COCHLEAR IMPLANTS
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Disability Rights
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Effective July 25, 2005, Medicare expanded the range of persons that qualify for cochlear implantation in order to be more consistent with FDA approval guidelines. This expansion is found at National Coverage Decision 50.3.
Since its 1998 National Coverage Determination, Medicare coverage had been limited to persons with severe to profound bilateral hearing loss (either prelingual or postlingual.) The expansion requested by Cochlear Americas now includes those with moderate hearing loss.
On January 9, 2005, ORM issued the following public comments regarding the proposed expansion:
"Otologic Reimbursment Management is a free information resource for persons seeking health plan payment of cochlear implant services. We fully support the proposed expansion of Medicare coverage criteria. However, it is important to note that the requestor of the expansion, Cochlear Americas, is currently under Federal investigation for civil and criminal violations of Medicare regulations. Cochlear's well-chronicled control of physician and audiologist referrals through illegal kickback schemes are the primary reason why the vast majority of Medicare beneficiaries that currently qualify for cochlear implants are unable to receive them (as recognized by RAND in 2000.)
Until this problem is corrected, exanding the Medicare implantation criteria will simply expand the opportunities for fraud by Cochlear Americas."
While ORM's purpose has always been efforts to expand access to cochlear implants, we believe that unless the actual barriers to access are first removed, this proposal is nothing but window dressing. Cochlear's control of the referral patterns for cochlear implants keep the price of cochlear implantation so high that hospitals are forced to lose $6,000-$12,000 on every Medicare or Medicaid surgery, per RAND. It is these staggering loses that limit the number of facilities that can sustain a cochlear implant program to those in large, urban areas. The result is that (as RAND concurred) most candidates for cochlear implantation never get implanted. Simply expanding the indications to allow those with moderate hearing loss to qualify will do nothing to enable them to actually access the device.
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