The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Appropriations
BILL: CS/SB 498
INTRODUCER: Banking and Insurance Committee and Senator Baxley and others
SUBJECT: Coverage for Hearing Aids for Children
DATE: January 26, 2022 REVISED:
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Johnson Knudson BI Fav/CS
2. Smith Brown HP Favorable
3. Sanders Sadberry AP Favorable
Please see Section IX. for Additional Information:
COMMITTEE SUBSTITUTE - Substantial Changes
I. Summary:
CS/SB 498 requires an individual health insurance policy or individual health maintenance
organization contract that provides major medical coverage or similar coverage for a dependent
child of an insured or subscriber, respectively, to provide hearing aid coverage for a covered
child from birth through age 18 who has been diagnosed with hearing loss by a licensed
physician or a licensed audiologist. The term, “hearing aid,” means any wearable instrument or
device designed for, offered for the purpose of, or represented as aiding persons with or
compensating for impaired hearing. The term does not include cochlear implants.
The bill requires the policies or contracts to provide a minimum coverage limit of $3,500 per ear
within a 24-month period. The insured or subscriber remains responsible for the cost of hearing
aids and related services that exceed the coverage limit provided for in the policy or contract. If,
however, a child experiences a significant and unexpected change in his or her hearing or
experiences a medical condition requiring an unexpected change in the hearing aid before the
existing 24-month period expires, and alterations to the existing hearing aid do not, or cannot,
meet the needs of the child, the bill requires that a new 24-month period must begin with full
benefits and coverage.
The bill’s requirements do not apply to the State Group Insurance Program since the bill does not
mandate that group or employer coverage provide the benefits. However, in accordance with
federal law at 45 Code of Federal Regulations 155.170, Florida may be required to defray the
BILL: CS/SB 498 Page 2
cost of any new coverage mandate that raises the cost of health insurance subsidies paid by the
federal government.
The bill applies to individual health insurance policies or contracts that are issued on or after
January 1, 2023, and the bill would take effect on that date.
II. Present Situation:
One in eight people in the United States (13 percent or 30 million) age 12 years or older has
hearing loss in both ears, based on standard hearing examinations.1 Hearing loss is one of the
most common birth defects2 in the United States. Approximately two or three out of every
1,000 children in the United States are born with a detectable level of hearing loss in one or both
ears.3
Many people who are deaf or hard-of-hearing have some hearing. In some instances, a hearing
aid may help a child with hearing loss to make the most of their residual hearing.4 Hearing aids
make sounds louder and can be worn by people of any age, including infants. Babies with
hearing loss may understand sounds better using hearing aids. There are many styles of hearing
aids. They can help many types of hearing loss. A young child is usually fitted with behind-the-
ear style hearing aids because they are better suited to growing ears.5
Hearing loss may be in one ear (unilateral loss) or in both ears (bilateral loss). The degree of
hearing loss can range from mild to profound, as described below:6
Mild Hearing Loss (26-40 decibels): may hear some speech sounds, but soft sounds are hard
to hear.
Moderate Hearing Loss (41-70 decibels): may hear almost no speech when another person is
talking at a normal level.
Severe Hearing Loss (71-90 decibels): will hear no speech when a person is talking at a
normal level and only hear some loud sounds.
Profound Hearing Loss (91 decibels or more): will not hear any speech and will hear only
very loud sounds.7
1
See National Institutes for Health, National Institute on Deafness and Other Communication Disorders, available at
https://www.nidcd.nih.gov/health/statistics/quick-statistics-hearing (last visited Jan. 21, 2022).
2
Florida Newborn Screening, Early Hearing and Intervention Program, available at
https://floridanewbornscreening.com/hearing/early-hearing-and-intervention-programs/ (last visited Jan. 21, 2022).
3
Id.
4
Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disorders (June 8, 2020),
available at https://www.cdc.gov/ncbddd/hearingloss/treatment.html (last visited Jan. 21, 2021). The amount of hearing a
deaf or hard-of-hearing person has is referred to as “residual hearing.”
5
Id. A plastic ear mold is connected to a behind-the-ear hearing aid and is fitted for the child’s ear. It directs sound from the
hearing aid into the ear canal. Each individual’s ear is shaped differently, and a child’s ear will change as he or she grows. An
audiologist uses a soft material to make a copy of the child’s outer ear canal. This is used to make an ear mold that will fit the
child. As the child grows, new ear molds can be made and attached to the same hearing aid.
6
Florida Department of Health and Children’s Medical Services, A Florida Parent’s Guide to Hearing (Apr. 2020 Edition),
available at http://floridanewbornscreening.com/wp-content/uploads/Hearing-Guide-English-FINAL-1.pdf (last visited
Jan. 21, 2022).
