Provider Factsheet - Changes to the Hearing Services Program - FAQ
The Department of Health (the department) is responsible for managing and administering the Australian Government Hearing Services Program (the program).
In October 2020, changes were announced to some services available under the program. Several program changes will take effect on 1 July 2021. To support the implementation of the changes, the program has sought feedback from stakeholders as part of the Hearing Services Program review.
These pages contain answers to frequently asked questions (FAQs) about the changes to the program. This should be read in conjunction with the Hearing Services Program Changes Update Factsheet and the Maintenance Services Provider Factsheet.
The program thanks all stakeholders who have provided feedback which has assisted us in drafting these FAQs.
The Draft Schedule of Service Items and Fees 2021-22 is now available here. The Schedule of Fees is currently being tested through the User Acceptance Testing with program stakeholders, and will be available in June.
Contents
General
What is changing from 1 July 2021?
Voucher Period: Client vouchers, which entitle eligible persons to subsidised hearing services through the program, will be extended from three to five years.
Client Reviews: Clients who are not fitted with a hearing device will now be entitled to an annual review appointment. This will allow their hearing to be monitored over time and improve access to services for these clients. Clients fitted with Assistive Listening Devices (ALDs) will now be eligible for the current client review (930).
Maintenance: Consumables will continue to be paid for initial fittings where a client has a maintenance agreement. Maintenance will not be claimable in the first 12 months after refittings. There will also be changes to the amount paid for client relocations and monaural maintenance.
Why have these changes been made?
The Australian Government is committed to ensuring that the program reflects best practice in terms of the consumer experience, service delivery, efficiency in the hearing support sector, and is sustainable into the future. The change in voucher length from three to five years aligns with the five years expected life of a hearing aid. A more extended voucher period will also reduce the burden on providers in reissuing vouchers.
The program is focused on enabling quality hearing services for all clients, not just those with hearing devices. The changes are part of the renewal of the program, which includes the Hearing Services Program Review and the initiatives funded through the Roadmap for Hearing Health.
When will these changes take effect?
Program changes will take effect from 1 July 2021.
When will the Schedule of Service Items and Fees be available?
The Schedule of Service Items and Fees is now available.
When will the COVID-19 special arrangements end?
The COVID-19 special arrangements will remain in place until 30 June 2021, and it is anticipated that we will revert to pre-COVID practices after that date.
Will telehealth services remain available to clients?
The program has recently published a Telehealth Factsheet listing all of the services available via telehealth in the program. The Schedule of Service Items and Fees also lists the service requirements for program items including if they are available via telehealth.
Will rechargeable devices be offered on the fully subsidised Schedule?
The decision to list devices on the Device Schedules is a business decision by device manufacturers.
Are there any changes to supports for clients with tinnitus?
The provisions for clients with tinnitus will remain the same. Currently, clients who suffer from severe and constant tinnitus as well as hearing loss are eligible for devices under the minimum hearing loss threshold (MHLT) requirements, provided the fitting addresses the hearing loss and reduces the tinnitus. From 1 July 2021, all unaided clients, including those who are experiencing tinnitus will be able to have an annual client review.
The program recognises that stakeholders support further tinnitus interventions, which is currently being considered by the Hearing Services Program Review.
Will the program be communicating the changes with clients?
The program does not routinely interact with clients regarding program changes and instead provides information to service providers to pass on to their clients.
From 1 July 2021, the welcome pack letter sent to new clients will be amended to reflect the extension of the voucher period.
Voucher
What happens to the voucher of a client already on the program?
Vouchers issued from 1 July 2021 will have a length of five years. All existing vouchers due to expire after 30 June 2021 will be automatically extended from three to five years.
Does the program suggest that clients should be fitted at the start of their 5 year voucher to ensure hearing aid life and the voucher period are consistent?
The aim of the extension of the voucher duration from 3 to 5 years was to reduce the administration of voucher issuing and better align the voucher with the expected minimum lifespan of a hearing device, which is 5 years. Fitting of clients should be based on clinical need and the client's readiness for a hearing device irrespective of the voucher period.
Client Review
How does the new annual client review service work for unaided clients?
The aim of the newly introduced unaided client review service (item 920) is to ensure clients who are not fitted with any devices are able to monitor their hearing health, as well as their hearing needs and goals. This service gives providers the opportunity to annually review the hearing and goals of their unaided clients.
The service will be available every 12 months from the anniversary of the last date of assessment, reassessment or unaided client review service.
The current client review services (items 930/940) are still available to aided clients, including those fitted with ALDs.
Does the item 920 include diagnostic assessment as opposed to only a 4 frequency screening?
The service requirements for the unaided client review are outlined in the Schedule of Service Items and Fees. A screening is not mandatory and is available from a selection of activities which are chosen based off clinical need. If the review identifies significant changes in a client’s hearing, providers will be able to apply for a revalidated reassessment service, if an assessment has been claimed on the client’s current voucher.
