Hearing Services Program (Schedule of Service Items and Fees 2021-22) Instrument (No. 2) 2021
I, Chris Carlile as delegate of the Minister for Health and Aged Care make the following instrument.
Dated 7 June 2021
Chris Carlile
Assistant Secretary
Hearing Services Branch
Cancer, Hearing and Program Support Division
Department of Health
This instrument is the Hearing Services Program (Schedule of Service Items and Fees 2021-22) Instrument (No. 2) 2021.
2 Commencement
(1) Each provision of this instrument specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.
Commencement information | ||
Column 1 | Column 2 | Column 3 |
Provisions | Commencement | Date/Details |
1. The whole of this instrument | 1 July 2021 |
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Note: This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument.
(2) Any information in column 3 of the table is not part of this instrument. Information may be inserted in this column, or information in it may be edited, in any published version of this instrument.
3 Repeals
The Hearing Services Program (Schedule of Service Items and Fees 2021-22) Instrument 2021 is repealed.
4 Authority
This instrument is made under the Hearing Services Program (Voucher) Instrument 2019.
Schedule 1 of this instrument contains the Schedule of Service Items and Fees 2021-22.
Australian Government
Hearing Services Program
Schedule
of
Service Items and Fees
About the Schedule of Service Items and Fees
Assistive Listening Devices (ALDs)
Minimum Hearing Loss Threshold (MHLT) Guidelines
Eligibility Criteria for Refitting
Clients who have a current voucher are entitled to a range of services through the Hearing Services Program (the program). Contracted service providers (providers) must comply with the program requirements. The Schedule of Service Items and Fees includes two program standards, the Minimum Hearing Loss Threshold (MHLT) Guidelines and the Eligibility Criteria for Refitting (ECR).
The Schedule of Service Items and Fees provides information on service, program and evidence requirements for the services available to program clients.
Services must be delivered in accordance with professional standards, including the Practitioner Professional Body (PPB) Code of Conduct and Scope of Practice. Any clinical concerns and questions should be escalated to the PPB.
Definitions used throughout the Schedule of Service Items and Fees are as defined by the Hearing Services Administration Act 1997, Hearing Services Program (Voucher) Instrument 2019, and/or Service Provider Contract. Additional definitions include:
Non-Routine Client
A non-routine client is a client found to have one or more of the following audiometric presentations
Specialist Services (Complex) Client
A client is eligible for specialist services if they have a
Clients eligible for Specialist Services must be advised that they may be eligible for additional services through Hearing Australia (Australian Hearing Services). When clients have made a decision about where they want to receive services, this must be notified through the Specialist Services checkbox in the portal.
Clients may be entitled to receive
An additional assessment or fitting service may be approved by the program as a Revalidated Service provided certain criteria are met.
General Program Service Requirements apply to all program services. Providers must comply with the following, as well as service requirements for each Service. | |
1 | The hearing services available to a client are subject to assessment of the voucher-holder’s clinical need for that service. |
2 | Clients must have a current voucher and the Date of Service must be within the current voucher period. |
3 | Providers must ensure the service is available on the client’s current voucher before delivering any service. |
4 | Services must be performed by a Qualified Practitioner (QP) or Provisional Practitioner under supervision of a QP in accordance with Practitioner Professional Body (PPB) requirements, excluding Maintenance and Rehabilitation Services. |
5 | Clients must be referred to an appropriate medical practitioner where clinically necessary. |
6 | Services must be delivered in accordance with the PPB Code of Conduct and Scope of Practice. |
7 | Services must be delivered in accordance with current Australian laws and standards, for example Australian Consumer Law, ambient noise level testing and audiometric equipment standards. |
8 | The Practitioner QP number must be valid and linked to the provider in the portal at the Date of Service. |
9 | The Site ID must be valid at the Date of Service. |
10 | A Claim for Payment form must be correctly completed. |
11 | Supporting evidence must be documented on the client record, as per the evidence requirements for each Service Item. |
12 | Portal information for the client must be updated as required, including:
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13 | Any reassessment, and/or consequent refitting, within 12 months of the original fitting, does not attract a Scheduled Fee but is considered part of the original Hearing Rehabilitation service unless specific approval to claim is provided. |
Device Supply Requirements | |
Detailed written device quote for every fitting Clients must receive a single detailed written device quote for all devices supplied under the program (fully and partially subsidised devices, replacements, spare aids and ALDs) that
The quote must include
| |
Only approved devices fitted The device/s fitted must be listed on a Schedule of Approved Devices on the fitting date, unless otherwise approved by the department, and the correct device code used when claiming. Device/s supplied to program clients and claimed through the program must be purchased directly by the provider from an Appointed Supplier. The device fitted to the client must
| |
The client or carer must be counselled on how to effectively manage the device. | |
Cost to Client Fully subsidised devices
Partially subsidised devices
|
Under the Australian Government Hearing Services Program, the GST exclusive amount for service items will be adjusted on the 1st day of each financial year, in accordance with the following indexes
The resultant GST amount will be rounded to the nearest cent.
The device prices payable are those specified in the Schedule of Fees current at the Date of Fitting.
Please refer to the Fully Subsidised Schedule of Devices for individual device pricing. The device prices can be found under the publications accordion when you are logged into the Hearing Services Online Portal.
Dispensing fee for behind-the-ear (BTE) hearing aids fitted
For item numbers 630, 631, 640, 641, 650, 651, 660, 661, 760, 761, 770, 771, 820, 821, 830, 831, 840, 850 and 960, an additional dispensing fee is paid for behind-the-ear hearing devices as listed in the Schedule of Fees.
Annual Hearing Aid Maintenance Co-payment
The client can be charged the specified Maintenance Co-payment listed in the Schedule of Fees in accordance with the Device Supply Requirements.
This GST amount is not recorded on the claim for payment form but must be declared in your Quarterly BAS Statement for each client who makes a payment within this period. This co-payment is GST inclusive and is payable by the client in relation to fitting and maintenance items.
Replacement Fee
Where the hearing device replacement fee is not covered by items 555 or 888, the client can be charged the specified Replacement Fee listed in the Schedule of Fees.
