Medicaid and Medicare
ACI Alliance Seeks to Protect Access to CI and Osseointegrated Devices in Medicare Hearing Health Legislation
ACI Alliance is promoting specific language to clarify that legislation to cover hearings aids for certain Medicare beneficiaries (i.e., H.R. 4618) does not inadvertently hurt patients with severe or profound hearing loss who would be better served by a referral for evaluation for cochlear implants (CIs) or osseointegrated devices. The inclusion of hearing aid coverage in this legislation is an important step to improving hearing health under the Medicare program, and we remain committed to working with Congress and other advocacy groups to ensure this bill meets the individualized needs of Medicare beneficiaries.
Congress has already recognized the importance of cochlear implants and osseointegrated devices for appropriate Medicare beneficiaries as the procedures are covered by Medicare. ACI Alliance is committed to working with policymakers to include the legislative language in H.R. 4618 and prevent any negative unintended consequences for patients.
Fact Sheet: Cochlear Implants, Hearing Aids, and Older Adults.
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ITEM Coalition Includes ACI Alliance Priorities in CMS Letter
ACI Alliance participates in coalitions with other organizations in healthcare or disability fields to expand opportunities to address public policy issues. In August 2019, the Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition included difficulty in securing long-term cochlear implant equipment under Medicaid in a letter to CMS regarding the Patients over Paperwork Initiative. The letter recommend that CMS should prioritize simplified and transparent coverage policies on cochlear implantation when reviewing state plan amendments and waiver requests. To read the letter in its entirety, please click here.
Ensuring that patients have appropriate access to insurance coverage is a key organizational priority. All 50 states and Washington, DC cover children under Medicaid, but the nature of coverage as well as the payment amount varies greatly. We have surveyed CI clinics and found that there are access to care issues created by state regulations that limit sound process replacements, numbers of batteries allowed, and sufficient coverage of therapy. We believe that these regulations interfere with Congressional intent on ensuring appropriate services for Medicaid covered children under federal law. We will be discussing the findings with appropriate Federal policy-makers in the Fall 2018.
CI coverage of adults under Medicaid is optional under Federal law; whether and how adults are covered is determined by the individual states. An estimated 60% of states cover eligible adults for cochlear implants under Medicaid. ACI Alliance was contacted by Disability Rights Maryland (DRM), an organization that advocates for the legal rights of Maryland residents with disabilities. DRM was interested in pursuing CI coverage for adults under Maryland Medicaid. ACI Alliance provided information and supported the effort. The State of Maryland made the decision to cover cochlear implants for adults under Medicaid starting in July 2018. Read our comments on the proposed rule HERE.
As part of our ongoing advocacy and education efforts on Medicaid, the ACI Alliance visited with staff at Centers for Medicare & Medicaid Services (CMS) as well as with the Majority and Minority staff for the House Energy and Commerce Committee and Senate Finance Committee. We shared information on cochlear implants and the life-changing benefits that they provide for children and adults. In addition, we discussed ongoing access issues Medicaid patients and providers face including reimbursement, replacement policies for sound processors and other equipment, caps on rehabilitative therapies, and MCOs. We encourage our members to contact Nichole Westin (firstname.lastname@example.org) or Donna Sorkin (email@example.com) to add to our collective knowledge on how Medicaid is serving children and adults who have or need cochlear implants.