This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives.
STORAGE NAME: h0079e.HHS
DATE: 2/28/2022
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/HB 79 Insurance Coverage for Hearing Aids for Children
SPONSOR(S): Health & Human Services Committee, Brannan, Zika and others
TIED BILLS: IDEN./SIM. BILLS: CS/SB 498
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Finance & Facilities Subcommittee 18 Y, 0 N Poche Lloyd
2) Appropriations Committee 26 Y, 0 N Lee Pridgeon
3) Health & Human Services Committee 17 Y, 0 N, As CS Poche Calamas
SUMMARY ANALYSIS
Approximately 30 million people in the U.S. aged 12 years and older have hearing loss in both ears, based on
standard hearing examination. Hearing loss is also one of the most common birth defects in the U.S. – two or
three out of every 1,000 children are born with a detectable level of hearing loss in one or both ears.
Many people who are deaf or hard-of-hearing have some hearing. In some instances, a hearing aid may help a
child with hearing loss maximize their residual hearing. Hearing aids make sounds louder and can be worn by
people of any age, including infants. Babies with hearing loss may understand sounds better using hearing
aids. There are many styles of hearing aids that can help many types of hearing loss. A young child is usually
fitted with behind-the-ear style hearing aids because they are better suited to growing ears. Florida law does
not require private health insurance policies or health maintenance organization (HMO) contracts to provide
coverage for hearing aids.
CS/HB 79 requires individual health insurers and HMOs to cover hearing aids for a covered child 18 years of
age and younger who is diagnosed with hearing loss by a licensed physician or licensed audiologist and for
whom the hearing aid is medically necessary. The term “hearing aid” includes ear molds, but does not include
cochlear implants. The bill requires a minimum coverage limit of $3,500 per ear within a 24-month period, and
requires coverage of 6 ear molds within a 24-month period. The insured or subscriber is responsible for the
cost of hearing aids and related services that exceed the coverage limit in the policy or contract.
If, however, a child experiences a significant and unexpected change in his or her hearing or experiences a
medical condition requiring an unexpected change in the hearing aid before the existing 24-month period
expires, and if alterations to the existing hearing aid do not or cannot meet the child’s needs, the bill requires a
new 24-month period to begin, including full benefits and coverage. The bill applies to private individual policies
or contracts issued or renewed on or after January 1, 2023.
The bill may have a significant, indeterminate negative fiscal impact on state government and the private
sector. The bill does not apply to the State Group Insurance Program. However, for health plans obtained
through federal marketplace exchanges, the state may be required to reimburse the cost of any new coverage
mandate that raises the cost of those plans. See Fiscal Analysis & Economic Impact Statement.
The bill provides an effective date of January 1, 2023. STORAGE NAME: h0079e.HHS PAGE: 2
DATE: 2/28/2022
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Approximately 30 million people in the U.S. aged 12 years and older have hearing loss in both ears,
based on standard hearing examination.
1
Hearing loss is also one of the most common birth defects
2
in
the U.S. – two or three out of every 1,000 children are born with a detectable level of hearing loss in
one or both ears.
3
Many people who are deaf or hard-of-hearing have some hearing. In some instances, a hearing aid
may help a child with hearing loss maximize their residual hearing.
4
Hearing aids make sounds louder
and can be worn by people of any age, including infants. Babies with hearing loss may understand
sounds better using hearing aids. There are many styles of hearing aids that can help many types of
hearing loss. A young child is usually fitted with behind-the-ear style hearing aids because they are
better suited to growing ears.
5
Hearing loss may be in one ear (unilateral loss) or in both ears (bilateral loss). The degree of hearing
loss can range from mild to profound:
6
Mild Hearing Loss (26-40 decibels): may hear some speech sounds, but soft sounds are hard
to hear.
Moderate Hearing Loss (41-70 decibels): may hear almost no speech when another person is
talking at a normal level.
Severe Hearing Loss (71-90 decibels): will hear no speech when a person is talking at a
normal level and only hear some loud sounds.
Profound Hearing Loss (91 decibels or more): will not hear any speech and will hear only very
loud sounds.
