Hearing Services Program (Schedule of Service Items and Fees 2022-23) Instrument (No. 2) 2022
I, Chris Carlile as delegate of the Minister for Health and Aged Care make the following instrument.
Dated 14 June 2022
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 2022-23) Instrument (No. 2) 2022.
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 2022 |
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Note: This table relates only to the provisions of this instrument as originally made.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The Hearing Services Program (Schedule of Service Items and Fees 2021-22) Instrument (No. 1) 2022 is repealed.
3 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 2022-23.
Australian Government
Hearing Services Program
Schedule of
Service Items and Fees
About the Schedule of Service Items and Fees
Glossary of terms in the Schedule of Fees
Claiming for services provided
Assistive Listening Devices (ALDs)
Minimum Hearing Loss Threshold (MHLT) Guidelines
Eligibility Criteria for Refitting
Documenting Consent and Agreement
Clients who have a current voucher are entitled to a range of services through the Hearing Services Program (program). The Schedule of Service Items and Fees (Services Schedule) provides information on service, program and evidence requirements for the services available to program clients.
Contracted service providers (providers) must comply with the program requirements. The Services Schedule includes the program standards; Minimum Hearing Loss Threshold (MHLT) Guidelines, the Eligibility Criteria for Refitting (ECR) and Documenting Consent and Agreement.
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.
The Commonwealth may, in exceptional circumstances where Service Providers may have difficulty in meeting requirements in the Services Schedule, issue a notice (Notice) that suspends the operation of any of these requirements and introduces interim requirements for a set period of time.
The Notice:
A notice received after 5.00 pm, or on a day that is not a Business Day in the place of receipt, is deemed to be effected on the next Business Day in that place.
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 Client
A client is eligible for specialist services if they have a
If a client is eligible for specialist services, the client record in the portal must be updated to notify the program of the client’s specialist status.
Clients eligible for Specialist Services must be advised that they may be eligible for additional services through Hearing Australia (Australian Hearing Services). Details of the information provided to the client, and the client’s decision of where to receive services, must be recorded on the client record.
Glossary of terms in the Schedule of Fees
ALD – Assistive listening device
BTE – Behind the ear
ITE – In the ear
ITC – In the canal
CIC – Completely in the canal
IIC – Invisible in the canal
CROS – Contralateral routing of signal
BiCROS – Bilateral CROS
NS – Non-standard
Voucher clients may be entitled to
An additional assessment or fitting service may be approved by the program as a revalidated service provided certain criteria are met
Program clients have the right to choose when and where they access hearing services, including purchasing services and devices
that are not available to them on their current voucher
not available under the program, and/or
from a non-program provider.
The client record must contain evidence that the client understood their rights under the program and consented to pay for private services and/or devices. This includes:
notes documenting the advice given by the qualified practitioner to the client regarding the program services available on their current and future voucher
notes confirming that a same/similar service or revalidated service was not available to the client on their current voucher (e.g. in the client record or private services agreement)
a device quote supplied for any fittings
the private services agreement signed and dated by the client, that includes
o a statement that the client understands the services available to them under the program, but has decided to purchase services and/or device/s privately
o what program services will no longer be available
o the total cost of the service/s and/or device/s and that no program subsidy is available
If there is a refitting, replacement or the client chooses to enter a maintenance agreement for a private device, the standard program record keeping requirements for these services apply and these form part of the client record.
The portal should have an accurate record of the client’s primary device/s.
If a client is fitted with a private device, the device information in the Service History accordion of the portal must be updated.
If the client’s private device/s are listed on a Schedule of Approved Devices, also include the device code in the Service History.
Providers should familiarise themselves with services for clients which may be covered by other Government funded programs, such as Medicare, National Disability Insurance Scheme, Department of Veterans Affairs, Disability Employment Services or My Aged Care.
