Download Minimum Hearing Loss Threshold (MHLT)

Minimum Hearing Loss Threshold (MHLT)
Table of Contents
Exemption Criteria to the Minimum Hearing Loss Threshold ............................................... 2
Guidelines for the Administration of the Minimum
Hearing Loss Threshold
3
Criterion 1 ...................................................................................................................... 3
Criterion 2 ...................................................................................................................... 4
Other Considerations
5
Asymmetrical Hearing Loss........................................................................................... 5
Monitoring and Compliance
5
The Office Review and Audit ......................................................................................... 5
Documentation and Claiming Requirements ................................................................. 5
Medicare e-claiming system .......................................................................................... 5
Manual claiming ............................................................................................................ 6
Recording 3FAHL of 23.3 dB ........................................................................................ 6
Contacting the Office Audiologists................................................................................. 6
References
6
Office of Hearing Services
www.hearingservices.gov.au
1800 500 726
[email protected]
The Minimum Hearing Loss Threshold is regulated under the Hearing Services
(Participants in the Voucher System) Determination 1997. As of 1 July 2010, clients whose
3 Frequency Average Hearing Loss is less than or equal to 23 dB in the ear being fitted,
cannot proceed to fitting to that ear, nor can they be provided with an Alternate Listening
Device, unless the client meets the exemption criteria (below).
In this document, a ‘minimal hearing loss’ is defined as a 3 Frequency Average Hearing
Loss (measured at 0.5, 1 & 2 kHz) of less than or equal to 23 dB (ie, 3FAHL ≤ 23 dB).
A degree of hearing loss does not on its own predict a need, benefit or outcome with
respect to a fitting. Much depends on the nature of the hearing loss, the configuration of
the hearing loss, the degree of communication difficulties experienced, and on the attitude,
motivation and goals of the individual client.
Not all eligible voucher holders who attend for a hearing assessment are looking to
proceed to a fitting. Some clients with a degree of hearing loss may not want or need a
hearing aid. Consideration of Item 670 (rehabilitation without hearing aids) may be a
suitable option for these clients.
Exemption Criteria to the Minimum Hearing Loss
Threshold
The Office of Hearing Services (the Office) recognises that some clients with a minimal
degree of hearing loss may benefit from the provision of a hearing device. For this
reason, a set of criteria for determining exemptions to the threshold has been
established in legislative regulations.
Hearing practitioners must follow these criteria when assessing whether it is appropriate to
fit or refit a client with minimal hearing loss within the context of the Australian Government
Hearing Service Program (the Program). It is anticipated that only a small number of
clients with minimal hearing loss will meet the criteria and proceed to a fitting.
The criteria address significant aspects of rehabilitation and when considered together as
a test battery, they will (a) maximise the likelihood of identifying those clients who are
experiencing serious consequences from their hearing loss, and (b) maximise the chance
of a successful rehabilitation outcome.
All voucher holders are subject to the following two criteria when determining exemptions
to the threshold. Under the first criterion the client must meet at least one of four
conditions. Both criteria must be met for an exemption to apply.
1. One of the following conditions applies
a. Client has a High Frequency Average Hearing Loss (measured at 2, 3 & 4
kHz) which is equal to or greater than 40dB (ie, HFAHL ≥40dB.) OR
b. Client has tinnitus, where both the hearing loss and the tinnitus can be
addressed through the use of an approved hearing device OR
c. Client has a visual impairment that cannot be corrected by treatment, and
which reduces the client’s ability to see mouth movements OR
d. Client has previously been fitted with a hearing device under the voucher
system, where the client can demonstrate consistent use of the previously
fitted hearing device.
And
2. Client has a positive attitude and is motivated to wear a hearing device,
demonstrated through responses to the Wishes and Needs Tool. The client’s
response to each of the individual questions on the Wishes and Needs Tool must
attract a score of at least 2 on the scale, and the total score must be 5 or greater.
MHLT Guidelines September 2015
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Guidelines for the Administration of the Minimum
Hearing Loss Threshold
Voucher clients must meet both exemption criteria in order to gain exemption from the
Threshold. In order to proceed to a fitting, clients who meet the exemption criteria must
meet the results required when assessing and fitting a hearing device –as outlined in the
Hearing Rehabilitation Outcomes for Voucher Holders (HROs). The exemption criteria
together with the results required in the HROs address significant aspects of rehabilitation
and together will (a) maximise the likelihood of identifying those clients who are
experiencing serious consequences from their hearing loss, and (b) maximise the chance
of a successful rehabilitation outcome.
