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-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medicare Audiologist 
Access and Services Act of 2019’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
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(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 depres-
sion, 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 profes-
sionals that are trained in the diagnosis, treatment 
and rehabilitation of individuals with hearing, bal-
ance, and related disorders. 
(6) The Medicare program covers a range of 
hearing health services, including diagnostic and 
therapeutic services. However, Medicare will only re-
imburse audiologists for a narrow set of diagnostic 
services—even when Medicare-covered treatment 
services are in the scope of practice of audiologists. 
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Medicare also requires patients to receive a physi-
cian 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 Of-
fice of Personnel Management (through many of its 
Federal Employees Benefit plans), and many Med-
icaid and private health plans provide patients ‘‘di-
rect access’’ to audiologists and do not condition re-
imbursement on referral by a physician. 
(8) The National Academy of Sciences, Engi-
neering, and Medicine issued a report, entitled 
‘‘Hearing Health Care for Adults: Priorities for Im-
proving Access and Affordability,’’ which rec-
ommended that the Centers for Medicare and Med-
icaid Services ‘‘examine pathways for enhancing ac-
cess to assessment for and delivery of auditory reha-
bilitation services’’ through Medicare, ‘‘including re-
imbursement to audiologists for these services’’. 
(9) Administrative requirements for referral, 
plan of care, consultation with the attending physi-
cian or other health care practitioner, and oversight 
unnecessarily delay care and may increase costs. 
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(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 pri-
vate insurance. 
SEC. 3. MEDICARE COVERAGE OF AUDIOLOGIST SERVICES. 
(a) IN GENERAL.—Section 1861(s) of the Social Se-
curity Act (42 U.S.C. 1395x(s)) is amended— 
(1) in paragraph (2)— 
(A) in subparagraph (A), by inserting ‘‘but 
excluding services furnished by a qualified audi-
ologist’’ before the semicolon; 
(B) in subparagraph (GG), by striking 
‘‘and’’ at the end; 
(C) in subparagraph (2)(HH), by striking 
the period at the end and inserting ‘‘; and’’; 
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 ex-
cluding services supervised by a qualified audiologist 
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under the supervision of a physician or other health 
care practitioner)’’ before the semicolon. 
(b) IMPROVED
ACCESS
TO
AUDIOLOGIST
SERV-
ICES.—Paragraph (3) of section 1861(ll) of the Social Se-
curity Act (42 U.S.C. 1395x(ll)) is amended to read as 
follows: 
‘‘(3) The term ‘audiologist services’ means such 
diagnostic or treatment services furnished by a 
qualified audiologist which the qualified audiologist 
is legally authorized to perform under State law (or 
the regulatory mechanism provided by State law), as 
would otherwise be covered if furnished by a physi-
cian or as an incident to a physician’s service, with-
out regard to any requirement that the individual re-
ceiving such audiologist services is under the care of 
(or referred by) a physician or other health care 
practitioner or that such services are furnished 
under the supervision of a physician or other health 
care practitioner.’’. 
(c) PAYMENT UNDER THE PHYSICIAN FEE SCHED-
ULE.— 
(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)) is amended by 
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inserting ‘‘audiologist services,’’ after ‘‘qualified psy-
chologist services,’’. 
(2) PAYMENT
AMOUNT
AND
COINSURANCE.— 
Section 1833(a)(1) of such Act (42 U.S.C. 
1395l(a)(1)) is amended— 
(A) by striking ‘‘and’’ before (CC); and 
(B) by inserting before the semicolon at 
the end the following: ‘‘; and (DD) 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 pro-
vided 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)) is amended by adding at 
the end the following new clause: 
‘‘(vii) An audiologist.’’. 
(4) PAYMENT UNDER PHYSICIAN FEE SCHED-
ULE.—Section 1848(j)(3) of such Act (42 U.S.C. 
1395w–4(j)(3)) is amended by inserting ‘‘(2)(II),’’ 
before ‘‘(3),’’. 
SEC. 4. RULE OF CONSTRUCTION. 
Nothing in the amendments made by this Act shall 
be construed to expand the scope of audiologist services 
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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 et seq.) beyond 
those services for which such payment may be made as 
of December 31, 2019. 
SEC. 5. EFFECTIVE DATE. 
The amendments made by this Act shall apply to 
items and services furnished on or after January 1, 2020. 
Æ 
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