Providers may charge clients for services not available on their voucher, including:
General Program Service Requirements apply to all program services. Providers must comply with the following, as well as service requirements for each Service Claimed services that do not meet the requirements must be reimbursed to the program. | |
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 on or between the start and end date of the voucher that was current at the date of service. |
3 | Providers must ensure the service is available on the client’s current voucher before delivering and claiming for any service. |
4 | Services must be performed by a Qualified Practitioner (QP) or Provisional Practitioner under supervision of a QP in accordance with 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 Privacy and Consumer Laws, 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 requirements published on the Department’s website and evidence requirements for each Service Item. |
12 | Portal information for the client must be updated as required, including:
|
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 a revalidated service is approved. |
14 | If a service is provided via telehealth, this must be documented on the client record and the client must be informed that a telehealth appointment is taking place |
Device Supply Requirements | |
Detailed written device quote Clients must receive a single detailed written device quote for all devices supplied under the program (fully and partially subsidised devices, replacements, spare devices 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. If a client requires a device that is not available on a Schedule of Approved Devices, you can submit a Non-scheduled Device Request for approval to fit the device to the client.
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 first day of each financial year, in accordance with the following indexes
The resultant GST amount will be rounded to the nearest cent.
The final indexed fee amount is rounded to the nearest 5 cents.
The device prices payable are those specified in the Schedule of Fees current at the Date of Fitting.
Please refer to the Fully Subsidised Device Schedule for individual device pricing. The device prices can be found on the Hearing Services Online Portal.
Dispensing fee for behind-the-ear (BTE) hearing aids fitted
An additional dispensing fee is paid for BTE hearing devices in Category 1 and 2 as listed in the Schedule of Fees for item numbers 630, 631, 640, 641, 650, 651, 660, 661, 760, 761, 770, 771, 820, 821, 830, 831, 840, 850 and 960.
Note: for BiCROS and CROS fittings, the dispensing fee is only paid for a BTE device fitted to the other ear.
Device 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.
Clients fitted with partially subsidised devices can be charged a higher Maintenance Co-payment. This must be documented in the quote or in the next Maintenance Agreement for relocated clients.
The GST amount for the co-payment 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.
Replacement Fee
The client can be charged the specified Replacement Fee listed in the Schedule of Fees per replacement device unless this is covered by items 555 or 888.
Claiming for services provided
Providers are responsible for ensuring the client has a current voucher prior to services being provided through the program. All services must be on or between the voucher start and expiry date of the voucher current at the time of the date of service, except where a fitting begins on one voucher and a follow up is completed on a new voucher. Claims for services must be submitted within 12 months of the date of service.
Items marked with an asterisk (*) in the Schedule of Fees must be submitted as a Portal (manual) claim.
Item | Schedule of Service Items & Fees – 2022/23 | Amount | GST Liable | GST | Total | |
600 | First Assessment | $147.95 | $0.00 | $0.00 | $147.95 | |
610 | Audiological Case Management (Review and Advice) | $46.95 | $0.00 | $0.00 | $46.95 | |
800 | Reassessment | $147.95 | $0.00 | $0.00 | $147.95 | |
810 | Audiological Case Management (Review and Advice) | $46.95 | $0.00 | $0.00 | $46.95 | |
630 | Initial fitting with Maintenance Agreement - Monaural | $472.15 | $10.00 | $1.00 | $473.15 | |
631 | Initial fitting with Maintenance Agreement - Non Follow up - Monaural | $236.05 | $10.00 | $1.00 | $237.05 | |
640 | Initial fitting with Maintenance Agreement - Binaural | $590.70 | $20.00 | $2.00 | $592.70 | |
641 | Initial fitting with Maintenance Agreement- Non Follow up - Binaural | $295.35 | $20.00 | $2.00 | $297.35 | |
