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House Bill No. 910 Mass. HAFCC House Bill No. 910 Mass. HAFCC "An Act to Provide Coverage for Hearing Aids For Children" "Children need to be able to hear, not just in the classroom, but also because hearing affects language competence, cognitive development, social and emotional well-being, and academic achievement, " "Children who cannot hear well — that is, when their hearing loss is untreated or under-treated — could face a life of underperformance and broken dreams. " Mass. HAFCC - 11/5/09 (Sergei Kochkin, Ph. D) 1

Types of Hearing Loss • Conductive • Sensorineural • Mixed • Unilateral Mass. HAFCC Types of Hearing Loss • Conductive • Sensorineural • Mixed • Unilateral Mass. HAFCC - 11/5/09 A decrease in sound caused by a problem in the outer or middle ear (e. g. , wax, eardrum perforation, fluid in the middle ear). A loss caused by damage to the inner ear or along the auditory nerve. A conductive loss and a sensorineural loss occurring at the same time. Affects only one ear. 2

Degree of Hearing Loss Degree of hearing loss Normal Slight Mild Moderately severe Severe Degree of Hearing Loss Degree of hearing loss Normal Slight Mild Moderately severe Severe Profound Hearing loss range (d. B HL) -10 to 15 16 to 25 26 to 40 41 to 55 56 to 70 71 to 90 91+ Degree of hearing loss refers to the severity of the loss. The numbers represent a person’s threshold, which is the softest intensity at which sound is perceived. Source: American Speech-Language Hearing Association Mass. HAFCC - 11/5/09 3

Universal Newborn Hearing Screening Program • In 1998, Massachusetts passed a law that mandates Universal Newborn Hearing Screening Program • In 1998, Massachusetts passed a law that mandates hearing screening for all newborns before leaving a hospital or birthing center. (Chapter 111, Section 67 F) • 1 of every 4 infants who do not pass a hearing screening in Massachusetts will be diagnosed with a hearing loss. (Executive Office of Health and Human Services) • A goal of newborn hearing screening is long-term cost savings because early identification results in improved language abilities, lower educational and vocational costs, and increased lifetime productivity. • However, once hearing loss is diagnosed and hearing aids are prescribed, parents or caregivers must pay out-of-pocket for hearing aids, which cost upwards of $2, 000 each. Mass. HAFCC - 11/5/09 4

Effect of No Insurance Coverage Diagnosis of hearing loss (ideally via Newborn Hearing Screening Effect of No Insurance Coverage Diagnosis of hearing loss (ideally via Newborn Hearing Screening or later) Hearing aids deemed medically necessary No insurance coverage Delayed access to hearing aids Continued decreased access to sound and speech resulting in delay in communication skills Greater probability for delays in language, education, social skills, emotional health and lifetime productivity Mass. HAFCC - 11/5/09 Increase lifetime costs for special education services, social services and medical care 5

“normal” range “mild” HL “moderate” HL “severe” HL “profound” HL Mass. HAFCC - 11/5/09 “normal” range “mild” HL “moderate” HL “severe” HL “profound” HL Mass. HAFCC - 11/5/09 6

Incidence of Pediatric Hearing Loss in MA in 2007 • In 2007, 212 infants Incidence of Pediatric Hearing Loss in MA in 2007 • In 2007, 212 infants out of 78, 724 births in MA were diagnosed with permanent (sensorineural) hearing loss. • Of these 212 children, approximately 150 will have hearing loss that makes them eligible for hearing aids. Information provided by Universal Newborn Screening Program, MA DPH Mass. HAFCC - 11/5/09 7

Distribution of Children Born in MA with Hearing Loss in 2007 0. 4% 0. Distribution of Children Born in MA with Hearing Loss in 2007 0. 4% 0. 1% 0. 2% 0. 3% 0. 4% Mass. HAFCC - 11/5/09 8

