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Hearing Loss answer line – Responses to your questions on the new hearing loss regulations The following are our responses to your questions on the Accident Compensation (Apportioning Entitlements for Hearing Loss) Regulations 2010, which came into effect on 1 January 2011. These questions are listed in numeric order for ease of referencing. Questions 1 to 20 1. Will there still be an ACC price list for hearing Aids? If so, what format will this be in? No, ACC does not intend to continue with the ‘ACC pricelist’. 2. Do you intend to maintain contracts with Hearing Aid Manufacturers? No. ACC does not intend to continue to maintain contracts with Hearing Aid Manufacturers. 3. Will the regulations address the issue of Manufacturers providing incentives to Audiology Providers to encourage prescription of their products? No. Regulations set out the client’s entitlement to hearing services support. 4. Will ACC continue to fund remote controls and other accessories for hearing aids, as are currently funded? ACC will fund hearing devices according to the definition set out in the regulations (excerpt below): devices means – (a) hearing aids: (b) accessories for hearing aids, including, but not limited to, remote controls: (c) consumables, excluding batteries, for the items in paragraphs (a) and (b). 5. The regulations state a minimum trial period of 2 weeks, is there a maximum trial period allowed? No. The trial period is a clinical decision made by audiologists in consideration of each individual client’s needs and circumstances. The maximum trial period is a matter between audiologists and their suppliers. 6. Does ACC intend to provide an Information Pack specific for Manufacturers? No, but a copy of the vendor information pack has been emailed to the manufacturers on the list held by ACC. 7. Will it be possible to see a draft of the brochure outlining all Government funding prior to the proposed availability mid-December? No. This is a cross-government document intended for people who have or think they have hearing loss. ACC will provide copies of the document to the hearing sector once published. 8. What is the Audiology Provider allowed to charge for ACC apportioned hearing aids? Can they charge only wholesale price, or are they allowed to charge a margin on the hearing aids? Regulations set out the entitlements that ACC can provide clients. The audiologist will determine what they charge for hearing aids. In some instances, there will be co-payments and such arrangements will be between the client and the audiologist. 9. Will the Audiology Providers be required to comply with the Ministry of Health Section 88 notice on invoices for ACC apportioned hearing aids? The planned Ministry of Health Section 88 notice is expected to apply only where hearing aids are funded solely by the Ministry of Health. As such, it would not apply to audiology providers when the fitting of hearing aids is funded by ACC alone or jointly by ACC and the Ministry. However, both agencies expect audiology providers to provide a professional and appropriate service for clients. 10.Can ACC provide copies of the standard AS ISO 8253.1-2009: Audiometric test methods, Part 1: Basic pure tone air and bone conduction threshold audiometry? Unfortunately not because standards are subject to copyright. You can organise to view ACC’s copy in Wellington, or order one yourself from Standards New Zealand for approximately $100 (ex GST). What we can provide is a summary of a report that will shortly be published by Suzanne Purdy and Warwick Williams, titled Guideline for diagnosis of occupational noise-induced hearing loss. Part 3: Audiometric standards. The summary may be of use because it discusses the maximum permissible ambient noise levels for the purpose of ACC assessments, which are taken from the new ISO standard. This summary will be incorporated into the detailed information pack that will be sent to audiologists before midDecember. 11.What happens to the current 5% prompt payment discount from the Suppliers? Regulations set out the client’s entitlement to hearing services support. Under the new arrangements, audiology practices will be able to agree prices and any discounts with their suppliers as they see fit. 12.As of 01/01/11 will hearing clinics be able to claim money for ACC clients receiving ear nurse appointments? ACC will continue to purchase ear nursing services where appropriate, such as when ear ‘toileting’ is required as a result of in-the-ear hearing devices. ACC purchases this service in two ways. First, under regulations, general nurses can charge $15.72 (inc. GST) for ear treatments such as cleaning (code NCON). Second, on a non-contracted basis, specialist ear nurses registered with ACC can charge $46.00 (inc. GST) for ear toileting by microscope (code RNP100). Ear nursing services are not covered by the new regulations. 13.Are we still required to do a needs assessment or needs reassessment before ordering new aids? Under the new regulations, ACC will no longer require a formal hearing needs assessment/reassessment report to be submitted. ACC expects that audiologists will determine the appropriate hearing device(s) for the client to trial before placing an order, as for non-ACC clients. ACC considers as part of good clinical practice the audiologist will complete an assessment of the individual client’s needs and this is part of the overall fitting fee service, to which we will contribute as per the new regulations. 14.Are any appointments covered for a claimant after the trial is over? eg. an annual review, problems, fitting moulds, etc. ACC's contribution to the fitting fee is intended as a contribution to the fitting of devices as well as follow-up services, and is payable no more than once every 6 years. ACC will contribute to services and repairs of a client's hearing devices as per the new regulations (ie maintenance up to $57.50 (inc. GST) no more than twice per year, repairs up to $230 (inc. GST) once every 2 years after the warranty period). It is up to the individual client to pay for services required beyond those that ACC contributes to. 15.Will ACC cover the cost of consumables other than batteries such as tubing, filters etc? Consumables (such as tubing and filters) fall under the definition of hearing devices in Regulation 4. As such, the client may (choose to) use some of ACC's contribution to the cost of hearing devices for each ear to pay for these consumables at the time of hearing aid fitting. ACC's contribution to hearing devices is available no more than once every six years. Batteries will continue to be provided by ACC direct to clients through the current processes. 16.How is ACC going to keep track of individual entitlements? ACC has systems and processes in place that identify all costs against all claims. 17.Can we have access to client funding communications? A number of client factsheets have been created which will be published shortly. In the meantime, the fact sheet Helping with your hearing loss (DOC 92KB) is available. 18.Detailed implementation pack The Audiologists’ detailed information pack (DOC 1,134KB) provides detailed information for implementing the regulations. 