Hearing Services and Devices

Transcription

1 Hearing Services and Devices Guidelines for providing hearing services and hearing devices to injured workers June 2013 The WorkSafe Agent can pay the reasonable costs of approved hearing services and hearing devices provided by WorkSafe approved hearing service providers to assist workers in the rehabilitation of work-related injuries or illness under Victorian workers compensation legislation (the legislation). This policy should be read in conjunction with the following documents: Hearing Services Fee Schedule for Contracted Hearing Services Fee Schedule for Non-contracted Hearing services providers should also refer to the current WorkSafe Approved Hearing Device List (the List). Prior approval from the Agent is required before a hearing device can be provided to a worker with an accepted hearing loss claim. Definitions In this policy: hearing services include Hearing Needs Assessments; submission of a Hearing Assessment and Device Request Form (or the Hearing Assessment and Device Exception Request Form in exceptional circumstances); provision and review of hearing devices from the List; and fitting, repair, adjustment or replacement of hearing devices and supply of hearing device batteries. hearing devices are hearing aids, assistive listening devices or accessories. The hearing devices that WorkSafe can pay for are contained in the List. hearing service providers are either audiologists or audiometrists who are approved by WorkSafe. contracted hearing service providers are approved hearing service providers who have entered into contractual agreements with WorkSafe to provide hearing services and hearing devices in accordance with the agreement and the WorkSafe Hearing Services Fee Schedule For Contracted. Contracted providers are located in Melbourne and in some regional areas and are listed as follows: Contracted Hearing service provider list - Metro Contracted Hearing service provider list - Regional (and interstate) non-contracted hearing service providers are approved hearing service providers that do not have contractual agreements with WorkSafe- please refer to the information sheet, Hearing services and devices, Information for workers the WorkSafe Approved Hearing Device List (the List) is the list of each WorkSafe approved hearing device by manufacturer, including the model name, number and the price Agents can pay as the reasonable costs for that device. Guidelines What does the Agent need to determine liability? In determining liability, the Agent requires the following information: a valid Worker s Injury Claim Form, and an Employer Injury Claim Report Form completed by the employer upon receipt of a Worker s Injury Claim Form. The Agent may also require additional information from the worker, employer and treating medical practitioner (GP) in order to determine liability. To obtain additional information, the Agent can request the completion of the following hearing services questionnaires: Worker Questionnaire - Hearing Services Employer Questionnaire - Hearing Services GP Questionnaire - Hearing Services. Once liability for a worker s hearing loss injury is accepted, the Agent will consider the following when determining the reasonableness of a hearing device request: the nature and circumstances of the worker's hearing loss, including the work-related component of that loss the communication, functional and clinical needs of the worker and the necessity and appropriateness of a hearing device the hearing service provider's assessment of the worker's needs clinical justification for the make, model and features of the requested hearing device on the basis of a worker s physical, psychological, vocational and functional status. Note: This policy is a guideline issued by WorkSafe Victoria under Victorian workers compensation legislation in respect of the reasonable costs of services, and services for which approval should be sought from the WorkSafe Agent or self-insurer (as the case may be) before the services are provided. WSV1427/03/05.13