7
Hearing loss can affect a child’s ability to develop communication, language, and social skills. Recent
research shows that early detection of hearing loss can help infants and children with learning and
reaching developmental milestones. In the U.S., researchers report children have more favorable
language outcomes, such as greater vocabulary and reading abilities, when hearing loss is identified
sooner and the child receives hearing aids and interventions at an earlier age.
8
A second study similarly
found children who received hearing aids and cochlear implants earlier had better language outcomes,
comparing language skills with a hearing aid at three months compared to 24 months:
9
1
National Institutes for Health, National Institute on Deafness and Other Communication Disorders, Quick Statistics About Hearing,
available at https://www.nidcd.nih.gov/health/statistics/quick-statistics-hearing.
2
Florida Newborn Screening, Early Hearing and Intervention Program, available at
https://floridanewbornscreening.com/hearing/early-hearing-and-intervention-programs/.
3
Id.
4
Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disorders (June 8, 2020), available
at https://www.cdc.gov/ncbddd/hearingloss/treatment.html. The amount of hearing a deaf or hard-of-hearing person has is referred to
as “residual hearing.”
5
Id. A plastic ear mold is connected to a behind-the-ear hearing aid and is fitted for the child’s ear, directing sound into the ear canal.
Each individual’s ear is shaped differently, and a child’s ear will change as he or she grows. An audiologist uses a soft material to make
a copy of the child’s outer ear canal, and the ear mold is made from it. As the child grows, new ear molds can be made and attached to
the same hearing aid.
6
Florida Department of Health, Children’s Medical Services, A Florida Parent’s Guide to Hearing (Apr. 2020 Edition), available at
http://floridanewbornscreening.com/wp-content/uploads/Hearing-Guide-English-FINAL-1.pdf.
7
Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disorders (June 8, 2020), available
at https://www.cdc.gov/ncbddd/hearingloss/types.html.
8
Christine Yoshinaga-Itano, Ph.D., et al, Early Hearing Detection and Vocabulary of Children with Hearing Loss, Pediatrics (Aug. 2017,
Vol. 140, No. 2), available at https://pediatrics.aappublications.org/content/140/2/e20162964.
9
Teresa Y.C. Ching, Ph.D., Age at Intervention for Permanent Hearing Loss and 5-Year Language Outcomes, Pediatrics (Sept. 2017,
Vol. 140, Issue 3), available at https://pediatrics.aappublications.org/content/140/3/e20164274. STORAGE NAME: h0079e.HHS PAGE: 3
DATE: 2/28/2022
The younger the child received intervention, the better the language
outcome. In addition, more substantial benefits of earlier access to
useful HAs (hearing aids) and CI (cochlear implants) were obtained
by those with worse hearing. Earlier intervening, rather than access
to UNHS (universal newborn hearing screening), improved
outcomes.
10
Florida Newborn Hearing Screening Program
Florida has a universal newborn hearing-screening program
11
requiring all licensed facilities providing
maternity and newborn care to screen, or refer for screening, all newborns prior to discharge for
hearing loss, unless a parent objects to the screening.
12
All test results, including recommendations for
any referrals or follow-up evaluations by a licensed audiologist, a physician licensed under chapters
458 or 459, F.S., or other newborn hearing screening providers in the hospital facility, must be placed
in the newborn’s medical records within 24 hours after completing the screening.
13
For babies born in a facility other than a hospital, the parents must be instructed on the importance of
having a screening conducted, information must be provided, and assistance must be given to make an
appointment within three months.
14
The initial newborn screening and any necessary follow-up and
evaluation are covered benefits reimbursable by Medicaid, health insurers, and health maintenance
organizations, with some limited exceptions.
15
For those newborns and children found to have
permanent hearing loss, the law also provides for referral to the state’s Part C program of the federal
Individuals with Disabilities Education Act
16
and Children’s Medical Services’ Early Intervention
Program, Early Steps.
17
Hearing Aid Coverage in Public Insurance Programs
Medicaid
Florida Medicaid provides hearing services for eligible recipients under the age of 21, if such services
are medically necessary to correct or ameliorate a defect, a condition, or a physical or mental illness.
