Jonathan Scott

This administrative regulation establishes the Kentucky Medicaid Hearing Program’s service and coverage provisions and requirements.

This administrative regulation is necessary to establish Kentucky Medicaid Hearing Program’s service and coverage provisions and requirements.

This administrative regulation conforms to the content of the authorizing statutes by establishing Kentucky Medicaid Hearing Program’s service and coverage provisions and requirements.

This administrative regulation assists in the effective administration of the statutes by establishing Kentucky Medicaid Hearing Program’s service and coverage provisions and requirements.

The amendment changes the administrative regulation by implementing a state plan amendment that allows for adults to receive hearing services. The amendment also increases the amount that can be charged per ear each thirty-six (36) months to $1,200 from $800. In addition, clarifications are made about how batteries can be provided to individuals with hearing aids. Finally, updated references to the department’s hearing program fee schedule are included.

This amendment is necessary to update the administrative regulation to reflect current hearing program policy, and to implement the approval of recent state plan amendments.

The amendment conforms to the content of the authorizing statutes by implementing a state plan amendment and updating the administrative regulation to conform to recent statutory and regulatory updates to the Medicaid program.

The amendment assists in the effective administration of the statutes by providing a periodic update of the hearing program, and to implement recently effective state plan amendments, administrative regulations, and statutes.

This administrative regulation will impact all adult and children recipients in the Medicaid program by enhancing the quality of hearing products that can be offered to recipients. There are currently 1.7 million individuals in the Medicaid program. The adult population that is newly eligible could include as many as 900,000 individuals from the traditional and expansion Medicaid populations. In addition, this administrative regulation will affect audiology providers participating in the Kentucky Medicaid program.

. Regulated entities will be required to take no new actions. However, adult hearing testing and referral requirements have been clarified.

. No cost is imposed by the amendment.

. Individual beneficiaries will benefit from access to hearing services such as hearing aids, testing, and improved batteries. Audiology providers will benefit from the opportunity to provide services to an additional population of Medicaid beneficiaries. (5) Provide an estimate of how much it will cost to implement this administrative regulation:

The Department for Medicaid Services (DMS) anticipates an increase of about $0.25 for each adult beneficiary’s per member per month capitation (PMPM) managed care organization (MCO) capitation rate. The total state expenditure for this additional benefit should be about $150,000. This expenditure should be balanced against expected savings that could be generated within the Medicaid adult population. Consistent with national trends, DMS expects that Medicaid hearing coverage will decrease the likelihood of dementia, depression, anxiety, and even myocardial infarctions. DMS furthermore expects that up to 16% of Kentucky adults have some degree of hearing loss, and that quality of life and employment opportunities could increase as a result of this additional benefit. As a result, this up-front expenditure should be balanced against expected savings that could be generated within the Medicaid adult population. Consistent with national trends, DMS expects that Medicaid audiology coverage will increase the likelihood of working full-time for adult beneficiaries. This could result in individuals leaving the Medicaid program as a result of receiving full-time employment. The department – due to the efficiencies created – will meet its budgetary requirements as established in House Bill 1 of the 2022 Regular Session.

DMS anticipates that movement out of the Medicaid program will intensify in future years. DMS further anticipates that the preventive care will reduce later utilization and bolster full-time employment opportunities. The department will revisit the PMPM for this service category with contracted actuaries prior to making future budget requests.

The sources of revenue to be used for implementation and enforcement of this administrative regulation are federal funds authorized under Title XIX of the Social Security Act and matching state funds appropriated in the biennium budget.

Neither an increase in fees nor funding will be necessary to implement the amendment.

This administrative regulation neither imposes nor increases any fees.

Tiering is no longer applied within this administrative regulation as audiology services are now available to all Medicaid recipients.