Providers are responsible in ensuring the client has a current voucher prior to services being provided through the program. All services must fall within the voucher issue and expiry date of the voucher current at the time of the date of service. Claims for services must be submitted within 12 months of the date of service.
| Item | Schedule of Service Items & Fees – 2021/22 | Amount | GST Liable | GST | Total |
Assessment& Referral | 600 | First Assessment | $145.48 | $0.00 | $0.00 | $145.50 |
610 | Audiological Case Management (Review and Advice) | $46.15 | $0.00 | $0.00 | $46.15 | |
800 | Reassessment | $145.48 | $0.00 | $0.00 | $145.50 | |
810 | Audiological Case Management (Review and Advice) | $46.15 | $0.00 | $0.00 | $46.15 | |
Initial Fittings | 630 | Initial fitting with Maintenance Agreement - Monaural | $464.25 | $9.81 | $0.98 | $465.25 |
631 | Initial fitting with Maintenance Agreement - Non Follow up - Monaural | $232.13 | $9.81 | $0.98 | $233.10 | |
640 | Initial fitting with Maintenance Agreement - Binaural | $580.82 | $19.61 | $1.96 | $582.80 | |
641 | Initial fitting with Maintenance Agreement- Non Follow up - Binaural | $290.40 | $19.61 | $1.96 | $292.35 | |
650 | Initial fitting (no Maintenance Agreement) - Monaural | $451.51 | $0.00 | $0.00 | $451.50 | |
651 | Initial fitting (no Maintenance Agreement) - Non Follow up - Monaural | $225.75 | $0.00 | $0.00 | $225.75 | |
660 | Initial fitting (no Maintenance Agreement) - Binaural | $541.59 | $0.00 | $0.00 | $541.60 | |
661 | Initial fitting (no Maintenance Agreement) - Non Follow up - Binaural | $270.80 | $0.00 | $0.00 | $270.80 | |
760 | Subsequent Initial Fitting with Maintenance Agreement | $118.89 | $9.81 | $0.98 | $119.85 | |
761 | Subsequent Initial Fitting with Maintenance Agreement - Non Follow up | $59.45 | $9.81 | $0.98 | $60.45 | |
770 | Subsequent Initial Fitting (no Maintenance Agreement) | $85.53 | $0.00 | $0.00 | $85.55 | |
771 | Subsequent Initial Fitting (no Maintenance Agreement) - Non Follow up | $42.78 | $0.00 | $0.00 | $42.80 | |
Refitting | 820 | Refitting - Monaural | $388.02 | $0.00 | $0.00 | $388.00 |
821 | Refitting - Non Follow up - Monaural | $194.00 | $0.00 | $0.00 | $194.00 | |
830 | Refitting - Binaural | $385.65 | $0.00 | $0.00 | $385.65 | |
831 | Refitting - Non Follow up - Binaural | $192.83 | $0.00 | $0.00 | $192.85 | |
(ALD) Alternative Listening Device | 635 | ALD: Initial fitting with Maintenance Agreement | $208.97 | $9.81 | $0.98 | $209.95 |
636 | ALD: Initial fitting with Maintenance Agreement- Non Follow up | $104.48 | $9.81 | $0.98 | $105.45 | |
655 | ALD: Initial fitting (no Maintenance Agreement) | $190.47 | $0.00 | $0.00 | $190.45 | |
656 | ALD: Initial fitting (no Maintenance Agreement) - Non follow- up | $95.23 | $0.00 | $0.00 | $95.25 | |
825 | ALD: Refitting | $134.01 | $0.00 | $0.00 | $134.00 | |
826 | ALD: Refitting - Non follow up | $67.00 | $0.00 | $0.00 | $67.00 | |
Maintenance | 700 | Maintenance and Battery Supply - Monaural | $99.33 | $49.67 | $4.97 | $104.30 |
710 | Maintenance and Battery Supply - Binaural | $198.66 | $99.33 | $9.93 | $208.60 | |
711 | Relocated Maintenance and Battery Supply - Monaural | $70.29 | $57.87 | $5.79 | $76.10 | |
722 | Relocated Maintenance and Battery Supply - Binaural | $95.12 | $70.29 | $7.03 | $102.15 | |
777 | Client Co-payment for Maintenance and Batteries - DVA eligible clients | $45.45 | $22.73 | $2.27 | $47.70 | |
790 | Maintenance and Battery Supply (Private Devices) – Monaural | $99.33 | $49.67 | $4.97 | $104.30 | |
791 | Maintenance and Battery Supply (Private Devices) – Binaural | $198.66 | $99.33 | $9.93 | $208.60 | |
Client Review | 920 | Client Review - Unaided | $81.99 | $0.00 | $0.00 | $82.00 |
930 | Client Review - Monaural or ALD | $81.99 | $0.00 | $0.00 | $82.00 | |
940 | Client Review - Binaural | $127.08 | $0.00 | $0.00 | $127.10 | |
Rehab | 670 | Rehabilitation Service - Unaided | $210.24 | $0.00 | $0.00 | $210.25 |
680 | Rehabilitation Plus (two sessions) | $148.97 | $0.00 | $0.00 | $148.95 | |
681 | Rehabilitation Plus (single session) | $73.95 | $0.00 | $0.00 | $73.95 | |
Replacement | 840 | Replacement of Lost/ Damaged Beyond Repair Device - Monaural | $72.79 | $0.00 | $0.00 | $72.80 |
850 | Replacement of Lost/ Damaged Beyond Repair Devices - Binaural | $106.21 | $0.00 | $0.00 | $106.20 | |
555 | Client Co-payment for Exempt Clients | $42.66 | $0.00 | $0.00 | $42.65 | |
888 | Client Co-payment for DVA Eligible Clients | $42.66 | $0.00 | $0.00 | $42.65 | |
Spare | 960 | Spare Device | $77.39 | $0.00 | $0.00 | $77.40 |
Remote | 4 | Remote Control (Manufacturer's invoice amount only < $200) | ||||
Device Fees | Category 1 - High powered BTEs | $493.17 | $0.00 | $0.00 | $493.15 | |
Category 2 - Low powered BTEs | $466.53 | $0.00 | $0.00 | $466.55 | ||
Category 3 - non-BTEs & non-standard devices (ALD, BICROS, CROS) | $428.41 | $0.00 | $0.00 | $428.40 | ||
BTE Dispensing Fee | $27.70 | $0.00 | $0.00 | $27.70 | ||
Other | 1 | Device Returned for Credit: Monaural – Half Cost of the Fitting item (no Maintenance Agreement) | ||||
2 | Devices Returned for Credit: Binaural – Half Cost of the Fitting item (no Maintenance Agreement) | |||||
3 | BTE Returned for Credit: Dispensing Fee | $27.70 | $0.00 | $0.00 | $27.70 | |
Client Fees | Maintenance fee for Fully Subsidised devices | $45.45 | $22.73 | $2.27 | $47.70 | |
Replacement Fee | $42.66 | $0.00 | $0.00 | $42.65 |
