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Behavioral Assessment of Hearing in 2 to 4 Year-old Children: A Two-interval, Observer-based Procedure Using Conditioned Play-based Responses
Published on: January 23, 2017
Medicaid reimbursement of hearing services for infants and young children
Margaret A McManus1, Ruti Levtov, Karl R White
1Maternal and Child Health Policy Research Center, Suite 1100, Washington, DC 20006, USA. mmcmanus@mchpolicy.org
Insights
Medicaid reimbursement rates for infant hearing services are significantly lower than Medicare and commercial insurance, hindering access to essential care for children with hearing loss.
Area of Science:
- Health Services Research
- Pediatric Audiology
- Public Health Policy
Background:
- Expanding newborn hearing screening necessitates adequate funding for pediatric hearing services.
- Medicaid is a primary funder, legally required to ensure sufficient provider participation.
- Timely hearing services are crucial for infants and young children with hearing loss to benefit from early identification.
Purpose of the Study:
- To compare 2005 Medicaid reimbursement rates for pediatric hearing services with Medicare and commercial insurance rates.
- To assess trends in Medicaid hearing service payment rates from 2000 to 2005.
- To identify potential barriers to accessing hearing services for young children within the Medicaid program.
Main Methods:
- Comparative analysis of 2005 reimbursement rates across 15 states.
- Inclusion of Medicaid, Medicare, and commercial health insurance payment data.
- Examination of state-specific billing codes for essential pediatric hearing services.
Main Results:
- Average Medicaid rates were 67% of Medicare and 38% of commercial rates for comparable services.
- A decline in Medicaid reimbursement rates was observed between 2000 and 2005.
- Many states lacked appropriate billing codes for critical hearing services required by infants and young children.
Conclusions:
- Low Medicaid reimbursement rates may limit provider participation, impacting service availability for children with hearing loss.
- Discrepancies in payment rates and coding may impede the provision of necessary hearing healthcare, undermining early intervention benefits.
- States may not be fully meeting federal mandates for adequate Medicaid provider networks to ensure accessible hearing services.
Abstract:
As newborn hearing-screening programs have expanded, more and more infants and young children need hearing services. Medicaid is one of the primary sources of funding for such services and, by law, must establish payment rates that are sufficient to enlist enough providers to provide services. In this study we compared 2005 Medicaid reimbursement rates for hearing services for infants and young children in 15 states with the payment rates for the same services by Medicare and commercially available health insurance. On average, Medicaid rates for the same services were only 67 as high as Medicare and only 38 as high as commercial fees. Furthermore, most Medicaid rates declined from 2000 to 2005, and many states did not have billing codes for a significant number of the hearing services needed by infants and young children. These factors likely contribute to infants and young children with hearing loss not being able to get the hearing services they need to benefit from early identification of hearing loss. These data also raise questions about the extent to which states are meeting the federal requirement that Medicaid payments be sufficient to enlist enough providers so that care and services are adequately available to the general population in the geographic area.
