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* 1. Are you a provider that currently accepts patients with Fee-For-Service (FFS) (i.e. “Straight”/ “Traditional”) Medicaid or Children’s Special Health Care Services (CSHCS)? Select all the plans you currently accept.

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* 2. Are you a provider that currently accepts patients with a Medicaid Health Plan? Select all the plans you currently accept.

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* 3. Does your office provide diagnostic audiological testing for Medicaid beneficiaries? Select all that apply.

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* 4. If your office does not provide diagnostic audiological testing for Medicaid infants and young children, what are the top two reasons why the service is not offered?  Please mark the top 2 reasons.

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* 5. Please provide more detail and/or specifics regarding the top reasons selected above for not providing diagnostic audiological testing to infants/children. If you provide testing to infants and young children, please skip this question.

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* 6. Does your office dispense hearing aids for Medicaid beneficiaries? Select all that apply.

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* 7. If your office does not currently dispense hearing aids for Medicaid infants/young children, what are the top two reasons why the service is not offered? Please select the top 2 reasons.

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* 8. Please provide more detail and/or specifics regarding the top reasons selected above for not dispensing aids to infants/children. If you dispense hearing aids to infants/children, please skip this question.

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* 9. If you selected the hearing aid dispensing reimbursement rate as a top reason for not serving Medicaid infants/young children, what rate does your office typically charge to do dispense a hearing aid to an infant or young child?

(*Medicaid’s dispensing rate includes the following services: device delivery, adjustments during the manufacturer warranty period, orientation and fitting, initial earmolds, and 90-day supply of disposal batteries*)

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* 10. If you selected the hearing aid dispensing reimbursement rate as a top reason for not serving Medicaid infants/young children, what percentage of your office's typical dispensing fee would be required to see infants/young children with Medicaid in your office?

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* 11. If your office does not currently dispense hearing aids for Medicaid adults, what are the top two reasons why the service is not offered? Please select the top 2 reasons.

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* 12. Please provide more detail and/or specifics regarding the top reasons selected above for not dispensing aids to adults. If you dispense hearing aids to adults, please skip this question.

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* 13. If you selected the hearing aid dispensing reimbursement rate as a top reason for not serving Medicaid adults, what rate does your office typically charge to dispense hearing aids to adults?

(*Medicaid’s dispensing rate includes the following services: device delivery, adjustments during the manufacturer warranty period, orientation and fitting, initial earmolds, and 90-day supply of disposal batteries*)

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* 14. If you selected the hearing aid dispensing reimbursement rate as a top reason for not serving adults on Medicaid, what percentage of your office's typical dispensing fee would be required to see adults with Medicaid in your office?

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* 15. Does your office provide diagnostic audiological testing or dispense hearing aids for Medicaid beneficiaries with complex medical or developmental needs? Select all that apply.

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* 16. If your office does not provide hearing aids services or diagnostic testing to beneficiaries with complex medical or development needs, why are the services not offered? Select all that apply.

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* 17. Do you have anything else you would like to share with Medicaid?

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* 18. If Medicaid has questions on any of your responses, can we reach out to you to discuss further?

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* 19. Michigan’s Early Hearing Detection & Intervention (EHDI) Program is looking to partner with hearing providers serving infants and young children for screening, diagnostic testing, ongoing audiology management, and amplification.  Additional EHDI program information can be found at  MDHHS - Early Hearing Detection and Intervention (EHDI) Program (michigan.gov/EHDI).  Would your office be willing to participate in the EHD program? 

(Participating offices do not need to be Medicaid providers, but must follow EDHI’s Best Practice Guidelines and are included on the EHDI’s Statewide provider list)

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