ASSESSMENTS / REASSESSMENTS Assessment and Reassessment Services to establish the nature and extent of a client’s hearing and communication needs and the client’s communication and hearing goals. | ||
Item | Service | |
600 | First Assessment | |
800 | Reassessment | |
Service Requirements | ||
1 | Comply with General Program Service Requirements (see page 4), the PPB Code of Conduct and Scope of Practice. | |
2 | Practitioners establish the nature and extent of client’s hearing and communication concerns through the following:
Practitioners support client’s decision making in the management of their communication and hearing goals through the following:
| |
Program Requirements | ||
3 | Item 600 can be claimed once only for each client. Item 800 can be claimed once only on each subsequent (Return) Voucher. | |
4 | Specialist Services (Complex) clients (see definitions) must
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5 | Non-routine clients (see definitions)
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6 | If the client is likely to proceed to a fitting, the client must
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7 | If the client is not proceeding to a fitting, the client must be advised about the Rehabilitation Service (Item 670) if appropriate. | |
8 | If a new client is bringing previously fitted devices onto the program, a Client Review (Items 930/940) can be claimed at the same time as the Items 600 & 790/791, providing the Client Review requirements are met. | |
9 | The Date of Service is the date of the assessment/reassessment. If an Audiological Case Management (Review and Advice) Service (Items 610/810) is required, the Date of Service for Items 600/800 is the date the advice is provided. | |
Evidence Requirements |
Evidence kept on the client record to substantiate Assessment/Reassessment Services MUST include
Evidence kept on the client record to substantiate Assessment/Reassessment Services MAY include
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AUDIOLOGICAL CASE MANAGEMENT (REVIEW AND ADVICE) Review and advice provided by a QP Audiologist to enable an Audiometrist to complete a non-routine client’s Assessment/Reassessment Service. | |||
Item | Service | ||
610 | Audiological Case Management (Review and Advice) – with Assessment Service (Item 600) | ||
810 | Audiological Case Management (Review and Advice) – with Reassessment Service (Item 800) | ||
Service Requirements | |||
1 | Comply with General Program Service Requirements (see page 4), the PPB Code of Conduct and Scope of Practice. | ||
2 | Practitioners ensure the safety of the clients through the following:
The Audiological Case Management (Review and Advice) Service is delivered by a QP Audiologist for a non-routine client (see definitions). | ||
Program Requirements | |||
3 | Item 610 can be claimed once only for each client. | ||
4 | Item 810 can be claimed only once on each subsequent (Return) Voucher. | ||
5 | Items 610 and 810 can only be claimed where an Audiometrist requests and receives advice from an Audiologist on the management of a non-routine client in order to complete an Assessment Service. | ||
6 | Items 610 and 810 cannot be claimed when a provisional (non-qualified) Audiometrist is under the supervision of an Audiologist. | ||
7 | The prerequisite Assessment Services (Items 600/800) must be delivered by a QP Audiometrist or a provisional Audiometrist under the supervision of a QP Audiometrist. | ||
8 | The Audiological Case Management (Review and Advice) Service may be subcontracted to a QP Audiologist. | ||
9 | Items 610 and 810 must be claimed with the QP number of the QP Audiologist who delivered the Audiological Case Management Service. | ||
10 | Date of Service for Audiological Case Management (Review and Advice) Service (Item 610/810) must match Date of Service for Assessment or Reassessment Items (600/800). | ||
Evidence Requirements | |||
Evidence kept on the client record to substantiate Audiological Case Management (Advice and Referral) Service MUST include
| |||
INITIAL AND SUBSEQUENT INITIAL FITTINGS
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Item | Service | |
630 | Initial Fitting – Monaural | |
631 | Initial Fitting – Non Follow up – Monaural | |
640 | Initial Fitting – Binaural | |
641 | Initial Fitting – Non Follow up – Binaural | |
650 | Initial Fitting (no Maintenance Agreement) – Monaural | |
651 | Initial Fitting (no Maintenance Agreement) – Non Follow up – Monaural | |
660 | Initial Fitting (no Maintenance Agreement) – Binaural | |
661 | Initial Fitting (no Maintenance Agreement) – Non Follow up – Binaural | |
760 | Subsequent Initial Fitting | |
761 | Subsequent Initial Fitting – Non Follow up | |
770 | Subsequent Initial Fitting (no Maintenance Agreement) | |
771 | Subsequent Initial Fitting (no Maintenance Agreement) – Non Follow up | |
Service Requirements | ||
1 | Comply with General Program Service Requirements (see page 4), the PPB Code of Conduct and Scope of Practice. | |
2 | Practitioner provides appropriate hearing aid technology for the client through the following:
| |
3 | Initial fittings and subsequent initial fittings can be completed via telehealth if the technology allows and the practitioner is satisfied client outcomes are not compromised. | |
Program Requirements | ||
4 | A fitting service consists of at least two appointments, the fitting and a follow up.
