Hearing Services And
Devices
Michigan Department of Health & Human Services
P u t t i n g p e o p l e f i r s t , w i t h t h e g o a l o f h e l p i n g a l l M i c h i g a n d e r s l e a d h e a l t h i e r
a n d m o r e p r o d u c t i v e l i v e s , n o m a t t e r t h e i r s t a g e i n l i f e .
New Provider and Policy Updates Webinar
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MDHHS HEARING SERVICE
PROVIDER VIRTUAL WEBINAR
▪ Welcome to MDHHS New Hearing Services Provider and
Policy Updates Virtual Training
▪ You may download the presentation documents along with
Adobe user guide within the files pod
▪ Please note: Audio is via your computer speakers.
o For additional information regarding audio please
download and follow the instructions in the Adobe User
Guide located in the Files Pod above.
o Select the Adobe User Guide document the Download
File(s) button will appear, click on the button and follow
the instructions.
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HEALTH CARE PROGRAMS
MICHILD
MEDICAID
HEALTHY
KIDS
Children's
Special Health
Care Services
(CSHCS)
* Not a complete list of available programs*
HEALTHY
MICHIGAN
PLAN
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PROGRAM ELIGIBLITY
MICHILD/HEALTHY KIDS
• Under age 19
• Income test
• $10 per family
monthly premium for
MIChild
• Comprehensive
package of health care
benefits including
audiology services
MEDICAID
• Parents and people
who act as
parents, caring for a
dependent child
• Aged, blind, or
disabled individuals
• Income and asset test
• Comprehensive
package of health care
benefits including
audiology services
• 19-64 years of age
• Income at/below 133% FPL
• Does not qualify
for/enrolled in Medicare or
other Medicaid programs
• Not pregnant at the time of
application
• Comprehensive package of
health care benefits including
audiology services
HEALTHY MICHIGAN PLAN
*For more information: Health Care Coverage
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◦ Created to find, diagnose, and treat children in Michigan who have chronic
illness or disabling conditions
◦ Individuals less than 21. (Exception: cystic fibrosis and certain coagulation
disorders)
◦ Income is not a factor in determining eligibility
◦ 2,500 different covered diagnoses.
❖ Examples: Hearing Loss, Diabetes, Epilepsy, Muscular Dystrophy,
Cerebral Palsy, Cleft Palate/Cleft Lip
❖ Diagnoses must meet a set of criteria such as: chronicity, severity, and
need for treatment by a Physician Sub-specialist
◦ Beneficiary may have CSHCS AND a commercial, Medicaid, or other primary
insurance
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HOW CSHCS CAN HELP
◦ Pays specialty services related to
qualifying diagnosis if Provider is
Medicaid enrolled and agrees to
accept client
◦ Assistance with Other Insurance
Premiums
◦ Care Coordination
◦ Community Resources
◦ Hearing Aids/Hearing Aid
Batteries
◦ Pharmacy/Medical Supplies
◦ Qualified Skilled Nursing Respite
◦ Therapies
◦ Transportation/Accommodation
◦ Equipment needs
◦ Wheelchairs
◦ Walkers
CSHCS does NOT cover primary care or mental health care
*For more information: Children's Special Health Care Services
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CHAMPS
Additional Information: CHAMPS Overview
➢ MI-Login Registration Instructions
➢ Information on each Subsystem (Tabs)
within CHAMPS
➢ Beginner User Guides
➢ Additional Webinars/Trainings
o A web-based, rules-driven, real-time Adjudication Medicaid
Management System.
o Uses: eligibility verification, provider enrollment, prior authorization
request submission, claim status
o All persons wishing to access CHAMPS must apply for a MILogin user
name and password then subscribe to the CHAMPS application.
www.michigan.gov/medicaidproviders
>> CHAMPS
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PROVIDER ENROLLMENT
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REGISTRATION
REGISTER FOR A CHAMPS MILOGIN ACCOUNT
Required to access the CHAMPS system. All users who need access to information
within CHAMPS must obtain a MILogin user ID and password. After completing
SIGMA registration allow 3 5 business days to begin and complete the CHAMPS
MILOGIN application.
