March 2015 Medicaid Update: The Billing of Hearing Aides and Repairs for ALP Participants

Shelley Wagar Sabo in NYSCAL Priority Alert

The Durable Medical Equipment provided to ALP Participants article in the DOH Medicaid Update, March 2007, Vol. 22, No.3, provides clarification regarding the provision of Durable Medical Equipment (DME) and medical supplies that are included in the daily Medicaid ALP rate. As outlined in the article, the ALP operates in adult homes and enriched housing programs and provides a combination of residential services and home care services to Medicaid and private pay residents.

The Medicaid Update article explains that a daily rate is paid to the ALP for Medicaid-eligible residents for the provision of nine services, including the provision of DME and medical supplies not requiring prior approval. Hearing aid batteries (V5266) are an example of medical supplies that are included in the ALP’s rate.

This notice is to clarify that hearing aids and their repairs are not considered DME or medical supplies.  Therefore, such items are not captured within the services paid for within the ALP Medicaid rate, and should be billed to the ALP participant’s individual Medicaid benefit.

For questions related to hearing aid policy and coverage guidelines, please send an email to ohipmedpa@health.ny.gov or contact the Division of OHIP Operations at 800-342-3005, option 1.

For questions related to assisted living policy and coverage, please contact the Division of Long Term Care at 518-474-5888.

To read the complete article and Medicaid Update, click http://www.health.ny.gov/health_care/medicaid/program/update/2015/mar15_mu.pdf