Medicare Audiologist Access and Services Act of 2021
Bill: S.1731 | Sponsor: Sen. Warren, Elizabeth (D-MA)
Policy area: Health

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.

To provide certain coverage of audiologist services under the Medicare 
                    program, and for other purposes.

    Be it enacted by the Senate and House of Representatives 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 2021''.

SEC. 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 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 
        Medicare.
            (7) The Department of Defense Medical Health System, the 
        Veterans Health Administration, the Office of Personnel 
        Management (through many of its Federal Employees Health 
        Benefits plans), and many Medicaid and private health plans 
        provide patients ``direct access'' to audiologists and do not 
        condition reimbursement on referral by a physician.
            (8) The National Academy of Sciences, Engineering, and 
        Medicine issued a report, entitled, ``Hearing Health Care for 
        Adults: Priorities for Improving Access and Affordability'', 
        which recommended that the Centers for Medicare & Medicaid 
        Services ``examine pathways for enhancing access to assessment 
        for and delivery of auditory rehabilitation services'' through 
        Medicare, ``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.

SEC. 3. MEDICARE COVERAGE OF AUDIOLOGIST SERVICES.

    (a) In General.--Section 1861(s) of the Social Security 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 
                audiologist'' before the semicolon;
                    (B) in subparagraph (GG), by striking ``and'' at 
                the end;
                    (C) in subparagraph (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 excluding services 
        supervised by a qualified audiologist under the supervision of 
        a physician or other health care practitioner)'' before the 
        semicolon.
    (b) Improved Access to Audiologist Services.--Paragraph (3) of 
section 1861(ll) of the Social Security 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 physician or as an incident to a 
physician's service, without regard to any requirement that the 
individual receiving 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 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)) is amended by inserting ``audiologist 
        services,'' after ``qualified psychologist 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 (DD); 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)) is 
        amended by adding at the end the following new clause:
                            ``(vii) An audiologist.''.
            (4) Payment under physician fee schedule.--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 or services for which payment 
may be made to other providers 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, 2021.

SEC. 5. EFFECTIVE DATE.

    The amendments made by this Act shall apply to items and services 
furnished on or after January 1, 2022.
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