Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid 600 Washington Street Boston, MA 02111 www.mass.gov/masshealth MASSHEALTH TRANSMITTAL LETTER AUD-13 November 2005 TO: Audiologists Participating in MassHealth FROM: Beth Waldman, Medicaid Director RE: Audiologist Manual (Changes to Provider Eligibility Requirements) This letter transmits changes to the Audiologist Manual program regulations. These revisions are effective for dates of service on or after December 1, 2005. Effective December 1, 2005, in-state audiologists participating in the MassHealth audiologist program will no longer be required to possess a Certificate of Clinical Competence in Audiology (CCC-A) issued by the American Speech-Language-Hearing Association (ASHA). Participating providers must continue to be licensed by the Division of Professional Licensure, Board of Registration in Speech-Language Pathology and Audiology. Out-of-state providers must participate in the Title XIX medical assistance program in the audiologist’s own state and either be licensed by the licensing authority in the audiologist’s own state or possess a CCC-A, if the audiologist’s own state does not license independent audiologists or such licensure does not meet certain requirements. If you want to obtain a fee schedule, you may purchase Division of Health Care Finance and Policy regulations from either the Massachusetts State Bookstore or directly from the Division of Health Care Finance and Policy (see addresses and telephone numbers below). You must contact them first to find out the price of the regulation. The Division of Health Care Finance and Policy also has the regulations available on disk and on their Web site. The regulation title for audiologist services is 114.3 CMR 39.00: Rehabilitation Clinics, Audiological and Restorative Services. The regulation title for hearing aid services is 114.3 CMR 23.00: Hearing Aid Dispensers. Massachusetts State Bookstore Division of Health Care Finance and Policy State House, Room 116 Two Boylston Street Boston, MA 02133 Boston, MA 02116 Telephone: 617-727-2834 Telephone: 617-988-3100 www.mass.gov/sec/spr www.mass.gov/dhcfp If you have any questions about the information in this transmittal letter please contact MassHealth Customer Service at 1-800-841-2900, e-mail your inquiry to providersupport@mahealth.net, or fax your inquiry to 617-988-8974. NEW MATERIAL (The pages listed here contain new or revised language.) Audiologist Manual Pages 4-3 and 4-4 OBSOLETE MATERIAL (The pages listed here are no longer in effect.) Audiologist Manual Pages 4-3 and 4-4 — transmitted by Transmittal Letter AUD-10 Commonwealth of Massachusetts Division of Medical Assistance Provider Manual Series SUBCHAPTER NUMBER AND TITLE 4 PROGRAM REGULATIONS (130 CMR 426.000) PAGE 4-3 AUDIOLOGIST MANUAL TRANSMITTAL LETTER AUD-13 DATE 12/01/05 Major Repair — a repair to a hearing aid that must be made at a repair facility other than the audiologist's place of business. Minor Repair — a repair to a hearing aid performed at the audiologist's place of business, such as, but not limited to, the replacement or cleaning of tubing. Monaural Fitting — the fitting of one hearing aid by an audiologist. Nonorganic Test Battery — a series of tests that determines functional hearing loss. Out-of-Office Visit — treatment provided in a nursing facility or at the member's residence rather than at the audiologist's usual place of business. Speech Reading — the training of the visual modality to improve the understanding of the speech or language of other speakers. Speech reading is one of the components of aural rehabilitation. 426.403: Eligible Members (A) (1) MassHealth Members. The MassHealth agency covers audiological services only when provided to eligible MassHealth members, subject to the restrictions and limitations described in the MassHealth regulations. MassHealth regulations at 130 CMR 450.105 specifically state, for each MassHealth coverage type, which services are covered and which members are eligible to receive those services. (2) Recipients of the Emergency Aid to the Elderly, Disabled and Children Program. For information on covered services for recipients of the Emergency Aid to the Elderly, Disabled and Children Program, see 130 CMR 450.106. (B) For information on verifying member eligibility and coverage type, see 130 CMR 450.107. 426.404: Provider Eligibility Payment for services described in 130 CMR 426.000 will be made only to an independent audiologist who is participating in MassHealth on the date of service. (A) In State. To participate in MassHealth, an independent audiologist in Massachusetts must currently be licensed by the Commonwealth of Massachusetts, Division of Professional Licensure, Board of Registration in Speech-Language Pathology and Audiology. (B) Out of State. To participate in MassHealth, an independent audiologist located outside Massachusetts must: (1) participate in the Title XIX medical assistance program in the audiologist’s own state; (2) in a state that licenses independent audiologists, be licensed by the appropriate licensing agency in its own state; and (3) possess a Certificate of Clinical Competence in Audiology (CCC-A) issued by the American Speech-Language-Hearing Association (ASHA), if any of the following conditions apply: PAGE 4-4 AUDIOLOGIST MANUAL TRANSMITTAL LETTER AUD-13 DATE 12/01/05 (a) the audiologist’s own state does not license independent audiologists; (b) the audiologist’s own state does license independent audiologists, but such licensure is not in full compliance with minimum state licensure requirements, specified in 42 CFR 440.110(3); or (c) the audiologist’s own state does license independent audiologists, but such licensure does not, at minimum, meet the academic and clinical requirements of the CCC-A. 426.405: Out-of-State Services The MassHealth agency pays out-of-state audiologists in accordance with 130 CMR 450.109. 426.406: Maximum Allowable Fees The MassHealth agency pays the lowest of the following for audiological services, hearing aids, and related batteries and accessories: (A) the audiologist's usual and customary fee; (B) the adjusted acquisition cost; or (C) the maximum fee listed in the applicable fee schedule of the Massachusetts Division of Health Care Finance and Policy. 426.407: Individual Consideration Services designated "I.C." in the list of service codes and descriptions in Subchapter 6 of the Audiologist Manual are given individual consideration by the MassHealth agency to determine the amount of payment to be made to the audiologist. The MassHealth agency determines the amount of payment using the following criteria: (A) the time required to perform the procedure; (B) the degree of skill required to perform the procedure; (C) the severity or complexity of the member's hearing disorder or disability; (D) the policies, procedures, and practices of other third-party purchasers of health care; and (E) the reasonable and customary practices of audiologists.