6.1 Overview of Services for Hearing Aids and Related Accessories

The standards in this chapter apply to the purchase in whole or in part of hearing aids and related accessories for Texas Workforce Solutions - Vocational Rehabilitation (VR) customers.

VR purchases hearing aids only from contracted manufacturers (contractors).

VR can authorize the purchase of rehabilitation technology, such as hearing aids, related accessories, and other forms of rehabilitation technology, only when it is vocationally necessary and is expected to improve the customer's ability to participate in VR services that are required to obtain, maintain, advance in, or regain employment as defined in the customer's individual plan for employment (IPE).

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6.2 Staff Qualifications for Hearing Aid Dispensers

Individuals who provide and bill for services associated with the purchase of hearing aids and related accessories must meet the qualifications and licensing requirements of the Texas Department of State Health Services, which is the designated regulatory authority for audiologists and hearing aid specialists (hearing aid dispensers).

Job Title Job Function Required Qualifications

Audiologist

Provides audiological examinations

May dispense hearing aids

May provide basic audiometric assessments

Licensed by the State Board of Examiners for Speech-Language Pathology and Audiology

To dispense hearing aids, the audiologist also must be licensed by the State Committee of Examiners in the Fitting and Dispensing of Hearing Instruments.

Hearing aid specialist

Dispenses hearing aids

May provide basic audiometric assessments (MAPS 92551–92559)

May provide hearing aid evaluations

Must comply with all provisions of:

Texas Administrative Code, Title 22, Examining Boards, Part 7, State Committee of Examiners in the Fitting and Dispensing of Hearing Instruments, Chapter 141, Licensure and Regulation of Hearing Instrument Fitters and Dispensers

 

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6.3 Procedures and Processes

The contractor provides the hearing aid dispenser with the list price and the VR net price by either supplying a price list or a written quote by letter, fax, or email.

The hearing aid dispenser must submit a completed DARS3105D, Hearing Aid Evaluation Report, and Recommendation, along with the manufacturer's cost to VR for the recommended hearing aids and any accessories.

Once approved by the VR counselor, two service authorizations will be issued: 1) to the contractor for the purchase of the hearing aid(s) and any accessories; and 2) to the hearing aid dispenser for related service fees.

The hearing aid dispenser will then submit the VR service authorization for the hearing aid(s) and any accessories to the contractor for fulfillment. The contractor ships the hearing aids and any accessories to the hearing aid dispenser for dispensing.

Upon receipt and acceptance of a service authorization for the service fees, the hearing aid dispenser agrees to provide the following services at no additional cost to VR or the customer:

  • Initial customer fitting (including activation of telecoil)
  • Instructions in the care and use of the instrument
  • Up to four follow-up visits for adjustments, including post-fitting evaluation and report of hearing aid performance and customer level of satisfaction.

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6.4 Description of Hearing Aids and Accessories

Accessories (for hearing aids) are useful add-ons that can be linked to a hearing aid to assist in hearing more clearly in challenging situations. Examples of accessories include Bluetooth devices and frequency modulation (FM) systems. (VR does not purchase cosmetic accessories.)

Analog hearing aids convert sound waves into electrical signals, which are amplified. Analog hearing aids are customized to meet the needs of each user. The aid is programmed by the manufacturer according to the specifications recommended by a hearing aid dispenser. Analog hearing aids have more than one program or setting and can be adjusted as needed. A hearing aid dispenser can program the aid using a computer, and individuals can change the program for different listening environments (for example, a small, quiet room; a crowded restaurant; and large, open areas, such as a theater or stadium). Analog and/or programmable circuitry can be used in all types of hearing aids.

Behind-the-ear (BTE) hearing aids consist of a hard plastic case worn behind the ear that is connected to a plastic ear mold that fits inside the outer ear. The electronic parts are held in the case behind the ear. Sound travels from the hearing aid through the ear mold and into the ear.

Bone-anchored hearing aids (BAHA) are small devices that attach to the bone behind the ear. The device transmits sound vibrations directly to the inner ear through the skull, bypassing the middle ear. BAHAs are generally used by individuals with middle ear problems or deafness in one ear. The BAHA strengthens sound vibrations entering the inner ear so that they can be detected by individuals with sensorineural hearing loss. Surgery is required to implant BAHA devices. Special consideration must be given by the customer and by the medical team to determine whether the potential benefits outweigh the potential risks.

Canal hearing aids fit into the ear canal and are available in two styles. The in-the-canal (ITC) hearing aid is made to fit the size and shape of an individual's ear canal. A completely-in-canal (CIC) hearing aid is nearly hidden in the ear canal. Both types are used for mild to moderately severe hearing loss. Because they are small, canal aids can be difficult for an individual to adjust and remove. Additionally, canal aids have less space available for batteries and additional devices, such as a telecoil. Canal hearing aids are not recommended for young children or for individuals with severe to profound hearing loss because their reduced size limits their power and volume.

Contralateral Routing of Signals (CROS) hearing aids treat unilateral hearing loss. The device takes sound from the ear with poorer hearing and transmits the sound to the ear with better hearing. Most systems are wireless and are used either behind the ear or custom built inside the ear. These wireless systems have replaced earlier wired units that were unreliable and bulky. These aids can be incorporated into eyeglasses. Transcranial CROS systems use the conductivity of the skull to transmit sound.

Digital hearing aids convert sound waves into numerical codes, similar to the binary code of a computer, before amplifying them. Because the code includes information about a sound's pitch or loudness, the aid can be specially programmed to amplify some frequencies more than others. Digital circuitry gives the hearing aid dispenser more flexibility in adjusting the aid to a user's needs and to certain listening environments. These aids also can be programmed to focus on sounds coming from a specific direction. Digital circuitry can be used in all types of hearing aids.