REGISTER FOR SIGMA
Providers must have their Social Security Number , Employer Identification
Number, or Tax Identification Number (TIN) enrolled with SIGMA Vendor Self
Service (VSS) prior to starting the enrollment process in CHAMPS.
SIGMA Web Address: www.Michigan.gov/SIGMAVSS .
*Rendering/Servicing Only providers do not have to register with SIGMA.
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DECIDE ON A DOMAIN
ADMINISTRATOR
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ST
MILogin user who submits
the Provider Enrollment
application becomes the
Provider Domain Administrator
The Domain Administrator has
the responsibility of assigning
rights for all users within the
organization
Multiple Domain
Administrators may be
established for a single
organization, but a separate
application must be completed
and approved for each
administrator.
Complete Information and
Instructions:
Domain Administrator
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INDIVIDUAL/SOLE
PROPRIETOR
Type 1 NPI. May also have
Type 2
Provider that owns his/her
own practice
Receive directs payments
from MDHHS for services
rendered at his/her practice
May associate to other
entities. Or Servicing providers
may associate to them
RENDERING/SERVICING
Provides services through a Group,
Organization, or Individual/Sole
Proprietor
Type 1 NPI
Does not bill Medicaid directly
Associated Billing Provider submits
claims and receives payments on
their behalf
PROVIDER TYPES
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PROVIDER TYPES
Group
Organization of
individual providers
Type 2 NPI
Servicing Providers
associate to the
Group
Providers associated will not
be able to complete a new
enrollment until the Group
has been approved in
CHAMPS.
Facility, Agency, or
Organization (FAO)
Entity (i.e. Hospitals,
Nursing Facilities,
Laboratories)
Servicing Providers
may associate to a FAO
Type 2 NPI
Providers associated will not be
able to complete a new enrollment
until the FAO has been approved in
CHAMPS
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ENROLL
❑ Complete each step and submit application. All Applications must be
completed and submitted within 30 calendar days of the original start date or
they will be deleted.
❑ Take note of your Application ID for tracking
❑ Providers will receive a letter letting them know whether they have been
approved or denied. The letter is sent to the Correspondence address
provided in the Enrollment Application.
❑ Step by Step Enrollment Guide
www.michigan.gov/medicaidproviders
>> Provider Enrollment
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HEARING SERVICE
AND DEVICE
COVERAGE
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Medicaid Provider Manual – Hearing Services Chapter
▪ Documentation Requirements
▪ Standards of Coverage
▪ Payment Rules
▪ Billing Instructions
Rate and Reference Tool – External Links Menu within CHAMPS
▪ Procedure Code Coverage, Rates, Limits, PA Requirements
COVERAGE RESOURCES
**UPDATED**
Medicaid Provider Manual
www.michigan.gov/medicaidproviders >>
Policy, Letters, & Forms >> Medicaid Provider
Manual
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Medicaid Fee Schedules – Hearing Services/ Hearing Aid Dealers
▪ Hearing Services: Audiologist covered CPTs
▪ Hearing Aid Dealers: Audiologist or Hearing Aid Dealers covered
CPTs/HCPCS
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COVERAGE RESOURCES
Hearing Services and Devices Fee Schedule
www.michigan.gov/medicaidproviders >> Billing &
Reimbursement >> Provider Specific Information
HEARING AIDS
Service Maximum: 1 per 5 years
MDHHS participates in a Multi-State Volume Purchase Hearing
Aid contract. Models should be selected from the contract list
whenever possible. Aids are ordered and purchased by the
provider directly from participating hearing aid vendors.
No PA is required for contract aids. This includes CROS/BICROS
models.
Contract Models and Vendors list maintained on MDHHS website.