42 U.S.C. 1396d(r)(4), 42 U.S.C. 1396a(a)(30)(A), 42 C.F.R. 441.56, and 45 C.F.R. 147.126.

KRS 194A.050(1) states, "The secretary shall promulgate, administer, and enforce those administrative regulations necessary to implement programs mandated by federal law, or to qualify for the receipt of federal funds and necessary to cooperate with other state and federal agencies for the proper administration of the cabinet and its programs." KRS 205.520(3) states: "it is the policy of the Commonwealth to take advantage of all federal funds that may be available for medical assistance. To qualify for federal funds the secretary for health and family services may by regulation comply with any requirement that may be imposed or opportunity that may be presented by federal law. Nothing in KRS 205.510 to 205.630 is intended to limit the secretary's power in this respect."

EPDST hearing coverage must include at least testing and diagnosis and treatment for hearing defects, including hearing aids. Hearing services must also be, "provided- (i) at intervals which meet reasonable standards of medical practice, as determined by the State after consultation with recognized medical organizations involved in child health care, and (ii) at such other intervals, indicated as medically necessary, to determine the existence of a suspected illness or condition." Additionally, state Medicaid programs are required to take measures to monitor that services are appropriate. States are required to establish a plan for review of the appropriateness and quality of care and services furnished to Medicaid recipients by appropriate health care professionals. The plan helps protect against overutilization or unnecessary care and to assure that reimbursement is consistent with efficiency, economy and quality of care. 42 U.S.C. 1396a(a)(30)(A) requires Medicaid state plans to:" provide such methods and procedures relating to the utilization of, and the payment for, care and services available under the plan (including but not limited to utilization review plans as provided for in section 1903(i)(4)) as may be necessary to safeguard against unnecessary utilization of such care and services" 45 C.F.R. 147.126 prohibits the application of annual dollar limits on essential health benefits. Medicaid program benefits are included in the scope of essential health benefits.

No.

The requirements are not stricter than federal requirements.

The Department for Medicaid Services (DMS) will be affected by this amendment.

42 C.F.R. 441.56; KRS 205.520.

The amendment will generate no revenue for DMS.

The amendment will generate no revenue for DMS.

The Department for Medicaid Services (DMS) anticipates an increase of about $0.25 for each adult beneficiary’s per member per month capitation (PMPM) managed care organization (MCO) capitation rate. This expenditure should be balanced against expected savings that could be generated within the Medicaid adult population. Consistent with national trends, DMS expects that Medicaid hearing coverage will decrease the likelihood of dementia, depression, anxiety, and even myocardial infarctions. DMS furthermore expects that up to 16% of Kentucky adults have some degree of hearing loss, and that quality of life and employment opportunities could increase as a result of this additional benefit. This could result in individuals leaving the Medicaid program as a result of receiving full-time employment. The department – due to the efficiencies created – will meet its budgetary requirements as established in House Bill 1 of the 2022 Regular Session.

DMS anticipates that movement out of the Medicaid program will intensify in future years. DMS further anticipates that the preventive care will reduce later utilization. The department will revisit the PMPM for this service category with contracted actuaries prior to making future budget requests.

DMS anticipates cost savings for hearing services providers who will be able to receive Medicaid reimbursement for a previously uncovered population of 900,000 people. The audiology services providers would have previously sought private pay reimbursement for these services and many recipients may have not accessed services as a result. In addition, other services – such as an increased expenditure limit for hearing aids and batteries - are now available to the entirety of the Medicaid population. This will provide a stable source of funding for these services.

DMS anticipates cost savings on an ongoing basis for vision services providers because expanded services, and higher quality products will now be from a more stable funding source.

DMS does not anticipate that regulated entities will incur costs as a result of this amendment in the first year.

DMS does not anticipate that regulated entities will incur costs as a result of this amendment in subsequent years.

"Major economic impact" means an overall negative or adverse economic impact from an administrative regulation of five hundred thousand dollars ($500,000) or more on state or local government or regulated entities, in aggregate, as determined by the promulgating administrative bodies. [KRS 13A.010(13)] The administrative regulation will not have a major economic impact – as defined by KRS 13A.010 – on regulated entities. DMS anticipates that this amendment may result in additional reimbursement for dentists.