Medicare Audiologist Access and Services Act of 2021

To provide certain coverage of audiologist services under the Medicare program, and for other purposes. 1. Short title This Act may be cited as the Medicare Audiologist Access and Services Act of 2021 2. Findings Congress finds the following: (1) Individuals with mild hearing loss are 3 times more likely to experience a fall, and falls are the leading cause of fatal injury for Americans over 65. (2) Seniors with hearing loss are more likely to develop cognitive problems and experience cognitive decline up to 40 percent faster than those without hearing loss. (3) Untreated hearing loss can lead to depression, anxiety, and social isolation. (4) Timely access to diagnosis and treatment for hearing and vestibular conditions can improve outcomes for beneficiaries and reduce overall cost of care. (5) Licensed audiologists in all 50 States and the District of Columbia are health care professionals that are trained in the diagnosis, treatment and rehabilitation of individuals with hearing, balance, and related disorders. (6) The Medicare program covers a range of hearing health services, including diagnostic and therapeutic services. However, Medicare will only reimburse audiologists for a narrow set of diagnostic services—even when Medicare-covered treatment services are in the scope of practice of audiologists. Medicare also requires patients to receive a physician order before even receiving diagnostic services from audiologists in order for those services to be covered by the Medicare program. (7) The Department of Defense Medical Health System, the Veterans Health Administration, the Office of Personnel Management (through many of its Federal Employees Benefit plans), and many Medicaid and private health plans provide patients direct access (8) The National Academy of Sciences, Engineering, and Medicine issued a report, entitled Hearing Health Care for Adults: Priorities for Improving Access and Affordability, examine pathways for enhancing access to assessment for and delivery of auditory rehabilitation services including reimbursement to audiologists for these services (9) Administrative requirements for referral, plan of care, consultation with the attending physician or other health care practitioner, and oversight unnecessarily delay care and may increase costs. (10) Medicare beneficiaries should have access to the same level of audiologic care as is available in the Veterans Administration, under the Federal Employees Health Benefits Program, and under private insurance. 3. Medicare coverage of audiologist services (a) In general Section 1861(s) of the Social Security Act ( 42 U.S.C. 1395x(s) (1) in paragraph (2)— (A) in subparagraph (A), by inserting but excluding services furnished by a qualified audiologist (B) in subparagraph (GG), by striking and (C) in subparagraph (HH), by striking the period at the end and inserting ; and (D) by adding at the end the following new subparagraph: (II) audiologist services (as defined in subsection (ll)(3)). ; and (2) in paragraph (3), by inserting (including services supervised by a qualified audiologist but excluding services supervised by a qualified audiologist under the supervision of a physician or other health care practitioner) (b) Improved access to audiologist services Paragraph (3) of section 1861(ll) of the Social Security Act ( 42 U.S.C. 1395x(ll) (3) The term audiologist services . (c) Payment under the physician fee schedule (1) Provision for payment under part B Section 1832(a)(2)(B)(iii) of the Social Security Act ( 42 U.S.C. 1395k(a)(2)(B)(iii) audiologist services, qualified psychologist services, (2) Payment amount and coinsurance Section 1833(a)(1) of such Act ( 42 U.S.C. 1395l(a)(1) (A) by striking and (B) by inserting before the semicolon at the end the following: , and (EE) with respect to audiologist services furnished under section 1861(s)(2)(II), the amounts paid shall be 80 percent of the lesser of the actual charge for the services or the fee schedule amount provided under section 1848 (3) Payment on assignment-related basis Section 1842(b)(18)(C) of such Act ( 42 U.S.C. 1395u(b)(18)(C) (vii) An audiologist. . (4) Payment under physician fee schedule Section 1848(j)(3) of such Act ( 42 U.S.C. 1395w–4(j)(3) (2)(II), (3), 4. Rule of construction Nothing in the amendments made by this Act shall be construed to expand the scope of audiologist services or the services for which payment may be made to other providers who may receive payment under title XVIII of the Social Security Act ( 42 U.S.C. 1395 5. Effective date The amendments made by this Act shall apply to items and services furnished on or after January 1, 2022.

Summary: Medicare Audiologist Access and Services Act of 2021 This bill provides for Medicare coverage of certain audiologist services. Specifically, the bill expands coverage to include diagnostic and treatment services that are furnished by audiologists and that would otherwise be covered if provided by a physician, including incidental services, regardless of whether such services are provided pursuant to a referral from, or under the supervision of, a physician or other health care practitioner.