18
Coverage includes diagnostic services, treatment, equipment, supplies, and other measures described
in 42 U.S.C. 1396d(a).
19
Medicaid recipients under the age of 21 have coverage for the following
hearing-related services:
Recipients who have documented, profound, severe hearing loss in one or both ears have
coverage for:
o An implanted device for recipients age five years and older; or
o A non-implanted (softband) device for recipients under age five.
Cochlear implants for recipients age 12 months and older who have documented, profound to
severe, bilateral sensorineural hearing loss.
For recipients who have moderate hearing loss or greater, the coverage is:
o One new, complete (not refurbished) hearing aid device per ear, every three years, per
recipient;
o Up to three pairs of ear molds per year, per recipient; and
o One fitting and dispensing service per ear, every three years, per recipient.
10
Id.
11
Florida’s Early Hearing Detection and Intervention Program (EHDI) is Florida’s newborn hearing-screening program, available at
https://floridanewbornscreening.com/hearing/early-hearing-and-intervention-programs/.
12
S. 383.145, F.S.
13
S. 383.145(3)(e), F.S.
14
S. 383.145(3)(i), F.S.
15
S. 383.145(3)(j), F.S.
16
Pub. L. No. 108-446. The Part C program provides benefits and services for infants and toddlers from birth to 36 months. Children’s
Medical Services within the Department of Health administers the Part C program, known as Early Steps.
17
The Early Steps program services children with disabilities, developmental delays, or children with a physical or mental condition
known to create a risk of a developmental delay, http://www.cmskids.com/families/early_steps/early_steps.html.
18
S. 1905(a)(4)(B) of the Social Security Act.
19
R. 54G-4.110, F.A.C. (2021). The hearing services coverage policy from the Agency for Health Care Administration is available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-06744. STORAGE NAME: h0079e.HHS PAGE: 4
DATE: 2/28/2022
A recipient under the age of 12 months may receive up to two newborn screenings. A second
screening may be conducted only if the recipient did not pass the test in one or both ears. An eligible
recipient may receive one hearing assessment every three years to determine hearing aid candidacy
and, if necessary, the most appropriate hearing aid.
20
Medicaid also covers repairs and replacement of
both Medicaid and non-Medicaid provided hearing aids, up to two hearing aid repairs every 366 days,
after the one-year warranty period has expired.
21
State Children’s Health Insurance Program
22
The Children’s Health Insurance Program (CHIP) was enacted as part of the Balanced Budget Act of
1997, and created Title XXI of the federal Social Security Act as a joint state-federal funding
partnership to provide health insurance to children in low to moderate income households.
23
The
Florida Healthy Kids Corporation
24
is one component of the Title XXI program, known as Florida
KidCare, and is the only program component using a non-Medicaid benefit package.
25
The other
program components – Medicaid for children, Medikids, and Children’s Medical Services Network –
follow the Medicaid benefit package.
26
For health benefits coverage to qualify for premium assistance payments, KidCare enrollees must
receive hearing screenings as a covered, preventative health service.
27
Additionally, s. 409.815(2)(h),
F.S., provides the benefits for durable medical equipment include within covered services equipment
and devices that are medically indicated to assist in the treatment of a medical condition and
specifically prescribed as medically necessary. Hearing aids are covered only when medically indicated
to assist in the treatment of a medical condition. There are no out-of-pocket costs for the well-child
hearing screening for subsidized Title XXI eligible children.
28
Hearing Aid Coverage in the Private Health Insurance Market
The Office of Insurance Regulation (OIR) is responsible for the regulation of all activities of insurers and
other risk-bearing entities that do business in Florida.
29
Florida law does not require health insurance
policies or health maintenance organizations contracts to provide coverage for hearing aids. According
to the OIR, some of the plans offered by UnitedHealthcare cover hearing aids if recommended by a
physician, and bone anchored hearing aids are covered with some restrictions. Molina and Health First
cover implant type hearing aids, if medically necessary.
30
Currently, 24 states appear to mandate health benefit plans to provide coverage for hearing aids for
children.
31
Coverage requirements range from authorizing a hearing aid every 24 months to every five
years. Many states include caps on the amount the insurer must pay, ranging from $1,000 to $4,000.
