Review of Service Items and Fees - Project Scope
An outline of the scope of the project to review the Hearing Services Program Schedule of Service Items and Fees.
Project scope
To develop a list of comparable hearing services items and benefits payable under the Hearing Services Program (the program) and the National Disability Insurance Scheme (NDIS) (where this is reasonable). This work is to support a whole of Government approach and ensure that there are no unjustifiable differences in pricing between the two programmes which would distort or disrupt the hearing sector, if implemented.
The project will undertake to
- conduct an analysis of the benefits and challenges inherent in the current voucher model for reimbursement, including the linking of the provision of some hearing services to hearing devices
- consider whether other reimbursement models may better support client outcomes, business processes and reduce the administrative burden on the Department of Health
- research and provide advice on a standard suite of hearing services to reflect the client journey in hearing rehabilitation, which takes into consideration any variables in the clinical needs of the different client cohorts (e.g. frequency of service)
- propose benchmark prices for that standard suite of hearing services based on an efficient price model
- consider funding options to support the delivery of services under the program in rural and remote areas and put forward a suggested preferred option
In undertaking this work, the project is to consider potential differences in service delivery for the following cohorts of clients
- infants and young children up to age 3 years
- children and young adults from 3 to 18 years
- adults up to age 65 years with hearing loss as their only disability which affects their ability to communicate
- complex adults with severe to profound hearing loss or who have other impairments which make communication more difficult
- senior people (65 years and older) with hearing loss
The project will pay specific attention to
- the need to maintain a healthy, competitive, viable hearing services industry
- the time, professional and practice costs, cohort and complexity in delivering a standard suite of hearing services to different cohorts of clients
- the previous and existing work of the program in developing a proposed simplified list of service items for the voucher component
- the need to support broader hearing rehabilitation services (i.e. in addition to the fitting of a device, if required), including claims by service providers that the existing hearing rehabilitation item (Rehab Plus) is under-utilised due to insufficient payment and the scope of permitted services
- the efficient price model for service delivery developed by the National Disability Insurance Agency (NDIA), together with the hourly rates for allied health professionals (including audiologists) set by the NDIA
- the NDIA benefits model which separates reimbursement for therapeutic services from the provision of assistive technology (including hearing devices)
- any other hearing related reimbursement programmes (e.g. Medical Benefits Scheme audiological diagnostic items and optometry items, state-based worker’s compensation schemes)
- comparative reimbursements for hearing services provided in other countries, such as the United States of America, Canada and the United Kingdom
- any additional cost of services delivered to Community Services Obligations (CSO) client groups
- different models to support flexibility in service delivery, such as tele-audiology and home visits (noting the NDIA funding model for provider travel)
- whether there is any justification for different pricing in the program and the NDIS for any comparable hearing service items
- the additional cost of service delivery to rural and remote areas provided for under the NDIS and carried by Australian Hearing for current CSO clients
- whether there should be differential benefits paid dependent on whether the service was delivered by a (tertiary qualified) audiologist or a (technically qualified) audiometrist (assuming that the service is able to delivered by an audiologist or audiometrist consistent with their scope of practice)
Out of scope
The sourcing (including pricing) of hearing devices is a separate project which is not to be considered as part of this work. This work assumes that there will be no cross subsidisation between the supply of hearing devices and delivery of hearing services.