650 | Initial fitting (no Maintenance Agreement) - Monaural | $459.20 | $0.00 | $0.00 | $459.20 | |
651 | Initial fitting (no Maintenance Agreement) - Non Follow up - Monaural | $229.60 | $0.00 | $0.00 | $229.60 | |
660 | Initial fitting (no Maintenance Agreement) - Binaural | $550.80 | $0.00 | $0.00 | $550.80 | |
661 | Initial fitting (no Maintenance Agreement) - Non Follow up - Binaural | $275.40 | $0.00 | $0.00 | $275.40 | |
760 | Subsequent Initial Fitting with Maintenance Agreement | $120.90 | $10.00 | $1.00 | $121.90 | |
761 | Subsequent Initial Fitting with Maintenance Agreement - Non Follow up | $60.45 | $10.00 | $1.00 | $61.45 | |
770 | Subsequent Initial Fitting (no Maintenance Agreement) | $87.00 | $0.00 | $0.00 | $87.00 | |
771 | Subsequent Initial Fitting (no Maintenance Agreement) - Non Follow up | $43.50 | $0.00 | $0.00 | $43.50 | |
820 | Refitting - Monaural | $394.60 | $0.00 | $0.00 | $394.60 | |
821 | Refitting - Non Follow up - Monaural | $197.30 | $0.00 | $0.00 | $197.30 | |
830 | Refitting - Binaural | $392.20 | $0.00 | $0.00 | $392.20 | |
831 | Refitting - Non Follow up - Binaural | $196.10 | $0.00 | $0.00 | $196.10 | |
635 | ALD: Initial fitting with Maintenance Agreement | $212.50 | $10.00 | $1.00 | $213.50 | |
636 | ALD: Initial fitting with Maintenance Agreement- Non Follow up | $106.25 | $10.00 | $1.00 | $107.25 | |
655 | ALD: Initial fitting (no Maintenance Agreement) | $193.70 | $0.00 | $0.00 | $193.70 | |
656 | ALD: Initial fitting (no Maintenance Agreement) - Non Follow- up | $96.85 | $0.00 | $0.00 | $96.85 | |
825 | ALD: Refitting | $136.30 | $0.00 | $0.00 | $136.30 | |
826 | ALD: Refitting - Non follow up | $68.15 | $0.00 | $0.00 | $68.15 | |
700 | Maintenance and Battery Supply - Monaural | $101.00 | $50.50 | $5.05 | $106.05 | |
710 | Maintenance and Battery Supply - Binaural | $202.05 | $101.00 | $10.10 | $212.15 | |
711 | Relocated Maintenance and Battery Supply - Monaural | $70.70 | $59.00 | $5.90 | $76.60 | |
722 | Relocated Maintenance and Battery Supply - Binaural | $95.95 | $71.50 | $7.15 | $103.10 | |
777 | Client Co-payment for Maintenance and Batteries - DVA eligible clients | $46.55 | $23.50 | $2.35 | $48.90 | |
790 | Maintenance and Battery Supply (Private Devices) – Monaural | $101.00 | $50.50 | $5.05 | $106.05 | |
791 | Maintenance and Battery Supply (Private Devices) – Binaural | $202.05 | $101.00 | $10.10 | $212.15 | |
920 | Client Review - Unaided | $83.40 | $0.00 | $0.00 | $83.40 | |
930 | Client Review - Monaural or ALD | $83.40 | $0.00 | $0.00 | $83.40 | |
940 | Client Review - Binaural | $129.25 | $0.00 | $0.00 | $129.25 | |
670 | Rehabilitation Service - Unaided | $213.80 | $0.00 | $0.00 | $213.80 | |
680 | Rehabilitation Plus (two sessions) | $151.50 | $0.00 | $0.00 | $151.50 | |
681 | Rehabilitation Plus (single session) | $75.20 | $0.00 | $0.00 | $75.20 | |
840 | Replacement of Lost/ Damaged Beyond Repair Device - Monaural | $74.05 | $0.00 | $0.00 | $74.05 | |
850 | Replacement of Lost/ Damaged Beyond Repair Devices - Binaural | $108.00 | $0.00 | $0.00 | $108.00 | |
555 | Client Co-payment for Exempt Clients | $43.40 | $0.00 | $0.00 | $43.40 | |
888 | Client Co-payment for DVA Eligible Clients | $43.40 | $0.00 | $0.00 | $43.40 | |
Spare | 960 | Spare Device | $78.70 | $0.00 | $0.00 | $78.70 |
Remote | 4* | Remote Control (Manufacturer's invoice amount only < $200) | ||||
Device Fees | Category 1 - High powered BTEs (plus dispensing fee, listed below) | $501.55 | $0.00 | $0.00 | $501.55 | |
Category 2 - BTEs (plus dispensing fee, listed below) | $474.45 | $0.00 | $0.00 | $474.45 | ||
Category 3 - Custom devices (ITE, ITC, CIC, IIC) | $435.70 | $0.00 | $0.00 | $435.70 | ||
Non-standard (NS) devices (ALD, BiCROS, CROS, bone conductor) | Refer FS Device Schedule for pricing | |||||
BTE Dispensing Fee | $28.15 | $0.00 | $0.00 | $28.15 | ||
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 | $28.15 | $0.00 | $0.00 | $28.15 | |
6* | Miscellaneous Claim: Only claimable when pre-approved by the program | |||||
Client Fees | Client Maintenance Co-payment | $46.55 | $23.50 | $2.35 | $48.90 | |
Client Replacement Co-payment | $43.40 | $0.00 | $0.00 | $43.40 |
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 6), the PPB Code of Conduct and Scope of Practice. | |
2 | Practitioners establish the nature and extent of client’s hearing and communication needs through the following: an accurate and complete assessment of the client’s clinical and audiological history
discussion of client’s expectations, motivation and attitude towards hearing rehabilitation informing the client about appropriate communication strategies and tactics.