19.Can we have examples of how the regulations will work during transition? Transitional Hearing Service Requests Scenario Payment Method for Hearing Aids and Fitting Fees Purchase order for providing fitting of hearing aids issued by ACC 29 December 2010 Client doesn’t visit audiologist to have aids fitted until 15 January 2011. Needs assessment completed and received by ACC on 29 December 2010 ACC doesn’t consider it/make decision until 15 January 2011. Client has received cover decision and is waiting to have a hearing needs assessment appointment with an audiologist Client can’t get an appointment with an audiologist before 1 January 2011. Contract rates apply – purchase approval honoured for up to 12 months. Contract rates apply – because the needs assessment was received by ACC before 1 January 2011. a Regulated rates apply – entitlement has not been determined at this stage. Transitional Repairs Requests Scenario Payment Method for Repairs Client visits audiologist for off-site repair on 15 December 2010 Audiologist sends manufacturer for repair Manufacturer’s invoice aid for to repair Contracted rates apply – manufacturer’s service date is before 1 January 2011. and service is dated 27 December. Client visits audiologist for off-site repair on 29 December 2010 Audiologist sends manufacturer for repair Manufacturer’s invoice for repair and service is dated 15 January 2011. Client visits audiologist for on-site repair (service) on 15 December 2010 Repair completed on-site the same day. Client visits audiologist for on-site repair (service) on 10 January 2010 Repair completed on-site the same day. aid to Regulated rates apply – key date for offsite repairs is service date and this is after 1 January 2011. Contracted rates apply - service date is before 1 January 2011. Regulated rates apply - service date is after 1 January 2011. 20.Could you please confirm if consumables such as tubes and domes and receiver wires can be billed under the $50 HL20 charge. Under the new detailed information HL 20 pack it says they cannot, then on page 4 it specifies "replacement of consumables". Yes, the client can choose to use ACC’s contribution to the servicing of hearing devices to have their consumable(s) replaced. However, if they do this they may not be able to use ACC’s contribution to pay for something else (e.g. repair of hearing aid), as regulated limits apply. Questions 21 to 40 21.Can receiver wires be replaced under the $200 off site repairs provision? This is a major hearing aid component and must be ordered in, however usually - but not always - the repair can be effected in the clinic. If this service is performed off site then the client can choose to use ACC’s contribution of up to $200 (ex GST) towards off site repairs. However, if this service is performed on site then it would be as per the on site service contribution i.e. up to a maximum $50 (ex. GST) per service, maximum two service per year. 22.Is the $200 (ex. GST) per client or per device? If the client has two, then they are discriminated against if it is $200 per client. The entitlement for an off-site repair of hearing devices is maximum $200 (ex GST) per client and is paid once every two years after the manufacturer’s warranty for the devices has expired. The sum available from ACC is intended as a contribution to the costs of a client’s hearing devices. 23.What happens if the aid needs repair during warranty period, but it is not a manufacturing defect – e.g. wax has got into the instrument, or water damage? Presumably it is the client’s cost. ACC will contribute to the cost of repairs after the manufacturer’s warranty for the device has expired. Any costs incurred during the warranty period lie with the client. 24.How will manufacturers know if it is a transitional claim? Can we ask the audiologist to submit a copy of the ACC paper work when they place their order? Seeking advice from audiologists is one way that manufacturers can confirm whether a claim is treated under the transitional provisions. Manufacturers can also contact ACC for this information at the following addresses: Hamilton Hearing Loss Unit - [email protected] Dunedin Hearing Loss Unit - [email protected] 25.What sort of time frame do you anticipate for transitional claims? Can we expect all orders to be processed by 31 January? We will aim to make decisions as quickly as possible over the immediate transitional period, but unfortunately are not able to specify a particular date as this will depend on the information required to make a decision on individual claims. If you have concerns about a particular claim, please contact the relevant ACC Hearing Loss Unit on: Hamilton Hearing Loss Unit - [email protected] Dunedin Hearing Loss Unit - [email protected] 26.ACC has indicated that any claimant needs assessments received prior to 31 December 2010 will be handled under the terms of the current contract, even if the order for the instruments is posted after 1 January 2011. If a manufacturer is planning on introducing new products early in the new year there is a good chance the audiologist may feel the new product is the most appropriate to meet the claimant’s needs. Of course any such product would not be on any existing ACC price list, so how will it be funded? Will it be necessary to submit pricing for distribution, or can some other arrangements be made? Unfortunately not. Because the contracted rates will be paid for these transitional claims, the product must be on the existing contracted price list. 27.Are ENTs going to be allowed to test air conduction as they have been doing up to now in non-proof testing conditions? Typically no BC or speech or tymps are performed. From 1 January 2011, ACC will provide ENTs with an audiometric assessment that has been completed by an audiologist. ACC will only request a second audiometric assessment if it considers the first one to be inaccurate. 28.Can you give us an example of how the bands and percentages will work? For example someone with NAL: 20% loss age deduction 5%. How will this work? This is a client with a typical NIHL shape with normal hearing in the low frequencies. All clients will receive a decision letter from ACC confirming their financial contribution, which will help the client and audiologist understand the funding assistance provided. In the example you've used, let's assume the remainder after age deduction is all attributed by the ENT to occupational noise-induced hearing loss (ONIHL), i.e. the client has 20% total hearing loss, made up of 15% ONIHL and 5% age-related hearing loss. Only the ONIHL is covered by ACC. ACC would calculate how much of the client's total hearing loss is due to injury in the following way: 15% / 20% = 75% covered injury-related hearing loss as a proportion of the total hearing loss. The client would therefore fall into Band 8 (70.0%-79.9%). For hearing devices, the client would be eligible for $1,200 (for each ear) from ACC, as well as $89 (for each ear) from the Ministry of Health; the total amount for hearing devices is administered by ACC. For fitting fees, the client would get $960 from ACC. ACC would also contribute to assessment, service and repair costs. Prices quoted are ex GST. 29. Is the total 100% considered from total loss % or from total hearing as it is now? 'Total' means the total percentage hearing loss of a client, as determined by the audiometric testing at the time of ACC’s decision. 