Hearing services and devices policy

The agent

The WorkSafe Agent ('the agent') can pay the reasonable costs of approved hearing services and hearing devices provided by Hearing service providers approved by WorkSafe Victoria (WorkSafe) to assist workers in the rehabilitation of work-related injuries or illness under Victorian workers’ compensation legislation.

Prior approval from the agent is required before a hearing device can be provided to a worker with an accepted hearing loss claim.

Definitions

In this policy:

• Assistive Listening Accessory (ALA): A generic electronic device designed and manufactured to overcome an individual's hearing loss by way of transmitting, processing or amplifying sound but does not take into account the person's individual hearing loss profile or audiogram. An ALA does not refer to a hearing device.
• Contracted practice: A hearing service practice that has entered into a contract with WorkSafe following a successful tender submission. The contracted practice is required to adhere to its obligations to WorkSafe under the terms of the Hearing services contract, which includes compliance with this policy.
• Hearing consultation, review and/or maintenance: has the meaning given to it in paragraph(s) of this policy entitled 'Hearing consultation, review and/or maintenance'.
• Hearing device: an electronic medical appliance designed and manufactured to overcome an individual's hearing loss by way of transmitting, processing or amplifying sound according to the individual hearing loss profile or audiogram of the hearing impaired person and is worn in or behind the ear (also commonly referred to as a hearing aid).
• Hearing device battery supply: has the meaning given to it in the paragraph(s) of this policy entitled 'Hearing device battery supply'.
• Hearing device fitting package: has the meaning given to it in the paragraph(s) of this policy entitled 'Hearing device fitting package'.
• Hearing device repairs: has the meaning given to it in the paragraph(s) of this policy entitled 'Hearing device repairs'.
• Hearing Needs Assessment: has the meaning given to it in the paragraph(s) of this policy entitled 'Hearing Needs Assessment'.
• Hearing Needs Assessment (Audiologist): a Hearing Needs Assessment that is performed by a Hearing Service Provider who is an audiologist.
• Hearing Needs Assessment (Audiometrist): a Hearing Needs Assessment that is performed by a Hearing Service Provider who is an audiometrist.
• Hearing services include:
  • hearing needs assessments
  • submission of a Hearing assessment and device request form, or a Hearing assessment and device exception request form
  • provision and review of hearing devices from the list, and
  • fitting, repair, adjustment or replacement of hearing devices and supply of hearing device batteries.
• Hearing service provider: an individual who is approved by WorkSafe Victoria under the WIRC Act for the purposes of providing hearing services.
• Hearing services practice: either a self-employed Hearing service provider or a business which employs Hearing service providers.
• Replacement hearing device: replaces the initial Hearing Device if it is no longer fit for purpose because the worker's needs have changed or the Hearing Device has been lost or damaged.
• WorkSafe approved hearing device list (List): a list of WorkSafe approved hearing devices by manufacturer, including the model name, WorkSafe item number and the applicable dates for which the hearing device can be prescribed to an injured worker by a Hearing service provider.

Hearing service providers approved by WorkSafe Victoria

Hearing services and devices can only be provided by Hearing service providers who have been approved by WorkSafe. Approval can be obtained by completing the WorkSafe "Application for registration to provide services to workers", and emailing the completed form with the required documentation to: [email protected]

Hearing service providers may provide services from either a Contracted practice or Non-contracted hearing services practice. Contracted practices have, through a tender process, entered into a contract with WorkSafe to provide hearing services in accordance with the contract terms and conditions.

For Contracted practices, the initial contract term is three years ending in June 2022, after which WorkSafe may extend the agreement for a further term of two years. WorkSafe will not be entering into contracts with any other Hearing service practices during the contract term.

Hearing services

The agent can pay for the following hearing services:

Hearing Needs Assessment

A Hearing Needs Assessment determines the worker's level of independence and hearing needs resulting from their work-related injury or illness. This includes:

• undertaking a range of diagnostic testing
• setting agreed rehabilitative goals with the worker
• recommendation of options for achieving the goals at a reasonable cost
• the provision of clinical justification for the proposed options
• completion of the Hearing assessment and device request form or the Hearing assessment and device exception request form

The agent can only pay the reasonable costs of a Hearing Needs Assessment once every five years for the same worker. If following a Hearing Needs Assessment a replacement device is indicated, please refer to the "Replacement devices" section of this policy for further information about the process for requesting a replacement device.