32
State Mandated Health Insurance Coverage
Prior to 2012, OIR identified 18 state-mandated benefits.
33
Subsequently, Florida has not enacted any
mandated benefits. Examples of benefits mandated under Florida law include:
20
Agency for Health Care Administration, Hearing Services Coverage Policy (June 2016), available at
http://ahca.myflorida.com/medicaid/review/specific_policy.shtml.
21
Id.
22
42 U.S.C. s. 1397aa-1397mm.
23
Pub. L. No. 105-33, 111 Stat. 251, H.R. 2015, 105th Cong. (Aug. 5, 1997).
24
Ss. 624.91-624.915, F.S.
25
Ss. 409.810-409.821, F.S.
26
S. 409.815(2)(a), F.S., and s. 391.0315, F.S.
27
S. 409.815(2)(a), F.S.
28
Florida Healthy Kids Corporation, Medical Benefits, available at https://www.healthykids.org/benefits/medical/.
29
OIR is under the Financial Services Commission, composed of the Governor, the Attorney General, the Chief Financial Officer, and
the Commissioner of Agriculture, who serves as the head of the commission. S. 20.121(3), F.S.
30
OIR correspondence (Dec. 8, 2020).
31
Information from the American Speech-Language-Hearing Association, available at
https://www.asha.org/advocacy/state/issues/ha_reimbursement/.
32
Id. STORAGE NAME: h0079e.HHS PAGE: 5
DATE: 2/28/2022
Treatment for temporomandibular joint disorders;
Coverage for bone marrow transplants;
Coverage for certain cancer drugs;
Diabetes treatment services;
Osteoporosis;
Certain coverage for newborn children;
Child health supervision services; and
Treatment of cleft lip and cleft palate in children.
34
Section 624.215, F.S., requires every person or organization seeking consideration of a legislative
proposal, which would mandate a health coverage or the offering of a health coverage by an insurer, to
submit to the Agency for Health Care Administration and the legislative committees having jurisdiction,
a report that assesses the social and financial impacts of the proposed coverage. Proponents
submitted a report to Senate Banking and Insurance Committee staff in 2021 indicating there are less
than 7,200 children under the age of 18 in Florida who are deaf.
35
Hearing aids and the services
necessary to prescribe, evaluate, fit, and manage children with hearing loss generally cost an average
of $3,500 per ear, depending on the technology and enhancements selected by the audiologist based
on the individual needs of the child.
36
Advocates of the bill note that untreated hearing loss may lead to tremendous expense for the
taxpayer, as described below:
Untreated pediatric hearing loss costs $420,000 in special education costs per child and $1
million dollars over the lifetime of the individual;
Longitudinal, peer-reviewed studies have shown that healthcare costs are significantly higher
for individuals with untreated versus treated hearing loss;
Increased costs are not confined to the medical bills in the studies. Medical providers must
absorb (and pass on via increased overall costs) costs incurred from longer visit times due to
communication difficulties, increased risk of malpractice lawsuits from communication
difficulties, and necessary accommodations like interpreter services;
Communication difficulties in deaf and hard of hearing patients, which would be mitigated by
appropriate access to sound, result in more physician visits and overuse of emergency rooms
and urgent care centers; and
Patients with untreated hearing loss are more likely to be misdiagnosed when visiting providers
for unrelated health issues and are more difficult to treat due to communication difficulties.
37
Federal Patient Protection and Affordable Care Act
The federal Patient Protection and Affordable Care Act (PPACA)
38
does not require health insurance
policies to cover hearing aids for adults or children. Under the PPACA, individuals and small
businesses can obtain health insurance coverage on or off the federal marketplace exchanges.
39
All
33
Centers for Medicare & Medicaid Services, Florida – State Required Benefits, available at
https://downloads.cms.gov/cciio/State%20Required%20Benefits_FL.pdf.
34
Id.
35
Florida Coalition for Spoken Language Options, 2021 Florida Legislature, SB 1268 Mandate Report.
36
Id.
37
Id.