What is the amount claimable for the item 920 (unaided client review)?
The claim amount for the new unaided client review (item 920) is in line with the monaural client review (item 930).
What is proposed if the item 920 client review shows a device fitting is now required?
If a fitting is indicated and the client is willing to proceed with devices, the provider should follow the appropriate steps to fit the client. If a significant change in hearing is indicated, providers may submit a request for a revalidated service in order to perform an assessment prior to fitting.
Will there be a minimum hearing loss requirement for item 920 claims?
There will be no minimum hearing loss required for clients to access the unaided client review service. The only requirements are that the client has a current voucher, has not been fitted, and it has been 12 months since their previous assessment, reassessment or unaided client review.
Are there changes to the client review service for aided clients?
Currently, clients fitted with ALDs are not eligible for client reviews. Effective 1 July 2021, clients fitted with ALDs will be eligible for an annual client review under item 930. Further information regarding the service requirements for item 930 and 940 are available in the Schedule of Service Items and Fees.
Maintenance
Are there changes to the timing of maintenance payments?
There will be no changes to the timing of maintenance payments. Maintenance payments will continue to be paid annually to providers in advance.
Are there changes to maintenance claim items?
Hearing aid maintenance claim items and numbers will remain the same. There will be no change to the number of maintenance claims.
Can I charge my client for consumables and non-warranty repairs within the 12 month period after a refitting?
If the client has entered into a maintenance agreement, they cannot be asked to pay for consumables and repairs. The client can only be charged the set client co-payment amount for fully subsidised devices and the agreed amount for partially subsidised devices. More information can be found in the Maintenance Services Provider Factsheet.
My client has been refitted and has 6 months left on their maintenance agreement. When can I claim maintenance again?
From 1 July 2021, the provider cannot claim maintenance within the first 12 months of the refitting.
Providers may offer for clients to enter into a new maintenance agreement at the time of refitting, irrespective of when the previous maintenance agreement expires. A co-payment may also be charged to the client to help cover the cost of consumables. This will ensure that the maintenance agreement is aligned with the 12 months maintenance freeze after refitting.
If my client’s current maintenance agreement expires in March and they are likely to be eligible for a refit in June, can I claim maintenance prior to their refitting?
Yes. Maintenance can be renewed annually on the anniversary of the previous maintenance agreement date with the written agreement of the client.
Please note that if the client is on a current maintenance agreement at the time of the refitting, providers may offer for clients to sign up to a new maintenance agreement at the time of refitting.
From 1 July 2021, the provider cannot claim maintenance within the first 12 months of the refitting.
Do the changes only apply to refits done after 1 July 2021? (eg. If a client was refitted in June 2021 (before the changes), and their current maintenance agreement expires in July 2021 (after the changes), can their provider renew their maintenance agreement in July 2021?
Yes. The provider can renew the maintenance agreement when due with the client’s written agreement, if the refitting occurred prior to 1 July 2021. However the provider will not be able to claim maintenance for 12 months from the date of the refitting where the refitting occurs on or after 1 July 2021.
What happens to maintenance when a client relocates?
From 1 July 2021, for relocated maintenance the program will pay the new provider a quarter of the standard maintenance fee plus the client co-payment amount. Therefore the amount for a 722 (binaural maintenance) will be around $102.15. Standard maintenance can be claimed on expiry of the previous provider’s maintenance agreement.
The program recognises that clients relocate for a variety of reasons, and there will be some clients who require more device maintenance than others. Relocated clients make up a small portion of program clients (around 1%, of which a third have an active maintenance agreement at the time of relocation).
Are there any changes to the client co-payment?
No, the client hearing aid maintenance co-payment will remain the same and will continue to be available to be charged for clients who take up maintenance annually.
Will there be changes to an initial fitting claim?
No, initial fitting items will stay the same. The initial fitting service items and amounts paid for the service will not change (except for indexation). Separate maintenance service items (e.g. 700/710) will continue to not be claimable within 12 months of an initial fitting service. Where the client enters a maintenance agreement with their initial fitting, the service item for the initial fitting includes a component for consumables. Providers can continue to charge the client the maintenance co-payment or waive the co-payment if they wish.
It is important to note that initial fitting claims are higher than refitting claims as they reflect the additional time and effort in providing a first time fitting.
Who will cover the warranty for hearing devices in the first 12 months?
Device suppliers are required to provide a warranty for new hearing devices for a minimum of 12 months after the date of supply. This means that for any defects or component failures, the device supplier will remedy the issue at no additional cost to providers. Consumer protections also apply to devices supplied through the program.
Are there any changes for clients who have a device previously fitted before entering the program?
No, these arrangements are not changing. Clients who choose to use hearing devices that were fitted before they joined the program will continue to have the same supports available to them for the life of that device. Providers can submit a claim for maintenance for new clients bringing previously fitted devices onto the program. The current claim items for Private Maintenance will remain the same.
