Medicare Audiologist Access and Services Act of 2019

II 116TH CONGRESS 1ST SESSION S. 2446 To provide certain coverage of audiologist services under the Medicare program, and for other purposes. IN THE SENATE OF THE UNITED STATES SEPTEMBER 9, 2019 Ms. WARREN (for herself, Mr. PAUL, Mr. BROWN, and Mr. WICKER) intro- duced the following bill; which was read twice and referred to the Com- mittee on Finance 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 (1) Individuals with mild hearing loss are 3 8 times more likely to experience a fall, and falls are 9 VerDate Sep 11 2014 01:33 Sep 10, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S2446.IS S2446 pamtmann on DSKBC07HB2PROD with BILLS 2 •S 2446 IS the leading cause of fatal injury for Americans over 1 65. 2 (2) Seniors with hearing loss are more likely to 3 develop cognitive problems and experience cognitive 4 decline up to 40 percent faster than those without 5 hearing loss. 6 (3) Untreated hearing loss can lead to depres- 7 sion, anxiety, and social isolation. 8 (4) Timely access to diagnosis and treatment 9 for hearing and vestibular conditions can improve 10 outcomes for beneficiaries and reduce overall cost of 11 care. 12 (5) Licensed audiologists in all 50 States and 13 the District of Columbia are health care profes- 14 sionals trained in the diagnosis, treatment, and re- 15 habilitation of individuals with hearing, balance, and 16 related disorders. 17 (6) The Medicare program covers a range of 18 hearing health services, including diagnostic and 19 therapeutic services. However, Medicare will only re- 20 imburse audiologists for a narrow set of diagnostic 21 services—even when Medicare-covered treatment 22 services are in the scope of practice of audiologists. 23 Medicare also requires patients to receive a physi- 24 cian order before even receiving diagnostic services 25 VerDate Sep 11 2014 01:33 Sep 10, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S2446.IS S2446 pamtmann on DSKBC07HB2PROD with BILLS 3 •S 2446 IS from audiologists in order for those services to be 1 covered by Medicare. 2 (7) The Department of Defense Medical Health 3 System, the Veterans Health Administration, the Of- 4 fice of Personnel Management (through many of its 5 Federal Employees Health Benefits plans), and 6 many Medicaid and private health plans provide pa- 7 tients ‘‘direct access’’ to audiologists and do not con- 8 dition reimbursement on referral by a physician. 9 (8) The National Academy of Sciences, Engi- 10 neering, and Medicine issued a report, entitled 11 ,‘‘Hearing Health Care for Adults: Priorities for Im- 12 proving Access and Affordability’’, which rec- 13 ommended that the Centers for Medicare & Medicaid 14 Services ‘‘examine pathways for enhancing access to 15 assessment for and delivery of auditory rehabilita- 16 tion services’’ through Medicare, ‘‘including reim- 17 bursement to audiologists for these services’’. 18 (9) Administrative requirements for referral, 19 plan of care, consultation with the attending physi- 20 cian or other health care practitioner, and oversight 21 unnecessarily delay care and may increase costs. 22 (10) Medicare beneficiaries should have access 23 to the same level of audiologic care as is available 24 in the Veterans Administration, under the Federal 25 VerDate Sep 11 2014 02:34 Sep 10, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S2446.IS S2446 pamtmann on DSKBC07HB2PROD with BILLS 4 •S 2446 IS Employees Health Benefits Program, and under pri- 1 vate insurance. 2 SEC. 3. MEDICARE COVERAGE OF AUDIOLOGIST SERVICES. 3 (a) IN GENERAL.