Hearing device fitting package

The Hearing device fitting package covers:

• the provision and fitting of the hearing device(s) and any ALAs fitted at the same time as the hearing device(s) or within 12 months of fitting of hearing device(s)
• a 12 month supply of batteries provided at the time of hearing device fitting
• any consumables required for the first 12 months
• all subsequent follow up consultations required to facilitate the worker's understanding of, recovery from, or adjustment to their work related hearing loss during the period of 12 months from the date the device was fitted
• any handling costs involved in supplying the hearing device(s) and/or ALAs

The agent can pay the reasonable costs of a hearing device fitting package once in any five year period for the same worker. Refer to the "Replacement hearing devices" section in this policy.

The agent may consider approval of an additional hearing device fitting package within a five year period if a worker was initially supplied with a monaural hearing device and there is significant clinical evidence that the worker now requires a binaural hearing device. In these circumstances the fitting of the binaural hearing devices can only be paid after written approval has been obtained from the agent and will be paid as the difference between the monaural and binaural fitting package fees.

A hearing device fitting package is not payable where the injured worker is provided with an ALA only. Where a consultation is required subsequent to the Hearing Needs Assessment to fit an ALA only, the agent can pay for a hearing consultation. Please refer to the "Hearing consultation, review and/or maintenance" section in this policy.

The hearing device fitting package does not include the price of any hearing device or ALA. Please refer to the 'Hearing device' section in this policy for further information.

Hearing consultation, review and/or maintenance

For workers who have been fitted with a hearing device(s), any hearing rehabilitation, ALA fittings, and adjustment of hearing device(s) within 12 months from the date of fitting is covered by the hearing device fitting package and the agent will not pay a Hearing consultation, review and/or maintenance fee.

After this period, the agent can pay for hearing device maintenance, adjustment ALA fitting and aural rehabilitation if it is necessary to ensure that the device is functioning to specification or to facilitate the worker's understanding of, recovery from, or adjustment to, their work-related hearing loss.

The agent can pay the reasonable costs of Hearing consultation, review, hearing device maintenance, and/or ALA fitting:

• after 12 months following the fitting of a hearing device
• for a maximum of up to 7 hours of service within five years of the provision of a hearing device

Where a worker is recommended an ALA only following their hearing needs assessment, the agent can pay a hearing consultation, review and/or maintenance fee to cover a consultation for the purpose of providing the worker with the ALA and educating the worker about the use of the ALA.

Hearing devices

WorkSafe approved hearing device list

The list contains a range of hearing devices with features identified by WorkSafe that will meet the majority of workers' needs.

The list is provided on the WorkSafe Victoria website. Hearing service providers must refer to the current list to ensure that the device they are prescribing is an approved device. Where a requested device is removed from the list, the agent will consider the device to be an approved device for any requests submitted prior to the date on which the device was removed from the list.

Commercial in confidence pricing can be obtained by contacting the applicable manufacturers and requesting their specific WorkSafe list, which will contain the agreed pricing information and WorkSafe item codes.

The list is reviewed annually and any enquiries regarding adding hearing devices and ALAs to the List can emailed to: [email protected]

Non-list hearing devices

The agent will only consider approving a hearing device not on the list where the provider can demonstrate that the non-listed hearing device is clinically required to meet the worker's functional and communication needs and there is no hearing device on the current approved list that meets those needs. Arrangements with preferred suppliers are not considered clinical requirements.

In making the decision the agent will consider:

• information provided on the Hearing assessment and device exception request form
• supporting clinical justification for the additional features in the context of the worker's communication and/or functional needs
• medical or clinical requirements that indicate or contraindicate the use of particular features of the proposed Hearing Device, and
• information received from the WorkSafe Clinical Panel

Assistive Listening Accessory (ALA)

An ALA is a generic electronic device designed and manufactured to overcome an individual's hearing loss by way of transmitting, processing or amplifying sound but does not take into account the person's individual hearing loss profile or audiogram. An ALA does not refer to a hearing device.