A claim should not be submitted until the fitting is considered successful and the client has accepted the device/s. A successful fitting is one where client has demonstrated improvement in their hearing goals and the ability to manage their devices. | |
5 | An Assessment or Reassessment Service must be completed prior to an Initial or Subsequent Fitting. The provider must ensure all fittings are based on the client’s current hearing thresholds. | |
6 | Only one Initial Fitting Item can be claimed for each client and no previous fitting through the program must have occurred. | |
7 | The client must receive a detailed written device quote and must only be fitted with approved devices in accordance with the Device Supply Requirements (see page 4). | |
8 | All clients receiving a fitting must be offered a Maintenance Agreement and clients can choose to enter into a Maintenance Agreement. Please refer to the Maintenance for Fitting Items on page 18 for further program requirements. | |
9 | All fitting items include initial supply of consumables. | |
10 | Where a client receives a MONAURAL Initial Fitting, an Initial Fitting to the other ear must be claimed as a SUBSEQUENT Initial Fitting (Items 760, 761, 770, 771). | |
11 | SUBSEQUENT Initial Fittings with Maintenance Agreement (Items 760,761) can only be claimed where the client has a current monaural Maintenance Agreement. | |
12 | The Date of Service is the date of the follow up (except for non-follow up fittings, when the Date of Service is the fitting date). | |
13 | If the client has 3FAHLs < 23dB in the ear to be fitted, the client must meet both MHLT exemption criteria (Criterion 1 and 2) prior to fitting (a 3FAHL of 23.3dB should be recorded as 23dB in the portal and on the claim form). | |
14 | Any Refitting within 12 months of the Initial Fitting is considered part of the original Fitting, unless the device/s have been returned for credit and a recovery processed (if already claimed), or if the fitting service has been revalidated. | |
15 | A SUBSEQUENT Initial Fitting Item can be claimed once only for a previously monaurally fitted client. | |
16 | If the client has private device/s maintained through the program, their first program fitting must be claimed as an Initial Fitting. | |
Evidence Requirements | ||
Evidence kept on the client record to substantiate the Fitting Service MUST include
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REFITTINGS These fittings are for clients who have been previously fitted on the same ear. A client may only be refit if they meet the Eligibility Criteria for Refitting (ECR). | |||
Item | Service | ||
820 | Refitting – Monaural | ||
821 | Refitting – Non follow up – Monaural | ||
830 | Refitting – Binaural | ||
831 | Refitting – Non follow up – Binaural | ||
Service Requirements | |||
1 | Comply with General Program Service Requirements (see page 4), the PPB Code of Conduct and Scope of Practice. | ||
2 | Practitioner provides appropriate hearing aid technology for the client through the following:
| ||
3 | Refittings can be completed via telehealth if the technology allows and the practitioner is satisfied client outcomes are not compromised. | ||
Program Requirements | |||
4 | A fitting service consists of at least two appointments, the fitting and a follow up.
A claim should not be submitted until the fitting is considered successful and the client has accepted the device/s. A successful fitting is one where client has demonstrated improvement in their hearing goals and the ability to manage their devices. | ||
5 | The client must have previously received a fitting through the program to the same ear. | ||
6 | If a fitting (doesn’t include replacements) has been claimed for the same ear on the current voucher, revalidation of a fitting service must be approved by the program prior to service provision. | ||
7 | Clients must not be refitted unless the fitting complies with the ECR.
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8 | A hearing Reassessment, screening or Client Review must have been completed before Refitting. The provider must ensure the fitting is based on the client’s current hearing thresholds. | ||
9 | If the client has 3FAHLs < 23dB in the ear to be fitted, the client must meet both MHLT exemption criteria (Criterion 1 and 2) prior to fitting.
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10 | If a monaural Refitting has been claimed and the opposite ear requires a refit on the same voucher, the previous fitting claim must be recovered and these services claimed as a binaural fitting (except where the client has relocated and the fittings are completed by different providers). | ||
11 | Any Refitting within 12 months of the Initial Fitting is considered part of the original Hearing Rehabilitation Program, unless the device/s have been returned for credit and a recovery processed (if already claimed), or if the fitting service has been revalidated. | ||
12 | The client must receive a detailed written device quote and must only be fitted with approved devices in accordance with the Device Supply Requirements (see page 4). | ||
13 | All clients receiving a fitting must be offered a Maintenance Agreement and clients can choose to enter into a Maintenance Agreement. Please refer to the Maintenance for Fitting Items on page 19 for further program requirements. | ||
14 | The Date of Service is the date of the follow up (except for non-follow up fittings, when the Date of Service is the Fitting date). | ||
Evidence Requirements |
Evidence kept on the client record to substantiate the Refitting Service MUST include
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ASSISTIVE LISTENING DEVICES (ALDs) – INITIAL FITTING To provide clinically suitable ALDs for clients who are not able to or do not wish to wear hearing aid(s). | |||
Item | Service | ||
635 | Initial ALD Fitting | ||
636 | Initial ALD Fitting – Non Follow up | ||
655 | Initial ALD Fitting (no Maintenance Agreement) | ||
656 | Initial ALD Fitting (no Maintenance Agreement) – Non Follow up | ||
Service Requirements | |||
1 | Comply with General Program Service Requirements (see page 4), the PPB Code of Conduct and Scope of Practice. | ||
2 | Practitioner provides appropriate assistive listening device technology for the client through the following:
| ||
3 | ALD Initial Fittings can be completed via telehealth if the technology allows and the practitioner is satisfied client outcomes are not compromised. | ||
Program Requirements | |||
4 | A fitting service consists of at least two appointments, a fitting and a follow up.