Practitioners support client’s decision making in managing their communication and hearing goals by: providing rehabilitation to clients to better manage their life with hearing loss. This may or may not include a device fitting informing the client of rehabilitation programs, including Rehabilitation Plus (680/681) and Rehabilitation Service (670) informing the client of the technological options available and suitable device choices (type, style and configuration), including fully subsidised device options | |
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
| |
5 | Non-routine clients (see definitions)
| |
6 | If the client is likely to proceed to a fitting, the client must
| |
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 is completed. If an Audiometrist requires advice for a non-routine client from an Audiologist or medical practitioner, 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
|
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 6), the PPB Code of Conduct and Scope of Practice. | ||
2 | Practitioners ensure the safety of the clients through Audiometrists liaising with an Audiologist about the management of non-routine clients. 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/Reassessment 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 | Items 610 and 810 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 Client’s first fitting service through the program to provide appropriate hearing technology which is clinically suitable to the client’s needs. A Subsequent Initial Fitting is for a client who has previously been monaurally fitted through the program and now requires a hearing device for their other (previously unfit) ear. | ||
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 6), the PPB Code of Conduct and Scope of Practice. | |
2 | Practitioner provides appropriate hearing 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. | |
4 | The client’s clinical and audiological history and hearing goals must be reviewed at fitting unless done so in the past 12 months at Assessment, Reassessment or Client Review | |
Program Requirements | ||
4 | A fitting service should consist of at least two appointments, the fitting and a follow up.
Where attempts have been made to contact the client and a follow up is not completed, or the follow up is sooner than seven calendar days after the fitting, a non-follow up claim must be submitted. Except for Non Follow up services, 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 | Only one Initial Fitting Item can be claimed for each client and no previous fitting through the program must have occurred. | |
6 | 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 23.3dB in the portal and on the claim form). | |
7 | An Assessment or Reassessment Service or Client Review 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 no more than 12 months old. | |
8 | Any Refitting within 12 months of the Initial Fitting is considered part of the original Hearing Rehabilitation Program and cannot be claimed, unless the device/s have been + returned for credit and a recovery processed (if already claimed), or if the fitting service has been revalidated. | |
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 pages 6 & 7).
| |
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 20 for further program requirements. | |
11 | 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). | |
12 | SUBSEQUENT Initial Fittings with Maintenance Agreement (Items 760,761) can only be claimed where the client has a current monaural Maintenance Agreement. | |
13 | A SUBSEQUENT Initial Fitting Item can be claimed once only for a previously monaurally fitted client. | |
14 | If the client has private device(s) maintained through the program, their first program fitting must be claimed as an Initial Fitting. | |
15 | 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 Fitting Service MUST include
| ||
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 6), the PPB Code of Conduct and Scope of Practice. | ||
2 | Practitioner provides appropriate hearing 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. | ||
4 | The client’s clinical and audiological history and hearing goals must be reviewed at fitting unless done so in the past 12 months at Reassessment or Client Review. | ||
Program Requirements | |||
4 | A fitting service should consist of at least two appointments, the fitting and a follow up.
