An Act to require insurers to provide coverage for hearing aids and related services to persons under age nineteen.
Be it enacted by the Legislature of the State of South Dakota:
Section 1. That 58-17-63 be AMENDED:
58-17-63.
For the purposes
of section
3 of this Act, 58-17-64,
58-17-84.1,
58-18-63,
58-38-36,
and 58-40-33,
a health benefit plan is any hospital or medical policy or
certificate, hospital or medical service plan, or health maintenance
organization subscriber contract. The term does not include specified
disease, hospital indemnity, fixed indemnity, fixed duration of one
year or less, accident only, credit, dental, vision, medicare
supplement, long term care, or disability income insurance,
coverage issued as a supplement to liability insurance, workers'
compensation or similar insurance, or automobile medical payment
insurance.
Section 2. That 58-17-153 be AMENDED:
58-17-153.
Any qualified
health plan issued on or after January 1, 2015, that offers coverage
for professional audiology services
shall
must include
coverage for medically necessary physician services appropriate for
the treatment of hearing impairment to a person under the age of
nineteen.
This shall
The coverage must
include professional services rendered by an audiologist licensed
pursuant to chapter 36-24.
The benefits provided
shall be
are subject to
the same dollar limits, deductibles, coinsurance and other
limitations provided for other covered benefits in the policy.
Nothing
in this section requires the payment by the
The health plan
of
is subject to the coverage requirements of section 3 of this Act for
hearing aids, devices,
or
and equipment
to correct hearing impairment or loss.
Section 3. That chapter 58-17 be amended with a NEW SECTION:
Any health benefit plan, as defined in 58-17-63, delivered, issued for delivery, or renewed in this state, on or after January 1, 2023, must provide coverage for medically necessary devices and equipment appropriate for the treatment of hearing impairment to a person under the age of nineteen. The coverage must include:
(1) A hearing aid purchased from an audiologist or hearing aid dispenser licensed pursuant to chapter 36-4, and costs related to dispensing the hearing aid;
(2) Evaluation, fitting, and programming of a hearing aid;
(3) Probe microphone measurements for verification that hearing aid gain and output meet prescribed targets;
(4) Repairs, follow-up adjustments, servicing, and maintenance of a hearing aid;
(5) Ear molds and ear mold impressions; and
(6) Auditory rehabilitation and training.
The items and services in this section must be covered on a continual basis to the extent that benefits paid during the immediately preceding forty-eight-month period do not exceed three thousand dollars. The benefits provided are subject to the same dollar limits, deductibles, coinsurance, and other limitations provided for other covered benefits in the policy.
For the purposes of this section, the term, hearing aid, means any wearable instrument or device offered for the purpose of aiding or compensating for impaired human hearing, and any parts, attachments, or accessories to the instrument or device, excluding batteries and cords. The term does not include cochlear implant or cochlear prosthesis.
Section 4. That 58-18-95 be AMENDED:
58-18-95.
Any qualified
health plan issued on or after January 1, 2015, that offers coverage
for professional audiology services
shall
must include
coverage for medically necessary physician services appropriate for
the treatment of hearing impairment to a person under the age of
nineteen.
This shall
The coverage must
include professional services rendered by an audiologist licensed
pursuant to chapter 36-24.
The benefits provided
shall be
are subject to
the same dollar limits, deductibles, coinsurance and other
limitations provided for other covered benefits in the policy.
Nothing
in this section requires the payment by the The
health plan
of
is subject to the coverage requirements of section 5 of this Act for
hearing aids, devices,
or
and equipment
to correct hearing impairment or loss.
Section 5. That chapter 58-18 be amended with a NEW SECTION:
Any health benefit plan, as defined in 58-18-42, delivered, issued for delivery, or renewed in this state, on or after January 1, 2023, must provide coverage for medically necessary devices and equipment appropriate for the treatment of hearing impairment to a person under the age of nineteen. The coverage must include:
(1) A hearing aid purchased from an audiologist or hearing aid dispenser licensed pursuant to chapter 36-4, and costs related to dispensing the hearing aid;
(2) Evaluation, fitting, and programming of a hearing aid;
(3) Probe microphone measurements for verification that hearing aid gain and output meet prescribed targets;
(4) Repairs, follow-up adjustments, servicing, and maintenance of a hearing aid;
(5) Ear molds and ear mold impressions; and
(6) Auditory rehabilitation and training.
The items and services in this section must be covered on a continual basis to the extent that benefits paid during the immediately preceding forty-eight-month period do not exceed three thousand dollars. The benefits provided are subject to the same dollar limits, deductibles, coinsurance, and other limitations provided for other covered benefits in the policy.
For the purposes of this section, the term, hearing aid, means any wearable instrument or device offered for the purpose of aiding or compensating for impaired human hearing, and any parts, attachments, or accessories to the instrument or device, excluding batteries and cords. The term does not include cochlear implant or cochlear prosthesis.
Section 6. That 58-18B-60 be AMENDED:
58-18B-60.
Any qualified
health plan issued on or after January 1, 2015, that offers coverage
for professional audiology services
shall
must include
coverage for medically necessary physician services appropriate for
the treatment of hearing impairment to a person under the age of
nineteen.
This shall
The coverage must
include professional services rendered by an audiologist licensed
pursuant to chapter 36-24.
The benefits provided
shall be
are subject to
the same dollar limits, deductibles, coinsurance and other
limitations provided for other covered benefits in the policy.
Nothing
in this section requires the payment by the The
health plan
of
is subject to the coverage requirements of section 7 of this Act for
hearing aids, devices,
or
and equipment
to correct hearing impairment or loss.
Section 7. That chapter 58-18B be amended with a NEW SECTION:
Any health benefit plan delivered, issued for delivery, or renewed in this state, on or after January 1, 2023, must provide coverage for medically necessary devices and equipment appropriate for the treatment of hearing impairment to a person under the age of nineteen. The coverage must include:
(1) A hearing aid purchased from an audiologist or hearing aid dispenser licensed pursuant to chapter 36-4, and costs related to dispensing the hearing aid;
(2) Evaluation, fitting, and programming of a hearing aid;
(3) Probe microphone measurements for verification that hearing aid gain and output meet prescribed targets;
(4) Repairs, follow-up adjustments, servicing, and maintenance of a hearing aid;
(5) Ear molds and ear mold impression; and
(6) Auditory rehabilitation and training.
The items and services in this section must be covered on a continual basis to the extent that benefits paid during the immediately preceding forty-eight-month period do not exceed three thousand dollars. The benefits provided are subject to the same dollar limits, deductibles, coinsurance, and other limitations provided for other covered benefits in the policy.
For the purposes of this section, the term, hearing aid, means any wearable instrument or device offered for the purpose of aiding or compensating for impaired human hearing, and any parts, attachments, or accessories to the instrument or device, excluding batteries and cords. The term does not include cochlear implant or cochlear prosthesis.
Section 8. That 58-41-127 be REPEALED:
Any qualified health plan
issued on or after January 1, 2015, that offers coverage for
professional audiology services shall include coverage for medically
necessary physician services appropriate for the treatment of hearing
impairment to a person under the age of nineteen. This shall include
professional services rendered by an audiologist licensed pursuant to
chapter 36-24.
The benefits provided
shall be subject to the same dollar limits, deductibles, coinsurance
and other limitations provided for other covered benefits in the
policy.
Nothing in this section
requires the payment by the health plan of hearing aids, devices, or
equipment to correct hearing impairment or loss.