38
The Patient Protection and Affordable Care Act (PPACA) (Pub. L. No. 111-148) was enacted on March 23. 2010. On March 30, 2010,
PPACA was amended by Pub. L. No. 111-152, the Health Care and Education Reconciliation Act of 2010. The two laws are collectively
referred to as the ‘‘Patient Protection and Affordable Care Act’’ or ‘‘PPACA.’’
39
Exchanges are entities established under PPACA through which qualified individuals and qualified employers can purchase health
insurance coverage in qualified health plans (QHPs). Many individuals who enroll in QHPs through individual market exchanges are
eligible to receive a premium tax credit (PTC) to reduce their costs for health insurance premiums and to receive reductions in required
cost-sharing payments to reduce out-of-pocket expenses for health care services. 42 U.S.C. s. 18031. STORAGE NAME: h0079e.HHS PAGE: 6
DATE: 2/28/2022
non-grandfathered health plans
40
must offer qualified health plans meeting certain federal mandates,
including the provisions of the following ten essential health benefits (EHB):
Ambulatory services (outpatient care);
Emergency services;
Hospitalization (inpatient care);
Maternity and newborn care;
Mental health and substance abuse disorder services;
Prescription drugs;
Rehabilitative services and rehabilitative services and devices;
Laboratory services;
Preventive care and chronic disease management; and
Pediatric services, including oral and vision care.
41
States may modify the EHB offered in their states by mandating additional coverage. However, states
must defray the associated costs of such benefits imposed on qualified health plans coverage, and
those costs should not be included in the percentage of premium attributable to the coverage of EHB
for calculating the premium tax credit for eligible enrollees
42
on the exchange.
43
The state may be
required to defray the costs of any additional benefits beyond the required EHB put in place after
2011.
44
For plan years beginning on or after January 1, 2020, each state must identify and report to the federal
Department of Health and Human Services (DHHS) benefits mandated by state law and identify which
of those benefits are in addition to EHB. The first annual submission deadline for states to notify the
DHHS of their state-mandated benefits was July 1, 2021.
45
Each qualified health plan issuer in the state
must quantify cost attributable to each additional required benefit and then report this to the state.
46
In May 2020, DHHS clarified existing rules to provide that it would also be permissible for issuers to
choose to rely on another entity, such as the state, to produce the cost analysis, provided the issuer
remains responsible for ensuring that the quantification complies with existing rules.
47
Further, the
DHHS noted that this calculation should be done prospectively to allow for the offset of an enrollee’s
share of premium and for purposes of calculating the PTC and reduced cost sharing.
48
Audiologist Scope of Practice and Licensure Requirements
An audiologist is licensed under part I of chapter 468, F.S., to practice audiology.
49
The practice of
audiology includes the application of principles, methods, and procedures for the prevention,
identification, evaluation, consultation, habilitation, rehabilitation, instruction, treatment, and research,
relative to hearing and the disorders of hearing, and to related language and speech disorders.
50
A
licensed audiologist may:
Offer, render, plan, direct, conduct, consult, or supervise services to individuals or groups of
individuals who have or are suspected of having disorders of hearing, including prevention,
40
A “grandfathered health plan” is a plan that maintains coverage that was in place prior to the passage of the PPACA or in which the
enrollee was enrolled on March 23, 2010, while complying with the consumer protection components of the PPACA. If a group health
plan enters a new policy, certificate, or contract of insurance, the group must provide the new issuer the documentation from the prior
plan so it can be determined whether there has been a change sufficient to lose grandfather status. S. 627.402, F.S.
41
42 U.S.C. s. 18022(b)(1)(A)-(J).
42
In Florida, 1,705,902 or 95% of the total marketplace exchange enrollees receive PTCs. Kaiser Family Foundation, Marketplace
Effectuated Enrollment and Financial Assistance (2020), available at https://www.kff.org/other/stateindicator/effectuated-marketplace-
enrollment-and-financialassistance/?currentTimeframe=0&sortModel=%7B”colld”:”Location”,”sort”:”asc”%7D.
43
HealthCare.gov, Subsidized Coverage, available at https://www.healthcare.gov/glossary/subsidized-coverage/. Household income
must be between 100 percent and 400 percent of the federal poverty level to qualify for a PTC.
