Medicaid Update Provides Clarification on ALP Billing Issue

The latest Medicaid Update contains an important clarification regarding the billing of hearing aids and repairs for Medicaid-eligible Assisted Living Program (ALP) residents. Upon learning that some ALPs were being billed for hearing aids and repairs, LeadingAge New York worked to rectify the issue with the Department of Health, and are pleased to be able share the official clarification. Any members that were billed for hearing aids or repairs inappropriately should let us know.

The article is copied below, but can also be accessed in the Update, here. 

The Billing of Hearing Aids and Repairs for Assisted Living Program (ALP) Participants

The Durable Medical Equipment Provided to Assisted Living Program Participants article in the DOH Medicaid Update March 2007 Vol. 22, No. 3, provided clarification regarding the provision of Durable Medical Equipment (DME) and medical supplies that are included in the daily Medicaid Assisted Living Program (ALP) rate. As outlined in the article, the ALP operates in adult homes and enriched housing programs and provides a combination of residential services and home care services to Medicaid and private pay residents. The Medicaid Update article explains that a daily rate is paid to the ALP for Medicaid-eligible residents for the provision of nine services, including the provision of DME and medical supplies not requiring prior approval. Hearing aid batteries (V5266) are an example of medical supplies that are included in the ALP’s rate.

This notice is to clarify that hearing aids and their repairs are not considered DME or medical supplies. Therefore, such items are not captured within the services paid for within the ALP Medicaid rate, and should be billed to the ALP participant’s individual Medicaid benefit.

For questions related to hearing aid policy and coverage guidelines, please send an email to: ohipmedpa@health.ny.gov or contact the Division of OHIP Operations at 1-800-342-3005, option 1. For questions related to Assisted Living policy and coverage, please contact the Division of Long Term Care at 1-518-474-5888.

Contact: Diane Darbyshire, ddarbyshire@leadingageny.org, 518-867-8828