**CHANGE**
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**UPDATED**
Age: Under
21 Years
❖ Hearing loss of 25 dB HL or greater in the ear to be aided
Age: 21 Years
or Over
❖ Hearing loss of 30 dB HL or greater in the ear to be aided
❖ A Hearing Handicap Inventory for Adults, Hearing Handicap
Inventory for the Elderly, Abbreviated Profile of Hearing Aid
Benefit, or similar inventory indicates a need for
amplification
❖ Hearing loss interferes with or significantly restricts
functional communication, routine activities of daily living,
education, and/or employment
Digital Monaural/Binaural Hearing
Aids Standards of Coverage:
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Contralateral Routing Hearing Aids
Standards of Coverage:
**UPDATED**
All Ages
❖Profound hearing loss in the poorer ear as demonstrated
by greater than 90 dB HL and indicates thresholds less than
or equal to 30 dB HL in the better ear;
OR
❖Profound hearing loss in the poorer ear as demonstrated
by greater than 90 dB HL and indicates a hearing loss
greater than 25 dB HL in the better ear
Age: 21 Years
or Over
In addition, adults must have:
❖A hearing inventory that indicates a need for amplification
(i.e. Hearing Handicap Inventory for Adults, Hearing
Handicap Inventory for the Elderly)
❖A hearing loss that interferes with or significantly restricts
functional communication, routine activities of daily
living, education, and/or employment.
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HEARING AIDS
SERVICES/SUPPLIES
• 2 per year
• Services include device inspection and cleaning,
volume adjustments, reprogramming, listening
checks, and other electro acoustic testing
HEARING AID
CHECKS
• 2 per year up to $150.00 per year maximum
REPAIRS AND
MODIFICATION
Maximums vary based on age
• Age 3 Years or Under: 4 per year
• Age 3 to 21 Years: 2 per year
• Age 21 Years or Over: 1 per year
EARMOLDS
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• 72 per year maximum (per aid). Up to 36
can be dispensed per day (per aid)
• Dispensable by Audiologist, Hearing Aid
Dealer, or Medical Supplier
(i.e. Walgreens)
BATTERIES
• $40 per year maximum
• Approved Supplies and Accessories List is
located on the Hearing Services/Hearing
Aid Fee Schedule Web Site.
Hearing Aid Supply List
SUPPLIES
AND
ACCESSORIES
HEARING AIDS
SERVICES/SUPPLIES
Updated July 2020!
**NEW**
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COCHLEAR IMPLANTS
▪ Unilateral and bilateral implantation is covered for all ages
▪ PA Required
▪ All the following requirements must be met :
A letter from the treating otolaryngologist establishing medical necessity
and recommending implantation.
Limited benefit demonstrated with consistent use of appropriately fitted
hearing aid(s) over a minimum of a three-month period.
Evidence of a functioning auditory nerve.
An accessible cochlear lumen structurally suited to implantation
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Freedom from middle ear infection or any other active disease.
Psychological development, motivation of the beneficiary, and/or
commitment of the beneficiary and family/caregiver(s) to undergo a
program of prosthetic fitting, training, and long-term rehabilitation.
Cognitive ability to use auditory cues.
No medical or behavioral health contraindications for anesthesia or
surgery.
Realistic expectations of beneficiary and/or family/caregiver(s) for
post-implant educational/vocational rehabilitation, as appropriate.
Reasonable anticipation by treating providers that the cochlear
implant(s) will confer awareness of speech at conversational levels.
Documented intervention or school placement, as appropriate
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COCHLEAR IMPLANTS
Audiological Criteria:
**UPDATED**
Age: Under 24
Months
❖Diagnosis of bilateral severe to profound sensorineural hearing
loss (PTA equal to or greater than 70 dB HL)
❖Lack of auditory skills development and minimal hearing aid
benefit documented by results or outcomes of parent
questionnaire.
Age: 24
Months - 17
Years
❖Diagnosis of bilateral severe to profound sensorineural hearing
loss (PTA equal to or greater than 70 dB HL.)
❖Lack of auditory skills development and minimal hearing aid
benefit documented by word recognition scores less than or
equal to 60 percent on open set tests or other age appropriate
developmental tests.