Where attempts have been made to contact the client and a follow up is not completed, or the follow up is sooner than seven calendar days after the fitting, a non-follow up claim must be submitted. Except for Non Follow up services, 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 | Clients must not be refitted unless the fitting complies with the ECR.
| ||
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.
| ||
8 | An Assessment, Reassessment, screening or Client Review must have been completed before Refitting. The provider must ensure the fitting is based on hearing thresholds no more than 12 months old. | ||
9 | Any Refitting within 12 months of a previous Fitting is considered part of the previous Hearing Rehabilitation Program and cannot be claimed, unless the device/s have been returned for credit and a recovery processed (if already claimed), or if the fitting service has been revalidated. | ||
10 | 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 pages 6 & 7). If the device was ordered specifically for the client on or before its withdrawal date from an Approved Device Schedule, the device can be fitted within 14 days. Please email the program for approval | ||
11 | 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 20 for further program requirements. | ||
12 | 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. | ||
13 | If a monaural Refitting has been claimed and the opposite ear requires a refit within 6 months 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). If the opposite ear is refitted more than 6 months following a monaural refit, a monaural refitting claim should be submitted and no recovery is required. | ||
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
|
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 6), 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 may consist of two appointments, a fitting and a follow up.
If no follow up appointment is required, the client does not attend a follow up, or the follow up is sooner than seven calendar days after the fitting, a non-follow up claim must be submitted. 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 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 device(s) in accordance with the Device Supply Requirements (see pages 6 & 7). | ||
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 20 for further program requirements. | ||
11 | The Date of Service is the date of the follow up (except for non-follow up fittings (items 636 and 656), 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
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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 6), 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 may consist of two appointments, a fitting and a follow up.
If no follow up appointment is required, or the client does not attend a follow up, or the follow up is sooner than seven calendar days after the fitting, a non-follow up claim must be submitted. 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 pages 6 & 7). | ||
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
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MAINTENANCE AND RELOCATED MAINTENANCE
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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 6), 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.
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5 | Maintenance Agreements cover:
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6 | Maintenance and repairs must
If same day repair is unavailable, a loan device should be offered where appropriate. | ||
7 | Warranty on the hearing aid must be utilised for specified hearing aid repairs, as detailed in the Deed of Standing Offer. | ||
8 | 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. | ||
9 | Standard maintenance can only be claimed once every 12 months, with the exception of: Relocated Maintenance (Items 711/722), refer to Requirement 15 below
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10 | 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. | ||
11 | 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. | ||
12 | The Date of Service is
| ||
13 | 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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14 | 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. | ||
15 | DVA Client Maintenance Co-payment, Item 777 (not applicable for Relocated Maintenance)
The DVA Client Maintenance Co-payment is listed in the Schedule of Fees. Clients must hold a DVA Gold Card or White Card (for hearing loss). DVA PCC clients are not entitled to this claim Item. Item 777 is claimed annually with Maintenance claims (Items 700, 710), for Initial Fitting claims that include Maintenance Agreement (Items 630, 635, 640) and with Private Device Maintenance (Items 790, 791). Item 777 Date of Service matches the Date of Service of the Maintenance claims (Items 700, 710, 790, 791) or the Date of Fitting for Initial Fitting claims that includes Maintenance Agreement (Items 630, 635, 640) or the Date of Fitting for Refitting claims (Items 820, 825, 830).
If a DVA Gold or White Card (for hearing loss) holder chooses a partially subsidised device, DVA will only pay the program’s set Client Maintenance Co-payment towards their Maintenance Agreement. The client must pay any difference between the provider’s quoted maintenance fee and the program set Client Maintenance Co-payment. The client must still sign a Maintenance Agreement if the Co-payment is paid by DVA. | ||
16 | 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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17 | Cost to Client
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18 | Non-approved devices A client cannot enter into a program maintenance agreement, and providers cannot claim maintenance from the program, if a client chooses private device(s) which are
If a provider sells a client private device(s) that are not on a Schedule of Approved Devices, the provider must be able to maintain the device(s) privately. The program will not provide replacements for non-approved devices. There is a risk if a client moves to a new provider that the new provider may not maintain the non-approved devices and the device(s) will not be able to be repaired under a program maintenance agreement.