30. Has ACC /MoH seen how much hearing aids costs overseas? My impression is 3 times more in UK, around 4 times more in USA and 5 to 6 times more in South America. We have clients that come to NZ to get hearing aids while on holiday. Maybe NZ is the cheapest country from the OECD? This is worth investigating, as overheads in private clinics are very high, and staff are well paid. Lowering our incomes is going to impact on everyone, i.e. loss of jobs, reduced quality of service, reduced time allocation per client, closure of some clinics and putting more pressure on the public audiology clinics that are hardly coping with the paediatrics. Thank you for your comments. The Government has signalled that it considers these changes will ensure there is a reasonable level of financial support to help people access hearing services in New Zealand. 31.If a person is in, for example, Band 6 which provides $1078 (ex. GST) but their hearing aid wholesale cost is $750 (ex. GST), I understand they can add in other devices and accessories such as a remote control or ear moulds etc as long as the total cost comes in under that figure. So, if the actual cost totals $950 do we claim the $1078 (ex. GST) on their behalf, or only the $950 (ex. GST)? As you note, the hearing devices contribution can be used for hearing aids as well as accessories such as remotes or ear moulds. ACC‘s contribution states the maximum amount we will contribute in the client’s Band, but it still relates to the actual cost of good supplied. So if the price charged to the client is less than the ACC and MOH entitlement then the audiologist can only claim reimbursement for the price charged, so in the example given, the audiologist would invoice ACC for $950 (ex. GST). 32.What happens when clients need their next lot of consumables, are they paid for by ACC just as batteries are, or is that a cost to the patient? If the cost of consumables can't be included in the service or repair contribution, the cost lies with the client. ACC will only supply batteries direct to the client 33.I cannot find the ACC5647 form on the website. Can you please direct me to that? The ACC5647 (Your guide to help with hearing loss) is available at http://www.acc.co.nz/publications/index.htm. However, it is not a form, it is a brochure outlining government support for people with hearing loss. Please contact [email protected] if you would also like a hard copy. 34.Where is the ACC324 (Confirmation of Successful Trial)? The ACC324 is an existing form and can be searched for at http://www.acc.co.nz/publications/index.htm. This form is also included in the Audiologists' detailed information pack located in question 18 of these questions and answers. Please note that this form will be retired as at 1 January 2011 and replaced by ACC611 Hearing Aid trial outcome report. 35.Forms 612 (Hearing Loss Audiometry) and 611 (Trial Outcome) - are they available yet? Both of these forms are in the Audiologists' detailed information pack, which was emailed to the audiology email list held by ACC on 7 December 2011. This pack is also available through Question 18 of these Questions and Answers. 36.There is provision for 2 onsite repairs per year. aid or per visit? Is that per hearing It is per visit. 37.The $200 for offsite repairs per two years - is that $200 per hearing aid or just a total of $200 in repairs for 2 years? The contribution of a maximum of $200 is payable for one visit every two years after the warranty has expired. The visit may involve repair of more than one device belonging to the same client. 38.Will the yearly hearing aid review this still be funded by ACC or will clients need to fund it themselves? If it is to be funded by ACC has the invoicing code changed? ACC will only contribute to audiometric testing costs once every 6 years. Clients will need to pay for any hearing review costs they incur more frequently than this. 39.Do the new regulations apply to hearing loss due to brain injury and medical misadventure? How will these claimants be managed? Yes, the new regulations apply to all hearing loss claims. Contribution for hearing loss from traumatic or treatment injury will be determined in the same way as claims for occupational noise-induced hearing loss, although they tend to be managed more closely (eg by case managers). Depending on the severity of the injury, different rehabilitation may be appropriate for these clients. 40.Are accessories such as Dry and Store units still supplied on request to prevent ongoing maintenance problems experienced by some claimants? Accessories for hearing aids such as Dry and Store units are considered accessories under the hearing devices definition and can therefore be purchased as part of the hearing devices contribution under regulations. Any costs that exceed this contribution lie with the client. Questions 41 to 60 41. If the hearing device(s) costs less than the client’s hearing device contribution, how do we invoice this? The Ministry of Health contribution is considered a top up and therefore the cost of that service code is reduced accordingly. For example (using hearing device service codes only and ex. GST): ACC and MoH hearing devices contribution total = $2,156 ($1,800 from ACC, $356 from Ministry of Health). Actual cost of hearing devices = $1,980. ACC approval letter Value HLBN06HD Hearing Loss – ACC Funding: two new hearing aids $1,800 HLBN06MH Hearing Loss – MoH subsidy: two new hearing aids $356 Audiologist invoice HLBN06HD Hearing Loss – ACC Funding: two new hearing aids HLBN06MH Hearing Loss – MoH subsidy: two new hearing aids Value $1,800 $180 42.Can you clarify what happens in the case of an insurance claim for instruments? Can the audiologist go ahead and fit new aids to the claimant and then simply inform ACC of what has changed in terms of the aid’s serial number and even, perhaps, battery size? Yes, the audiologist can fit new aids. Unless the client is eligible for new hearing aids under regulations, all costs will need to be covered by insurance and/or the client. ACC requests that the audiologist provide ACC with a copy of the manufacturer’s invoice for the new aids, as this will give us the serial numbers and manufacturer’s warranty information, as well as any details for change of batteries. 43.Does ACC expect that an audiologist will perform a hearing needs assessment? Is ACC contributing to the cost of the hearing needs assessment under the regulations? If so, how much is ACC contributing? Where in the regulations is payment for hearing needs assessments provided for? ACC would expect that an assessment of the client’s needs will occur as part of good clinical practice in determining the appropriate hearing aids to fit for a client regardless of whether the aids were funded by ACC. ACC no longer requires the paperwork or the specific ACC assessment that was used to support the hearing needs assessment under contracted arrangements and therefore a separate fee will no longer be paid. 44.What guidance will the ACC provide to an ENT specialist to assist them to exactly determine which band a claimant falls into? ACC will determine what band a client falls into, based on the percentage level of total hearing loss (provided by an audiologist) and the percentage level of covered injury-related hearing loss (provided by an ENT specialist). 