—Section 1861(s) of the Social Se- 4 curity Act (42 U.S.C. 1395x(s)) is amended— 5 (1) in paragraph (2)— 6 (A) in subparagraph (A), by inserting ‘‘but 7 excluding services furnished by a qualified audi- 8 ologist’’ before the semicolon; 9 (B) in subparagraph (GG), by striking 10 ‘‘and’’ at the end; 11 (C) in subparagraph (2)(HH), by striking 12 the period at the end and inserting ‘‘; and’’; 13 and 14 (D) by adding at the end the following new 15 subparagraph: 16 ‘‘(II) audiologist services (as defined in sub- 17 section (ll)(3)).’’; and 18 (2) in paragraph (3), by inserting ‘‘(including 19 services supervised by a qualified audiologist but ex- 20 cluding services supervised by a qualified audiologist 21 under the supervision of a physician or other health 22 care practitioner)’’ before the semicolon. 23 (b) IMPROVED ACCESS TO AUDIOLOGIST SERV- 24 ICES.—Paragraph (3) of section 1861(ll) of the Social Se- 25 VerDate Sep 11 2014 01:33 Sep 10, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S2446.IS S2446 pamtmann on DSKBC07HB2PROD with BILLS 5 •S 2446 IS curity Act (42 U.S.C. 1395x(ll)) is amended to read as 1 follows: 2 ‘‘(3) The term ‘audiologist services’ means such diag- 3 nostic or treatment services furnished by a qualified audi- 4 ologist which the qualified audiologist is legally authorized 5 to perform under State law (or the regulatory mechanism 6 provided by State law), as would otherwise be covered if 7 furnished by a physician or as an incident to a physician’s 8 service, without regard to any requirement that the indi- 9 vidual receiving such audiologist services is under the care 10 of (or referred by) a physician or other health care practi- 11 tioner or that such services are furnished under the super- 12 vision of a physician or other health care practitioner.’’. 13 (c) PAYMENT UNDER THE PHYSICIAN FEE SCHED- 14 ULE.— 15 (1) PROVISION FOR PAYMENT UNDER PART 16 B.—Section 1832(a)(2)(B)(iii) of the Social Security 17 Act (42 U.S.C. 1395k(a)(2)(B)(iii)) is amended by 18 inserting ‘‘audiologist services,’’ after ‘‘qualified psy- 19 chologist services,’’. 20 (2) PAYMENT AMOUNT AND COINSURANCE.— 21 Section 1833(a)(1) of such Act (42 U.S.C. 22 1395l(a)(1)) is amended— 23 (A) by striking ‘‘and’’ before (CC); and 24 VerDate Sep 11 2014 01:33 Sep 10, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S2446.IS S2446 pamtmann on DSKBC07HB2PROD with BILLS 6 •S 2446 IS (B) by inserting before the semicolon at 1 the end the following: ‘‘; and (DD) with respect 2 to audiologist services furnished under section 3 1861(s)(2)(II), the amounts paid shall be 80 4 percent of the lesser of the actual charge for 5 the services or the fee schedule amount pro- 6 vided under section 1848’’. 7 (3) PAYMENT ON ASSIGNMENT-RELATED 8 BASIS.—Section 1842(b)(18)(C) of such Act (42 9 U.S.C. 1395u(b)(18)(C)) is amended by adding at 10 the end the following new clause: 11 ‘‘(vii) An audiologist.’’. 12 (4) PAYMENT UNDER PHYSICIAN FEE SCHED- 13 ULE.—Section 1848(j)(3) of such Act (42 U.S.C. 14 1395w–4(j)(3)) is amended by inserting ‘‘(2)(II),’’ 15 before ‘‘(3),’’. 16 SEC. 4. RULE OF CONSTRUCTION. 17 Nothing in the amendments made by this Act shall 18 be construed to expand the scope of audiologist services 19 or services for which payment may be made to other pro- 20 viders under title XVIII of the Social Security Act (42 21 U.S.C. 1395 et seq.) beyond those services for which such 22 payment may be made as of December 31, 2019. 23 VerDate Sep 11 2014 02:34 Sep 10, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S2446.IS S2446 pamtmann on DSKBC07HB2PROD with BILLS 7 •S 2446 IS SEC. 5. EFFECTIVE DATE. 1 The amendments made by this Act shall apply to 2 items and services furnished on or after January 1, 2020. 3 Æ VerDate Sep 11 2014 01:33 Sep 10, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6301 E:\BILLS\S2446.IS S2446 pamtmann on DSKBC07HB2PROD with BILLS