Medicare Audiologist Access and Services Act of 2021

I 117TH CONGRESS 1ST SESSION H. R. 1587 To provide certain coverage of audiologist services under the Medicare program, and for other purposes. IN THE HOUSE OF REPRESENTATIVES MARCH 3, 2021 Mr. RICE of South Carolina (for himself, Mr. CARTWRIGHT, Mr. KELLY of Pennsylvania, Mr. YOUNG, Mr. COLE, Mr. BILIRAKIS, Mr. RODNEY DAVIS of Illinois, Ms. UNDERWOOD, Mr. NORMAN, Mr. COHEN, Mr. MCKINLEY, Mr. FITZPATRICK, Ms. WILD, Ms. MCCOLLUM, Mr. BUTTERFIELD, Mr. RESCHENTHALER, Mr. WELCH, Mr. RUTHERFORD, Mr. MASSIE, Mr. YARMUTH, Ms. BLUNT ROCHESTER, Mr. O’HALLERAN, Mrs. MCBATH, Mr. NEGUSE, Ms. SCHAKOWSKY, and Mr. FOSTER) intro- duced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To provide certain coverage of audiologist services under the Medicare program, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Medicare Audiologist 4 Access and Services Act of 2021’’. 5 VerDate Sep 11 2014 22:19 Apr 18, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H1587.IH H1587 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 1587 IH SEC. 2. FINDINGS. 1 Congress finds the following: 2 (1) Individuals with mild hearing loss are 3 3 times more likely to experience a fall, and falls are 4 the leading cause of fatal injury for Americans over 5 65. 6 (2) Seniors with hearing loss are more likely to 7 develop cognitive problems and experience cognitive 8 decline up to 40 percent faster than those without 9 hearing loss. 10 (3) Untreated hearing loss can lead to depres- 11 sion, anxiety, and social isolation. 12 (4) Timely access to diagnosis and treatment 13 for hearing and vestibular conditions can improve 14 outcomes for beneficiaries and reduce overall cost of 15 care. 16 (5) Licensed audiologists in all 50 States and 17 the District of Columbia are health care profes- 18 sionals that are trained in the diagnosis, treatment 19 and rehabilitation of individuals with hearing, bal- 20 ance, and related disorders. 21 (6) The Medicare program covers a range of 22 hearing health services, including diagnostic and 23 therapeutic services. However, Medicare will only re- 24 imburse audiologists for a narrow set of diagnostic 25 services—even when Medicare-covered treatment 26 VerDate Sep 11 2014 22:19 Apr 18, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1587.IH H1587 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 1587 IH services are in the scope of practice of audiologists. 1 Medicare also requires patients to receive a physi- 2 cian order before even receiving diagnostic services 3 from audiologists in order for those services to be 4 covered by the Medicare program. 5 (7) The Department of Defense Medical Health 6 System, the Veterans Health Administration, the Of- 7 fice of Personnel Management (through many of its 8 Federal Employees Benefit plans), and many Med- 9 icaid and private health plans provide patients ‘‘di- 10 rect access’’ to audiologists and do not condition re- 11 imbursement on referral by a physician. 12 (8) The National Academy of Sciences, Engi- 13 neering, and Medicine issued a report, entitled 14 ‘‘Hearing Health Care for Adults: Priorities for Im- 15 proving Access and Affordability,’’ which rec- 16 ommended that the Centers for Medicare and Med- 17 icaid Services ‘‘examine pathways for enhancing ac- 18 cess to assessment for and delivery of auditory reha- 19 bilitation services’’ through Medicare, ‘‘including re- 20 imbursement to audiologists for these services’’. 21 (9) Administrative requirements for referral, 22 plan of care, consultation with the attending physi- 23 cian or other health care practitioner, and oversight 24 unnecessarily delay care and may increase costs. 25 VerDate Sep 11 2014 22:19 Apr 18, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1587.IH H1587 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 1587 IH (10) Medicare beneficiaries should have access 1 to the same level of audiologic care as is available 2 in the Veterans Administration, under the Federal 3 Employees Health Benefits Program, and under pri- 4 vate insurance. 