Section 140.497  Hearing Aids

a)         Hearing aids are reimbursed in accordance with Section 140.481(d).

b)         In order to be eligible for reimbursement from the Department for monaural and binaural hearing aids, the following criteria must be met:

1)         When testing is performed in an acoustically treated sound suite:

A)        The hearing loss must be 20 decibels or greater at any two of the following frequencies:  500, 1000, 2000, 4000, 8000 Hertz; or

B)        The hearing loss must be 25 decibels or greater at any one of 500, 1000, 2000 Hertz.

2)         When testing is performed in other than an acoustically treated sound suite:

A)        The hearing loss must be 30 decibels or greater at any two of the following frequencies:  500, 1000, 2000, 4000, 8000 Hertz; or

B)        The hearing loss must be 35 decibels or greater at any one of 500, 1000, 2000 Hertz.

3)         A written statement, dated and signed by a licensed physician, that the patient's hearing loss has been medically evaluated and the patient is considered a candidate for a hearing instrument. The statement must include the date when the medical evaluation took place and the sale of the hearing instrument cannot be more than 6 months immediately following the date of the evaluation.

c)         The following items are to be kept in the patient's file:

1)         The written statement required by subsection (b)(3).

2)         Audiogram.

3)         Hearing Aid Evaluation Results.

4)         Case history and identifying information.

5)         Copy of Manufacturer's invoice with patient's name and hearing aid serial number.

6)         Copy of Manufacturer's invoice for ear mold, if applicable.

d)         Payment for all hearing aids is contingent upon providers fitting and dispensing hearing aids in accordance with the requirements set forth in the Hearing Instrument Consumer Protection Act [225 ILCS 50] and implementing Public Health regulations, except that no payment will be made when there has been a medical evaluation waiver signed by the prospective user.

(Source:  Amended at 39 Ill. Reg. 12825, effective September 4, 2015)