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Evidence Requirements | |||
Evidence kept on the client record to substantiate the Maintenance Service MUST include
| |||
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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For Parallel Services
An email should be sent to hearing@health.gov.au to request that a client's status in the portal is updated to 'specialist services - parallel' The client should be listed under the provider maintaining and supporting the hearing aid Only the hearing aid should be entered into the portal, and not the implantable device Monaural maintenance claims should be submitted for the hearing aid supplied through the voucher program Hearing Australia will support the implantable device under the CSO program An annual maintenance fee may be payable to both Hearing Australia and their other provider |
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 6), 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:
discussion of client’s expectations, motivation and attitude towards hearing rehabilitation inform client about appropriate communication strategies and tactics.
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 Training and communication strategies to manage the effects of hearing loss Education on impact of hearing loss and hearing loss prevention. Discussion of rehabilitation options, including hearing devices and ALDs available to assist clients to manage their hearing loss and enhance communication | |
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 (including ALDs) under the program and does not have private devices maintained under the program. | |
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 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 6), the PPB Code of Conduct and Scope of Practice. | |
2 | Client Review service must include Review of the client’s clinical and audiological history
And, three or more of the following additional activities (four or more if completed at same time as a Reassessment) Only activities marked with ( * ) may be performed for clients with ALDs. Hearing screening, including a check of middle ear status if clinically indicated* Speech testing (including for validation of devices)* Review of client’s device management with reinstruction* Review of device expectations and management* Training and communication strategies to manage the effects of hearing loss* Education on impact of hearing loss and hearing loss prevention* Device verification (e.g. REM, LSM, 2cc Coupler Measurement, etc.) or aided threshold measurement Resetting and/or reprogramming device parameters to accommodate changes in hearing thresholds or needs, including assessment of MPO Fitting new ear moulds or modification of the current ear mould/shell (e.g. retubing, replacement of ear hook) | |
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) under the program or has private devices maintained under the program. | |
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).
| |
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 6), the PPB Code of Conduct and Scope of Practice. | |
2 | The service must
| |
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 6), 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, private devices brought onto the program 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:
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8 | Item 680 consists of:
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. If services are provided at a location not operated by the provider, claim using the site ID where the client’s record is held. | ||
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 6), 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 | A fitting service item has previously been processed and approved | |
5 | Device(s) have been lost or damaged beyond repair. | |
6 | A Replacement can be claimed at any time after a claim for an Initial Fitting through the program. | |
7 | Replacement must be for the primary device(s). | |
8 | Replacements must be for the same device if still available on a Schedule of Approved Devices.
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9 | Lost device/s require a correctly completed Statutory Declaration (Commonwealth or State/Territory form)
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10 | Damaged Beyond Repair (DBR) device/s require a DBR letter from the device manufacturer
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11 | 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. | |
12 | 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 Replacement fees must be waived and an Item 888 claimed for DVA clients with a Gold Card DVA clients with a White Card issued for hearing loss.
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13 | The Date of Service for all Replacement Items (Items 840/850/555/888) is the date the replacement device is provided. | |
14 | If a client loses a hearing device between the fitting and follow-up appointment:
If the client finds the lost device, send the replacement back to the manufacturer, and do not claim item 840 or 850. | |
15 | 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. If the client has received a fitting through the program and they meet the ECR, they are entitled to receive a Refitting Service, provided they accept device(s) from a Schedule of Approved Devices. | |
Evidence Requirements | ||
Evidence kept on the client record to substantiate the Replacement Service MUST include
documentation of justification for Item 555 claim (e.g. client file note, nursing home letter). | ||
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 6), the PPB Code of Conduct and Scope of Practice. | ||
2 | Spare device fittings can be completed via telehealth if the technology allows and the practitioner is satisfied client outcomes are not compromised. | ||
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 cannot be claimed for a CROS fitting. 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.
