Rule 37.86.802 - HEARING AID SERVICES, REQUIREMENTS, AND LIMITATIONS(1) These requirements are in addition to those contained in rule provisions generally applicable to Medicaid providers.(2) Over-the-counter hearing aids are not a covered benefit.(3) A prescription hearing aid may be covered under the Medicaid program if all of the following conditions are satisfied: (a) the member's physician or mid-level practitioner has referred the member to an audiologist for an audiological evaluation;(b) the licensed audiologist has determined a prescription hearing aid would be effective in improving the member's hearing;(c) the licensed audiologist's evaluation has concluded that the member requires a prescription hearing aid or aids;(d) prior authorization for the prescription hearing aid has been granted by the department or its designated review organization; and(e) the prescription hearing aid is provided by a licensed hearing aid dispenser or an audiologist.(4) The date of service is defined as the date the prescription hearing aid(s) is ordered by the dispenser.(5) For members aged 21 or over, a replacement prescription hearing aid purchased by Medicaid requires prior authorization.Mont. Admin. r. 37.86.802
NEW, 1980 MAR p. 973, Eff. 3/14/80; AMD, 1987 MAR p. 895, Eff. 7/1/87; AMD, 1988 MAR p. 596, Eff. 3/25/88; AMD, 1988 MAR p. 758, Eff. 4/15/88; AMD, 1990 MAR p. 1326, Eff. 7/13/90; AMD, 1998 MAR p. 2168, Eff. 8/14/98; AMD, 1999 MAR p. 1379, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 481; AMD, 2009 MAR p. 2485, Eff. 1/1/10; AMD, 2011 MAR p. 2293, Eff. 10/28/11; AMD, 2024 MAR p. 2024, Eff. 8/10/2024AUTH: 53-2-201, 53-6-113, MCA; IMP: 53-2-201, 53-6-101, 53-6-111, 53-6-141, MCA