5 SEC. 3. MEDICARE COVERAGE OF AUDIOLOGIST SERVICES. 6 (a) IN GENERAL.—Section 1861(s) of the Social Se- 7 curity Act (42 U.S.C. 1395x(s)) is amended— 8 (1) in paragraph (2)— 9 (A) in subparagraph (A), by inserting ‘‘but 10 excluding services furnished by a qualified audi- 11 ologist’’ before the semicolon; 12 (B) in subparagraph (GG), by striking 13 ‘‘and’’ at the end; 14 (C) in subparagraph (HH), by striking the 15 period at the end and inserting ‘‘; and’’; and 16 (D) by adding at the end the following new 17 subparagraph: 18 ‘‘(II) audiologist services (as defined in 19 subsection (ll)(3)).’’; and 20 (2) in paragraph (3), by inserting ‘‘(including 21 services supervised by a qualified audiologist but ex- 22 cluding services supervised by a qualified audiologist 23 under the supervision of a physician or other health 24 care practitioner)’’ before the semicolon. 25 VerDate Sep 11 2014 22:19 Apr 18, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1587.IH H1587 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 1587 IH (b) IMPROVED ACCESS TO AUDIOLOGIST SERV- 1 ICES.—Paragraph (3) of section 1861(ll) of the Social Se- 2 curity Act (42 U.S.C. 1395x(ll)) is amended to read as 3 follows: 4 ‘‘(3) The term ‘audiologist services’ means such diag- 5 nostic or treatment services furnished by a qualified audi- 6 ologist which the qualified audiologist is legally authorized 7 to perform under State law (or the regulatory mechanism 8 provided by State law), as would otherwise be covered if 9 furnished by a physician or as an incident to a physician’s 10 service, without regard to any requirement that the indi- 11 vidual receiving such audiologist services is under the care 12 of (or referred by) a physician or other health care practi- 13 tioner or that such services are furnished under the super- 14 vision of a physician or other health care practitioner.’’. 15 (c) PAYMENT UNDER THE PHYSICIAN FEE SCHED- 16 ULE.— 17 (1) PROVISION FOR PAYMENT UNDER PART 18 B.—Section 1832(a)(2)(B)(iii) of the Social Security 19 Act (42 U.S.C. 1395k(a)(2)(B)(iii)) is amended by 20 inserting ‘‘audiologist services,’’ after ‘‘qualified psy- 21 chologist services,’’. 22 (2) PAYMENT AMOUNT AND COINSURANCE.— 23 Section 1833(a)(1) of such Act (42 U.S.C. 24 1395l(a)(1)) is amended— 25 VerDate Sep 11 2014 22:19 Apr 18, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1587.IH H1587 kjohnson on DSK79L0C42PROD with BILLS 6 •HR 1587 IH (A) by striking ‘‘and’’ before (DD); and 1 (B) by inserting before the semicolon at 2 the end the following: ‘‘, and (EE) with respect 3 to audiologist services furnished under section 4 1861(s)(2)(II), the amounts paid shall be 80 5 percent of the lesser of the actual charge for 6 the services or the fee schedule amount pro- 7 vided under section 1848’’. 8 (3) PAYMENT ON ASSIGNMENT-RELATED 9 BASIS.—Section 1842(b)(18)(C) of such Act (42 10 U.S.C. 1395u(b)(18)(C)) is amended by adding at 11 the end the following new clause: 12 ‘‘(vii) An audiologist.’’. 13 (4) PAYMENT UNDER PHYSICIAN FEE SCHED- 14 ULE.—Section 1848(j)(3) of such Act (42 U.S.C. 15 1395w–4(j)(3)) is amended by inserting ‘‘(2)(II),’’ 16 before ‘‘(3),’’. 17 SEC. 4. RULE OF CONSTRUCTION. 18 Nothing in the amendments made by this Act shall 19 be construed to expand the scope of audiologist services 20 or the services for which payment may be made to other 21 providers who may receive payment under title XVIII of 22 the Social Security Act (42 U.S.C. 1395 et seq.) beyond 23 those services for which such payment may be made as 24 of December 31, 2021. 25 VerDate Sep 11 2014 22:19 Apr 18, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H1587.IH H1587 kjohnson on DSK79L0C42PROD with BILLS 7 •HR 1587 IH SEC. 5. EFFECTIVE DATE. 1 The amendments made by this Act shall apply to 2 items and services furnished on or after January 1, 2022. 3 Æ VerDate Sep 11 2014 22:19 Apr 18, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6301 E:\BILLS\H1587.IH H1587 kjohnson on DSK79L0C42PROD with BILLS