45.Regarding on and off site repairs (where there are two repairs on site per year), is this two per aid or two per client? Also, regarding one off site repair every two years, is this per aid or per client? For on-site repairs, ACC will contribute to two services per client each year. For off-site repairs, ACC will contribute to one repair per client every two years ($200 ex GST) (also see Question 22 and 37). 46.Consumables – will these remain fully funded by ACC or will clients contribute – also is there a limit on each consumable per aid per year? Refer to Question 32. 47.47. Can you let me know if the standard from 1 January 2011 for audiometric assessment means an objective calibration every 3 months of the audiometer, or every 2 years as it is currently the practice? Is ACC going to contribute with the payment of this calibration? If needed only for ACC clients to be every 3 months when are the bills expected to be paid to the audiology clinics? And if there are delays can we charge ACC an interest for late payment of let’s say 15%? Compliance with AS ISO 8253.1-2009 comes into force on 1 January 2012, a year after the other changes, to allow audiology clinics to make any necessary modifications. ACC will not contribute to the costs of calibration. AS ISO 8253.1-2009 recommends that periodic objective tests are carried out every three months. However, this is a guideline only, and section 12.2 of the standard acknowledges that a different interval should be used if there is evidence it would be more appropriate. ACC considers such evidence to be provided by the report by Suzanne Purdy and Warwick Williams (Guideline for diagnosis of occupational noise-induced hearing loss). A summary of their report (available on page 9 of the Audiologists’ detailed information pack referred to under Question 18) sets out the following requirements: “Formal calibration of all audiometric test equipment shall be carried out on an annual basis for equipment that moves between testing locations or biennially for equipment kept in a fixed testing location. Calibration will be undertaken by an accredited testing laboratory with full documented traceability to National Standards. Formal calibration shall be carried out in accordance with the relevant ISO and IEC standards (IEC 60318, IEC 60645 & ISO 389). Daily listening checks are very important. A brief listening check should be carried out on a daily basis.” 48.Could you please explain the process to be followed when an ACC claimant requires replacement of hearing aids that are more than six years old and are not meeting the claimant’s needs or can no longer be repaired? Will ACC require a report from an audiologist explaining why the aids need replacement? Will ACC pay for the claimant’s review appointment? Who will determine the funding band for the replacement hearing aids? Will the claimant have to wait for an ENT assessment to establish hearing loss percentages before funding can be determined? For details of the re-aiding process, refer to page 11 of the Audiologists’ detailed information pack (see Question 18). ACC no longer pays for hearing reviews, but can contribute $155 (ex GST) to an audiometric assessment once every six years to determine whether replacement hearing aids are needed and the level of any financial contribution. As is the case now, a new ENT assessment will only be sought if we have reason to suspect there is an error with the original ENT decision or an updated assessment is required, for instance because the client has been exposed to workplace noise since the last ENT assessment. Otherwise, ACC will use the information from the previous ENT assessment and the latest audiogram to determine what contribution we can now make to replacement hearing devices. 49.Will the new regulations apply to clients whose hearing loss claims are managed by other insurance providers (e.g. CRM and AON)? Yes, accredited employers and third-party administrators such as CRM and AON are required to abide by the same legislation and regulations as ACC. This means that they must pay as a minimum the ACC regulation entitlements for entitled clients. 50. Can you give us an idea of the time frame likely from application to fit approval for new applicants? There are many factors that can affect the timeframes for ACC making a decision on whether to approve entitlement funding. These include the availability of specialist resources, time taken for clients and employers (if required) to return questionnaires. If you are concerned about the timeframes for a specific client please contact ACC. The hearing loss Regulations are not expected to impact decision timeframes. 51.Are new applicants given a choice of provider by ACC for their hearing assessment and again for their fitting or is it presumed they will go back to the provider chosen in the first instance. It will be up to the client to see the audiologist of their choice at all stages of the claims process. For details of the claims process under regulations, please refer to page 10 of the Audiologists’ detailed implementation pack (see question 18). 52.In the Detailed Implementation Pack regarding examples of where to use onsite repair and maintenance it states “Client presents to clinic stating that hearing aids are lacking clarity. Fault finding determines issues with wax impairing the function of aids. After a clean out the hearing aids are working satisfactorily. Client has presented once in the past year so the cost of the repair can be invoiced to ACC up to a maximum of $50.00 (ex. GST).” Could you please confirm that an onsite repair fault finding does not need to be performed by an MNZAS Audiologist? ACC does not specify that onsite repairs need to be carried out by MNZAS audiologists. This is no change to the pre 1 January 2011 process. 53.Do you have any examples of the types of letters audiologists will be receiving regarding entitlements and contributions? Yes, we have an example of a Hearing aid approval letter (DOC 50K) . 54.When the claimant receives approval from ACC, will they be given a list of local provider clinics? ACC will stop sending the list of local provider clinics to clients with the funding approval letter as in all cases the client will have already visited an audiologist for a audiometric assessment and it is likely that most clients will return to the audiologist who they have previously seen. 55.I understand that under the new system, we won’t be paid for HT unless we have the ACC letter requesting one. However, we have several booked in for an ENT visit in January. ACC have booked them with us and the ENT on the same day, the earliest ENT appointments available. The appointment requests come to us from the ENT, and they then notify ACC who write to the client, advising of those appointments. Can you please confirm how we should proceed with these appointments to ensure we can be paid? There is no change to the current hearing therapy process. It has always been a requirement for providers to seek approval from ACC before commencing this service. 56.Can the Failed Fitting fee (HL11) be invoiced for each unsuccessful hearing aid client trial? The failed fitting fee, whether for a binaural or monaural failed fitting, is payable only once every six years. 57.The Vendor information pack states in the key changes that “Clients will use a combination of government funding and their own financial resources to purchase their hearing devices, in consultation with their audiologist of choice”. Could you please confirm that the ACC and MoH hearing aid/device funding, is for contribution towards the actual cost of the device from an Audiologist, not the wholesale cost? Refer to Question 8. 