Rep. Gus Bilirakis (R-Fla.), a member of the House Energy
and Commerce Committee, introduced legislation into the House of
Representatives that would provide Medicare coverage for the full range of
audiologic diagnostic and treatment services.
H.R. 2330, introduced in June, is a "comprehensive coverage" bill that would allow Medicare-enrolled audiologists to bill for services under the rules for other covered nonphysician services. Current regulations allow audiologists to bill only for diagnostic services, with treatment services billable only by other providers.
Original co-sponsors of the bill, which is supported by the
American Academy of Otolaryngology-Head and Neck Surgeons, include G. K.
Butterfield (D-N.C.), Lois Capps (D-Calif.), Jim Gerlach (R-Pa.), Brett Guthrie
(R-Ky.), Bill Huizenga (R-Mich.), David McKinley (R-W.Va.), Pat Meehan (R-Pa.)
and Michael Michaud (D-Maine).
The bill, which has been referred to the Energy and Commerce Committee for consideration, would provide Medicare beneficiaries with coverage of comprehensive audiology services, including preventive, diagnostic, habilitative and treatment services.
The bill would amend Title XVIII of the Social Security Act
by adding audiology services to the definition of "medical and other health services." It redefines covered audiology services to include a list of specific services when the services are ordered or referred by a physician and furnished by a qualified audiologist (as defined in the statute):
- Hearing and balance assessment.
- Auditory treatment, including auditory processing and
auditory rehabilitation treatment.
- Vestibular treatment.
- Intraoperative neurophysiologic monitoring.
All audiology professional organizations want to increase
access to audiology services for Medicare beneficiaries, but continue to debate
the best approach. ASHA fully supports comprehensive coverage as the most reasonable
and achievable way to provide consumers with more of the audiology services
ASHA, with members' input to the annual public policy agenda and through discussions with the Health Care Economics Committee, Audiology Advisory Council and the Board of Directors, began in 2010 to pursue a comprehensive Medicare audiology benefit that would include both diagnostic and rehabilitative services (see "ASHA Supports Comprehensive Benefit Over Direct Access," The ASHA Leader, July 5, 2011).
ASHA's decision came after discussions with other audiology organizations, extensive analysis of the current political climate and the changing landscape of health care, and consideration of opposition—from physicians and the Centers for Medicare and Medicaid Services—to certain proposed provisions.
ASHA also considered the very real potential that "direct access" legislation—allowing audiologists to provide the diagnostic services currently covered under Medicare but dropping the requirement for physician referral—could codify audiology as a diagnostic-only service.
These compelling factors pointed to a shift in legislative
resources and strategy to a comprehensive audiology benefit. After discussions
with other hearing health organizations, ASHA included an opt-out provision in
its legislative strategy.
With the passage of the Patient Protection and Affordable
Care Act, and congressional and administrative pressure to overhaul the
Medicare system, health care is changing dramatically. New models emphasize
care coordination and establishing medical homes to increase quality of care
and decrease costs. President Obama's 2014 budget proposal reinforced this message by encouraging providers to move to accountable care organizations and ultimately linking payment to such participation.
Under ASHA's approach, beneficiaries would have greater choice in choosing providers. The bill would not add new services to Medicare, as rehabilitation and vestibular therapy are covered services when billed by other Medicare providers. Instead, the legislation allows beneficiaries to seek those services from audiologists who could also manage their patients' care.
Critics have raised concerns that the comprehensive benefit
would lower Medicare reimbursement rates for audiology services. ASHA does not
anticipate that outcome as those services, which are covered benefits when
delivered by other providers, already have a value under the Medicare program.
Additionally, new models of care demand measurement of
quality and efficiency. Under the current Medicare system, outcomes are more
difficult to measure because the audiology provider performing the evaluation
is not managing the care of the patient and is limited to reporting the
findings of a diagnostic test. Once diagnosed, patients must be referred to
other providers who offer treatment, even though those providers have not
diagnosed the condition. To develop meaningful measures to assess quality,
efficiency and patient outcomes of audiology services, clinically appropriate
diagnosis and intervention measures must be included.
"Although the audiology community is discussing other options for legislative changes, ASHA believes that a bill focusing on comprehensive benefits is most likely to garner legislative support," says ASHA President Patty Prelock. "We are also committed to continued communication with our colleagues in other audiology organizations about these legislative efforts, and to advocate for the best interests of audiologists and the patients they serve."