A claim should not be submitted until the fitting is considered successful and the client has accepted the ALD. A successful fitting is one where client has demonstrated improvement in their hearing goals and the ability to manage their devices. | ||
5 | The client must not have received a previous fitting, including ALD through the program. | ||
6 | An Assessment or Reassessment Service must be completed prior to an Initial Fitting. The provider must ensure the fitting is based on the client’s current hearing thresholds. | ||
7 | If the client has 3FAHLs < 23dB in the ear to be fitted, the client must meet both MHLT exemption criteria (Criterion 1 and 2) prior to fitting (a 3FAHL of 23.3dB should be recorded as 23dB in the portal and on the claim form) Note: An ALD fitting recorded in the portal will default to the ear with the highest 3FAHLs. | ||
8 | Clients can receive an ALD or a hearing aid fitting, but not both on the same voucher unless a revalidated service is approved. | ||
9 | The client must receive a detailed written device quote and must only be fitted with approved devices in accordance with the Device Supply Requirements (see page 4). | ||
10 | All clients receiving a fitting must be offered a Maintenance Agreement and clients can choose to enter into a Maintenance Agreement. Please refer to the Maintenance for Fitting Items on page 19 for further program requirements. | ||
11 | The Date of Service is the date of the follow up (except for non-follow up fittings, when the Date of Service is the date the ALD was provided to the client). | ||
Evidence Requirements | |||
Evidence kept on the client record to substantiate the ALD Fitting Service MUST include
| |||
ASSISTIVE LISTENING DEVICES (ALDs) REFITTING To provide clinically suitable ALDs for clients who are not able to or do not wish to wear hearing aid(s). A client may only be refit if they meet the Eligibility Criteria for Refitting (ECR). | |||
Item | Service | ||
825 | ALD Refitting | ||
826 | ALD Refitting – Non Follow up | ||
Service Requirements | |||
1 | Comply with General Program Service Requirements (see page 4), the PPB Code of Conduct and Scope of Practice. | ||
2 | Practitioner provides appropriate assistive listening device technology for the client through the following:
| ||
3 | ALD Refittings can be completed via telehealth if the technology allows and the practitioner is satisfied client outcomes are not compromised. | ||
Program Requirements | |||
4 | A fitting service consists of at least two appointments, a fitting and a follow up.
A claim should not be submitted until the fitting is considered successful and the client has accepted the fitting. A successful fitting is one where client has demonstrated improvement in their hearing goals and the ability to manage their devices. | ||
5 | The client has previously been fitted with an ALD or hearing aid against a previous voucher. | ||
6 | An ALD should only be refitted when the client will no longer be using previous device/s. | ||
7 | If a fitting (hearing aid or ALD) has been claimed on the current voucher, revalidation of a fitting service must be approved by the program prior to service provision. | ||
8 | Clients should not be refitted unless they meet the ECR. | ||
9 | A Reassessment Service or a Client Review (if appropriate) must be completed prior to an ALD Refitting. The provider must ensure the fitting is based on the client’s current hearing thresholds. | ||
10 | If the client has 3FAHLs < 23dB in the ear to be fitted, the client must meet both MHLT exemption criteria (Criterion 1 and 2) prior to fitting (a 3FAHL of 23.3dB should be recorded as 23dB in the portal and on the claim form). Note: An ALD fitting recorded in the portal will default to the ear with the highest 3FAHLs. | ||
11 | Clients can receive an ALD fitting or a hearing aid fitting, but not both on the same voucher. | ||
12 | The client must receive a detailed written device quote and must only be fitted with approved devices in accordance with the Device Supply Requirements (see page 4). | ||
13 | All clients receiving a fitting must be offered a Maintenance Agreement and clients can choose to enter into a Maintenance Agreement. Please refer to the Maintenance for Fitting Items on page 19 for further program requirements. | ||
14 | The Date of Service is the date of the follow up (except for non-follow up fittings, when the Date of Service is the date the ALD was provided to the client). | ||
Evidence Requirements |
Evidence kept on the client record to substantiate the ALD Refitting Service MUST include
|
MAINTENANCE AND RELOCATED MAINTENANCE
| |||
Item | Service | ||
700 | Maintenance and Battery Supply – Monaural | ||
710 | Maintenance and Battery Supply – Binaural | ||
711 | Relocated Maintenance and Battery Supply – Monaural | ||
722 | Relocated Maintenance and Battery Supply – Binaural | ||
777 | Client Co-payment for Maintenance and Battery Supply – DVA Eligible Clients | ||
790 | Maintenance and Battery Supply (Private Devices) – Monaural | ||
791 | Maintenance and Battery Supply (Private Devices) – Binaural | ||
Program Requirements | |||
1 | Comply with General Program Service Requirements (see page 4), the PPB Code of Conduct and Scope of Practice. | ||
2 | Maintenance Services can be delivered by persons with the appropriate skills. | ||
3 | The client has a current fitting. | ||
4 | All clients receiving a fitting must be offered a Maintenance Agreement.
| ||
5 | Maintenance Agreements cover appropriate battery supply, fitting adjustments, replacement ear moulds, and repairs to the device as well as to any other attachments necessary for the operation of the device. | ||
6 | An appropriate number and type of batteries must be supplied in a timely manner so the client is not without the use of their device for any significant period. | ||
7 | Repairs must
| ||
8 | Warranty on the hearing aid must be utilised for specified hearing aid repairs, as detailed in the Deed of Standing Offer. | ||
9 | Maintenance Items (with exceptions of 711 and 722) cannot be claimed earlier than 12 months after the Date of Fitting for Initial Fitting and Refitting Items. | ||
10 | Standard maintenance (Items 700/710) can only be claimed once every 12 months, with the exception of:
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11 | Clients must not sign a Maintenance Agreement or pay their Maintenance Co-payment more than 45 days before the date on which Maintenance services commence. | ||
12 | Where the client enters into a Maintenance Agreement towards the end of the current voucher, the provider must honour the Maintenance Agreement for 12 months from the agreement commencement date, even if the client’s voucher expires. | ||
13 | The Date of Service is
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14 | Where the client has agreed to enter into a Maintenance Agreement, Maintenance (Items 700/710) may be claimed on or after
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15 | Relocated Maintenance, Items 711/722 (where client has relocated from one provider to another)
NOTE: Relocated Maintenance cannot be claimed again if a client relocates away from a provider and then returns within the same Maintenance Agreement period. | ||
16 | DVA Client Maintenance Co-payment, Item 777 (not applicable for Relocated Maintenance)
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17 | Private Devices Maintenance, Items 790/791
the client has never been fitted through the program the client enters into a Maintenance Agreement the private device/s will be the primary device/s, and the private device/s are on a Schedule of Approved Devices.