58.Our client has two Resound Canta ITEs received in 2004. He has been struggling greatly with them and is not wearing them. I have loaned him some of our loan BTE aids which he is wearing in the meantime and finds them much better. With the new contract coming into effect on 1 Jan, and we no longer have to do a Needs Reassessment, how do I now get our client reassessed for new hearing aids? If the client chooses to seek replacement hearing aids on or before 31 December 2010 a hearing needs assessment is required. If the replacement hearing aids are sought on or after 1 January 2011 a new audiometric assessment is required under regulations to be submitted to ACC. Once ACC receives this we will issue a funding decision to the client which will detail their entitlements. Once the client has received a contribution to hearing aids under the regulations, he will not be able to get new ones for another six years. 59.Could you clarify whether the $50 onsite (HL20) and $200 off-site (HL21) charges have to be used as a single charge, or if they can be made up of multiple transactions. HL20: e.g. a client’s earmould is retubed at a cost of $15.00 – is there $35.00 remaining for them to use, or have they used up one of their services for the year and they lose the $35.00? HL21: e.g. a client’s hearing aid is sent away and has a minor repair charge of $60.00 – is there $140.00 remaining for them to use, or have they used up their two-year repair and lose that $140.00? The client is entitled to a maximum of two on site services per year and the maximum cost the corporation can contribute to each service is $50. The client is entitled to a maximum of one off site repair every two years from the end of the warranty period. The maximum cost the corporation can contribute to this repair is $200. Multiple transactions can be made during a repair/service, but any balance cannot be carried over to subsequent repairs. If the actual cost is lower than the maximum entitlement ACC would expect to be charged the lesser amount. Questions 61 - 80 60.If during the warranty period a repair is required that is not covered by the warranty, will the client be entitled to $200 subsidy? No. ACC’s contribution to repairs is prescribed by the new regulations, which state that “the cost to which the claimant is entitled is payable for a maximum of 1 repair every 2 years from the end of the warranty period on the device” (Regulation 10(3)). This means that ACC cannot contribute to repairs during the warranty period, regardless of whether the particular repair is within the scope of the warranty coverage, and thus any costs incurred lie with the client. (Also see Question 23.) 61.Phonak are about to release a new array of aids and would expect that some clients who will still be provided aids under the 'old' system will be prescribed these. They are currently not on the price list. How will we deal with these? Refer to Question 26. If a client chooses a hearing aid that is not on ACC’s current manufacturers’ price list, only regulated contributions will be paid by ACC. 62.Can you please inform me of the process required now (as of 1 Jan) to get replacement aids? Now that Needs Reassessments are no longer required, do I just get the patient in for a hearing assessment and write a letter to ACC requesting replacement aids? Is there another form that ACC may have for this? Who pays for this assessment? For details of process for applying for replacement hearing aids, see page 11 of the Audiologists’ detailed information pack, available under Question 18. ACC will pay for an audiometric assessment once every 6 years under the Regulations. 63.Please could you send through an electronic version of the new NAL tables? The new NAL tables are viewable here on the New Zealand Legislation website, as part of the Accident Insurance (Occupational Hearing Assessment Procedures) Amendment Regulations 2010. 64.If a client has lost their hearing aids and they have no contents insurance does ACC replace the aids as per the old scheme? If a client has not had a hearing aid contribution under regulations from ACC for six years the client may apply to ACC for a contribution to their replacement hearing aids. 65.I have a client who was declined hearing aids as his hearing loss was 6% attributed to Noise Induced Hearing loss and 17% to other causes – can they reapply for hearing aids under the new scheme? And if yes, when? The introduction of the regulations does not change any previous entitlement decisions issued by ACC. 66.I ordered replacement moulds for a client who had his aids funded 3 years ago – the moulds were ordered before Christmas but have been invoiced by the manufacturer and received in January. Will ACC cover the cost of these moulds for him or does this come into the $200 off site repair code? If the date of the invoice for the ear moulds is on or after 1 January 2011, regulations apply, and ACC can only contribute up to $200 (ex GST). For more examples, see information on transitional repairs requests under Question 19. 67.My client had a hearing test performed in 2009 and at that stage the hearing aids were functioning well. He came in recently and the hearing aids were sent to the manufacturer and they were deemed obsolete and not repairable (no spare parts available due to the age of the aids). Now he needs new hearing aids, but he will need a more recent hearing test. Will ACC pay for another hearing test (as the Hearing Loss Audiometric Report requires a current audiogram)? Yes, ACC will pay for a new audiometric assessment as long as the client has not had one funded already since the regulations came into force on 1 January 2011. This audiometric assessment must be provided to ACC. On receipt of the audiometric assessment ACC will issue a funding decision to the client on what funding can be provided towards replacement hearing aids. Once this audiometric assessment has been completed and paid for by ACC, ACC will not be able to contribute to another audiometric assessment for six years. 68.If a client needs a hearing test (because their last one was more than six years ago) and they are happy with their current hearing aids, do we fill in the Hearing Loss Audiometric Report? Or do we send our own typed report? The intention of the audiometric assessment is to determine whether a client has a need for hearing aids, and to apply for a contribution from ACC (and Ministry of Health where there is also non-injury hearing loss). ACC must receive this information on the standard report form (ACC612). Bearing in mind that ACC can only contribute toward this cost once every six years from the first time the client has this assessment under regulations, if the client is happy with their current hearing aids now, but there is a chance they may need new aids over the next six years, the client may choose not to seek ACC funding for this assessment in order to save it for a later date. In this case, ACC would not require any paperwork. 69.What information about the regulations is being sent to existing hearing loss clients? Clients are being sent HLSIS07 Changes to funding for hearing services from 1 January 2011 (PDF 46K). 