Both Criterion 1 and Criterion 2 must be met.
Criterion 1
One of the following conditions applies
a) Client has a High Frequency Average Hearing Loss (measured at 2, 3 & 4 kHz)
which is equal to or greater than 40 dB (ie, HFAHL ≥40dB.) OR
b) Client has tinnitus , where both the hearing loss and the tinnitus can be
addressed through the use of an approved hearing device OR
c) Client has a visual impairment that cannot be corrected by treatment, and which
reduces the client’s ability to see mouth movements OR
d) Client has previously been fitted with a device under the voucher system, where
the client can demonstrate consistent use of the previously fitted hearing device.
a) Client has a High Frequency Average Hearing Loss (measured at 2, 3 & 4 kHz)
which is greater than or equal to 40 dB (ie, HFAHL ≥40dB.).
1. Calculate the high-frequency average hearing loss, measured at 2, 3 & 4 kHz
(HFAHL). If the HFAHL is greater than or equal to 40 dB then the client is a
potential candidate for fitting.
2. If the HFAHL is LESS than 40 dB then the client is NOT considered a
candidate for fitting under this criterion.
3. Note - 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. As a condition
separate to hearing impairment, tinnitus cannot be the sole reason to provide
hearing aids to eligible clients. However, an exemption to the MHLT will be granted
to clients with a minimal hearing loss for whom amplification serves to reduce or
eliminate severe or constant tinnitus that affects quality of life. Fitting may proceed
where amplification can be shown both to address the hearing loss and to reduce
the tinnitus. The practitioner must be able to show through their documentation that
aiding the client has had successful outcomes for both their hearing loss and
tinnitus relief.
In such cases, it will be necessary to document evidence of the severity of the tinnitus,
using a tool such as the Tinnitus Reaction Questionnaire (TRQ), the Tinnitus Handicap
Inventory (THI), the Assess Your Stress Inventory (eg Hari’s Stress Inventory), or the
Stress Vulnerability Scale.
MHLT Guidelines September 2015
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c) Client has a visual impairment that cannot be corrected by treatment, and
which reduces the client’s ability to see mouth movements. Erberi describes an
8-9 dB improvement when clients have access to visual cues. Minimal hearing loss
clients with concurrent vision loss may therefore experience greater communication
difficulties than minimal loss clients with good visual acuity, and are possible
candidates for fitting.
In such cases, it will be crucial to document evidence that amplification serves to improve
audibility of speech, as required under the HROs.
Clients with more serious visual impairments should continue to be notified to the Office as
Complex Clients.
d) Client has previously been fitted with a hearing device under the voucher
system, where the client can demonstrate consistent use of the previously
fitted hearing device.
For clients with minimal hearing loss previously fitted under the Program (with either
hearing aids or an Alternate Listening Device), practitioners must provide evidence that the
client has consistently used a device previously fitted.
Documented evidence of consistent use may come from sources such as
• hours-of-use information from data logging
• repeated supply of replacement batteries and on-going minor repairs.
Additionally, evidence of benefit and satisfaction from the use of a listening device may be
provided through responses to self-report outcomes questionnaires such as IOI-HAii
or HAUQ.
And
Criterion 2
Client has a positive attitude and is motivated to wear a hearing device
From 1 July 2010, use of the Wishes and Needs Tool (WANT) is mandatory for all clients
with a 3FAHL of less than or equal to 23 dB in the ear being fitted.
The WANT consists of the two questions as issued by the National Acoustic Laboratories
on 1 July 2010. This tool is a client self-report instrument. Clients will answer the two
questions, and their answers will be recorded as part of the client file. Wherever possible,
clients should complete these questions without assistance from the practitioner or others
to ensure that the answers reflect the clients’ own perspective on attitude and motivation.
There should be no information included on the tool that might lead the client to a
particular score.
The WANT should be stored as part of the client file, either physically or electronically.
The tool is simple, quick to apply and easy to score. The questions are intended to be
administered towards the end of the assessment/reassessment appointment.
Dilloniii identified that clients who were motivated were more likely to be successful hearing
aid wearers. In a 2005 survey of clients, analysis of client answers to two questions
correlated highly with device fitting outcomes. Information about clients’ readiness to
accept hearing aids gives valuable information about fitting candidacy.