7
See Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disorders
(June 8, 2020), available at https://www.cdc.gov/ncbddd/hearingloss/types.html (last visited Jan. 21, 2022).
BILL: CS/SB 498 Page 3
Hearing loss can affect a child’s ability to develop communication, language, and social skills.
Early detection of hearing loss can help infants and children with learning and reaching
developmental milestones, according to recent research. In the United States, researchers have
reported children have more favorable language outcomes, such as greater vocabulary and
reading abilities, when hearing loss is identified sooner and the child receives hearing aids and
interventions at an earlier age.8 A second study similarly found children who received hearing
aids and cochlear implants earlier had better language outcomes, comparing language skills with
the provision of a hearing aid at three months compared to 24 months.9 The authors’ state:
The younger the child received intervention, the better the language
outcome. In addition, more substantial benefits of earlier access to useful
HAs (hearing aids) and CI (cochlear implants) were obtained by those
with worse hearing. Earlier intervening, rather than access to UNHS
(universal newborn hearing screening), improved outcomes.10
Florida Newborn Hearing Screening Program
Florida has a universal newborn hearing-screening program11 requiring all Florida-licensed
facilities that provide maternity and newborn care to screen, or refer for screening, all newborns
prior to discharge for hearing loss, unless a parent objects to the screening.12 All test results,
including recommendations for any referrals or follow-up evaluations by a licensed audiologist,
a physician licensed under chs. 458 or 459, F.S., or other newborn hearing screening providers in
the hospital facility, must be placed in the newborn’s medical records within 24 hours after the
completion of the screening procedure.13 For babies born in a facility other than a hospital, the
parents are to be instructed on the importance of having a screening conducted, information must
be provided, and assistance must be given to make an appointment within three months.14
The initial newborn screening and any necessary follow-up and evaluation are covered benefits
reimbursable by Medicaid, health insurers, and health maintenance organizations, with some
limited exceptions.15 For those newborns and children found to have a permanent hearing loss,
the law also provides for referral to the state’s Part C program of the federal Individuals with
8
Christine Yoshinaga-Itano, Ph.D., et al, Early Hearing Detection and Vocabulary of Children with Hearing Loss,
PEDIATRICS, (Aug. 2017, Vol. 140, No. 2), available at https://pediatrics.aappublications.org/content/140/2/e20162964 (last
visited Jan. 21, 2022).
9
Teresa Y.C. Ching, Ph.D., Age at Intervention for Permanent Hearing Loss and 5-Year Language Outcomes, Pediatrics,
(Sept. 2017, Vol. 140, Issue 3), available at https://pediatrics.aappublications.org/content/140/3/e20164274 (last visited
Jan. 21, 2022).
10
Id.
11
Florida’s Early Hearing Detection and Intervention Program (EHDI) is Florida’s newborn hearing-screening program,
available at https://floridanewbornscreening.com/hearing/early-hearing-and-intervention-programs/ (last visited
Jan. 21, 2022).
12
See s. 383.145, F.S.
13
Section 383.145(3)(e), F.S.
14
Section 383.145(3)(i), F.S.
15
Section 383.145(3)(j), F.S.
BILL: CS/SB 498 Page 4
Disabilities Education Act16 and Children’s Medical Services’ Early Intervention Program, Early
Steps.17
Hearing Aid Coverage in Public Insurance Programs
Medicaid
Florida Medicaid provides hearing services for eligible recipients under the age of 21, if such
services are medically necessary to correct or ameliorate a defect, a condition, or a physical or
mental illness. This coverage includes diagnostic services, treatment, equipment, supplies, and
other measures described in 42 U.S.C. 1396d(a).18 Medicaid recipients under the age of 21 have
coverage for the following hearing related services:
Recipients who have documented, profound, severe hearing loss in one or both ears have
coverage for:
o An implanted device for recipients age five years and older; or
o A non-implanted (softband) device for recipients under age five.
Cochlear implants for recipients age 12 months and older who have documented, profound to
severe, bilateral sensorineural hearing loss.
For recipients who have moderate hearing loss or greater, the coverage is:
o One new, complete, (not refurbished) hearing aid device per ear, every three years, per
recipient;
o Up to three pairs of ear molds per year, per recipient; and
o One fitting and dispensing service per ear, every three years, per recipient.
A recipient under the age of 12 months may receive up to two newborn screenings. A second
screening may be conducted only if the recipient did not pass the test in one or both ears.
