Statement indicating insurance coverage, or a lack of coverage A statement indicating the reason assistance from the loan bank is requested A statement indicating the reason assistance from the loan bank is requested

18. Hearing Aid Loan Period Standard length of the hearing aid loan is six-months. Standard length of the hearing aid loan is six-months. A loan extension, in 3 month intervals, may be granted upon written request from the parent. A loan extension, in 3 month intervals, may be granted upon written request from the parent.

19. Budget Outline Personnel Personnel Communications Communications Travel Travel Contractual Services Contractual Services Supplies Supplies Equipment Equipment

20. Hearing Aids and Earmolds Digital Hearing Aids - Binaural Fitting Digital Hearing Aids - Binaural Fitting Earmolds (1st set) Earmolds (1st set) The dispensing audiologist is responsible for fitting and monitoring the hearing aid and earmold during the loan period

21. Manufacturer Support Educate key sales representative Educate key sales representative Discount purchasing Discount purchasing Donations on individual case basis Donations on individual case basis

22. Making a Difference May- Dec. 2003 May- Dec. 2003 20 Hearing Aids disbursed to 10 families In 2004 61 hearing aids were disbursed to 32 families In 2004 61 hearing aids were disbursed to 32 families

23. The Good News! As of March, 2005 the return rate for loaned hearing aids is 100%

24. Maryland Infants and Toddlers Staff Development Programs Grants from DHMH/Sponsored by MSDE Beginning the Journey:Intervention for Infants and Toddlers with Hearing Loss and their Families - 2003 Beginning the Journey:Intervention for Infants and Toddlers with Hearing Loss and their Families - 2003 Continuing the Journey: Supporting Families in Understanding: The Grieving Process Associated with Hearing Loss and Intervention with Infants and Toddlers with Cochlear Implants - 2004 Continuing the Journey: Supporting Families in Understanding: The Grieving Process Associated with Hearing Loss and Intervention with Infants and Toddlers with Cochlear Implants - 2004 Team Collaboration: Everyone Has a Role to Play - 2005 Team Collaboration: Everyone Has a Role to Play - 2005 Parent support and participation is an integral part of each conference

25. Strengths SchoolReadiness EI Early Intervention EI EI EI EarlyDetection Of Hearing LossUNHSUNHS UNHS Loan Bank Fast Access Hearing Aids

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

27. Contact Information Paul K. Farrell Director, Maryland Hearing Aid Loan Bank (410) 767-0739 pfarrell@msde.state.md.us Sue Griebler Educational Consultant (410) 767-2331 sgriebler@msde.state.md.us Ilene Briskin Education\Health Care Consultant Public Policy\Grant Writing ilenebriskin@comcast.net