Where a client has previously been fitted with a device through the program and wishes to purchase private devices and bring them onto the program, providers may claim Maintenance (Items 700/710) if
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18 | Cost to Client
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Evidence Requirements | |||
Evidence kept on the client record to substantiate the Maintenance Service MUST include
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For Initial Fitting Services
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For Subsequent Initial Fitting Services
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For Refitting Services
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For ALD Fitting Services
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CLIENT REVIEW SERVICES - UNAIDED To enable annual reviews of the client’s current hearing status. The service aims to allow clients’ ear and hearing health to be monitored over time and improve the access to services for these clients. | ||
Item | Service | |
920 | Client Review – Unaided | |
Service Requirements | ||
1 | Comply with General Program Service Requirements (see page 4), the PPB Code of Conduct and Scope of Practice. | |
2 | Practitioner establishes the nature and extent of client’s hearing and communication concerns through the following:
Client Review Service must include
And, two or more of the following additional activities Hearing screening, including a check of middle ear status if clinically indicated Speech testing Review of communication strategies Training and strategies to manage the effects of hearing loss Discussion of rehabilitation options, including hearing devices and ALDs available to assist clients to manage their hearing loss and enhance communication Education of impact of hearing loss and hearing loss prevention. | |
3 | Client Reviews can be completed via telehealth if the technology allows and the practitioner is satisfied client outcomes are not compromised. | |
Program Requirements | ||
4 | Client must not be fitted with devices. | |
5 | Claimable annually, where it is 12 months or more from the last program Assessment or Reassessment date and 12 months or more from the last Client Review – Unaided service. | |
6 | The Date of Service is the date the Client Review is completed. | |
Evidence Requirements | ||
Evidence kept on the client record to substantiate the Client Review Service MUST include
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CLIENT REVIEW SERVICES - AIDED To enable annual reviews of the client’s current hearing status and to ensure the client is receiving benefit from their device/s. The service also aims to extend the life of the fitting and address any hearing related issues the client may have. | ||
Item | Service | |
930 | Client Review – Monaural or ALD | |
940 | Client Review – Binaural | |
Service Requirements | ||
1 | Comply with General Program Service Requirements (see page 4), the PPB Code of Conduct and Scope of Practice. | |
2 | Client Review service must include
And, three or more of the following additional activities (four or more if completed at same time as a Reassessment) Activities marked with ( * ) may be performed for clients with ALDs. Hearing screening, including a check of middle ear status if clinically indicated* Speech testing* Review of client’s device management with reinstruction* Review of device expectations and management* Review of communication strategies* Training and strategies to manage the effects of hearing loss* Education of impact of hearing loss and hearing loss prevention* Repetition of real device verification or aided threshold measurement Repetition of validation of the devices through speech testing Resetting and/or reprogramming device parameters to accommodate changes in hearing thresholds or needs Fitting new ear moulds or modification of the current ear mould/shell (e.g. retubing, replacement of ear hook) Assessment of MPO settings following device adjustment or modification. | |
3 | Client Reviews can be completed via telehealth if the technology allows and the practitioner is satisfied client outcomes are not compromised. | |
Program Requirements | ||
4 | Client must be fitted with at least one device (including ALDs) | |
5 | Claimable annually, where it is 12 months or more from the last program fitting date and 12 months or more from the last Client Review service.
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6 | A Client Review Service can be completed and claimed on the same date as an Assessment/Reassessment Service (Items 600/800).
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7 | The Date of Service is the date the Client Review is completed. This may occur over one or more appointments. | |
Evidence Requirements | ||
Evidence kept on the client record to substantiate the Client Review Service MUST include
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REHABILITATION SERVICE - UNAIDED To provide an alternative for clients who are not to be fitted with a hearing device but who would benefit from receiving training and strategies to manage the effects of their hearing loss. | ||
Item | Service | |
670 | Rehabilitation Service – Unaided | |
Service Requirements | ||
1 | Comply with General Program Service Requirements (see page 4), the PPB Code of Conduct and Scope of Practice. | |
2 | The service must
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3 | Rehabilitation Service can be completed via telehealth. | |
Program Requirements | ||
4 | Rehabilitation Service may be claimed once only for each client. | |
5 | Cannot be claimed if the client has been fitted previously through the program. | |
6 | Must not be claimed if the client has indicated interest in being fitted with device(s). | |
7 | Client can receive a fitting at a later date, if eligible, and changes in client’s circumstances are recorded on the client record. | |
8 | Can only be claimed within 12 months after an Assessment/Reassessment service. | |
9 | Rehabilitation Service (must be provided over two appointments, minimum 30 minutes duration per appointment)
Appointments should be recorded separately on the client record and on the Claim for Payment form. | |
10 | The Date of Service is the date the initial Rehabilitation appointment occurs. The Date of Follow-up is recorded on the Claim for Payment form. | |
Evidence Requirements | ||
Evidence kept on the client record to substantiate the Rehabilitation Service MUST include
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REHABILITATION PLUS SERVICES - AIDED To assist clients being fitted for the first time to acquire and apply skills to maximise their communication abilities and better manage their hearing loss. | |||
Item | Service | ||
680 | Rehabilitation Plus (two sessions) | ||
681 | Rehabilitation Plus (single session) | ||
Service Requirements | |||
1 | Comply with General Program Service Requirements (see page 4), the PPB Code of Conduct and Scope of Practice. | ||
2 | The service must:
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3 | The service must not address issues of device fitting (inserting devices, cleaning, changing batteries, program/volume control management etc.) and adjustment (sound adjustments) as these are expected activities for the Fitting Service. | ||
4 | Rehabilitation Plus can be completed via telehealth. | ||
Program Requirements | |||
5 | Only available to clients receiving fully subsidised devices, partially subsidised devices at no cost to client or an ALD for the first time through the program. | ||
6 | Clients are only entitled to one Rehabilitation Plus program, either one Item 680 OR two Item 681.
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7 | Service/s must take place after fitting follow up
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8 | Item 680 consists of at least
Partners/significant others can attend any session. | ||
9 | Item 681 consists of
Partners/significant others can attend any session. | ||
10 | Claim form must specify the QP number of the QP who delivered (or managed, if group sessions), the service/s and Site where services were provided.