2 What can the Agent pay for in relation to hearing services and hearing devices? The Agent can pay the reasonable costs of hearing services and hearing devices that are: required as a result of a work-related injury or illness and where the claim has been accepted by the Agent provided by an audiologist or audiometrist approved by WorkSafe listed in the WorkSafe Hearing Services Fee Schedule For Contracted or the Hearing Services Fee Schedule For Non-contracted specified on the current List or separately approved by WorkSafe in exceptional circumstances clinically justified on the basis of a worker's physical, psychological, vocational and functional status. The Agent can pay for the following hearing services and hearing devices: Hearing Needs Assessment The purpose of a Hearing Needs Assessment is to determine the worker s level of independence and hearing needs as a result of their work-related injury through a range of diagnostic testing. This hearing service includes: setting agreed rehabilitative goals with the worker recommendation of options for achieving the goals at reasonable cost provision of clinical justification for the proposed options completion of the Hearing Assessment and Device Request Form (or the Hearing Assessment and Device Exception Request Form in exceptional circumstances). The Agent can only pay the reasonable costs of a Hearing Needs Assessment for a maximum of once every five years for the same worker. Hearing Devices The List contains hearing devices that have features identified by WorkSafe as appropriate to meet the needs of the majority of workers. The List is provided by WorkSafe to all Agents and hearing service providers and contains a range of devices meeting WorkSafe s required features. The List is usually updated on 1 January and 1 July each year. Hearing service providers must refer to the most up to date List to ensure a device is, or remains, approved by WorkSafe at the time the device is provided. In exceptional circumstances, WorkSafe will consider approval of a hearing device which is not on the List for a worker who requires additional features due to their communication or functional needs. Assistive Listening Device (ALD) The Agent will consider approval of ALDs, taking into account: the current hearing aid used by the worker clinical justification for the ALD previous ALDs provided to the worker as part of a WorkSafe claim. Hearing Device Fitting Package This hearing service is to provide and fit the approved hearing device and to assist in restoring the worker s independence and ability to manage day-to-day life with hearing loss. The Hearing Device Fitting Package covers all consultations required by the worker in the first 12 months following the initial fitting and provision of the device and should include follow-up appointments to facilitate the worker s understanding of, recovery from, or adjustment to, their work-related hearing loss. The Agent can only pay the reasonable costs of a Hearing Device Fitting Package where the Agent has provided prior written approval to the hearing service provider. The Agent can only pay the reasonable costs of a Hearing Device Fitting Package once every five years for the provision of a hearing device for the same worker, except where the worker initially had a monaural hearing device fitted but is subsequently determined that the worker would benefit from a binaural hearing device. In such cases, the hearing provider is entitled to be paid for a binaural device fitting fee package. If the Agent approves the provision of ALD in addition to a hearing device, the Agent can only pay one Hearing Device Fitting Package fee. If the Agent approves the provision of an ALD only, the Hearing Device Fitting Package fee is not payable. Management Fees Management fees take into account the handling costs involved in the provision of a hearing device and differ depending on the type of hearing device provided. The Agent can pay the management fees as follows: Hearing aid only one hearing aid management fee Hearing aid plus an ALD within 12 months of provision of the hearing aid one hearing aid management fee Hearing aid plus an ALD 12 months or more after provision of the hearing aid one hearing aid management fee paid when the hearing aid was provided and one ALD management fee paid when the ALD is provided ALD only one ALD management fee.

3 Hearing Device Maintenance and Hearing Review Within the first 12 months following the fitting of a hearing device, maintenance of the hearing device and reviews of a worker s hearing function are covered by the Hearing Device Fitting Package. The Agent can pay for hearing device maintenance and review service provided 12 months or more after the initial fitting of a device. This may include making adjustments to ensure that the hearing device is functioning to specification or to facilitate the worker s understanding of, recovery from, or adjustment to, their work-related hearing loss. The Agent can pay the reasonable costs of hearing device maintenance and hearing review in accordance with the WorkSafe Hearing Services Fee Schedules: after 12 months following the fitting of a device to the worker for a maximum of up to seven hours of service within five years of the provision of a hearing device. Hearing Device Battery Supply The provision of batteries for the initial six month period is included in the Hearing Device Fitting Package. Batteries should be provided to the worker at the time of device fitting. After the six months, the Agent can pay the reasonable costs of battery supply in accordance with the List. Hearing Device Repairs This hearing service includes any restoration of a hearing device carried out offsite by the manufacturer to improve its condition for better use. The Agent can pay the reasonable costs of maintenance repairs to hearing devices caused by normal wear and tear. As all hearing devices on the List are covered by a minimum 12 month warranty, the Agent will not pay for the repair and maintenance of hearing devices where covered by the manufacturer or supplier warranty. The Agent can also consider paying for: Replacement devices The Agent will consider the following when determining the reasonableness of a replacement hearing device: the current nature and circumstances of the worker's hearing loss including the work-related component of that loss the current communication, functional and clinical needs of the worker and the necessity and appropriateness of a hearing device the hearing service provider's assessment of the worker's current needs whether the current device continues to meet the worker s needs the current clinical justification for the make, model and features of the requested hearing device. The Agent can pay the reasonable costs of a replacement hearing device five years after the initial fitting of the hearing device. In exceptional circumstances, and only if prior written approval is sought, the Agent will consider approval of early replacement of a hearing device before five years have elapsed if the worker s hearing needs have significantly changed. When considering a request for early replacement, the Agent will consider the clinical justification for the hearing device and whether the replacement hearing device will meet the worker s needs for the next five years. Where early replacement is approved, the Agent can pay a Hearing Device Fitting Package fee and management fee. Lost Devices Hearing devices are the property of the worker. It is expected that workers will ensure that hearing devices are used and maintained responsibly. Workers should ensure that their hearing devices are at all times: used only by them used as intended and in a responsible manner not wilfully damaged or destroyed properly maintained stored responsibly. The Agent will only consider paying for lost hearing devices: in exceptional circumstances for only one instance of loss within five years of the worker receiving an original or replacement hearing device on receipt of a signed Statutory Declaration completed by the worker which outlines the circumstances of the loss. If the Agent accepts liability for a lost device, they will: consider a replacement hearing device that is identical to the lost hearing device where that device is available on the current List consider a different hearing device if: an identical hearing device is not available on the current List, and the lost device was provided more than 12 months previously, and the hearing service provider submits a Hearing Assessment and Device Request Form (or the Hearing Assessment and Device Exception Request Form in exceptional circumstances) to provide information about