44
42 U.S.C. s. 18031(d)(3)(B)(ii).
45
45 CFR § 156.111.
46
45 CFR § 155.170(c).
47
85 Fed. Reg. 29218 (May 14, 2020).
48
Id.
49
S. 468.1125(1), F.S.
50
S. 468.1125(6)(a), F.S. STORAGE NAME: h0079e.HHS PAGE: 7
DATE: 2/28/2022
identification, evaluation, treatment, consultation, habilitation, rehabilitation, instruction, and
research;
Participate in hearing conservation, evaluation of noise environment, and noise control;
Conduct and interpret tests of vestibular function and nystagmus, electrophysiologic auditory-
evoked potentials, central auditory function, and calibration of measurement equipment used for
such purposes;
Habilitate and rehabilitate, including, but not limited to, hearing aid evaluation, prescription,
preparation, fitting and dispensing, assistive listening device selection and orientation, auditory
training, aural habilitation, aural rehabilitation, speech conservation, and speechreading;
51
Fabricate ear molds;
Evaluate tinnitus; and
Include speech and language screening, limited to a pass/fail determination for identifying
individuals with disorders of communication.
52
To become licensed as an audiologist, an applicant must:
Earn a doctoral degree in audiology or complete the academic requirements of a doctoral
degree program, with a major emphasis on audiology at an institution that meets specified
requirements;
53
Receive a passing score on a national examination;
54
and
Demonstrate a minimum of 11 months of full-time professional employment or practice with a
provisional license.
55
An audiologist is required to perform a final fitting for a client to ensure the physical and operational
comfort of the hearing aid “when indicated.”
56
Hearing Aid Specialist Scope of Practice and Licensure Requirements
A hearing aid specialist is licensed under part II of chapter 484, F.S., to practice the dispensing of
hearing aids.
57
To become a hearing aid specialist, an applicant must:
Graduate from an accredited high school or its equivalent;
Complete a training program as established by the Board of Hearing Aid Specialists that is a
minimum of six months in length, or be licensed or certified and have been actively practicing
for at least 12 months as a licensed in another state; and
Pass an examination established by the Board of Hearing Aid Specialists.
58
A hearing aid specialist is required to perform a final fitting for all clients to ensure the physical and
operational comfort of the hearing aid.
59
Effect of Proposed Changes
CS/HB 79 requires individual health insurers and health maintenance organizations (HMOs) to provide
hearing aid coverage for a covered child from birth through age 18 who is diagnosed with hearing loss
by a licensed physician or a licensed audiologist and for whom the hearing aid is medically necessary.
The term “hearing aid” includes ear molds, but does not include cochlear implants. The bill requires a
minimum coverage limit of $3,500 per ear within a 24-month period, and requires coverage for 6 ear
molds in the same 24-month period. The insured or subscriber remains responsible for the cost of
hearing aids and related services that exceed the coverage limit provided in the policy or contract.
51
An audiologist is authorized to prescribe assistive hearing devices under s. 468.1125(6)(b)4., F.S.
52
S. 468.1125(6)(b), F.S.
53
S. 468.1155(3)(b), F.S.
54
S. 468.1155(1)(a), F.S.
55
Id.
56
S. 468.1225(3), F.S.
57
S. 484.041, F.S.
58
S. 484.045, F.S.
59
S. 484.0501(3), F.S. STORAGE NAME: h0079e.HHS PAGE: 8
DATE: 2/28/2022
If, however, a child experiences a significant and unexpected change in his or her hearing or
experiences a medical condition requiring an unexpected change in the hearing aid before the existing
24-month period expires, and alterations to the existing hearing aid do not, or cannot, meet the needs
of the child, the bill requires that a new 24-month period must begin with full benefits and coverage.
The bill applies to policies or contracts that are issued or renewed on or after January 1, 2023.
The bill provides an effective date of January 1, 2023.
B. SECTION DIRECTORY:
Section 1: Creates s. 627.6413, F.S., relating to coverage for hearing aids for children.
Section 2: Amends s. 641.31, F.S., relating to health maintenance contracts.
