Section 182-547-0100. Hearing aids—General—For clients twenty years of age and younger.

Unless otherwise defined in WAC 182-547-0200, the terms within this chapter are intended to correspond with the terms in chapter 18.35 RCW.

(1) The agency covers the hearing aids listed in this chapter, according to agency rules and subject to the limitations and requirements in this chapter. See also WAC 182-531-0375 audiology services.

(2) The agency pays for hearing aids when:

(a) Covered;

(b) Within the scope of an eligible client's medical care program;

(c) Medically necessary as defined under WAC 182-500-0070;

(d) Authorized, as required within this chapter, chapters 182-501 and 182-502 WAC, and the agency's published billing instructions and provider notices;

(e) Billed according to this chapter, chapters 182-501 and 182-502, and the agency's published billing instructions and provider notices; and

(f) The client is twenty years of age or younger and completes a hearing evaluation, including an audiogram and/or developmentally appropriate diagnostic physiologic test results performed and/or interpreted by a hearing health care professional.

(3) The agency requires prior authorization for covered hearing aids when the clinical criteria set forth in this chapter are not met. The agency evaluates these requests on a case-by-case basis to determine whether they are medically necessary, according to the process found in WAC 182-501-0165.

[Statutory Authority: RCW 41.05.021. WSR 13-20-013, § 182-547-0100, filed 9/20/13, effective 10/21/13. WSR 11-14-075, recodified as § 182-547-0100, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090. WSR 11-11-015, § 388-547-0100, filed 5/9/11, effective 6/9/11. Statutory Authority: RCW 74.08.090 and 74.09.530. WSR 09-12-034, § 388-547-0100, filed 5/27/09, effective 7/1/09.]

RCW 41.05.021. WSR 13-20-013, § 182-547-0100, filed 9/20/13, effective 10/21/13. WSR 11-14-075, recodified as § 182-547-0100, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090. WSR 11-11-015, § 388-547-0100, filed 5/9/11, effective 6/9/11. Statutory Authority: RCW 74.08.090 and 74.09.530. WSR 09-12-034, § 388-547-0100, filed 5/27/09, effective 7/1/09.

Rules

182-547-0200,182-531-0375,182-500-0070,182-501,182-502,182-501,