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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 pages 6 & 7). | ||
10 | Replacement
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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. | ||
Evidence Requirements | |||
Evidence kept on the client record to substantiate the Spare Device Service MUST include
history of monaural fitting or fitting with Bi-CROS system justification of need for a spare device, including high dependence on device (e.g. data logging) explanatory notes from practitioner if the device is no longer clinically appropriate details of spare device (serial number, model and device code) client payment receipt (if applicable). | |||
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 6), 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 submit a manufacturer’s invoice 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. | ||
12 | Item 4 claims must be submitted as portal claims against the individual client record | ||
Evidence Requirements | |||
Evidence kept on the client record to substantiate the Remote Control Service MUST include
Justification of client’s need for a remote control File notes regarding client’s ability to otherwise manage their device(s) independently Program email approval for if the remote is valued over $200 or if a subsequent remote control is required on the same voucher Statutory Declaration if remote is Replacement Copy of manufacturer’s invoice showing the actual cost paid. | |||
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 hearing device in the near future (≤ 2 months after devices returned). | ||
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 BTE device(s) returned for credit (Item 3)
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7 | Item 1, 2 and 3 claims must be submitted as portal claims against the individual client record | ||
Specialist Services | Updating of text to provide that a note must be kept on file to indicate client's chosen service provider. |
Available Services | Information regarding services not available on the voucher which can be charged for |
Private Services | New section - general information and requirements for providing private services. Detailed requirements outlined in relevant claim item |
General Requirements | Point 12: Addition of 'contact information' and 'changes in devices used by the client' |
Device Supply Requirements | Addition to only approved devices fitted: If a client requires a device that is not available on a Schedule of Approved Devices, you can submit a Non-scheduled Device Request for approval to fit the device to the client. Addition - If you wish to fit a device without sufficient reserve gain, please email the program for approval, including why you wish to fit this device Addition - device fitted to the client must include initial supply of consumables |
Annual indexation of fees | Addition - The final indexed fee amount is rounded to the nearest 5 cents. |
Device Pricing | Addition - Dispensing fee is paid to BTE devices from Category 1 and 2 |
Payments from clients | Addition - Clients fitted with partially subsidised devices can be charged a higher Maintenance Co-payment. This must be documented in the quote or in the next Maintenance Agreement for relocated clients. Agreement if a client relocates |
Claiming for services provided | Addition - Items marked with an asterisk (*) in the Schedule of Fees must be submitted as a Portal (manual) claim. |
Schedule of Fees | ALDs separated into refitting and initial fitting in spreadsheet |
Assessment | Program Requirement 4 update: Specialist Services (Complex) clients must: be allowed at least 10 business days (without being provided further services) before being contacted to ask whether they have decided to receive additional services from Hearing Australia, unless the client notifies their decision earlier |
Audiological Case Management | Removal of 'referral to a medical practitioner for evaluation where clinically appropriate' as this is a general requirement |
QP Number | Evidence Requirement: Removal of QP number for all service items |
Fittings | Service Requirement 2: Addition of follow up to 'evaluation of the short term outcome(s) of the clients rehabilitation program' |
ALD | Program Requirement 4 updated: A fitting service may consistent of two appointments. |
Maintenance | Program Requirement 5: Updated to reflect list of items and services covered under maintenance from maintenance factsheet |
Client Review - Unaided | Service Requirement 2: Removal of 'review of communication strategies' |
Client Review - Aided | Removal of ‘extend the life of the fitting’ |
Rehabilitation - Aided | Program Requirement 5: Private devices included as fitting type in which clients can access rehab plus |
Replacements | Program Requirement 4: Addition of 'a fitting service item has previously been processed and approved'. |
Spare Device | Service Requirement 2 Updated: Spare device fittings can be completed via telehealth if the technology allows and the practitioner is satisfied client outcomes are not compromised. |
Remote Control | Service Requirement 9: Addition 'replacement claim for a remote control is an item 4' |
MHLT | Update of 3 FAHL to greater than or equal to 23.3 dB (not 23) |
ECR | Change in wording of ‘revalidated services’ to reflect program requirements |
Documentation and Record Keeping | New program Standard - Information from factsheet |
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 23.3dB (3FAHL ≥ 23.3dB), 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 < 23.3dB) 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 hearing 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 Fees, and ECR must also be met).