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Clients who are identified as being unready to accept hearing aids, or whose
responses indicate minimal communication difficulties, should not proceed to
fitting.
The expectation is that practitioners operating under the Program, as in all clinical settings,
will use a range of formal and informal approaches to assess clients’ attitude and
motivation towards rehabilitation and hearing device fitting.
In addition to the mandatory WANT attitude and motivation may be evaluated using
questionnaires, or by informal questioning during the initial interview/history.
One example of informal questioning is that used by Goldstein and Stephens (1981)iv.
Examples of questionnaires completed by the client prior to the initial appointment include
• Hearing Handicap Inventory for the Elderly (HHIE)v
• Denver Scale of Communication Function (DSCF)vi
Other Considerations
Asymmetrical Hearing Loss
Practitioners may fit clients with unaidable hearing in the poorer ear at their own discretion
(eg with a CROS device) providing requirements against the Hearing Rehabilitation
Outcomes are met.
When a client has one ear with a 3FAHL (0.5, 1 & 2 kHz) above the 23 dB threshold and
one ear with a 3FAHL equal to or below the 23 dB threshold (the better ear), then each ear
needs to be evaluated independently.
In order to fit the better ear, the exemption and fitting HRO results must be met.
Monitoring and Compliance
Monitoring will include, but not be limited to, client surveys, targeted audits and clinical file
reviews.
The Office Review and Audit
Files of all clients with minimal losses (those who are fitted as well as not fitted) will be
subject to the usual Office review and audit processes. Reviews will focus on file
documentation relating to each of the above considerations as well as the final outcome
for clients.
Documentation and Claiming Requirements
Documentation must be kept on file regarding all criteria for each client with a minimal
hearing loss who is considered for device fitting. As with all fittings, claiming should not
proceed if fitting has not achieved its purpose and is therefore unsuccessful.
Medicare e-claiming system
All providers are to enter the client’s recorded hearing loss into the Medicare e-claiming
system. Providers who are found not to be entering this information into the Medicare eclaiming system will be targeted for audits conducted on Program client files to ensure
their claiming practices are meeting their obligations as a service provider.
MHLT Guidelines September 2015
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The Office will take action against providers who claim for a service under the Program for
clients who do not meet the MHLT criteria. This action may include, but is not limited to,
recovery of all funds claimed.
Manual claiming
If a manual claim is required for a client fitted under the MHLT criteria, include the client’s
audiogram, a signed copy of the WANT tool (in the form as issued by NAL), and if
applicable, documentation showing how the client meets one of the four exemption criteria
(i.e. a completed copy of a tinnitus questionnaire, a letter from a relevant professional
documenting a client’s visual difficulties, etc).
Recording 3FAHL of 23.3 dB
As the closest whole number to 23.3 dB is 23 dB, it is appropriate to enter the client’s
3FAHL as 23 dB. When claiming electronically, proceed as per usual and ensure the
audiogram on file corroborates that the client’s 3FAHLs are actually 23.3 dB. If claiming
manually, include information on the manual claim cover sheet that the client’s 3FAHL is
23.3 dB and include a copy of the client’s most recent audiogram.
Contacting the Office Audiologists
Practitioners are welcome to contact the Office with enquiries about the content of this
document, or to discuss individual cases. You should note however, that the Office
audiologists are unable to grant any exemptions to the MHLT beyond those which are
determined using the criteria outlined above.
References
i. Erber, NP. Hearing, Vision, Communication and Older People, Clavis Publishing (2002)
ii. Cox RM, Alexander GC (2002) “The International Outcome Inventory for Hearing Aids
(IOI-HA) psychometric properties of the English version.” International Journal of
Audiology 41(1) 30-35
iii. Denis Byrne Oration (2008), presented at Audiology Australia Conference, Canberra,
2008
iv. Goldstein and Stephens. Audiological Rehabilitation. Management Model 1,
International Journal of Audiology 1981, 20(5), 432-452
v. Weinstein, BE, Spitzer, JB, Ventry, IM. Test-Retest Reliability of the Hearing Handicap
Inventory for the Elderly. Ear and Hearing Oct 1986, Vol 7, Issue 5
vi. Kaplan, H, Feeley, MA, Brown, J. A modified Denver Scale Test-Retest Reliability.
JARA Vol XI, 2, Oct 1978
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