COCHLEAR IMPLANTS
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Disability Rights
|
|
|
|
|
|
|
Sitemap
|
|
|
|
|
|
|
The Oregon Health Plan (OHP) is regarded as the most innovative Medicaid program in the nation.
In 1993, Oregon secured a Federal Section 1115 demonstration waiver allowing them to experiment with their Medicaid reimbursement methodology. The State ranked over 700 medical procedures in order of clinical benefit, cost-effectiveness, and surveyed preferences of Oregon taxpayers.
Only the first 545 of these procedures were covered by Medicaid. Cochlear implants were not among these.
Mark Hobratschk of Cochlear Corporation secured a Federal directive mandating Medicaid coverage for cochlear implants in children under age 21. This mandate applied to all States except for Oregon, whose waiver of Federal regulations allowed them to exclude cochlear implants for all beneficiaries.
Mr. Hobratschk aggresively lobbied the Oregon Health Services Commission for over 18 months, presenting cost-effectiveness research demonstrating that cochlear implants were far more cost-effective than covered services on the prioritized list (such as leprosy and migraine headaches). With the support and invaluable assistance of the Oregon Health Sciences University, he presented these findings to them in December 1994, and in fall 1995 represented a Medicaid child in OHP administrative hearings to appeal the denial of his cochlear implant.
Despite their waiver, the Commission voted in May 1996 to revise the 1997 prioritized list to include cochlear implants. Cochlear implants for children age five or under currently ranks at line 303, while over age five ranks at line 512.
As of May 1, 2002, only the first 566 procedures from the full prioritized list of 736 procedures are covered by OHP. This cutoff annually moves up or down depending on funding from the State Legislature. However, since 1997, cochlear implants have never moved off the list in any given year.
OHP covers all cochlear implant services. Beneficiaries are required to enroll in managed care plans, and payment for cochlear implants comes out of the plans capitated payment rate.
|
|
|