An eligible recipient may receive one hearing assessment every three years for the purposes
of determining hearing aid candidacy and the most appropriate hearing aid. 19
Medicaid also covers repairs and replacement of both Medicaid and non-Medicaid provided
hearing aids, up to two hearing aid repairs every 366 days, after the one-year warranty period
has expired.20
State Children’s Health Insurance Program21
The Children’s Health Insurance Program (CHIP) was enacted as part of the Balanced Budget
Act of 1997, and it created Title XXI of the federal Social Security Act as a joint state-federal
funding partnership to provide health insurance to children in low to moderate income
16
See Pub. L. No. 108-446. The Part C program provides benefits and services for infants and toddlers from birth to age
36 months. Children’s Medical Services, within the Department of Health, administers Florida’s Part C program, which is
known as Early Steps.
17
The Early Steps program services children with disabilities, developmental delays, or children with a physical or mental
condition known to create a risk of a developmental delay. See http://www.cms-
kids.com/families/early_steps/early_steps.html (last visited Jan. 21, 2022).
18
See Fla. Admin. Code R. 54G-4.110 (2021). The hearing services coverage policy from the Agency for Health Care
Administration, available at https://www.flrules.org/Gateway/reference.asp?No=Ref-06744 (last visited Jan. 21, 2022).
19
See Agency for Health Care Administration, Hearing Services Coverage Policy (June 2016), available at
http://ahca.myflorida.com/medicaid/review/specific_policy.shtml (last visited Jan. 21, 2022).
20
Id.
21
42 U.S.C. s. 1397aa-1397mm.
BILL: CS/SB 498 Page 5
households.22 The Florida Healthy Kids Corporation23 is one component of Florida’s Title XXI
program, known as Florida KidCare, and is the only program component utilizing a
non-Medicaid benefit package.24 The other program components, Medicaid for children,
Medikids, and Children’s Medical Services Network, follow the Medicaid benefit package.25
In order for health benefits coverage to qualify for premium assistance payments, KidCare
enrollees must receive hearing screenings as a covered, preventative health service.26
Additionally, s. 409.815(2)(h), F.S., provides the benefits for durable medical equipment include
within covered services equipment and devices that are medically indicated to assist in the
treatment of a medical condition, and specifically prescribed as medically necessary. Hearing
aids are covered only when medically indicated to assist in the treatment of a medical condition.
There are no out of pocket costs for the well-child hearing screening for subsidized Title XXI
eligible children.27
Hearing Aid Coverage in the Private Health Insurance Market
The Office of Insurance Regulation (OIR) is responsible for the regulation of all activities of
insurers and other risk-bearing entities that do business in Florida.28 Florida law does not require
health insurance policies or health maintenance organizations contracts to provide coverage for
hearing aids. According to the OIR, some of the plans offered by UnitedHealthcare (All Savers,
Neighborhood Health, etc.) cover hearing aids if recommended by a physician, and bone-
anchored hearing aids are covered with some restrictions. Molina and Health First cover implant
type hearing aids, if medically necessary.29
Currently, 24 states appear to mandate health benefit plans to provide coverage for hearing aids
for children.30 Coverage requirements range from authorizing coverage of a hearing aid every
24 months to every five years. Many states include caps on the amount the insurer must pay.
These caps range from $1,000 to $4,000.31
State Mandated Health Insurance Coverage
Prior to 2012, the OIR identified 18 state mandated benefits.32 Subsequently, Florida has not
enacted any mandated benefits. Examples of benefits mandated under Florida law include:
22
Pub. L. No. 105-33, 111 Stat. 251 (1997).
23
See ss. 624.91-624.915, F.S.
24
See ss. 409.810-409.821, F.S.
25
See s. 409.815(2)(a), F.S., and s. 391.0315, F.S.
26
Section 409.815(2)(a), F.S.
27
Florida Healthy Kids Corporation, Medical Benefits, available at https://www.healthykids.org/benefits/medical/ (last
visited Jan. 21, 2022).
28
The Office of Insurance Regulation (OIR) is under the Financial Services Commission, which is composed of the
Governor, the Attorney General, the Chief Financial Officer, and the Commissioner of Agriculture, which serves as the
agency head of the commission. Section 20.121(3), F.S.
29
Office of Insurance Regulation correspondence (Dec. 8, 2020) (on file with Senate Committee on Banking and Insurance).
30
See information gathered by the American Speech-Language-Hearing Association, available at
https://www.asha.org/advocacy/state/issues/ha_reimbursement/ (last visited Jan. 21, 2022).
31
Id.
32
Centers for Medicare & Medicaid Services, Florida – State Required Benefits, available at
https://downloads.cms.gov/cciio/State%20Required%20Benefits_FL.pdf (last visited Jan. 21, 2022).
BILL: CS/SB 498 Page 6
Treatment for temporomandibular joint disorders;
Coverage for bone marrow transplants;
Coverage for certain cancer drugs;
Diabetes treatment services;
Osteoporosis;
Certain coverage for newborn children;
Child health supervision services; an