Changes proposed to Ontario’s hearing aid grant program raise alarm

Ontario’s Hearing Instrument Specialists (HIS) say proposed changes to the way hearing aids are dispensed under the province’s Assistive Devices Program (ADP) are going to create more barriers for people to access hearing care.

Currently, a patient is assessed by either an audiologist or HIS and a hearing test is conducted. If needed, hearing aid recommendations are provided and the ADP hearing aid grant process is initiated.

The grant covers $500 for each hearing aid, totalling $1,000, every three to five years for those with an Ontario Health Card.

Current grant process

The ADP grant form currently requires both an authorizer and a prescriber’s signature.

Authorizers can be either an audiologist or HIS who assess the patient. Prescribers can be either an audiologist or a physician.

In order to sign as a prescriber, an audiologist must personally assess the patient.

However, if the prescriber is an audiologist, they must not be financially related to the authorizer, as that would constitute a conflict of interest. This, therefore, means that the same audiologist cannot be both authorizer and prescriber on the same grant form.

As it stands then, when the authorizer is an HIS, the prescriber can only be a physician.

Proposed changes to the ADP grant process

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On Jan. 24, the Ministry of Health’s Assistive Devices Program sent out a memo with changes that were meant to “modernize processes and make it easier for people to access the services they need.”

It effectively stated that going forward, ADP grants can only be authorized by audiologists or speech-language pathologists

The memo reads:

“Effective Jan. 29, 2024, eligible Ontarians will only require one signature from an audiologist or speech-language pathologist who is registered with the ADP as an authorizer on the ADP’s hearing devices application form. A second signature from a physician or hearing instrument specialist will no longer be required.”

Audiology is a regulated profession under the College of Audiologists and Speech-Language Pathologists of Ontario (CASLPO) whereas Hearing Instrument Specialists are not regulated and are represented by the Association of Hearing Instrument Practitioners of Ontario (AHIP).

The memo made special note of this saying:

“Audiologists and speech-language pathologists are fully qualified to provide assessments and authorize hearing devices under the Audiology and Speech-Language Pathology Act, 1991. Audiologists and speech-language pathologists are regulated health professionals under the College of Audiologists and Speech-Language Pathologists of Ontario (CASLPO), which ensures their members provide services in an ethical and professional manner.”

Chris Arnold, President of AHIP, says the move has potentially disastrous consequences for Ontarians.

“It’s going to cause a giant log jam of waiting times and even remove access for a lot of people,” he says.

Given the conflict of interest rules in play, an authorizing audiologist would still need to contact another audiologist to sign off as a prescriber or get a physician to sign a separate prescription.

With just 933 audiologists in Ontario, Arnold says if the changes were to go through, it would take months to get an appointment with an audiologist and it could lead to various detrimental health impacts for Ontarians.

“If they’re in remote areas where there might be only a hearing instrument specialist in that area, and there’s no audiologist for a hundred kilometres, I don’t know what the option is for them,” he says.

Arnold feels it is obvious that the less accessible a service is, the less likely people are to seek it out, causing more complications.

“This could cause them to put off getting treatment and the longer and longer you put the treatment off can lead to other comorbidities — stroke, hearing loss, there’s even been some studies that possibly dementia … it could lead to issues with the brain, with the heart and there’s so many other effects — there’s been research that diabetes affects hearing loss. And so therefore, with all these things, it could increase hospital visits, it could increase major health concerns outside of hearing,” he says.

Changes to ADP grant process paused

After concerns were raised with the ministry, another memo was sent out on Jan. 28 pausing some of the changes.

It read in part:

“Effective immediately, the Hearing Devices Application Forms requiring a prescriber signature and an authorizer signature that are currently in use to apply for funding for an authorized hearing device will continue to be accepted. We are removing physicians as prescribers.”

Arnold says that statement only partially addresses the problem and there is still a lot of confusion that needs to be cleared up.

“With the temporary pause they put in, we are allowed to sign in the authorizer section. However, we still need to get a prescription aside from the ADP grant form, which physicians could sign as well as an audiologist. However, the physicians have been instructed that they no longer need to sign those forms,” he says.

That leaves only audiologists to sign off on hearing aid prescriptions that may be authorized by hearing instrument specialists after a patient assessment.

But given the requirement for audiologists to personally assess patients and the conflict of interest rules, that is not possible either and it’s not clear whether changes will be made to those stipulations.

“So as it stands right now, no one really knows what the straightforward path is — because some audiologists who do assume, ‘okay, I can sign my own prescription,’ may go look somewhere else and find out no, there’s a conflict of interest. So what we really need is clarity,” says Arnold.

In a statement to The Leader Spirit, CASLPO echoed Arnold’s uncertainty.

“The current situation is uncertain, and CASLPO has been seeking clarification from the ADP to provide guidance to audiologists, who continue to provide care to their patients,” they said.

In the memo announcing the pause, the ministry mentioned they would take time for “further consultation with the hearing devices sector.”

Arnold says they reached out to the ADP and finally heard back late Friday (Feb. 8) that they will have the opportunity to meet with them on Tuesday, Feb. 13, to express their concerns and get some clarity.

“If I could have my own way, I would like to go back to how things were before that [first] memo. Right now, the path forward needs to be at least clearing up a lot of this gray area so that audiologists can sign prescriptions where they work, as well as define what a ‘personal assessment’ is. Because it’s unfeasible to have audiologists come in and do every single hearing assessment that’s done in Ontario every single day,” he says, adding that the meeting can’t come soon enough.

“Because we are going to come to a point in a week or two where we’re gonna have to start telling patients we can’t fit this hearing aid. We can’t give you the grant because we’re going to get denied for this reason or another. So it’s really more of an urgent time thing and we all want to work together on it to get it solved.”

CASLPO says some patients are already feeling the impacts of the sudden changes and the pause that followed.

“Because these announcements were unexpected, some patients have experienced challenges in having their application forms accepted by the ADP and getting financial assistance for their hearing aids,” they said in a statement.

Arnold says such delays are detrimental to a patient’s health. He hopes their meeting with the ADP will lead to a quick resolution because when it comes to hearing care, time is of the essence.

Hearing loss gets worse the longer it goes unaddressed, which he says often leads to social isolation and depression.

“We don’t want families to have a relative that no longer comes to events because they can’t hear things. And we see it every day. And this is why when we fit hearing aids and do what we’re doing, we see those people break out in tears when they realize they can hear,” says Arnold.

“I love when they come back and they tell me these stories [that] they went to their daughter’s wedding and were able to hear the ‘I dos’ … I would hate to see people lose things like this because they’re stuck waiting and waiting and waiting.”

The Leader Spirit reached out to the Ministry of Health and received the same memo sent out on Jan. 28 that paused some changes but removed physicians as prescribers, with no further updates at this time.