Clients with a 3FAHL < 23.3dB in either ear cannot receive a fitting to that ear, or an ALD, unless they meet at least 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 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 ≤ 23.3dB.
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 ECR provide guidance for providers of 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.
MHLT
Refitting’s for clients with a 3FAHL < 23.3dB in any ear must meet both MHLT exemption criteria.
If an assessment or refitting service is not available on their current voucher and the client requires:
providers may request a revalidated service.
If a hearing device is lost or DBR, and it is still available on a Schedule of Approved Devices, the replacement must be the same hearing device. If the client meets an ECR then a refitting should occur.
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
For revalidated services: the client’s hearing thresholds have permanently deteriorated by 15dB or more at two or more frequencies between 500Hz and 4000Hz in at least one ear. |
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, cognitive ability or speech discrimination since last fitting. |
And
And
For revalidated services: A letter from a medical practitioner is required when selecting ECR 2 to provide evidence of a deterioration in health, dexterity or cognitive ability. |
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
For revalidated services: A letter from a medical practitioner is required when selecting ECR 3 to provide evidence of change in physical condition of ear or ear health. |
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. And
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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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Client consent and agreement – signature policy
Program documents, forms and agreements that require client signature may be signed by various methods.
The Electronic Transactions Act 1999 (ETA) states that if a person or persons are asked to produce or provide information in writing, that person or persons may, given the appropriate circumstances, provide that information in an electronic manner (subsection 9(1)).
Subsection 10(1) makes reference to the signing of a document using electronic means. The requirements of a signature according to the ETA are that it must
Acceptable methods of consent or agreement
Depending on the form or agreement used, the program accepts that if a client is required to ‘sign and date’ a form, the following methods may be available for use:
For instances where a form has been sent to a client via text message or email, the client must be identifiable, and response must be captured on the client record.
For recorded conversations, the contents of the form must be read aloud to the client before the client can provide verbal agreement. This recording is required as part of the client record, including if a client relocates to another provider. Under The Privacy Act 1988, clients must be informed and give consent to any recording of conversations.
Please see below table outlining the acceptable methods of obtaining consent for program forms and templates:
Form | Verbal | Physical /digital | Evidence Required |
Claim for Payment/Tax Invoice | No | Yes | Form - physical or digital only Tick box in portal |
Client Application | Yes (portal) | Yes | Portal - verbal agreement (tick box signed) and read out privacy notice |
Client Relocation Consent | Yes (to relocate) | Yes (before providing services) | Form - physical or digital Verbal - template must be read to client and note on client record |
Device Quote | No | Yes | Form - physical or digital only |
Lost Device Statutory Declaration | No | Yes | Form - physical or digital only |
Maintenance Agreement | Yes | Yes | Form - physical or digital |
Private Services and Devices Acknowledgement | Yes | Yes | Form - physical or digital |
Wishes and Needs Tool (WANT) | No | Yes | Form - physical or digital only |
Definitions
Methods:
Digitising - The act of making a digital representation of a document or part of a document that can then be used in electronic documents.
Electronic Completion - The form is completed using a computer to fill in the required input using either a .pdf editing program (e.g. Adobe® Reader®) or a word processing program (e.g. Microsoft® Word)
Electronic Submission/delivery - The subject matter of the form is completed, and the form is transmitted to the intended recipient using an electronic means such as email or facsimile.
Signatures:
Digital Signature - In the case of electronic documents, certificates, letters and correspondence a digital signature can be attached to identify the person and person’s intention towards the material it is attached. E.g. Adobe Digital Signature, DocuSign etc.
Digitised Signature - An analogue of handwritten signature of an individual that has been digitised for use with electronic documents. In most cases a digitised signature will not meet the requirements of the ETA.
Electronic Signature - A signature that identifies an individual using a computer-generated means. The most common example is the signature block affixed to emails.
eSignature - An ink stamp may be fixed to a program form before it is digitised, or an electronic equivalent may be affixed to the document electronically. It is also possible to accept electronically completed forms which are not stamped, as long as the information that would be in the stamp is included in the other fields of the form.