In-the-ear (ITE) hearing aids fit completely inside the outer ear and are used for mild to severe hearing loss. The case holding the electronic components is made of hard plastic. ITE aids can have added features installed, such as a telecoil.

Middle ear implant (MEI) is a small device attached to one of the bones of the middle ear. Rather than amplifying the sound traveling to the eardrum, an MEI moves these bones directly. The MEI strengthens sound vibrations entering the inner ear so that they can be detected by individuals with sensorineural hearing loss. Surgery is required to implant MEI devices. Special consideration must be given by the customer and by the medical team to determine whether the potential benefits outweigh the potential risks.

Open-fit hearing aids fit completely behind the ear, with only a narrow tube inserted into the ear canal, enabling the canal to remain open. They are often used for individuals who experience a buildup of earwax, since this type of aid is less likely to be damaged by such substances. Some individuals may also prefer the open-fit hearing aid because their perception of their own voice is less distorted.

Post-fitting evaluation is a report of hearing aid performance and customer satisfaction.

Telecoil is a small magnetic coil that allows users to receive sound through the circuitry of the hearing aid, rather than through its microphone. This makes it easier to hear conversations over the telephone. A telecoil also helps individuals hear in facilities that have installed special sound systems, called induction loop systems. These systems can be found in many churches, schools, airports, and auditoriums.

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6.5 Outcomes Required for Payment

6.5.1 Contractor

For the contractor to receive payment, the contractor must:

  • provide new (unused) hearing aids and accessories as specified on a VR service authorization at the rate established in 6.6 Methodology for Payment (refurbished aids cannot be used to meet this requirement);
  • deliver to the specified address on the date and time mutually agreed upon by the counselor, customer, and contractor within 10 days of receipt of the service authorization date, or notify the VRS staff listed on the service authorization of the estimated delivery date upon receipt of the service authorization;
  • deliver the product in an assembled and fully functional state, including adaptations or fabrication of parts (parts and labor) necessary to meet the described individual needs of the VRS customer; and
  • provide a minimum three-year warranty on all hearing aids purchased with VR funds, and a minimum one-year warranty on all hearing aid accessories purchased with VR funds.

The contractor must submit an invoice for payment that must comply with the requirements explained in Chapter 3: Basic Standards, and must include:

  • the current manufacturer's lowest list price;
  • the applicable discount rate for the item purchased; and
  • the warranty coverage dates or warranty expiration date.

6.5.2 Hearing Aid Dispenser

For the hearing aid dispenser to receive payment for services provided, the hearing aid dispenser must submit the following documentation:

  • A completed DARS3105E, Hearing Aid Fitting and Post-Fitting Report, indicating that the customer has received the hearing aids, and is satisfied with the hearing aids and any accessories, as indicated by the customer signing and dating the form; or
  • Post-fitting documentation:
    • Audiogram of functional results for each ear (aided); or
    • Measurements for each ear (aided)
  • An invoice with the following:
    • Vendor's complete name and address;
    • Vendor's 14-digit Texas identification number (TIN);
    • Vendor's contact name and telephone number;
    • VR service authorization number;
    • VR delivery address;
    • VR contract number, if applicable;
    • A description of the goods or services provided, including the dates of service;
    • The quantity and the unit cost being billed, as documented on the original order; and
    • Other relevant information supporting and explaining the payment requested or identifying a successor organization to an original vendor, if necessary.

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6.6 Methodology for Payment

The following established discounts apply to the purchase of all hearing aids and accessories:

Hearing aids and accessories (paid to contractor)

  • Hearing aid: 35 percent discount from the manufacturer's lowest list price
  • Accessories: 25 percent discount from the manufacturer's lowest list price

Service Charge (paid to hearing aid dispenser)

The service charge is the hearing aid dispenser's usual and customary charge (not to exceed Maximum Affordable Payment Schedule amounts) for:

  • initial fitting (including activation of the telecoil); and
  • up to four follow-up visits for adjustments, including:
    • post-fitting evaluation;
    • report of hearing aid performance and customer level of satisfaction; and
    • instructions in the care and use of the instrument.

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6.7 Additional Responsibilities

6.7.1 Hearing Aid Dispenser

The hearing aid dispenser that dispensed the goods or equipment to the customer must provide VR with written notice to the VR office that issued the service authorization when any goods or equipment purchased with VR funds are being returned to the manufacturer for any reason.

This notice must include:

  • a description of the item returned;
  • a description of the condition of the item returned;
  • the date the item was returned;
  • the reason for the return;
  • the amount of credit due to VR;
  • the customer's name;
  • the case identification number; and
  • descriptions of subsequent actions that were taken (that is, returned to contractor, exchanged, or replaced).

6.7.2 Contractor Returns and Refunds

Returns

Contractors must provide the VR staff that issued the service authorization with a written notice of all goods or equipment purchased with VR funds that are subsequently returned to, exchanged, or replaced by the contractor.

This notice must include:

  • a description of the item returned;
  • the date the item was returned;
  • the reason for the return;
  • the amount of credit due, if any;
  • the customer's name;
  • the case identification number; and
  • a description of subsequent actions that were taken (for example, if the hearing aids were exchanged or replaced).

If the item(s) being returned have a different price or are a substantially different hearing aid or accessory, then a new service authorization for the new item must be received from VR staff.

Refunds

When a refund is due, the contractor must remit to VR a check in the amount of the total credit accumulated during the previous calendar month by the 15th of each month. This payment must be accompanied by supporting documentation and/or credit invoices for each transaction or item for which the credit reimbursement is issued. The supporting documentation and/or credit invoices supplied must include the service authorization number and the customer's VR case identification number.

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