70.Can we have some scenario examples of how the regulations work? NOTE: All of the following scenario examples are based on fitting of Binaural Aids. Prices quoted are exclusive of GST. SCENARIO 1 On 1 January 2011 Client A submits a claim to ACC for ONIHL. Client A is still working and has a 20% total loss with 19% attributed to ONIHL see example 1a. The client proceeds with hearing aids and has them fitted. Example 1a Total Loss% 20% ACC funded % of Total Loss ONIHL% 19% ACC Contribution Band Traumatic Injury% Hearing Aid ($) Treatment Injury% MOH Contribution ($) Fitting Fee 95% 10: 90-100% $3,000.00 $0.00 $1,200.00 Client A then approaches ACC on 2nd January 2017 requesting funding for replacement hearing aids. Client A had continued to work from 1st January 2011 until retiring in 2015 and had been exposed to noise at work during that time. Client A now has a total loss of 23% (determined by a new audiogram) and ONIHL of 20% (determined by a new ENT assessment).See example 1b Example 1b Total Loss% 23% ACC funded % of Total Loss ONIHL% 20% ACC Contribution Band Traumatic Injury% Hearing Aid ($) Treatment Injury% MOH Contribution ($) Fitting Fee 87% 9: 80-89.9% $2,700.00 $88.00 $1,080.00 Client A then approaches ACC on 3rd January 2023 requesting funding for replacement hearing aids, is now retired, and has had no further exposure to occupational noise since retiring in 2015. Client A now has a total hearing loss of 32% (determined by a new audiogram) with ONIHL still at 20%. A new ENT assessment is not considered necessary given that the client has not been exposed to further workplace noise. See example 1c Example 1c Total Loss% 32% ACC funded % of Total Loss ONIHL% 20% ACC Contribution Band 63% 7: 60-69.9% Traumatic Injury% Hearing Aid ($) $2,100.00 Treatment Injury% MOH Contribution ($) $266.00 Fitting Fee $840.00 SCENARIO 2 Client B has approached ACC for a new claim for noise induced hearing loss. Client B has a total hearing loss of 7% and all of this is attributed to ONIHL. The client is retired and no longer working. See example 2a. The client proceeds with hearing aids and has them fitted. Example 2a Total Loss% 7% ACC funded % of Total Loss ONIHL% 7% ACC Contribution Band 10: 100% Traumatic Injury% Hearing Aid ($) $3,000.00 Treatment Injury% MOH Contribution ($) Fitting Fee 100% $0.00 $1,200.00 10 years later the client requests funding for replacement aids. The new audiogram shows that the client now has a total hearing loss of 25%. There is no reason to re-visit the earlier ENT assessment as the client has not been exposed to further workplace noise in the last 10 years, meaning that the previous decision to attribute 7% to ONIHL remains. See example 2b. Example 2b Total Loss% ONIHL% 25% 7% ACC funded % of Total Loss ACC Contribution Band 28% 3: 20-29.9% Traumatic Injury% Hearing Aid ($) $900.00 Treatment Injury% MOH Contribution ($) $622.00 Fitting Fee $360.00 SCENARIO 3 Client C was fully funded for hearing aids prior to regulations being introduced. Client C had a total loss of 25% with an ONIHL of 12%. Client C requests funding for replacement hearing aids and his total loss is now 26% with ONIHL of 13%. This was determined by a new ENT assessment because Client C had been working and has been exposed to workplace noise since the previous ENT assessment see example 3a. Example 3a Total Loss% 26% ACC funded % of Total Loss ONIHL% 13% ACC Contribution Band 50% 6: 50-59.9% Traumatic Injury% Hearing Aid ($) $1,800.00 Treatment Injury% MOH Contribution ($) $356.00 Fitting Fee $720.00 SCENARIO 4 Client E approaches ACC for a new hearing loss claim. It is determined that the client has a total loss of 30% with a traumatic hearing loss from a loud explosion of 10% as determined by an ENT assessment. See example 4a. Example 4a Total Loss% 30% ONIHL% Traumatic Injury% Treatment Injury% ACC funded % of Total Loss ACC Contribution Band 10% Hearing Aid ($) 33% 4: 30-39.9% $1,200.00 MOH Contribution ($) $532.00 Fitting Fee $480.00 71.How will ACC determine which vendor receives the referral to carry out an HL01 on a new claimant? Under the new system, ACC does not make a referral - it is up to the client to choose an audiologist to complete the audiometric assessment and report (HL01). 72.When does the 6-year period begin in terms of billing ACC for an HL01 - is it as of Jan 1 2011? Or is it dated from the last time ACC was billed for a "Hearing Review" under the old contract, or even perhaps the last time ACC was billed for an "Audiogram Report" as per the old contract? The 6 year period begins from the date that the first Audiometric Assessment is undertaken under Regulations. After that, ACC is unable to fund Audiometric testing for a further 6 years. If you are unsure, please contact your ACC Hearing Loss Team to confirm if funding is available prior to completing the testing. 73.Is the ACC contribution for a repair based entirely on the manufacturers invoice or can we include a modest fee to cover handling time and courier charges? Nowhere is this specifically clarified that I could find. Otherwise a claimant will always have to be charged a co-payment even if ACC’s contribution is not fully used. Offsite repairs always incurs costs for a clinic and can’t be treated in isolation. ACC's contribution is toward the cost of repairing the device. If you consider that this cost includes handling time and courier charges, you can include these costs in your invoice and ACC will pay up to $200 (ex GST) once every two years. 74. I understand that once a hearing loss claim is lodged with ACC the client will receive a letter detailing how to go about getting an audiometric assessment. Can you please provide an example copy of the this letter (HLS14) or at least provide more detailed information about what this letter advises (ie is the client given a list of MNZAS audiologist who they can see for their audiometric assessment?). Here is an example of a HLS14 letter (DOC 60K). 75. If ACC is to pay $1035.00 towards the cost of Hearing Aids and $414.00 towards the fitting fee can the MOH contribution of $715.00 be used towards either the Hearing Aids or the fitting, since the $414 will not cover the fitting costs. The Ministry of Health contribution is a top up to the ACC hearing aids contribution and therefore can only be used towards the cost of hearing aids. 76. I would like to get clarification on invoicing repairs under the new regulations for two examples we have encountered (assuming of course that the client has not already used either entitlement). A. Onsite repairs – can two HL20’s be charged for a service on the same day? An example might be a client who attended an appointment for a full retune, refit of hearing aids and was also supplied some consumables to maintain proper function of their hearing aids. B. Offsite repairs – is it acceptable to invoice for an HL20 if an onsite repair is unsuccessful and a subsequent offsite repair is needed? (ie the invoice would have both an HL20 and an HL21) For question A, in such circumstances, the client may choose to use both on site service contributions up to a maximum of $50 (excl. GST) each. However, the client should be made aware that they will not be eligible for another on site service contribution for at least 12 months. For question B, as the client has not already had their regulated limit for services and repairs, then invoicing for both on site service and off site repair would be acceptable. 