Distribution of Children Born in MA with Hearing Loss in 2007 EOHHS* Region of Distribution of Children Born in MA with Hearing Loss in 2007 EOHHS* Region of Residence Total Births Total with perm. Hearing Loss (%) Overall 78724 212 (0. 3) Boston 21802 32 (0. 1) Central 9485 32 (0. 3) Metro West 16357 41 (0. 3) Northeast 11452 43 (0. 4) Southeast 10287 41 (0. 4) Western 9074 21 (0. 2) Out of State n/a 2 (n/a) * Executive Office of Health and Human Services Mass. HAFCC - 11/5/09 9

How Hearing Aids Work • A microphone picks up sound waves, converts them to How Hearing Aids Work • A microphone picks up sound waves, converts them to electrical impulses and sends them to an amplifier that makes them louder. • A circuit modifies the electrical impulses with the prescribed amount of amplification. • A receiver converts the amplified sound back to sound waves and delivers them through the ear canal. • A battery supplies power to the hearing aid. • Hearing aids allow users to also rely on their residual hearing to respond to sound. • The most common hearing aid worn by children is a behind-the-ear aid. Mass. HAFCC - 11/5/09 10

Early Amplification is Key “Children who are early identified and receive intervention prior to Early Amplification is Key “Children who are early identified and receive intervention prior to six months of age have significantly better receptive language, expressive language, personal-social skills, receptive vocabulary, expressive vocabulary and speech production. ” Source: Apuzzo & Yoshinagi-Itano, 1995; Moeller, 1998; Yoshinaga-Itano et al, in press; Yoshinaga-Itano & Apuzzo, in press. Mass. HAFCC - 11/5/09 11

Massachusetts House Bill No. 910 • Filed by Representative S. Garballey (Arlington) in January Massachusetts House Bill No. 910 • Filed by Representative S. Garballey (Arlington) in January 2009. • Mandates insurance coverage for the cost of hearing aids for children up to 18 years old. • Up to $1, 600 per hearing aid every 3 years. • Allows insured to choose higher priced hearing aid and pay the difference in cost. • Supporters include: – – – Audiologists at Children’s Hospital Private audiologists in MA Parents, including members of Mass. HAFCC Speech-language pathologists Teachers of the Deaf Mass. HAFCC - 11/5/09 12

Other Costs Related to Owning and Maintaining Hearing Aids (NOT covered by insurance ) Other Costs Related to Owning and Maintaining Hearing Aids (NOT covered by insurance ) Item Replacement Need Estimated cost Ear molds Every 3 -6 months (more often for young children due to ear growth) ~$300. 00/pair Batteries Dependent on degree of hearing loss (~1 week) $15. 99 for 16 batteries Battery testers ~Every 1 -2 years ~$9. 99 per unit Dry and Storage containers ~Every 3 years ~$100. 00 per unit Desiccant (drying briks) ~Every 2 months ~$10. 00 for 3 briks Cleaning Wipes Dependent of frequency of use ~$19. 95 for box of 100 Testing Stethoscope ~Every 1 -2 years ~$30. 00 Clips for Younger children Dependent of activity level of child ~$9. 95 per unit Tubing Air Blower ~Every 1 -2 years ~$7. 95 per unit Hearing Aid sweat bands ~Every year ~$21. 95 Lubricant (Oto-ease) Dependent of frequency of use ~$3. 50 for 1 ounce Loss and Damage Insurance Yearly Individualized Mass. HAFCC - 11/5/09 13

Mass. HAFCC - 11/5/09 http: //monarch. tamu. edu/~smrs/09434649. gif 14 Mass. HAFCC - 11/5/09 http: //monarch. tamu. edu/~smrs/09434649. gif 14

States that Have Passed Hearing Aid Legislation • 2001: • • 2002: 2003: 2004: States that Have Passed Hearing Aid Legislation • 2001: • • 2002: 2003: 2004: 2007: 2008: 2009: 2010: Mass. HAFCC - 11/5/09 Maryland, Connecticut, Oklahoma, Rhode Island Kentucky Minnesota Louisiana, Missouri New Mexico, Maine Colorado, Delaware, New Jersey Arkansas, Wisconsin North Carolina, New Hampshire 15

