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 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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Medicare Audiologist 

5 Access and Services Act of 2019’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 


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1 (1) Individuals with mild hearing loss are 3 

2 times more likely to experience a fall, and falls are 

3 the leading cause of fatal injury for Americans over 

4 65. 

5 (2) Seniors with hearing loss are more likely to 

6 develop cognitive problems and experience cognitive 

7 decline up to 40 percent faster than those without 

8 hearing loss. 

9 (3) Untreated hearing loss can lead to depres10 sion, anxiety, and social isolation. 

11 (4) Timely access to diagnosis and treatment 

12 for hearing and vestibular conditions can improve 

13 outcomes for beneficiaries and reduce overall cost of 

14 care. 

15 (5) Licensed audiologists in all 50 States and 

16 the District of Columbia are health care profes17 sionals that are trained in the diagnosis, treatment 

18 and rehabilitation of individuals with hearing, bal19 ance, and related disorders. 

20 (6) The Medicare program covers a range of 

21 hearing health services, including diagnostic and 

22 therapeutic services. However, Medicare will only re23 imburse audiologists for a narrow set of diagnostic 

24 services—even when Medicare-covered treatment 

25 services are in the scope of practice of audiologists. 


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1 Medicare also requires patients to receive a physi2 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 Of7 fice of Personnel Management (through many of its 

8 Federal Employees Benefit plans), and many Med9 icaid and private health plans provide patients ‘‘di10 rect access’’ to audiologists and do not condition re11 imbursement on referral by a physician. 

12 (8) The National Academy of Sciences, Engi13 neering, and Medicine issued a report, entitled 

14 ‘‘Hearing Health Care for Adults: Priorities for Im15 proving Access and Affordability,’’ which rec16 ommended that the Centers for Medicare and Med17 icaid Services ‘‘examine pathways for enhancing ac18 cess to assessment for and delivery of auditory reha19 bilitation services’’ through Medicare, ‘‘including re20 imbursement to audiologists for these services’’. 

21 (9) Administrative requirements for referral, 

22 plan of care, consultation with the attending physi23 cian or other health care practitioner, and oversight 

24 unnecessarily delay care and may increase costs. 


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1 (10) Medicare beneficiaries should have access 

2 to the same level of audiologic care as is available 

3 in the Veterans Administration, under the Federal 

4 Employees Health Benefits Program, and under pri5 vate insurance. 

6 SEC. 3. MEDICARE COVERAGE OF AUDIOLOGIST SERVICES. 

7 (a) IN GENERAL.—Section 1861(s) of the Social Se8 curity Act (42 U.S.C. 1395x(s)) is amended— 

9 (1) in paragraph (2)— 

10 (A) in subparagraph (A), by inserting ‘‘but 

11 excluding services furnished by a qualified audi12 ologist’’ before the semicolon; 

13 (B) in subparagraph (GG), by striking 

14 ‘‘and’’ at the end; 

15 (C) in subparagraph (2)(HH), by striking 

16 the period at the end and inserting ‘‘; and’’; 

17 and 

18 (D) by adding at the end the following new 

19 subparagraph: 

20 ‘‘(II) audiologist services (as defined in 

21 subsection (ll)(3)).’’; and 

22 (2) in paragraph (3), by inserting ‘‘(including 

23 services supervised by a qualified audiologist but ex24 cluding services supervised by a qualified audiologist 


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1 under the supervision of a physician or other health 

2 care practitioner)’’ before the semicolon. 

3 (b) IMPROVED ACCESS TO AUDIOLOGIST SERV4 ICES.—Paragraph (3) of section 1861(ll) of the Social Se5 curity Act (42 U.S.C. 1395x(ll)) is amended to read as 

6 follows: 

7 ‘‘(3) The term ‘audiologist services’ means such 

8 diagnostic or treatment services furnished by a 

9 qualified audiologist which the qualified audiologist 

10 is legally authorized to perform under State law (or 

11 the regulatory mechanism provided by State law), as 

12 would otherwise be covered if furnished by a physi13 cian or as an incident to a physician’s service, with14 out regard to any requirement that the individual re15 ceiving such audiologist services is under the care of 

16 (or referred by) a physician or other health care 

17 practitioner or that such services are furnished 

18 under the supervision of a physician or other health 

19 care practitioner.’’. 

20 (c) PAYMENT UNDER THE PHYSICIAN FEE SCHED21 ULE.— 

22 (1) PROVISION FOR PAYMENT UNDER PART

23 B.—Section 1832(a)(2)(B)(iii) of the Social Security 

24 Act (42 U.S.C. 1395k(a)(2)(B)(iii)) is amended by 


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1 inserting ‘‘audiologist services,’’ after ‘‘qualified psy2 chologist services,’’. 

3 (2) PAYMENT AMOUNT AND COINSURANCE.— 

4 Section 1833(a)(1) of such Act (42 U.S.C. 

5 1395l(a)(1)) is amended— 

6 (A) by striking ‘‘and’’ before (CC); and 

7 (B) by inserting before the semicolon at 

8 the end the following: ‘‘; and (DD) with respect 

9 to audiologist services furnished under section 

10 1861(s)(2)(II), the amounts paid shall be 80 

11 percent of the lesser of the actual charge for 

12 the services or the fee schedule amount pro13 vided under section 1848’’. 

14 (3) PAYMENT ON ASSIGNMENT-RELATED

15 BASIS.—Section 1842(b)(18)(C) of such Act (42 

16 U.S.C. 1395u(b)(18)(C)) is amended by adding at 

17 the end the following new clause: 

18 ‘‘(vii) An audiologist.’’. 

19 (4) PAYMENT UNDER PHYSICIAN FEE SCHED20 ULE.—Section 1848(j)(3) of such Act (42 U.S.C. 

21 1395w–4(j)(3)) is amended by inserting ‘‘(2)(II),’’ 

22 before ‘‘(3),’’. 

23 SEC. 4. RULE OF CONSTRUCTION. 

24 Nothing in the amendments made by this Act shall 

25 be construed to expand the scope of audiologist services 


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1 or the services for which payment may be made to other 

2 providers who may receive payment under title XVIII of 

3 the Social Security Act (42 U.S.C. 1395 et seq.) beyond 

4 those services for which such payment may be made as 

5 of December 31, 2019. 

6 SEC. 5. EFFECTIVE DATE. 

7 The amendments made by this Act shall apply to 

8 items and services furnished on or after January 1, 2020. 

Æ 


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