4 the worker s hearing status and the clinical justification for a different hearing device. not pay a Hearing Device Fitting Package fee or management fee for the replacement hearing device only consider paying reasonable costs of the applicable excess where a lost hearing device is covered by a manufacturer s loss and damage warranty. Hearing Device Repairs All approvals for the reasonable costs of hearing device repairs are at the discretion of the Agent and will only be considered on receipt of a copy of the manufacturer s invoice for the repairs. Who can provide hearing services and hearing devices? Hearing services and hearing devices can be provided by either audiologists or audiometrists who are approved by WorkSafe. Audiologists and audiometrists must complete the WorkSafe Application for Registration to Provide Services to Workers in order to be approved by WorkSafe. Audiologists and audiometrists who are not approved by WorkSafe cannot be paid for services and devices under The Act. What information does the Agent require to consider paying for hearing services and hearing devices? In order to consider a request for hearing services and hearing devices, a worker must have an accepted claim upon which the Agent has determined liability for the worker s hearing loss. As a condition of payment of the reasonable costs of a hearing device, hearing service providers must obtain written approval from a worker s Agent before proceeding with the provision and fitting of an approved hearing device. The hearing service provider should complete and the WorkSafe Hearing Assessment and Device Request Form (or the Hearing Assessment and Device Exception Request Form in exceptional circumstances) and send it to the Agent for prior approval. In considering a request for a hearing device that is not on the List, WorkSafe will consider: information provided on the Hearing Assessment and Device Exception Request Form supporting clinical justification for the additional features as being necessary to meet the needs of the worker medical or clinical requirements that either indicate or contraindicate the use of particular features information received from the WorkSafe Clinical Panel. Please refer to the information sheet - More Information About Hearing Devices Exceptions Process. When will a response be received from the Agent? Where liability for a claim has been accepted and the Agent has received the WorkSafe Hearing Assessment and Device Request Form (or the Hearing Assessment and Device Exception Request Form),the Agent will advise whether: the request has been approved or denied, or further information is required to make a decision which may include referral to the WorkSafe Clinical Panel for review. Where further information is required or where the request has been referred to the WorkSafe Clinical Panel, the Agent will advise whether the hearing services and hearing devices have been approved or denied within 10 working days of receiving the additional information. What are WorkSafe s invoice requirements? Invoices for hearing services and hearing devices must be submitted to the Agent in accordance with the How to Invoice WorkSafe guidelines. What fees are payable for hearing services and hearing devices? The Agent can pay the reasonable costs of hearing services and hearing devices in accordance with the: Hearing Services Fee Schedule for Contracted Hearing Services Fee Schedule for Non-contracted WorkSafe Approved Hearing Device List. In relation to hearing services and hearing devices, what won t the Agent pay for? The Agent will not pay for hearing services or hearing devices that are: not required as a result of the worker s accepted workrelated injury or illness not reasonable, necessary or appropriate in the circumstances not clinically justified, safe and effective not in accordance with WorkSafe s guidelines or where the cost of the service and/or device is not reasonable devices that are not approved by WorkSafe under the legislation or services not in the Hearing Services Fee Schedules provided by an audiologist or audiometrist not approved by WorkSafe under the legislation provided outside Australia without prior written approval from the Agent

5 services cancelled or not attended by a worker services provided more than once on the same day to the same worker provided to someone other than the worker provided by a non-registered subcontracted provider services provided by telephone or other non face to face mediums including the cost of telephone calls and telephone consultations between providers and workers, and between other providers, including hospitals. Further information Contact the referring Agent, info@worksafe.vic.gov.au or refer to: How to Invoice WorkSafe Contracted Hearing service provider list - Metro Contracted Hearing service provider list - Regional (and interstate) Hearing Services - Fee Schedule For Contracted Hearing Services - Fee Schedule For Non-contracted Hearing Assessment and Device Request Form Hearing Assessment and Device Exception Request Form Introducing WorkSafe - A Guide for Allied Healthcare Professionals Application for Registration to Provide Services to Workers WorkSafe s Clinical Panel review process WorkSafe s Online Claims Manual (refer to Chapter 10.5) Information Sheet - More Information About Hearing Devices Exceptions Process Information Sheet Hearing Services and Devices, Information for workers

6