In December 2012, DHCS announced an amendment to the reimbursement policy for hearing aids, effective for dates of service on or after January 15, 2013. DHCS changed the definition of "one-unit wholesale cost" from the price not including discounts or rebates to the price that is net rebates, discounts, or other reductions in price. After hearing from beneficiaries, providers, manufacturers, and billers, DHCS re-instituted the prior reimbursement policy pending further analysis with the intention of implementing a new reimbursement policy April 15.

Based on an evaluation of the data submitted, DHCS proposes to make the reimbursement changes noted in the attached document to the mark-up and other hearing aid related services. DHCS projects these changes to be budget-neutral compared to the policy in effect prior to January 15.  DHCS professes its continued belief that it is inappropriate to reimburse providers for more than the cost of the hearing aid. This is contrary to the hearing healthcare profession and HHP's position that there is a significant service component that increases provider costs above the "cost" of the hearing aid device.

Click here to access the DHCS proposal.

In addition to the increases noted, the proposed changes also reduce the wholesale cost based on discounts or rebates received by the provider.  In order to ensure that stakeholders have had the opportunity to review this revised proposal and provide comment, the Department will not implement the new policy on April 15.  However, it is our intention to implement this new revised policy shortly after the stakeholder review and discussion.  We will likely be looking at implementation by the end of the month of April. 

The stakeholder discussion will be held Friday, April19 from 10:30-12:00 at the following location:

Department of Health Care Services

1501 Capitol Avenue, Suite 71.1203 (Pine Room)

Sacramento, CA 95899-7417

Interested parties that are not able to attend in person may also call in using the following dial-in information:

1-888-390-1020
Code 5544426

Should you plan to attend in person, please provide your name to Michele Taylor at [email protected] by April 17 to ensure access to the meeting room.  Additionally, if you have any questions or comments, please contact Jonathan Wunderlich at 916-440-7800 or by e-mail at [email protected].