Australian Government - Department of Health - Office of Hearing Services
Hearing Services Program

Minimum Hearing Loss Threshold Guidelines

The Minimum Hearing Loss Threshold (MHLT) is regulated under the Hearing Services (Participants in the Voucher System) Determination 1997.

The Australian Government Hearing Services Program (the program) requires clients being fitted with a hearing device to meet a minimum 3 Frequency Average Hearing Loss threshold of greater than 23dB (3FAHL > 23dB), measured at 0.5, 1 and 2 kHz. Each ear must be evaluated independently.

Not all clients who have a hearing loss and attend an assessment want or need a hearing device. Before proceeding with a fitting of any client, practitioners must consider the nature and configuration of the hearing loss, the degree of communication difficulties experienced, and the attitude, motivation and goals of the client.

Clients with hearing loss below the program’s threshold (3FAHL ≤ 23dB) should, in most instances, be provided with a rehabilitation service (communication training and strategies to manage their hearing loss) rather than be fitted with a hearing device.

The only exception to the program’s minimum hearing loss threshold requirement is where a client meets two MHLT exemption criteria legislated under the Hearing Services (Participants in the Voucher System Determination) 1997. Both criteria must be met before a client can be fitted or refitted under the program, and all other program assessment and fitting requirements (eg. Schedule of Service Items, Hearing Rehabilitation Outcomes, and Eligibility Criteria for Refitting) must also be met.

Exemption criteria for fitting a client with hearing loss below the MHLT (3FAHL ≤ 23dB)

Program requirements

Clients with a 3FAHL ≤ 23dB in either ear cannot receive a fitting to that ear, or an Assistive Listening Device (ALD), unless they meet one condition under Criterion 1 and meet Criterion 2 of the MHLT exemption criteria.

Criterion 1

The client must meet one of the following four conditions

a.         Client has a High Frequency Average Hearing Loss, equal to or greater than 40dB (HFAHL ≥ 40dB), measured at 2, 3 and 4 kHz. Where there is an air-bone gap in the high frequencies, check headphone placement/collapsing canals before calculating HFAHL.

b.         Client has tinnitus, where both the hearing loss and the tinnitus can be addressed through the use of an approved hearing device. Tinnitus cannot be the sole reason to provide devices. Fitting may proceed where amplification can be shown to both address the mild hearing loss and reduce severe or constant tinnitus that significantly affects quality of life. Documented evidence must show that aiding the client has had successful outcomes for both their hearing loss and tinnitus relief. Tinnitus severity or stress tools may be used prior to the fitting and at the follow-up to evaluate the device fitting. Results must be kept on the client’s file.

c.         Client has a visual impairment that cannot be corrected by treatment, which reduces the client’s ability to see mouth movements. Clients with a mild hearing loss and vision loss may experience greater communication difficulties compared to clients with mild hearing loss and good vision, and may benefit from receiving a device. Documented evidence that amplification improves speech audibility must be kept on the client’s file. Clients with more serious visual impairments should continue to be identified as Specialist Services (Complex) clients.

d.         Client has previously been fitted under the program and can demonstrate consistent use of the previously fitted hearing device (includes Assistive Listening Device). Documented evidence of consistent device use must be kept on the client’s file, and may come from sources such as data logging reports, repeated supply of replacement batteries and on-going minor repairs. Evidence of benefit and satisfaction from the use of a device may be provided through responses to self-report outcomes questionnaires and/or file notes from client reviews or other appointments.

Top of Page

Criterion 2

The client must demonstrate they have a positive attitude and are motivated to wear a hearing device through their response to the Wishes and Needs Tool (WANT).

The WANT is a client self-report questionnaire intended to be administered towards the end of the assessment/reassessment appointment, prior to each fitting, and consists of two questions

Question 1 How strongly do you want to get hearing device/s?

1) Don’t want them  2) Slightly want them  3) Want moderately  4) Want them quite a lot  5) Want them very much

Question 2 Overall, how much difficulty do you have hearing (without hearing device/s)?

1) No difficulty  2) Slight difficulty  3) Moderate difficulty  4) Quite a lot of difficulty  5) Very much difficulty

Each client should complete the questions without assistance or prompting from the practitioner or others, to ensure that the answers reflect their own attitude and motivation. If a client indicates they are not ready for devices or indicates minimal communication difficulties, a fitting should not proceed.

Each response is scored (scores equal the clients’ answer numbers). The client must score at least 2 or more for each question and a total score of 5 or more (when both scores are added together), to be considered to have an acceptable attitude and motivation for a fitting. No information should be provided to the client to influence their responses.

The WANT must be signed and dated by the client and kept on the client’s file.

A new WANT should be completed prior to each MHLT fitting.

Asymmetrical Hearing Loss

Practitioners may fit clients with unaidable hearing in the poorer ear at their own discretion (e.g. with a CROS device) even if the better ear does not meet MHLT guidelines.

Claiming

Client 3FAHLs must be recorded on claim forms and 23.3dB should be rounded to 23dB.

Documented evidence to justify clients meeting Criterion 1 and 2 must be kept on the client file, along with signed and dated claim forms.

Monitoring and Compliance

MHLT claims are routinely monitored and audited. Providers will be required to reimburse the Commonwealth if a client with hearing loss under the MHLT has been fitted with a device but does not meet both MHLT exemption criteria.

Top of Page

 

Minimum Hearing Loss Threshold (PDF 85 KB)

Wishes and Needs Tool (WANT)

Wishes and Needs Tool (PDF 61 KB)

Complementary Content