Basic Facts: Pediatric Hearing Loss • • • #1 birth defect: ~ 3 of Basic Facts: Pediatric Hearing Loss • • • #1 birth defect: ~ 3 of every 1, 000 births in the U. S. More than 90 % of children diagnosed with hearing loss are born to parents who have typical hearing. In 2002 alone, over 70, 000 students (ages 6 -21) received Special Education services due to their hearing loss. 1 Children who do not receive early intervention cost schools an additional $420, 000 and face overall lifetime costs of $1 million in special education, lost wages, and health complications. 2 There are 1. 4 million children with hearing loss in America (1. 7% prevalence); yet only 12% use hearing aids (as identified by their parents). 3 – 1 out of 5 (22%) parents said they were unable to afford hearing aids – On average, a pair of hearing aids costs $4, 000 Alexander Graham Bell Association for the Deaf and Hard of Hearing 1 US Department of Education 2 International Journal of Pediatric Otorhinolaryngology, 1995 3 Better Hearing Institute national survey of 53000 households Mass. HAFCC - 11/5/09 16

Basic Facts: Pediatric Hearing Loss A 2007 Better Hearing Institute Study determined the most Basic Facts: Pediatric Hearing Loss A 2007 Better Hearing Institute Study determined the most serious problems experienced with untreated hearing loss were: – – – – Social skills (52%) Language/speech development (51%) Grades in school (50%) Emotional health (42%) Relationships with peers (38%) Self-esteem (37%) Relationships with family (36%) Mass. HAFCC - 11/5/09 17

Basic Facts: Pediatric Hearing Loss • Babies and young children learn to talk by Basic Facts: Pediatric Hearing Loss • Babies and young children learn to talk by listening to the voices of family members and caregivers from the time they are born. Any degree of hearing loss has the potential to interrupt speech and language development. • Early intervention combined with the use of hearing aids enables a child with hearing loss to develop language skills comparable to their hearing peers by the time they enter first grade. • Today, most infants have a hearing loss screening before they leave the hospital. Early detection of a hearing loss means earlier access to hearing technology and early intervention, and a better opportunity for a child to develop spoken language. Source: Alexander Graham Bell Association for the Deaf and Hard of Hearing Mass. HAFCC - 11/5/09 18

Educational Impact • Any degree of hearing loss can be educationally significant for children. Educational Impact • Any degree of hearing loss can be educationally significant for children. Even children with mild to moderate hearing losses can miss up to 50% of classroom discussions. • 37% of children with only minimal hearing loss fail at least one grade (Bess, 1998). • Unmanaged hearing loss in children can affect their speech and language development, academic capabilities and educational development, and self-image and social/emotional development. • Studies estimate that as much as 90% of what young children learn is attributable to incidental conversations around them (Flexer, 1993). Mass. HAFCC - 11/5/09 19

Mass. HAFCC The Massachusetts Hearing Aids for Children Coalition is a statewide network of Mass. HAFCC The Massachusetts Hearing Aids for Children Coalition is a statewide network of families of children who are deaf or hard of hearing and professionals working together to maximize a child’s lifetime potential through educational, medical, social and emotional support. Mass. HAFCC’s current focus is to work to pass legislation in MA that would compel insurance companies to cover the cost of hearing aids for children. Mass. HAFCC - 11/5/09 20

Contact Information Lisa Adams: lcadams 56@hotmail. com President, Mass. HAFCC Yahoo Group: http: //health. Contact Information Lisa Adams: lcadams [email protected] com President, Mass. HAFCC Yahoo Group: http: //health. groups. yahoo. com/group/Mass. HAFCC/ Facebook: http: //www. facebook. com/home. php? #!/group. php? gid=107850185906 949 Blog: http: //masshafcc. blogspot. com/ Mass. HAFCC - 11/5/09 21