Section 3: Provides an effective date of January 1, 2023.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
The bill may have a significant, indeterminate negative fiscal impact on state government.
PPACA requires states to pay for the cost differential in health insurance premium caused by a
mandated health benefit. The total cost of the bill’s coverage mandate for all commercial health
plans in Florida is unknown; per federal rules, the state may select a new essential health benefits
(EHB) benchmark plan for plan years beginning on or after January 1, 2020. If the state opts to
select a new EHB-benchmark plan, including state mandated coverage, the state is required under
federal rule to submit an actuarial certification and associated actuarial report
60
affirming that the
state’s new EHB-benchmark plan provides a scope of benefits that is equal to, or greater than, the
scope of benefits provided under a typical employer plan
61
and that it does not exceed the
generosity of the most generous plans.
62
The report will detail the amount the state must reimburse individuals in the commercial health
insurance market for increased premium costs due to state-mandated benefits. This could result in
additional costs to the state of an estimated $1.5 million per year, as accounted below.
Recent data indicates 2,257,600 persons covered by individual health insurance in Florida in
2020.
63
There are roughly 4,546,301 persons aged 0 to 18 in Florida, which is 21 percent of the
total population.
64
Applying this rate and assuming an incidence rate of 0.17% of children with
hearing loss, approximately 806 children covered by individual health insurance coverage in Florida
have hearing loss. Subtracting the children with slight hearing loss that does not require hearing
aids, those with profound hearing loss or mixed hearing loss who are cochlear implant candidates,
60
45 C.F.R. s. 156.111(e)(2)(i) and (ii).
61
45 C.F.R. s. 156.111(b)(2)(i).
62
45 C.F.R. s. 156.111(b)(2)(ii)(A) and (B).
63
Kaiser Family Foundation, State Health Facts, Health Insurance Coverage of the Total Population – 2020 Current Population Survey,
available at https://www.kff.org/other/state-indicator/health-insurance-coverage-of-the-total-population-
cps/?dataView=1¤tTimeframe=0&sortModel=%7B”colld”:”Location”,”sort”:”asc”%7D. Data also shows 8,557,300 persons
covered by employer-backed insurance, for a total of 10,814,900 persons with private individual or group health insurance coverage in
Florida. Id.
64
Office of Economic and Demographic Research, Florida Population by Age Group, available at
www.edr.state.fl.us/Content/population-demographics/data/Pop_Census_Day.pdf. STORAGE NAME: h0079e.HHS PAGE: 9
DATE: 2/28/2022
and those covered under Early Steps, an estimated 520 children who are candidates for hearing
aids may be impacted by the bill.
Using data from the federal Centers for Disease Control, 39 percent of children with hearing loss
are candidates for a unilateral hearing aid, and 61 percent are candidates for bilateral hearing aids.
Of the 520 children impacted by the bill, 203 may need a unilateral hearing aid, and 317 may need
bilateral hearing aids. At a cost of $3,500 per ear, which is the minimum coverage amount required
by the bill, the total cost impact is an estimated $2,929,500 over 24 months, or $1,464,750 annually.
Note: Because the bill only applies to individual health coverage under a health insurance policy or
HMO contract, the bill does not apply to the State Group Insurance Program, which is a group plan.
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
The bill requires individual health insurers and HMOs to cover hearing aids for insured children aged 21
years and younger. Plans subject to PPACA, and individuals covered by them, should not be negatively
impacted since the state is responsible for increased costs associated with the mandated coverage for
hearing aids.
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not applicable. The bill does not appear to impact county or municipal governments.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
The bill provisions do not require additional rule-making authority for implementation.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/ COMMITTEE SUBSTITUTE CHANGES
STORAGE NAME: h0079e.HHS PAGE: 10
DATE: 2/28/2022
On February 28, 2022, the Health and Human Services Committee adopted a strike-all amendment and
reported the bill favorably as a committee substitute. The strike-all amendment:
Lowered the age for required coverage of hearing aids from 21 to 18.
Included ear molds as a covered assistive hearing device, and limits coverage to 6 molds every 24
months.
Excluded cochlear implants from the coverage requirement.
This analysis is drafted to the committee substitute as passed by the Health & Human Services Committee.