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) introduced the following bill; which was read twice and referred to the Committee on Finance 

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: 

8 (1) Individuals with mild hearing loss are 3 

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


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1 the leading cause of fatal injury for Americans over 

2 65. 

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

4 develop cognitive problems and experience cognitive 

5 decline up to 40 percent faster than those without 

6 hearing loss. 

7 (3) Untreated hearing loss can lead to depres8 sion, anxiety, and social isolation. 

9 (4) Timely access to diagnosis and treatment 

10 for hearing and vestibular conditions can improve 

11 outcomes for beneficiaries and reduce overall cost of 

12 care. 

13 (5) Licensed audiologists in all 50 States and 

14 the District of Columbia are health care profes15 sionals trained in the diagnosis, treatment, and re16 habilitation of individuals with hearing, balance, and 

17 related disorders. 

18 (6) The Medicare program covers a range of 

19 hearing health services, including diagnostic and 

20 therapeutic services. However, Medicare will only re21 imburse audiologists for a narrow set of diagnostic 

22 services—even when Medicare-covered treatment 

23 services are in the scope of practice of audiologists. 

24 Medicare also requires patients to receive a physi25 cian order before even receiving diagnostic services 


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1 from audiologists in order for those services to be 

2 covered by Medicare. 

3 (7) The Department of Defense Medical Health 

4 System, the Veterans Health Administration, the Of5 fice of Personnel Management (through many of its 

6 Federal Employees Health Benefits plans), and 

7 many Medicaid and private health plans provide pa8 tients ‘‘direct access’’ to audiologists and do not con9 dition reimbursement on referral by a physician. 

10 (8) The National Academy of Sciences, Engi11 neering, and Medicine issued a report, entitled 

12 ,‘‘Hearing Health Care for Adults: Priorities for Im13 proving Access and Affordability’’, which rec14 ommended that the Centers for Medicare & Medicaid 

15 Services ‘‘examine pathways for enhancing access to 

16 assessment for and delivery of auditory rehabilita17 tion services’’ through Medicare, ‘‘including reim18 bursement to audiologists for these services’’. 

19 (9) Administrative requirements for referral, 

20 plan of care, consultation with the attending physi21 cian or other health care practitioner, and oversight 

22 unnecessarily delay care and may increase costs. 

23 (10) Medicare beneficiaries should have access 

24 to the same level of audiologic care as is available 

25 in the Veterans Administration, under the Federal 


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1 Employees Health Benefits Program, and under pri2 vate insurance. 

3 SEC. 3. MEDICARE COVERAGE OF AUDIOLOGIST SERVICES. 

4 (a) IN GENERAL.—Section 1861(s) of the Social Se5 curity Act (42 U.S.C. 1395x(s)) is amended— 

6 (1) in paragraph (2)— 

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

8 excluding services furnished by a qualified audi9 ologist’’ before the semicolon; 

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

11 ‘‘and’’ at the end; 

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

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

14 and 

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

16 subparagraph: 

17 ‘‘(II) audiologist services (as defined in sub18 section (ll)(3)).’’; and 

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

20 services supervised by a qualified audiologist but ex21 cluding services supervised by a qualified audiologist 

22 under the supervision of a physician or other health 

23 care practitioner)’’ before the semicolon. 

24 (b) IMPROVED ACCESS TO AUDIOLOGIST SERV25 ICES.—Paragraph (3) of section 1861(ll) of the Social SeVerDate Sep 11 2014 01:33 Sep 10, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S2446.IS S2446

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1 curity Act (42 U.S.C. 1395x(ll)) is amended to read as 

2 follows: 

3 ‘‘(3) The term ‘audiologist services’ means such diag4 nostic or treatment services furnished by a qualified audi5 ologist which the qualified audiologist is legally authorized 

6 to perform under State law (or the regulatory mechanism 

7 provided by State law), as would otherwise be covered if 

8 furnished by a physician or as an incident to a physician’s 

9 service, without regard to any requirement that the indi10 vidual receiving such audiologist services is under the care 

11 of (or referred by) a physician or other health care practi12 tioner or that such services are furnished under the super13 vision of a physician or other health care practitioner.’’. 

14 (c) PAYMENT UNDER THE PHYSICIAN FEE SCHED15 ULE.— 

16 (1) PROVISION FOR PAYMENT UNDER PART

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

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

19 inserting ‘‘audiologist services,’’ after ‘‘qualified psy20 chologist services,’’. 

21 (2) PAYMENT AMOUNT AND COINSURANCE.— 

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

23 1395l(a)(1)) is amended— 

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


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1 (B) by inserting before the semicolon at 

2 the end the following: ‘‘; and (DD) 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 pro7 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 SCHED14 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 services for which payment may be made to other pro21 viders under title XVIII of the Social Security Act (42 

22 U.S.C. 1395 et seq.) beyond those services for which such 

23 payment may be made as of December 31, 2019. 


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1 SEC. 5. EFFECTIVE DATE. 

2 The amendments made by this Act shall apply to 

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

Æ 


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