Medicare Audiologist Access and Services Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 4056 To provide certain coverage of audiologist services under the Medicare program, and for other purposes. IN THE HOUSE OF REPRESENTATIVES JULY 25, 2019 Mr. RICE of South Carolina (for himself, Mr. CARTWRIGHT, Mr. MEADOWS, Mr. NORMAN, Mr. KELLY of Pennsylvania, Ms. SCHAKOWSKY, Mr. SCHNEIDER, Ms. KUSTER of New Hampshire, Mr. BILIRAKIS, and Ms. BLUNT ROCHESTER) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Com- mittee 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 2019’’. 5 SEC. 2. FINDINGS. 6 Congress finds the following: 7 VerDate Sep 11 2014 21:22 Aug 14, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H4056.IH H4056 khammond on DSKBBV9HB2PROD with BILLS 2 •HR 4056 IH (1) Individuals with mild hearing loss are 3 1 times more likely to experience a fall, and falls are 2 the leading cause of fatal injury for Americans over 3 65. 4 (2) Seniors with hearing loss are more likely to 5 develop cognitive problems and experience cognitive 6 decline up to 40 percent faster than those without 7 hearing loss. 8 (3) Untreated hearing loss can lead to depres- 9 sion, anxiety, and social isolation. 10 (4) Timely access to diagnosis and treatment 11 for hearing and vestibular conditions can improve 12 outcomes for beneficiaries and reduce overall cost of 13 care. 14 (5) Licensed audiologists in all 50 States and 15 the District of Columbia are health care profes- 16 sionals that are trained in the diagnosis, treatment 17 and rehabilitation of individuals with hearing, bal- 18 ance, and related disorders. 19 (6) The Medicare program covers a range of 20 hearing health services, including diagnostic and 21 therapeutic services. However, Medicare will only re- 22 imburse audiologists for a narrow set of diagnostic 23 services—even when Medicare-covered treatment 24 services are in the scope of practice of audiologists. 25 VerDate Sep 11 2014 21:22 Aug 14, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H4056.IH H4056 khammond on DSKBBV9HB2PROD with BILLS 3 •HR 4056 IH Medicare also requires patients to receive a physi- 1 cian order before even receiving diagnostic services 2 from audiologists in order for those services to be 3 covered by the Medicare program. 4 (7) The Department of Defense Medical Health 5 System, the Veterans Health Administration, the Of- 6 fice of Personnel Management (through many of its 7 Federal Employees Benefit plans), and many Med- 8 icaid and private health plans provide patients ‘‘di- 9 rect access’’ to audiologists and do not condition re- 10 imbursement on referral by a physician. 11 (8) The National Academy of Sciences, Engi- 12 neering, and Medicine issued a report, entitled 13 ‘‘Hearing Health Care for Adults: Priorities for Im- 14 proving Access and Affordability,’’ which rec- 15 ommended that the Centers for Medicare and Med- 16 icaid Services ‘‘examine pathways for enhancing ac- 17 cess to assessment for and delivery of auditory reha- 18 bilitation services’’ through Medicare, ‘‘including re- 19 imbursement to audiologists for these services’’. 20 (9) Administrative requirements for referral, 21 plan of care, consultation with the attending physi- 22 cian or other health care practitioner, and oversight 23 unnecessarily delay care and may increase costs. 24 VerDate Sep 11 2014 21:22 Aug 14, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4056.IH H4056 khammond on DSKBBV9HB2PROD with BILLS 4 •HR 4056 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 (2)(HH), by striking 15 the period at the end and inserting ‘‘; and’’; 16 and 17 (D) by adding at the end the following new 18 subparagraph: 19 ‘‘(II) audiologist services (as defined in 20 subsection (ll)(3)).’’; and 21 (2) in paragraph (3), by inserting ‘‘(including 22 services supervised by a qualified audiologist but ex- 23 cluding services supervised by a qualified audiologist 24 VerDate Sep 11 2014 21:22 Aug 14, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H4056.IH H4056 khammond on DSKBBV9HB2PROD with BILLS 5 •HR 4056 IH under the supervision of a physician or other health 1 care practitioner)’’ before the semicolon. 2 (b) IMPROVED ACCESS TO AUDIOLOGIST SERV- 3 ICES.—Paragraph (3) of section 1861(ll) of the Social Se- 4 curity Act (42 U.S.C. 1395x(ll)) is amended to read as 5 follows: 6 ‘‘(3) The term ‘audiologist services’ means such 7 diagnostic or treatment services furnished by a 8 qualified audiologist which the qualified audiologist 9 is legally authorized to perform under State law (or 10 the regulatory mechanism provided by State law), as 11 would otherwise be covered if furnished by a physi- 12 cian or as an incident to a physician’s service, with- 13 out regard to any requirement that the individual re- 14 ceiving such audiologist services is under the care of 15 (or referred by) a physician or other health care 16 practitioner or that such services are furnished 17 under the supervision of a physician or other health 18 care practitioner.’’. 19 (c) PAYMENT UNDER THE PHYSICIAN FEE SCHED- 20 ULE.— 21 (1) PROVISION FOR PAYMENT UNDER PART 22 B.—Section 1832(a)(2)(B)(iii) of the Social Security 23 Act (42 U.S.C. 1395k(a)(2)(B)(iii)) is amended by 24 VerDate Sep 11 2014 21:22 Aug 14, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H4056.IH H4056 khammond on DSKBBV9HB2PROD with BILLS 6 •HR 4056 IH inserting ‘‘audiologist services,’’ after ‘‘qualified psy- 1 chologist services,’’. 2 (2) PAYMENT AMOUNT AND COINSURANCE.— 3 Section 1833(a)(1) of such Act (42 U.S.C. 4 1395l(a)(1)) is amended— 5 (A) by striking ‘‘and’’ before (CC); and 6 (B) by inserting before the semicolon at 7 the end the following: ‘‘; and (DD) with respect 8 to audiologist services furnished under section 9 1861(s)(2)(II), the amounts paid shall be 80 10 percent of the lesser of the actual charge for 11 the services or the fee schedule amount pro- 12 vided under section 1848’’. 13 (3) PAYMENT ON ASSIGNMENT-RELATED 14 BASIS.—Section 1842(b)(18)(C) of such Act (42 15 U.S.C. 1395u(b)(18)(C)) is amended by adding at 16 the end the following new clause: 17 ‘‘(vii) An audiologist.’’. 18 (4) PAYMENT UNDER PHYSICIAN FEE SCHED- 19 ULE.—Section 1848(j)(3) of such Act (42 U.S.C. 20 1395w–4(j)(3)) is amended by inserting ‘‘(2)(II),’’ 21 before ‘‘(3),’’. 22 SEC. 4. RULE OF CONSTRUCTION. 23 Nothing in the amendments made by this Act shall 24 be construed to expand the scope of audiologist services 25 VerDate Sep 11 2014 21:22 Aug 14, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H4056.IH H4056 khammond on DSKBBV9HB2PROD with BILLS 7 •HR 4056 IH or the services for which payment may be made to other 1 providers who may receive payment under title XVIII of 2 the Social Security Act (42 U.S.C. 1395 et seq.) beyond 3 those services for which such payment may be made as 4 of December 31, 2019. 5 SEC. 5. EFFECTIVE DATE. 6 The amendments made by this Act shall apply to 7 items and services furnished on or after January 1, 2020. 8 Æ VerDate Sep 11 2014 21:22 Aug 14, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6301 E:\BILLS\H4056.IH H4056 khammond on DSKBBV9HB2PROD with BILLS