77. There is some confusion on funding of Aids. Can I please seek clarification? Example: Say the Manufacturers Wholesale price for two Aids is $3,000 and the audiologists Retail Price is $4,000. Say ACC has approved $3,500 for both Aids (this is only for the aids). A. Will ACC pay $3,500 and the Client needs to pay $500? OR B. Will ACC pay only $3,000 [Wholesale Price] although approval was for $3,500 and the Client needs to pay $1,000? The funding contribution from ACC (including the Ministry of Health in this context) is a contribution towards the cost that would be payable by the client. In other words, the wholesale cost is irrelevant in determining what ACC will pay; ACC's approved contribution amount should be subtracted from the client's total invoice for hearing devices, and the client is required to pay any balance. In the example provided, as ACC's funding is $3500, and the total cost to the client was $4000, ACC would contribute $3500, and the client would be required to pay the remaining $500. The wholesale cost is irrelevant. 78.Which version of the ACC612 Hearing loss audiometric report should audiologists use from 1 January 2011 onwards? There is only one valid version from 1 January 2011 it is the ACC612 Hearing loss audiometric report (DOC 169K). 79.Please clarify the current situation regards compliance with the new ISO standard. It seems there are different interpretations of the maximum permissible sound levels for test conditions and I'd like to know exactly which one to base our room measurements on so that we can ensure compliance. If we need to order sound proof booths we'll need plenty of time to do this. We refer you to the Audiologists Detailed Implementation Pack (DOC 1.1M). In particular page 9 of the embedded document, the Summary of Guideline for diagnosis of occupational noise-induced hearing loss. Part 3: Audiometric standards. All test environments used for diagnostic audiology should meet the ambient noise requirements for bone conduction testing. As a result, test environments should comply with the ambient noise levels specified in the right hand column (titled “Bone conduction audiometry”) in table 1 in the summary document. 80.If an offsite repair from the manufacturer costs $150 (inc GST) and our courier handling fee costs ($20 inc GST) will ACC pay $170 inc GST or will the patient have to pay the $20. In this instance the manufacturers invoice will of course say $150 but our invoice to ACC will be more? ACC's contribution is toward the cost of repairing the device. If you consider that this cost includes handling time and courier charges you can include these costs, as well as a description of the services over and above the manufacturers costs, in your invoice and ACC will pay up to $200 (ex GST) once every two years. In the example you have provided, ACC would pay both the $150 and the $20 (inc GST) under the service code HL21. Questions 81 81.If a claimant attends an appointment for a hearing test (that is paid for by ACC) and uses one of their on-site repairs for fine tuning ($50 +GST) do we need to provide ACC with a report to let ACC know what happened at the appointment? The ACC612 Audiometric Report is used to advise ACC the outcome of an audiometric test. A report regarding the outcome of any on site (or off site) repair is not required, we just need your invoice to describe the service/repair that was performed eg fault finding. 82.I have a question regarding Earmoulds for our ACC clients. Are we able to invoice these under HL21 offsite repairs? Earmoulds are $130 per pair and the allowance is $200 every two years. The Earmould gets made offsite. An ear impression also would be required which is $45. The fitting of the Earmoulds is another $45. All this totals $220.00. This falls under the amount able to be used for the offsite repair. Is this allowed? ACC classifies Earmoulds as accessories for hearing aids therefore are part of the contribution to the devices. As such, the only provision for ACC contribution towards Earmoulds is at the time of the fitting and not for the manufacturing or Earmould impression appointments. When fitting replacement Earmoulds, the audiologist's time involved could be charged as an on-site service if the client elects to use the service allocation that way. ACC will contribute up to $50 (excl. GST) towards a maximum of two on site repairs in any 12 month period. The manufacture of the replacement Earmould (which is performed off-site) can be charged as an off-site repair if the client elects to use the repair allocation that way. ACC will contribute up to $200 (excl. GST) once every two years outside the warranty period of the device(s). 83.Can you please clarify the 12 month period in which two on-site repairs are due to a client? Is it 12 months from the fitting, 12 months from the finalisation or is it the calendar year since the new regs took effect (Jan to Jan?). That question would also pertain to the off-site repair every two years. For both on-site services and off-site repairs we will always look backwards from the service date in question to see if the entitlements have been used within the applicable periods. That is one year for on-site services and two years for off site repairs once the device(s) is outside of the warranty period. As the regulations came into force on 1 January 2011, we will be looking back to that date in the first instance. So calendar year is irrelevant. 84.After a client has been in for a hearing loss assessment report and has received an acceptance from ACC stating their banding and the amount of subsidy they are entitled too – is there a time frame for them to use this subsidy in? i.e. the aids they choose or are best for their life style will require a top up payment by the client – they decide they will wait a year or so to do this – will the funding still be available for them or does it have an expiry date? There is no expiry date on ACC’s decision on entitlement funding, subject to legislation and regulations staying the same. However, if the acceptance decision was issued more than 12 months before fitting, the client should contact ACC to ensure than no further assessment is required and to obtain a valid purchase order number. 85.We invoiced ACC for aural toileting, using contract code AUD01, which was declined by ACC. I understand that under regulations general nurses can charge $15.72 (incl. GST) for ear treatments such as cleaning (code NCON) – although in this case the aural toileting was performed by an audiologist, not a general nurse. Can you please explain why the code AUD01 was declined? ACC will only pay for ear toileting when it is performed by a general nurse or a specialist ear nurse (registered with ACC) and that service is submitted for payment under the correct service code (RNP100 for specialist ear nurses or NCON for general nurses). ACC will not pay for ear toileting services if performed by anyone other than general nurses or specialist ear nurses. This was the case before the regulations came in to effect as well. 86.Given that hearing aids purchased under the old contract will not be considered for replacement unless the old criteria for replacement are met (eg cannot be repaired), surely the old criteria for servicing of those hearing aids still stands i.e. no limit to repairs. It seems grossly unfair that the hearing aids are being viewed as "under the contract" for replacement but servicing of those same hearing aids must be under the new regulations. Please clarify your justification or take this discrepancy into consideration. It seems that the claimant is disadvantaged on both counts. The ‘old criteria’ you refer to are the legislative criteria for determining whether ACC is liable to meet the costs of maintaining, repairing or replacing a hearing aid or device, and still apply (see Clause 13, Schedule 1 of the Accident Compensation Act 2001). What the regulations do is set out how much ACC is liable to contribute, and in what circumstances, if the legislative criteria are met. ACC will allow eligible clients in this situation to choose whether to have their existing hearing aids repaired (as per regulated rates) or receive ACC's contribution toward new aids. If they choose to receive the contribution, they should be aware that a contribution to new aids will not be available again for another 6 years, as per regulated limits. 