Hearing Loss Regulations Vendor information pack

Transcription

1 Hearing Lss Regulatins Vendr infrmatin pack Nvember 2010

2 Implementing the Accident Cmpensatin (Apprtining Entitlements fr Hearing Lss) Regulatins 2010 The Minister fr ACC, the Hn. Dr Nick Smith, has annunced that new regulatins n financial supprt fr peple with hearing lss will cme int frce n 1 January The regulatins will intrduce changes t entitlements, prcesses and claim management fr hearing lss at ACC. This dcument prvides vendrs with details f the changes and helps them priritise their preparatins t enable the easiest pssible transitin frm the current Audilgy Services cntract t perating in the regulated envirnment. What s changing? Key changes Current Frm 1 January 2011 Apprtinment f the cause f hearing lss is undertaken fr cver decisin purpses Injury/nn-injury causes f hearing lss will be apprtined fr funding entitlements Injury-related hearing lss will be presented as ACC rutinely funds assistance fr nn-injury related hearing lss when cvering clients with injury-related hearing lss Current ACC funded clients are unable t access Ministry f Health funding a prprtin f ttal hearing lss Financial assistance fr clients will be based n apprtinment, and shwn in 10 funding bands Ministry f Health will cntribute funding t entitled ACC clients with mixed cause hearing lss where the injury-related prtin is less than 90%. Clients entitled t ACC assistance twards mixed cause hearing lss may nw be able t access Ministry f Health funding administered by ACC Clients entitled t fully-funded hearing aids frm the Ministry f Health will be able t chse between that funding stream and ACC/Ministry f Health jint funding N time limit n replacing hearing aids Funding will be available nt mre than nce every six years fr replacement hearing aids/device Cntracted rates fr assessment, repairs and maintenance ACC purchases hearing devices n behalf f clients, based n an audilgist s recmmendatin Clients wh are nt eligible fr funding frm ACC (i.e. have n injury related lss) are able t access funding frm Ministry f Health ACC cntributins fr assessment, repairs and maintenance will be set in regulatins and time-limited Clients will use a cmbinatin f Gvernment funding and their wn financial resurces t purchase their hearing devices, in cnsultatin with their audilgist f chice N change clients nt entitled t ACC assistance will cntinue t be able t access funding direct frm the Ministry f Health Full details, including the regulatins, will be available n ACC s website. Only ACC s cntributin t hearing services is regulated, the Ministry f Health s cntributin is nt regulated, but has been agreed by the Gvernment. Accident Cmpensatin Crpratin Page 2 f 8 Hearing Lss Regulatins Vendr Implementatin Pack

3 The changes in detail Funding fr hearing devices Frm 1 January 2011, mst peple with a mix f injury-related and nn-injury-related hearing lss wh are entitled t ACC assistance will have access t financial supprt twards hearing devices frm bth ACC and the Ministry f Health. Hearing devices include, but are nt limited t, hearing aids, accessries, remte cntrls and cnsumables. The level f hearing device funding will depend n the mix f the client s hearing lss: If 90% r mre f the client s cvered hearing lss is injury related, they will be entitled t the maximum ACC cntributin f $3, (ex. GST) fr tw hearing aids/device. These clients will nt be eligible fr any Ministry f Health funding. If all f the client s hearing lss is nn injury-related, the Ministry f Health will cnsider funding, such as a subsidy f $ (ex. GST) fr tw hearing aids/devices, r the whlesale cst f hearing aids if the client is eligible. These clients will nt be eligible fr any funding frm ACC. If the client is entitled t ACC assistance and their hearing lss is a mix f injury and nninjury factrs, and the prprtin f their injury related hearing lss is less than 90%, they will have access t sme hearing aid funding frm ACC and sme frm the Ministry f Health. The csts will be apprtined between the tw agencies, depending n hw much f the ttal hearing lss is due t injury and nn injury causes. Table 1 shws hearing aid funding fr clients with mixed cause hearing lss wh are entitled t assistance frm ACC. Aids can be replaced every six years fllwing re-assessment. Table 1: Jint ACC / Ministry f Health hearing aid/device funding (per ear) Band Injury as a prprtin f ttal hearing lss (%) Maximum ACC will pay Maximum the Ministry f Health will pay Jint maximum fr mixed injury and nninjury hearing lss Ex. GST Inc. GST Ex. GST Inc. GST Ex. GST In.c GST $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $1, $ $ $1, $1, $1, $1, $ $ $1, $1, $1, $1, $89.00 $ $1, $1, $1, $1, $44.00 $50.60 $1, $1, $1, $1, $00.00 $00.00 $1, $1,

