The Social Security Administration (SSA) has revised and updated the disability criteria for evaluating hearing loss in a final rule effective August 2. The rule also stipulates who may perform audiometric testing.
The regulations appear in the Listing of Impairments [Sections 2.00 and 102.00—Special Senses and Speech—in the Code of Federal Regulations (Title 20, Part 404, Subpart P, Appendix 1)]. The amended regulations were published in the Federal Register, June 2, 2010.
These criteria, last revised in 2004, no longer specify [hearing] aided testing. And, for the first time, criteria to evaluate individuals who have cochlear implants (CIs) are included. The rule expands guidance on word recognition testing and clarifies that pure tone testing and physiologic testing (such as ABR and otoacoustic emissions), when used only as screening tests, cannot be used to assess functional limitations due to hearing loss.
Under the rule, audiometric testing may be performed by, or under the direct supervision of, an otolaryngologist or qualified audiologist. State licensure or registration determines qualification status. If there is no state licensure/registration available, the audiologist must have certification from ASHA (CCC-A) or the American Board of Audiology.
Audiometric testing requirements are segmented by age. Testing requirements for individuals without a CI are specified in four age groups through age 17. For those with CIs, the rules consider a child to have a disability until age 5 or one year after initial implantation, whichever is later. After age 5, word recognition testing is required.
In October 2008 comments on the proposed rule [PDF], ASHA recommended treating bilateral cochlear implantation differently from unilateral implantation. SSA did not accept that recommendation; no reason was provided in the final rule.
SSA included clarification in the rule's preamble regarding the provision in sections 2.00B1c and 102.00B1c that permits audiometric testing by a non-audiologist under the supervision of an otolaryngologist. SSA accepted the requirement that non-audiologists "conduct testing only under direct supervision, in accordance with Medicare regulations requiring the physician to be present in the office suite when the service is being performed and to assist if necessary." However, rather than include this statement in the regulations, the preamble states, "We will provide guidance to our adjudicators on how to apply the rule in our [SSA] instructions and training."
SSA rejected comments proposing acceptance of results of audiometric testing conducted independently by a hearing aid specialist [also called Hearing Instrument Specialist (HIS)]. SSA states that the educational and other qualifications required for HIS licensure or certification are less comprehensive than those of otolaryngologists and audiologists and can vary from place to place. However, if an HIS conducts the testing under the direct supervision of an otolaryngologist, the results would be acceptable both for establishing a medically determinable impairment and assessing its severity.
Previously this rule stated that an otologic examination by a physician should precede audiometric testing. This requirement has been revised clearly to allow testing to occur before or after the complete otologic examination. The regulation also states that audiometric testing "should" rather than "must" be performed within two months of the otologic exam. Thus as stated in the preamble, SSA adjudicators would be allowed to use evidence that is outside the two-month period in appropriate cases.
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