Australian Government - Department of Health and Aged Care - Office of Hearing Services
Hearing Services Program
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Eligibility Criteria for Refitting

The Eligibility Criteria for Refitting (ECR) provide guidance for Contracted Service Providers of the Australian Government Hearing Services Program when deciding whether to refit a client. The ECR outline the situations where a client’s current hearing aid(s) are no longer suitable due to a significant change in the client’s circumstances since their last fitting. The client therefore requires new hearing aid(s) and must be refitted. The client’s current devices must be evaluated and found to be unsuitable before new device(s) are discussed with the client.

Eligibility criteria for refitting

Evidence required on file
  1. The current hearing aid(s) are unsuitable because they can no longer be optimised by adjustments or any other modifications to meet current gain requirements.

Documented evidence on file details that the current hearing aid(s) are established to be in optimal working order through manufacturer service/repair, mould/shell modification or replacement.

And

After adjustment/modification has been made to current hearing aid(s) to accommodate changes in thresholds, Real Ear Measurements show a poor match to targets.

Or

Aid specifications show that the client’s current Hearing Threshold Level (HTL) is outside the range of the current hearing aid(s) and they were previously optimally fitted.

For revalidated services - the client’s hearing thresholds have permanently deteriorated by 15dB or more at two or more frequencies between 500Hz and 4000Hz in at least one ear.
  1. The current hearing aid(s) are unsuitable because the client can no longer use their aid(s) due to a significant deterioration in health, dexterity or cognitive ability or speech discrimination since last fitting.

Documented evidence on file describes the client’s deterioration and how this affects the client’s ability to manage their hearing aid(s) or a letter from the client’s doctor, carer, nurse, supervisor etc. giving details of how the condition affects current hearing aid usage.

And

Details what has been tried with the current hearing aid(s) or why they cannot be modified.

And

Details how the new aid(s) proposed for refitting will address the issues with the current hearing aid(s).

For revalidated services - A letter from a medical practitioner is required when selecting ECR 2 to provide evidence of a deterioration in health, dexterity, or cognitive ability.
  1. A change in physical condition of the ear or ear health has occurred since last fitting and the client requires a different style of hearing device(s) to accommodate this change.

Documented evidence on file, such as case notes, that describe the change in physical condition of the ear or ear health.

And

Details what has been tried with the current aid(s) or why they cannot be modified.

And

Details how the new hearing aid(s) proposed for refitting will address the issues with the current hearing aid(s).

For revalidated services - A letter from a medical practitioner is required when selecting ECR 3 to provide evidence of change in physical condition of ear or ear health.
  1. The current hearing aid(s) are unsuitable because the client requires a telecoil, and current hearing aid(s) do not have a telecoil and cannot be retrofitted.

 

Please Note: This situation does NOT allow for refitting with an FM system or streamer or equivalent.

Documented evidence on file, such as case notes, that states the specific goal which can only be met with the inclusion of a telecoil.

And

Indicates a change in client needs relating to telecoil since the last fitting.

Please Note: From 1 July 2012, client must opt-out of having a telecoil.

And

A statement from the manufacturer that a telecoil cannot be retrofitted without re-shelling and/or faceplate modification.
  1. Client currently fitted with an Assistive Listening Device (ALD) and now requires hearing aid(s).

Documented evidence on file, such as case notes, detailing a change in client circumstances that indicates hearing aid fitting.

  1. Client’s previous initial fit or refit occurred more than five (5) years ago.
Evidence that no fittings have been claimed within the last five (5) years for the ear(s) proposed for refitting.

Contracted Service Provider responsibility

It is the responsibility of the Contracted Service Provider to check the client’s current voucher eligibility for the new hearing aid(s) prior to refitting and ensure that the required ECR evidence is documented on file. If the required ECR evidence supporting the case for refitting is not documented on file, the Department of Health may initiate a recovery of inappropriate claims.

If a clients' hearing or health changes significantly after they have received the full entitlement of their current voucher (i.e. they have been assessed, received a hearing device and /or rehabilitation), then you are able to Request a revalidated service before the existing voucher expires.

Lost or damaged

If a hearing aid is lost or damaged beyond repair (DBR), and this hearing aid is available on the Schedule of Approved devices, the replacement should be the same hearing aid, unless the client’s circumstances have changed, and they meet the Eligibility Criteria for Refitting.

Spare aids

For spare aid fittings the following criteria must be met for eligibility

  • Client has only one aidable ear
  • Client highly dependent on aiding of better ear
  • Client does not have a second aid that could be adapted to act as a spare for the aidable ear
  • No previous spare aid fitted for this client.

Clear notes justifying the need for a spare aid fitting must be retained on the client’s file.

If the spare aid has been lost, damaged beyond repair or clinically no longer appropriate, follow normal device replacement process.

A spare aid can be claimed through a batch eClaim or the portal.


PDF Version: Eligibility Criteria for Refitting

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