CMS Proposes Change to Eligibility Criteria for Cochlear Implants

The Centers for Medicare and Medicaid Services (CMS) has issued a draft coverage determination to broaden the eligibility requirements for coverage of cochlear implants. The proposed change would cover cochlear implants for Medicare beneficiaries who have test scores of 40% or less in the ear to be implanted on tape-recorded tests of open set sentence recognition. The draft policy would also cover cochlear implants for scores of 40% - 60% if the beneficiary is participating in a Medicare approved clinical trial. The draft decision memo can be found at www.cms.hhs.gov/mcd/viewdraftdecisionmemo.asp?id=134.

Current Medicare policy covers cochlear implants for beneficiaries with recognition scores of 30% or lower. CMS is requesting public comment on the proposed change. Comments must be received by February 6, 2005 and can be submitted via the CMS Web site at www.cms.hhs.gov/mcd/viewnca.asp?where=indexncacomment&nca_id=134&basket=nca:00107N:134:Cochlear+Implantation:Pending:New. After the close of the public comment period, CMS will have 60 days to issue a final policy.

ASHA will be submitting comments on the draft proposal. For additional information, please contact Ingrida Lusis, ASHA's Director of Health Care Regulatory Advocacy, at ilusis@asha.org or by phone at 800-498-2071, ext. 4482.