ALAs can be used with or without a hearing device. Where an ALA is provided to an injured worker who has been, or will be fitted, with a hearing device, the hearing service provider must provide clinical justification to support the need for the ALA in addition to the hearing device. If the worker is being fitted with a new hearing device, the agent may request that the new hearing device is trialled for a period of time prior to considering a request for an ALA.

A Hearing device fitting package fee is not payable where an injured worker is provided with an ALA only. Where an ALA is fitted within 12 months of a hearing device being fitted no further fee is payable. Please refer to description of services included in the Hearing device fitting package above.

Where an injured worker is provided with an ALA only or where an ALA is requested and approved more than 12 months after the fitting of a hearing device, the agent can pay for a hearing consultation associated with the provision of the ALA. Please refer to the Hearing consultation, review and/or maintenance section above.

Hearing device battery supply

The Hearing device fitting package includes a supply of batteries for the first 12 months which should be provided to the worker at the time the hearing device is fitted.

After 12 months from the hearing device fitting date the agent can pay the reasonable cost of a hearing device battery supply once in any 12 month period. A hearing device battery supply includes a 12 month supply of batteries for a single hearing device and any service component required to supply the batteries to the injured worker. A hearing device battery supply should only be provided when requested by the injured worker.

Hearing device repairs

Hearing device repairs comprises any restoration of a hearing device to improve the condition of the hearing device for better usage that is carried out by the manufacturer offsite.

The agent can pay the reasonable costs of maintenance repairs to hearing devices caused by normal wear and tear. As all hearing devices on the list are covered by a minimum 36 month warranty and ALAs on the list covered by a minimum 12 month warranty, the agent will not pay for the repair and maintenance of Hearing Devices and/or ALAs where it is covered by the manufacturer or supplier warranty.

All approvals for the reasonable costs of hearing device repairs are at the discretion of the agent and will only be considered on receipt of a copy of the manufacturer's invoice for the repairs.

Replacement hearing devices

Prior written approval is required for the supply of a replacement hearing device. The agent will only pay for a replacement hearing device(s) five years after the initial fitting if replacement is reasonable and/or necessary.

A request for a replacement hearing device should follow a Hearing Needs Assessment undertaken by a hearing service provider at which the adequacy of their existing hearing device(s) is assessed. In addition to diagnostic testing, the hearing service provider should obtain sufficient information about the worker's current communication, functional and clinical status and whether this has changed since the provision of the current hearing device(s).

The hearing service provider must supply the agent with the following before a decision can be made on a replacement hearing device(s):

• the date the worker contacted the hearing service provider and the reasons given by him/her for requesting a replacement hearing device
• confirmation that the worker has attended a Hearing Needs Assessment with the hearing service provider and the date of the assessment
• details of the worker's current communication, functional and clinical status and whether this has changed since the provision of the current hearing device(s), and
• a Hearing assessment and device request form or the Hearing assessment and device exception request form signed by the worker at the Hearing Needs Assessment

The agent will consider the following when deciding whether to pay for a replacement hearing device:

• whether the current Hearing Device continues to meet the worker's needs
• evidence of the worker's use of the existing Hearing Device over the previous five years (the agent may request the data log from the worker’s current hearing device)
• the current nature and circumstances of the worker's hearing loss and its relationship to work
• the Hearing Service Provider's assessment of the worker's current communication, functional and clinical needs
• the worker's reasons for requesting a new Hearing Device
• the clinical justification for the make, model and features of the requested replacement Hearing Device
• any changes to the worker's hearing since the last Hearing Device was supplied, and
• whether the proposed Hearing Device is on the approved List or whether separate approval is required in exceptional circumstances

Early replacement of devices

The agent may approve the replacement of a hearing device within five years if:

• the worker's hearing has changed significantly, and
• the existing hearing device is no longer suitable and cannot be adjusted to meet the worker's current hearing needs

When considering a request for early replacement, the agent will consider:

• the clinical justification for the requested Hearing Device, and
• whether it will meet the worker's needs for the next five years

A Hearing device fitting package fee may apply where early replacement is approved.

