COCHLEAR IMPLANTS
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The Arizona Health Care Cost Containment System(AHCCCS) is Arizona's version of Medicaid.
It is among the nation's most innovative program in that it was the first to contract the majority of its Medicaid beneficiaries into managed care plans (except for long-term care). Until 1982, Arizona was the only State without a Medicaid program, as it refused to accept the Federal regulatory oversight that was a condition of Federal funding for the majority of Medicaid expenditures.
However, AHCCCS has also been among the national leaders in Medicaid lawsuits, as the ten AHCCCS managed care plans frequently did not provide the same level of benefits as traditional Medicaid, even though Federal regulations required them to do so. AHCCCS managed care plans also repeatedly lost cases in which they did not follow Medicaid rules for appeals.
Cochlear implants were not an AHCCCS covered benefit until 1995, after Mark Hobratschk, the Supervisor of Reimbursement Services for Cochlear Corporation, successfully lobbied the Health Care Financing Adminstration (HCFA) for a Federal directive requiring coverage by all States for children under age 21.
AHCCCS refused to develop an actual coverage policy until Mr. Hobratschk again intervened in 1997, representing an adult cochlear implant candidate that was repeatedly denied Medicaid benefits. After this beneficiary was awarded coverage for all cochlear implant services by an administrative hearing officer, AHCCCS implemented a formal coverage policy for post-lingual adults and children.
However, AHCCCS continued to refuse coverage for prelingual candidates. In 1998, Mr. Hobratschk represented another adult beneficiary and received three favorable rulings from hearing officers awarding benefits, each of which was overruled by the Medicaid director.
Finally, the Medicaid director agreed in 1999 to implant the current AHCCCS cochlear implant policy that essentially follows Medicare criteria. It covers all cochlear implants services for both prelingual and postlingual adults and children.
Chapter 320 of the AHCCCS Medical Policy Manual provides benefits for bilateral implants (i.e. a second cochlear implant device in the contralateral ear) in children under age 21 but not adults.
AHCCCS payment for cochlear implant services is also similar to Medicare. Effective April 1, 2002, the following rates apply:
- Cochlear implant system (L8614) $15492.31
- Replacement of speech processor (L8619) $6650.75
- Physician professional fee (69930) $1226.89
- Programming and aural rehabilitation (92510) $127.94
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