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COCHLEAR IMPLANTS
Audiological Criteria Continued:
Age: 18 Years
and Older
❖Diagnosis of bilateral moderate to profound
sensorineural hearing loss (PTA equal to or greater
than 40 dB HL, or level appropriate for model to be
implanted).
❖Minimal hearing aid benefit documented by a score
of less than or equal to 50 percent under best-
aided conditions on an open-set sentence
recognition test.
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COCHLEAR IMPLANT
PROGRAMMING/MAPPING
**CHANGE**
5 subsequent
programming/mapping
sessions per year
(per implant).
1 initial post-operative
session
(per implant)
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AUDITORY REHABILATATION
**CHANGE**
Maximums: 36 visit per
calendar year
Covered for beneficiaries who
have received a hearing device
or who have pre-lingual or
post-lingual hearing loss
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BONE ANCHORED HEARING
DEVICES
▪ Unilateral and bilateral devices are covered for all ages. Includes non-
implantable soft band/headband devices
▪ Only bilateral devices need PA
▪ All the following requirements must be met :
**CHANGE**
* Unilateral or bilateral conductive or mixed hearing loss or unilateral profound
sensorineural hearing loss
* Has at least one of the following conditions:
> Congenital malformation(s) of the middle/external ear or microtia
> Severe chronic otitis externa and/or chronic suppurative otitis media with
chronic drainage preventing use of conventional air conduction hearing aids
> Conductive hearing loss due to ossicular disease and is not appropriate for
surgical correction
> Tumors of the external ear canal and/or tympanic cavity
> Unilateral sensorineural hearing loss
> Condition that contraindicates an air conduction hearing aid
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BONE ANCHORED HEARING
DEVICES
Audiological Criteria:
Unilateral/
Bilateral
Conductive or
Mixed Hearing
Loss
• PTA bone conduction threshold less than or equal to 65 dB HL or level
appropriate for model to be implanted; and
• Speech recognition scores less than or equal to 60 percent using age
appropriate speech recognition testing or other age appropriate
developmental testing.
Unilateral
Sensorineural
Hearing Loss
• Confirmed profound hearing loss (greater than or equal to 90 dB HL in
one ear, with normal hearing on the contralateral side.)
Bilateral
Implantation
or Devices
• Bilateral symmetrical conductive or mixed hearing loss with a PTA bone
conduction threshold less than or equal to 65 dB HL in each ear; and
• Bone conduction threshold of less than or equal to 15 dB HL average
difference between ears.
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REPAIRS, SUPPLIES, AND
ACCESSORIES
▪ $400/year maximum
▪ Use HCPCS L7510
▪ Sound Processor Replacement – 1 per 4 years
✓ Bilateral replacement requires PA
Approved Supplies and Accessories
List is located on the Hearing Services
and Devices Fee Schedule Web page
Cochlear Implant/BAHD Replacement
Parts and Accessories List
**Updated July 2020**
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PRIOR AUTHORIZATION
Enter requests directly into the CHAMPS
{“PA Request List” page.}
MSA-1653-B form and Supporting
Documentation must be uploaded within
the “Additional Documents” section.
If items can’t be uploaded, items can be
faxed (517-335-0075) separately using the
bar-coded fax sheet created by CHAMPS.
Note the separate documents in the
“Procedure Code” field of the PA request.
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PRIOR AUTHORIZATION
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LISTSERV
Register!
❖ Informational Letters
❖ Medicaid Provider Manual Updates
❖ New Policies
❖ Policies out for Public Comments
ListServ Sign Up
https://public.govdelivery.com/accounts/MIDHHS/
subscriber/new
ListServ Registration Instructions
www.michigan.gov/medicaidproviders>>Resources>>Listserv Instructions
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QUESTIONS
General Questions?
(i.e. eligibility, benefits, claims, etc.)
Phone: 1-800-292-2550
Email: prov[email protected]
Enrollment Questions?
Phone: 1-800-292-2550
Email: [email protected]
Prior Authorization Questions?
Phone: 1-800-622-0276
Hearing Services Policy Questions?
Email: ms[email protected]
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