The $1.9 trillion Build Back Better Act was narrowly passed by the US House of Representatives on Friday, November 19, and is now with the Senate for what is sure to be a bumpy ride. The bill includes coverage of hearing aids once every 5 years for people with moderately severe to profound hearing loss, as well as funding for universal preschool, expanded Child Tax Credits, several health and pandemic-related initiatives, renewable energy credits, and more.

Although it continues to be modified, under the current provisions, hearing aids could be furnished once every 5 years for people with moderately severe to profound hearing losses. Any hearing aid covered by Medicare would require written recommendation from a physician, qualified audiologist or hearing care professional, physician assistant, nurse practitioner, or clinical nurse specialist.  The bill also includes some aural rehabilitation and treatment services, and categorizes hearing aids as a prosthetic device (as opposed to durable medical equipment)—two extremely important provisions for dispensing professionals and the hearing industry. It also now includes language to include “qualified hearing aid professionals” for the services in addition to audiologists. Hearing aids would also be excluded from competitive bidding when furnished by a physician or other practitioner to their own patients as part of a professional service. Because the Medicare coverage extends only to the severe and profound loss category, the upcoming class of over-the-counter (OTC) hearing aids being considered by FDA would not be covered under the Act.

According to an update from the American Speech Language Hearing Association, the bill also incorporates provisions from the Medicare Audiologist Access and Services Act (H.R. 1587/S. 1731), also known as MAASA, that would reclassify audiologists as practitioners under Medicare. However, ASHA expressed disappointment that “the bill does not remove the physician order requirement for coverage of diagnostic audiology services, which is essential for beneficiary access.” The audiology organizations are also making “recommendations to differentiate hearing aid dispensers and define hearing aid dispensing services in a manner congruent with state licensure.”

Other top priorities for inclusion in the bill is to enable Medicare beneficiaries to “top-up” the cost of a hearing aid from the funded amount so they can retain a choice in technologies and obtain the best hearing solution for their individual needs.

The Build Back Better bill passed on a 220-213 vote in the US House. In total, 13 Republicans and 6 Democrats crossed party lines to vote for or against the bill, respectively. Its passage was hailed as a major victory for House Speaker Nancy Pelosi.

It will now be championed by Senate Majority Leader Chuck Shumer (D-NY) who says he hopes to pass the legislation by Christmas. Standing in his way are Senate Republicans and possibly at least two Democrats—Senators Joe Manchin of West Virginia and Kyrsten Sinema of Arizona—who have chiefly expressed concerns about the costs of the bill. With a 50/50 split in Senate seats, Shumer will need all 50 Democratic votes and the tie-breaking vote of Vice President Kamala Harris to pass the legislation.

“The House did a very strong bill,” said Senator Shumer in a press conference. “Everyone knows that Manchin and Sinema have their concerns, but we’re going to try to negotiate with them and get a very strong, bold bill out of the Senate which will then go back to the House and pass.”

To gain the support of Senators Manchin and Sinema, some provisions in the bill will probably need to be modified and/or cut, necessitating a return vote in the US House. Although its possible that any of the bill’s provisions could be cut, the Medicare expansion to cover hearing aids are seen as being popular on both sides of the aisle, even given the Congressional Budget Office’s 10-year estimated cost of about $89 billion for hearing care.

If the legislation is passed, the Medicare hearing benefit provision would take effect in 2023.

Correction: The original version of this article stated that hearing aid coverage would apply only to people with severe and profound hearing losses. In fact, the bill’s language was modified to include “moderately severe” with severe and profound hearing loss. Because these are relatively nebulous definitions, it is not yet known how a Medicare beneficiary’s hearing loss would be defined relative to these hearing loss categories.