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11 | Providers may subcontract the delivery of Rehabilitation Plus group sessions to a person with the appropriate skills. Note: Services must be claimed with the QP number of the QP who managed the group session. | ||
12 | The Date of Service is the date the final Rehabilitation Plus Service is provided. | ||
Evidence Requirements | |||
Evidence kept on the client record to substantiate the Rehabilitation Plus Service MUST include
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REPLACEMENTS for lost/damaged devices To enable clients who have lost or damaged their device/s to return to their previous device status. | ||
Item | Service | |
840 | Replacement of Lost/Damaged Beyond Repair Device – Monaural | |
850 | Replacement of Lost/Damaged Beyond Repair Device – Binaural | |
555 | Client Co-payment for Exempt Clients | |
888 | Client Co-payment for DVA Eligible Clients | |
Service Requirements | ||
1 | Comply with General Program Service Requirements (see page 4), the PPB Code of Conduct and Scope of Practice. | |
2 | Devices must be set to the client’s preferred settings. The client should be offered a Client Review Service, if they have not received a Client Review Service in the past 12 months. | |
3 | Replacement fittings can be completed via telehealth when replacing with like for like devices, and if no changes in the client’s ear and hearing health is reported. | |
Program Requirements | ||
4 | Device/s have been lost or damaged beyond repair. | |
5 | A Replacement can be claimed at any time after a claim for an Initial Fitting through the program. | |
6 | Replacement must be for the primary device/s. | |
7 | Replacements should be for the same device if still available on a Schedule of Approved Devices.
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8 | Lost device/s require a correctly completed Statutory Declaration (Commonwealth or State/Territory form)
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9 | Damaged Beyond Repair (DBR) device/s require a DBR letter from the device manufacturer
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10 | Clients with partially subsidised devices can be charged for their replacement device above the standard device subsidy for that category device. This must be no more than the cost provided on a quote to the client prior to Replacement. | |
11 | Replacement Fee: Providers may charge clients a Replacement fee, not exceeding the amount specified in the Schedule of Fees current at the Date of Service. Exceptions
client has dementia device was lost/DBR in hospital or a nursing home the device was lost/DBR in the post
DVA clients with a Gold Card DVA clients with a White Card issued for hearing loss.
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12 | The Date of Service for all Replacement Items (Items 840/850/555/888) is the date the replacement device is provided. | |
13 | Private devices: If a client is using private devices as their primary devices and the client loses or damages their private devices beyond repair, they are entitled to receive the services available to them on their current voucher.
is on a Schedule of Approved Devices, the device should be replaced with the same device is no longer on a Schedule of Approved Devices, the device should be replaced with a similar device the above Service Requirements for a Replacement Service apply.
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Evidence Requirements | |
Evidence kept on the client record to substantiate the Replacement Service MUST include
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SPARE DEVICE To ensure clients who only have one aidable ear and are heavily reliant on a device are able to have continuous use of a device even when their fitted device is unavailable due to loss/damage/repair. | |||
Item | Service | ||
960 | Spare Device | ||
Service Requirements | |||
1 | Comply with General Program Service Requirements (see page 4), the PPB Code of Conduct and Scope of Practice. | ||
2 | Spare aid fittings can be completed via telehealth if the spare aid is identical to the client’s primary device and the client is satisfied with the performance of their current device. | ||
Program Requirements | |||
3 | Client has only one aidable ear and is currently monaurally fitted or has a Bi-CROS fitting. | ||
4 | Client is highly dependent on aiding of the better ear. | ||
5 | Client does not have a second device that could be adapted to act as a spare. | ||
6 | Client has not had a spare device previously fitted through the program. | ||
7 | Spare device must be for the primary device
A Spare Device can only be claimed for the receiver component of a Bi-CROS fitting. | ||
8 | Spare device must be the same device, or if no longer available, the same device category as the fitted device. | ||
9 | The client must receive a detailed written device quote and must only be fitted with approved devices in accordance with the Device Supply Requirements specified on page 4. | ||
10 | Replacement
If the spare device is no longer suitable due to a significant change in hearing threshold levels: the practitioner must provide explanatory file notes. | ||
11 | The Date of Service is the date the spare device is provided to the client. | ||
12 | Future maintenance must be monaural unless client is fitted with a Bi-CROS system. | ||
13 | Client has only one aidable ear and is currently monaurally fitted or has a Bi-CROS fitting. | ||
Evidence Requirements | |||
Evidence kept on the client record to substantiate the Spare Device Service MUST include
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REMOTE CONTROL To enable clients with significant dexterity issues to adjust the volume or change the program of their device/s. | |||
Item | Service | ||
4 | Remote Control (Manufacturer's invoice amount < $200) | ||
Service Requirements | |||
1 | Comply with General Program Service Requirements (see page 4), the PPB Code of Conduct and Scope of Practice. | ||
2 | Client has been fitted with a device through the program (fully or partially subsidised) or is maintaining private device/s through the program. | ||
3 | Client has not received a Remote Control for their current fitting.
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4 | Program approval is required if a subsequent remote control is required on the same voucher. | ||
5 | Clinical assessment identifying the client has significant functional limitations and/or dexterity issues and cannot effectively manage their device’s standard manual controls for volume adjustment or the program settings without a remote control or other technology. | ||
6 | Where appropriate, a newer fitted ear must be fitted with the same device as the older fitted ear to ensure the client can use the same remote for both devices. | ||
7 | Only the actual remote control cost paid by the provider to the manufacturer/supplier (excluding postage and handling and after any discounts received) up to a cap of $200 per remote control can be claimed. | ||
8 | Remote controls costing more than $200 require pre-approval. The provider must email hearing@health.gov.au with the manufacturer’s invoice attached, for pre-approval by the program before it is supplied to the client.
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9 | If a client’s remote control is lost or damaged beyond repair, a Statutory Declaration must be completed explaining the loss or how it is damaged beyond repair, and be signed and dated by the client or their representative, (and appropriately witnessed).
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10 | If a client’s hearing device is lost or damaged beyond repair and the replacement device is not compatible with the previously supplied remote control, a new remote control may be provided.
