|Date Requested:February 20, 2013
Time Requested:02:45 PM
| FUND(S) |
Sources of Revenue
Legislation creates:Neither Program nor Fund
Effect this measure will have on costs and revenues of state government.
| The purpose of this bill is to require health insurers to cover hearing aids for individuals under eighteen years of age, when prescribed by a licensed physician. Coverage is limited as follows: (1) Initial hearing aids and replacement hearing aids not more frequently than every thirty-six months: (2) hearing aids when alterations to the existing hearing aids cannot adequately meet the needs of the covered individual: and (3) services, including audiometric testing , the initial hearing aid evaluation, fitting, and adjustment, and supplies, including ear molds. Covered individuals may have to meet deductibles, coinsurance, or other limitations.
The Public Employees Insurance Agency (PEIA) utilized websites for the National Institutes of Health, Centers for Disease Control (CDC) and the Better Hearing Institute to ascertain prevalence rates of hearing loss in children. Prevalence and incidence of hearing loss fluctuated with analysis. The CDC National Health and Nutrition Examination indicated 14.9% of children ages 6-19 years of age have low frequency or high frequency hearing loss of at least 16 dB in one or both ears. (Minimum hearing loss falls in 16dB -24dB category.) Another analysis from the American Speech Language Hearing Association (ASLHA) indicates that roughly eight percent of all those suffering profound hearing loss are under age eighteen. Another CDC study showed that 1.4 per 1,000 infants screened for hearing loss were diagnosed with hearing loss. ALSHA indicates that 1.2 percent of children with disabilities between the ages of 6 - 21 received services for hearing. Generally other sites visited including the National Institute on Deafness and other Communication Disorders reflected prevalence rates of anywhere from one to six per 1,000.
The PEIA has approximately 40,456 individuals covered under the program who are under eighteen years of age. It is difficult to know how many children have been diagnosed and already possess a hearing device. However, it will be assumed for projection purposes that approximately one and a half percent of those under eighteen will take advantage of this benefit. This is an attempt to “split the difference” of study results and a rather liberal assumption that 75% of children requiring hearing aids have already received treatment. The proposed benefit would cover six hundred forty two who would initially require hearing aids including all covered services. It is projected an additional ninety six for year two with a 5% increase for year three.
PEIA is utilizing cost per patient of a WVCHIP bilateral procedure reimbursement rate of $1,487. This benefit is covered when prescribed by a licensed physician. The PEIA is assuming 963 office visits in conjunction with passage of this bill in year one, 96 in year two and a 5% increase for year 3. This is to account for multiple professional service procedures associated with a hearing aid. These procedures include audiometric testing, evaluations, fittings, adjustments and ear molds. The anticipated cost of office visits is $66,000 over the thirty-six month period. All costs estimate an assumed member payment of deductible and coinsurance.
Year One Cost $958,012
Year Two Cost $136,260
Year Three Cost $143,074
Total thirty-six month cost is anticipated to be $1,237,346
|Effect of Proposal||Fiscal Year|
|1. Estmated Total Cost||0||0||0|
|Repairs and Alterations||0||0||0|
|2. Estimated Total Revenues||0||0||0|
3. Explanation of above estimates (including long-range effect):