Lost or damaged hearing devices

The agent will not replace a hearing device which has:

• not been used, maintained and stored in accordance with the manufacturer's instructions
• been wilfully damaged or destroyed, or
• been used by persons other than the worker

The agent may replace a lost or damaged hearing device in exceptional circumstances and only once within five years of supply of an original or replacement hearing device. The loss or damage must:

• be explained in a statutory declaration, and
• not be covered by the manufacturer or supplier warranty or the worker's insurance

If the agent accepts liability for a lost or damaged hearing device, it will:

• pay for a replacement Hearing Device that is identical to the lost or damaged hearing device where that hearing device is available on the current List
• consider a different hearing device if:
  • an identical hearing device is not available on the current list, or
  • the lost or damaged hearing device was provided more than 12 months previously and the Hearing Service Provider submits a Hearing assessment and device request form or the Hearing assessment and device exception request form to provide information about the worker's hearing status and the clinical justification for a different hearing device

The agent will not pay a hearing device fitting package fee for replacement hearing devices that are identical to the lost or damaged hearing device. The agent will only consider paying the reasonable costs of the applicable excess where a lost hearing device is covered by a manufacturer's loss and damage warranty.

Guidelines

Fees payable for hearing services and devices

Non-contracted hearing service providers:

Contracted practices – operate under a commercial in confidence fee schedule. Please contact your hearing service practice's contract manager for further details.

What can the agent pay for in relation to hearing services and hearing devices?

The agent can pay the reasonable costs of hearing services and hearing sevices:

• required as a result of a work-related injury or illness and where the claim has been accepted by the agent in accordance with WorkSafe's guidelines
• that are reasonable, necessary or appropriate in the circumstances
• that are clinically justified, safe and effective in the context of a worker's physical, psychological, vocational and functional status
• that have been assessed as necessary and appropriate by a Hearing Service Provider for the communication, functional and clinical needs of the worker that are on the current List or approved by WorkSafe in exceptional circumstances
• approved by WorkSafe under Victorian workers compensation legislation

What the agent won't pay for in relation to hearing services and devices:

The agent will not pay for:

• treatment or services for a person other than the worker
• treatment or services that are not reasonable, necessary or appropriate in the circumstances
• devices that are not approved by WorkSafe under the legislation or services not in the hearing services fee schedules
• services or devices provided by an audiologist or audiometrist not approved by WorkSafe under the legislation
• services provided more than once on the same day to the same worker
• fees associated with cancellation or non-attendance
• treatment or services provided outside the Commonwealth of Australia without prior written approval from the agent
• treatment or services provided by telephone or other non-face to face mediums
• telephone calls and telephone consultations between providers and clients/workers, and between other providers, including hospitals
• battery supply where the worker has not requested the supply

What information does the agent require to consider paying for Hearing Services and Hearing Devices?

To consider paying for Hearing Services and Hearing Devices, the agent requires:

• a valid Worker's injury claim form, and
• an Employer injury claim report

The Hearing Service Provider should complete the WorkSafe Hearing assessment and device request form or the Hearing assessment and device exception request form and send it to the agent for prior approval.

If additional information is required the agent may request one or all of the following:

• worker questionnaire - Hearing services
• employer questionnaire - Hearing services
• GP questionnaire - Hearing services

When will the agent respond to a request?

Within 10 working days of receiving the WorkSafe Hearing assessment and device request form (or the Hearing assessment and device exception request form), the agent will advise whether:

• the request has been approved
• the request has been denied, or
• further information is required to make a decision which may include referral to the WorkSafe Clinical Panel for review

The agent will advise whether the request has been approved or denied within 10 working days of receiving the requested additional information or the Clinical Panel's advice.

Suspended from providing services to WorkSafe clients

If WorkSafe gives notice to a provider advising them that they are suspended from providing services to WorkSafe clients, WorkSafe will notify their professional body of the suspension and the grounds on which the suspension has been issued.