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11 | The Date of Service is the date the remote control is provided. | ||
Evidence Requirements | |||
Evidence kept on the client record to substantiate the Remote Control Service MUST include
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RETURNED DEVICES | |||
Item | Service | ||
1 | Device Returned for Credit: Monaural - Half Cost of the Initial Fitting (no Maintenance) | ||
2 | Devices Returned for Credit: Binaural - Half Cost of the Initial Fitting (no Maintenance) | ||
3 | BTE Returned for Credit: Dispensing Fee | ||
Claiming Requirements | |||
1 | The client returns monaural/binaural device/s or ALD to the provider, and the provider is able to return the device/s/ALD to the manufacturer for credit. | ||
2 | The client is not motivated to be fitted with a different style of hearing device in the near future (≤ 2 months). | ||
3 | If the fitting claim has been submitted it must be recovered before the Item 1 or Item 2 claim is processed. | ||
4 | The Date of Service is the date of fitting of the returned device/s/ALD. | ||
5 | The provider will be paid one half of the Fitting (no Maintenance) Item fee. | ||
6 | Dispensing fee for Behind the Ear (BTE) device/s returned for credit (Item 3)
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The Australian Government Hearing Services Program (the program) requires clients being fitted with a hearing device to meet a minimum 3 Frequency Average Hearing Loss threshold of greater than or equal to 23dB (3FAHL ≥ 23dB), measured at 0.5, 1 and 2 kHz. Each ear must be evaluated independently.
Not all clients who have a hearing loss and attend an assessment want or need a hearing device. Before proceeding with a fitting of any client, practitioners must consider the nature and configuration of the hearing loss, the degree of communication difficulties experienced, and the attitude, motivation and goals of the client.
Clients with hearing loss below the program’s threshold (3FAHL < 23dB) should, in most instances, be provided with a rehabilitation service (communication training and strategies to manage their hearing loss) rather than be fitted with a device.
If a qualified practitioner determines that a client would benefit from a device, the client can be exempt from the MHLT requirements if the client meets both MHLT exemption criteria legislated under the Hearing Services Program (Voucher) Instrument 2019. Both criteria must be met before a client can be fitted or refitted under the program, and all other program assessment and fitting requirements (eg. Schedule of Service Items, and Eligibility Criteria for Refitting) must also be met.
Clients with a 3FAHL < 23dB in either ear cannot receive a fitting to that ear, or an Assistive Listening Device (ALD), unless they meet one condition under Criterion 1 and meet Criterion 2 of the MHLT exemption criteria.
The client must meet one of the following four conditions
The client must demonstrate they have a positive attitude and are motivated to wear a hearing device through their response to the Wishes and Needs Tool (WANT).
The WANT is a client self-report questionnaire, consisting of two questions, intended to be administered towards the end of the assessment/reassessment appointment, prior to each fitting.
Each client should complete the questions without assistance or prompting from the practitioner or others, to ensure that the answers reflect their own attitude and motivation. If a client indicates they are not ready for devices or indicates minimal communication difficulties, a fitting should not proceed.
Each response is scored (scores equal the clients’ answer numbers). The client must score at least 2 or more for each question and a total score of 5 or more (when both scores are added together), to be considered to have an acceptable attitude and motivation for a fitting. No information should be provided to the client to influence their responses. The WANT must be signed and dated by the client and kept on the client’s file. A new WANT should be completed prior to each MHLT fitting.
Asymmetrical Hearing Loss
If a client has a hearing loss in one ear that cannot be aided due to the severity of the loss or the ear health, the better ear can be fitted with a Contralateral Routing of Signal (CROS) device without meeting the MHLT guidelines. For clients being fitted with a BiCROS device, the better ear must meet the MHLT exemption criteria if the 3FAHL is ≤ 23dB.
Claiming
Client 3FAHLs must be recorded on claim forms and 23.3dB should be rounded to 23dB.
Documented evidence to justify clients meeting Criterion 1 and 2 must be kept on the client file. Evidence supporting fittings under the MHLT exemption criteria and any associated claim forms can be requested by the program at any time.
Monitoring and Compliance
Fitting under the MHLT exemption criteria are routinely monitored and audited. Providers will be required to reimburse the Commonwealth, and if applicable the client, if a fitting does not comply with the MHLT guidelines.
The Eligibility Criteria for Refitting (ECR) provide guidance for Contracted Service Providers (providers) of the Australian Government Hearing Services Program (the program) when deciding whether to refit a client.
The ECR outline the situations where a client’s current hearing device/s are no longer suitable due to a significant change in the client’s circumstances since their last fitting. The client therefore requires new hearing device/s and must be refitted.
The client’s current devices must be evaluated and found to be unsuitable before new device/s are discussed with the client. Before refitting, it is the responsibility of the provider to check that a refitting service is available on the client’s current voucher.
Minimum Hearing Loss Threshold
Refitting’s for clients with a 3FAHL < 23dB in any ear must meet both Minimum Hearing Loss Threshold exemption criteria.
If a client’s hearing or health changes significantly, they require an additional assessment or refitting not available on their current voucher and the criteria for revalidation is met, providers may request a revalidated service.
If a hearing device is lost or damaged beyond repair (DBR), and it is still available on a Schedule of Approved Devices, the replacement should be the same hearing device, unless the client’s circumstances meets an ECR.
Please ensure that the required ECR evidence is documented on file. Before proceeding with a refitting of any client, practitioners must consider and document
Any program refitting must meet one of the following criteria and the client file must include notes referencing the criterion used to support the refitting and the evidence listed under the evidence requirements for that criterion.
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And
Or
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2. The current hearing aid(s) are unsuitable because the client can no longer use their aid(s) due to a significant deterioration in health, dexterity or cognitive ability since last fitting. |
And
And
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3. A change in physical condition of the ear or ear health has occurred since last fitting and the client requires a different style of hearing device(s) to accommodate this change. |
And
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4. The current hearing aid(s) are unsuitable because the client requires a telecoil, and current hearing aid(s) do not have a telecoil. Please note, this situation does NOT allow for refitting with an FM system/streamer or equivalent. |
And
Please note, clients must opt-out of having a telecoil for any fitting. |
5. Client currently fitted with an Assistive Listening Device (ALD) and now requires hearing aid(s). |
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6. Client’s previous initial fit or refit occurred more than five (5) years ago. |
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