87.Are claimants still able to claim for travel expenses? Yes. The regulations do not introduce any changes regarding travel expenses. 88.If a patient (first fitted under old regulations) needs replacement hearing aids now, even if they are over 6 years old, I understand we submit an ACC 612 form. What other documentation does one need to attach? Audiologists should provide ACC with a completed ACC612 and attach a summary of their audiometric findings for the client. Note that the six year re-aiding limit applies from the first time the client receives hearing aids under the regulations (ie it does not have to have been six years since existing clients received their last set of aids for them to re-apply for aids under the new regulations). 89.In a hypothetical example whereby a patient had aids fitted in 2007 (4 yrs old) but then got equipment such as a telephone or doorbell system in 2009 (2 yrs ago), then is their 6 year funding period dated from the hearing aid fitting or the extra equipment – i.e. can they get funding again for aids in 2013 or 2015? The six year re-aiding limit applies from the first time the client receives hearing aids under the regulations. In your example, the dates the client last received ACC-funded equipment are irrelevant – it’s a “blank slate” from 1 January 2011. See also Questions 67, 68 and 72. 90.For a new patient under new regulations, what would be the scenario if aids were fitted in 2011 and they then received extra equipment (such as a telephone) in 2013? When would they be eligible for further funding (2017 or 2019)? ACC’s contribution is only available when devices are first fitted. Any funding not spent at the first fitting cannot be carried over to subsequent fittings. In your example, and assuming eligibility criteria are met, ACC would contribute to hearing aids in 2011, and contribute again six years later in 2017. The client would be responsible for any new aid or device costs (such as a telephone) in the interim. 91.We have had people coming in who have evacuated from Christchurch due to the earthquake and who were unable to get their batteries prior to leaving their homes. Is ACC able to accept any batteries being invoiced by clinics to tide these people over. The batteries are normally very slow being dispatched from the distributor and as at this stage the people do not know how long they will be out of Christchurch, they need assistance now. We have been giving packets away - but as this will go on for a while yet - have you put anything into place? We have discussed this situation with our supplier (Propharma) and amended the battery order process for those clients impacted by the earthquake. If a client asks an audiologist for batteries the audiologist should contact ACC and advise the client's name, battery type, numbers of packs and the client's temporary delivery address. ACC will immediately process the order and Propharma will endeavour to despatch the batteries the same day. This should result in delivery to the client within a maximum of two working days. 92.Clients that are being treated for trauma injuries require a hearing assessment at the beginning of the treatment to assess the level of hearing loss and one at the end of the treatment to determine the outcome of the treatment. Occasionally, there may be one or more further hearing assessments required at the various stages throughout the treatment (as identified by the clients ENT). The regulations state that ACC will only contribute to an audiometric assessment at least once every six years, but this appears to disadvantage clients with trauma injuries. Please advise how we deal with hearing assessments for trauma clients. Clients that are being provided treatment under a trauma claim can have hearing assessments as required by their ENT. Audiologists that have clients referred to them for such assessments must obtain prior approval from ACC which can be obtained by email or a phone call to the Hearing Loss Unit that services the audiologist’s area. We have implemented two new services codes for trauma claims: HL02 Hearing Loss Trauma Assessment Pretreatment HL03 Hearing Loss Trauma Assessment Posttreatment Cost is $107 (excl. GST) To be used for the first assessment of trauma induced hearing loss, and Where there is a need to have one or more ongoing assessment as part of the course of treatment Cost is $155 (excl. GST) To be used as the final assessment determine the outcome of the treatment Must be submitted with an ACC612 report (as per HL01). Should a hearing loss claim eventuate as a result of the trauma injury, this to report may be used as the assessment for the hearing loss claim. 93.My understanding was that before regulations it was an “all or nothing” contribution for hearing aids from ACC. Now the regulations are stating that there is part payment for those with accepted hearing loss. My client’s hearing loss was accepted but the total cost of the cover for hearing aids was declined [pre-regulations]. Shouldn’t these people now be able to have their case reviewed and have hearing costs paid for depending on what accepted hearing loss they have i.e. what band they fall into? As you note, prior to the introduction of regulations, ACC funded the full cost of hearing aids where the need for the hearing aid was a direct consequence of the covered injury (as per our legislation). The introduction of the regulations has not changed the legislative requirement that the need for the hearing aid/s must be as a result of the covered injury. What has changed is that regulations now prescribe how much ACC can contribute (matched to the level of injury-related loss as a proportion of the client's total hearing loss), once a need arising from the covered injury has been established. Without having all the details of the case you describe it is difficult to comment, as each case is assessed on its own merits. However, in general terms, if the client’s need for the entitlement was not as a result of their covered injury prior to regulations, and the client’s injury-related needs have not changed since ACC's previous decision, then it is unlikely that the previous decision would change. The client would not be entitled to funding under the regulations as the need for the rehabilitation would still not be as a result of the covered injury.