ACI Alliance State Champions met in Nashville to discuss our work, which thus far has largely related to assessing coverage of cochlear implantation under Affordable Care Act Marketplace plans. We also discussed branching out to other topics. Our findings indicate that while Marketplace Plans do cover CI, we have thus far seen few patients come through who are accessing their insurance coverage through the Marketplace Plans. The concerns that we have relate to limitations on the number of therapy sessions available under such plans, which are typically limited to 30 sessions per year—regardless of the age of the patient. Such limits, which are often referred to as “therapy caps”, are increasingly common in private insurance plans as well.
To share our concerns on this topic, ACI Alliance provided written comments to the US Department of Health and Human Services and to the US Office of Personnel Management. Several of our State Champions submitted comments as CI clinicians. We emphasized the critical need for appropriate follow-up care post CI surgery. You may view our comments on the ACI Alliance website at https://c.ymcdn.com/sites/www.acialliance.org/resource/resmgr/Docs/ACIA_comments_on_ACA_copy_(2.pdf
Our lively discussion in Nashville also addressed our focus going forward. We explored two topics that impede access to care: (1) Low Medicaid payment rates for cochlear implant surgery and follow-up services and (2) The need for language in the Reauthorization of the Early Hearing Detection and Intervention Act of 2015 to address the lack of information provided to families on technology and communications options for a young child with hearing loss.
With regard to the issue of low Medicaid payment, we will develop materials that can be utilized by State Champions who wish to lead initiatives in their own states to address Medicaid payment and coverage concerns. Our Washington, DC State Champions have already initiated such a process involving clinicians, educators, and families.
With regard to the issue of parent information, CI clinicians continue to see children arrive at their clinics who were identified deaf at birth but enter the CI process late because families were not given information regarding cochlear implants as part of early intervention advisement. US pediatric CI utilization rates are half of comparable rates in Western Europe, largely because families do not receive the information they need to make informed and timely choices for their children. ACI Alliance has joined with other organizations in the hearing health field to address this concern.
Our advocacy efforts have been greatly advanced by these dedicated individuals working at the state level. Most of our meetings are held in the evening via teleconference. We will hold an in-person meeting at the upcoming CI2015 DC Symposium. For a listing of our State Champions, please go to https://acialliance.site-ym.com/?ACIAStateChamps. We hope to have at least one State Champion in every state. If you are interested in serving, please contact me at dsorkin@acialliance.org.
For more information on the work of the American Cochlear Implant Alliance, please visit www.acialliance.org.
Donna L. Sorkin, MA, Executive Director, ACI Alliance