Revalidated Services
What if my client has a change in hearing and requires a full hearing test before 5 years?
Program clients will continue to have access to a review of their hearing and devices annually (currently claimed as items 930 or 940). Providers can also request a revalidation of certain services if they are no longer available on the client’s current voucher. For example, where a client has a significant deterioration in hearing, service providers can submit an application for a revalidated Reassessment service. This will allow service providers to perform and claim a full reassessment service. Clients who have specialist hearing needs may also be eligible for additional services through the CSO component of the program. Hearing assessment services may also be available to clients through Medicare.
What if my client needs a refitting during the voucher period? Will this be through revalidations only?
The program acknowledges that a client's hearing may deteriorate significantly, or their needs may change during their voucher period. As a fitting can only be claimed once per ear, per voucher, a revalidated service will need to be requested further fittings.
Providers will need to determine if a client's hearing or health circumstances have changed significantly. They may then complete a form from the webpage Requesting for a Revalidated Service . If a client meets Eligibility for Refitting (ECR), Reason B, they will need to identify how this criteria has been met as well as the intended item number.
Note: Currently, special arrangements for COVID-19, are in effect. The Request for a Revalidated Service form should be completed and kept on the client’s file – rather than being submitted to the program. Please see the Requesting a revalidated service webpage for further information.
What happens if my client loses their hearing device 6 months before they are due to be refit? Would this be a replacement or refit?
Refitting must meet the ECR. If a client has lost their device, has had a change in circumstances, and meets the Eligibility Criteria for Refitting, then a refit may be appropriate instead of replacement. It is important to evaluate the client's circumstances when a device is lost and needs replacing.
If the client requires a different style of device, from a different category or tier, or an assistive listening device (ALD), a refit is required and not a replacement.
If a refit is not available to the client and the eligibility criteria for refitting is met, providers can apply for a revalidated service.
General Principles:
- If the client is eligible for a Refit – Refit.
- If the client is NOT eligible for a Refit – Replacement with the same devices.
- If devices are no longer available – similar devices that are appropriate for the client.
It is important to note that even though clients may be refit after five years, refittings must be based on the client's clinical need and because the current devices are no longer suitable.
Do revalidated requests need to be sent to the program Dropbox and will the new process improve traceability and processing times?
From 1 July 2021, if a client requires an assessment or refitting and has already used the service on their voucher, the provider will be required to submit a request for a revalidated service. The process for requesting a revalidated service is currently being reviewed to improve efficiency and make the process easier. The revalidation form will be completed online, like a survey, without the need for a client signature. It will be intuitive, so you will only need to answer questions that are relevant to the reason that is chosen. We anticipate this will significantly reduce the time taken to process revalidated service requests. We will have more information to you over the next few months.
What will be the minimum timeframe for a response to a revalidated service request?
The program anticipates that the new revalidated service request process will significantly reduce processing time. This will be dependent on the number of applications the program needs to process.
Will there be any changes to evidence and criteria for Reason A (Reassessment)?
There will be no changes to the criteria to claim Reason A (client requires a reassessment) for a Revalidated Service.
The new process will remove the need to attach audiograms and will instead allow practitioners to select tick boxes to demonstrate where deterioration has occurred between the previous audiogram from the last assessment claimed and the most recent audiogram or screening. There will be no additional reasons for submitting Reason A. In instances where a medical referral is indicated, practitioners must always follow best clinical practice and refer clients through appropriate channels.
Software
What changes will be needed for claiming systems?
On a five year voucher, the services that may be available to clients will include one assessment, rehabilitation services, a fitting and follow-up, annual client reviews, optional maintenance, and replacements.
All existing service items will be retained. However, some items will have new fee amounts set.
Specific Changes
- From 1 July 2021, there will be a new 920 service item for the new unaided client review service. (Refer to the Unaided Client Review FAQ).
- Standard maintenance (items 700/710) will not be claimable for the first 12 months from the date of refitting, noting that standard maintenance is already not claimable for initial fittings. (Refer to the Maintenance FAQs).
- Relocated maintenance (items 711/722) will be one quarter of the standard maintenance fee plus the client co-payment amount. Standard maintenance is then claimable at the expiry of the client’s previous maintenance agreement. (Refer to the Relocated Maintenance FAQ).
- Clients with an ALD will now be able to receive annual client reviews (item 930). (Refer to the Client Review FAQs).
What support is available for software vendors and providers?
The program is continuing to liaise with software vendors and providers who have their own claiming system. Factsheets and quick reference guides will be made available, and the program will provide online demonstrations. If vendors or providers have specific questions about the system changes, please email hearing@health.gov.au
More Information
How can I get more information about the changes to the program?
For more information regarding the changes, please visit www.hearingservices.gov.au
Alternatively, you can contact the program by email to hearing@health.gov.au