4 Fitting fees ACC s cntributin t fitting fees is intended as a cntributin t the csts f fitting hearing aids (including an assessment f the client s needs), a trial perid f at least 2 weeks, fllw-up services, and handling and management. Only clients entitled t ACC assistance fr injury related hearing lss can get a cntributin t fitting fees because ACC makes a cntributin t these csts but the Ministry f Health des nt. Table 2 shws hw much ACC will cntribute t fitting fees. Csts are payable nt mre than nce every six years. Table 2: ACC cntributin t fitting fees Band Injury as a prprtin f ttal hearing lss (%) ACC cntributin (binaural) ACC cntributin (mnaural) Ex. GST Inc. GST Ex. GST Inc. GST $ $ $90.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $ $ $1, $1, $ $ $1, $1, $ $1, An example: If 55% f a client s ttal hearing lss results frm an injury they wuld qualify fr Band 6. If they wanted hearing aids in bth ears, they wuld be eligible fr the fllwing supprt. Prices are quted ex GST. $2,156 (ex. GST) ($1,800 frm ACC; $356 frm the Ministry f Health) tward hearing devices; and $720 (ex. GST) frm ACC twards fitting csts; and sme financial assistance with repairs and maintenance frm ACC batteries, at the client s request, as needed direct frm ACC (nt regulated). If the client wants hearing aids that cst mre than the funding available, they wuld need t tp up t the price. Other fitting fee cntributins payable: ACC will cntribute up t $ (ex. GST) if a client has undergne the fitting prcess but ultimately chses nt t purchase hearing devices. 4

5 ACC will cntribute a flat rate f $ (ex. GST) if a client has a single hearing aid fitted, and decides within a year t have anther ACC funded hearing aid fitted fr the ther ear. The mnaural fitting fee wuld nt apply fr the secnd aid fitted. Services and Repairs Peple wh receive a financial cntributin frm ACC fr hearing devices and fees are als entitled t cntributins t the repair and maintenance f their hearing devices: Fr each client, ACC will cntribute up t $50.00 (ex. GST) per service fr n-site hearing device repairs, fr a maximum f tw services per year. Fr each client, ACC will cntribute up t $ (ex. GST) per service fr ff-site hearing device repairs, nce every tw years after the device is ut f warranty. As is the case nw, the Ministry f Health pays fr hearing aid repairs fr peple wh qualify fr full whlesale payment f hearing aids. Technical amendments t existing regulatins n assessment prcedures Sme changes will als be made t the requirements fr assessing gradual prcess hearing lss claims. These requirements are in the Accident Insurance (Occupatinal Hearing Assessment Prcedures) Regulatins Tw changes will take effect frm 1 January 2011: A mre recent table fr deducting standardised percentages f age-related hearing lss frm a client s ttal hearing lss will replace the current table. Outdated references t base-line hearing tests will be remved. A further change will take effect later. Frm 1 January 2012, the current acustical testing standard (ISO 6189) required by regulatins will be replaced by the standard that is cnsidered best practice fr diagnstic audilgy in New Zealand (AS ISO ) see belw. Implementatin f the regulatins Implementatin f the regulatins will require changes bth t ACC s prcesses and t vendrs business practices. This sectin f the infrmatin pack cvers issues related t the administratin and implementatin f the regulatins. Administratin A key change is that ACC will administer supprt fr mst clients with mixed cause hearing lss requiring jint ACC/Ministry f Health funding. Clients with injury related hearing lss will make a claim t ACC, and ACC will determine cver and entitlements. Clients will nt be required t apprach mre than ne agency. Fr clients, the prcess fr seeking help frm gvernment agencies will nt change: If injury is a causal factr, GPs will cntinue t ldge ACC claims An assessment (r pssibly a reassessment) will be required frm an audilgist t determine the extent f hearing lss An assessment will als be required frm an ENT specialist n the apprtinment f the hearing lss between injury and nn-injury causes 5

6 ACC will use this infrmatin t decide cver. What will change is that ACC will use the ENT reprt t allcate the claim t a funding band. Vendrs will receive new ACC templates and mre detailed prcess dcumentatin befre mid- December Purchasing hearing aids There will als be changes t the prcess f purchasing hearing aids fr clients with mixed cause hearing lss, r lss caused entirely by injury. Under the current prcess, ACC purchases hearing aids n behalf f the client based n recmmendatins frm audilgists and fllwing a trial fr suitability. Under the new apprach, clients will be respnsible fr purchasing their hearing aids using their entitlement and any tp up they wish t pay t meet their specific requirements. Discussin n the type and apprpriateness f the client s aids will take place between the client and the audilgist, ACC will nt be invlved. Based n the whlesale prices in the current ACC price list, there are hearing aids at each funding band level. Clients whse hearing lss is caused entirely by nn-injury factrs will be funded by the Ministry f Health in the nrmal way, and the purchasing prcess will nt change. Clients will nt be able t access bth funding streams. Cmpliance with ISO standards (frm 1 January 2012) An amendment has been made t the existing regulatins 1, changing the acustical testing standard t AS ISO : Audimetric test methds, Part 1: Basic pure tne air and bne cnductin threshld audimetry. Vendrs that wish t prvide hearing assessment services t ACC will need t have their clinics tested by an accredited labratry t this standard. This amendment will take effect a year later than ther amendments, meaning that there will be an pprtunity t phase this in during 2011 t ensure cmpliance by 1 January The relevant ambient nise levels are thse fr bne cnductin and these shuld be accurate t 5 db HL. Vendrs will be required t declare that they cmply with these standards n the ACC 612 Hearing Lss Audimetric Reprt frm, which is cmpleted as part f the claim prcess. Transitinal prvisins Under the regulatins all decisins issued frm ACC fr existing and new clients frm 1 January 2011 will be aligned t the new regulatins. The nly exceptin will be where audilgists have submitted a cmpleted ACC Needs Assessment r Reassessment frm, these have been received by ACC prir t 1 January 2011 and ACC has nt yet issued a decisin prir t the regulatins start date. ACC will nly issue a decisin under the existing funding arrangements fr these transitinal requests. 1 The Accident Insurance (Occupatinal Hearing Assessment Prcedures) Regulatins

7 Fr these transitinal requests nly, ACC wuld expect vendrs t align their apprach with that f the current cntract and invice ACC fr services and aids at cntract prices. There wuld be n change t invicing prcesses r cdes fr transitinal claims. The alternative wuld be fr all claims, regardless where they are in the claims prcess, t be managed under the regulatins. ACC will wrk with the sectr n these issues and will lk at intrducing the mst practicable slutin. New service cdes New service cdes have been develped t accmpany the changes. They have been attached t this implementatin pack in the frm f an Excel spreadsheet. High level prcess The fllwing utlines the ACC prcess fr new hearing device claims: 1 GP ldges client s claim with ACC 2 ACC cllects infrmatin frm the client and client s emplyer 3 Audilgist cmpletes audimetric assessment 4 ENT cmpletes specialist assessment 5 ACC issues funding decisin t client 6 If ACC agrees t fund, client visits audilgist with ACC apprval letter 7 Audilgist assesses the client s needs and fits/trials hearing aids 8 Audilgist prvides their invice, successful trial frm and manufacturer s invice t ACC Cmmunicatins ACC wants t maintain cmmunicatins with vendrs during the implementatin prcess prir t 1 January 2011 and during the bedding in perid in the New Year. T ensure this takes place, an cntact address has been set up t receive cmments and questins frm vendrs 7

8 and thse invlved in wrking with the regulatins: We welcme yur questins. Questins will be reviewed and answers prvided t the sectr via ACC s web site at: - see Prvider News. In additin, a mre detailed vendr implementatin pack will be issued t all vendrs befre mid-december It will cntain the revised frms and detailed prcesses which need t be fllwed t ensure ACC can make payment t yu under the new arrangements. 8