On July 25, 2019, US Representatives Tom Rice (R-SC), Matt Cartwright (D-PA), Mark Meadows (R-NC), Ralph Norman (R-SC), Mike Kelly (R-PA), Jan Schakowsky (D-IL), Brad Schneider (D-IL), Ann Kuster (D-NH), Gus Bilirakis (R-FL), and Lisa Blunt-Rochester (D-DE) introduced the Medicare Audiologist Access and Services Act of 2019 (HR 4056). This legislation reportedly “will enhance the Medicare benefit by providing beneficiaries critical direct access to both diagnostic and therapeutic services of audiologists.”
In a joint statement of support, the American Academy of Audiology (AAA), the Academy of Doctors of Audiology (ADA), the American Speech-Language-Hearing Association (ASHA), and the Hearing Loss Association of America (HLAA), announced their endorsement of the bill. According to the statement, Senators Elizabeth Warren (D-MA) and Rand Paul (R-KY) plan to introduce a Senate companion bill imminently.

AAA, ASHA, and ADA have a long history of clashing over Medicare reimbursement or “direct access” issues, which included various versions of the previous Audiology Services Enhancement Act. Hearing Review covered ASHA, AAA, and ADA’s agreement earlier this year to join forces to develop legislation that expands access to and coverage of audiology services under Medicare, as well as the controversy over the Audiology Patient Choice Act introduced by Warren and Paul.

The Medicare Audiologist Access and Services Act of 2019 (HR 4056) will remove “unnecessary barriers, allowing patients to receive appropriate, timely, and cost-effective audiologic care,” according to the bill. This legislation is said to improve outcomes for beneficiaries by allowing direct access to audiologic services and streamlining Medicare coverage policies so that audiologists can provide the full range of Medicare-covered diagnostic and treatment services that correspond to their scope of practice, according to the statement. The legislation would also reclassify audiologists as practitioners, which is consistent with the way Medicare recognizes other non-physician providers, such as clinical psychologists, clinical social workers, and advanced practice registered nurses.

In a separate statement, the ADA praised the lawmakers who worked on the introduction of HR 4056.

“Seniors who suffer from hearing conditions shouldn’t have to jump through hoops to see their preferred audiologist,” said Rep Rice. “The Medicare Audiologist Access and Services Act cuts through the red tape to help Medicare patients access quality, affordable care. I will continue to reach across the aisle to find straightforward solutions to health care problems.”

The Medicare Audiologist Access and Services Act can help improve outcomes and reduce barriers to care by allowing Medicare beneficiaries to seek treatment directly from audiologists if they suspect they have a hearing or balance problem, according to the ADA’s statement.

“Hearing and balance disorders become more prevalent with age and, if left untreated, pose significant health, social, and financial risks,” said ADA President Ram Nileshwar, AuD, in a press statement. “ADA applauds Rep Rice and his colleagues for acting to remove impediments to the delivery of efficient, high-quality hearing and balance health care for millions of Medicare beneficiaries across the country.”

“ADA staff and leaders are proud to work alongside our esteemed colleagues to advocate for better access to care for our patients and to ensure that audiologists are classified within the Medicare system in a manner that reflects their extensive training, education, and scope of practice,” said Nileshwar.

ASHA, in a separate statement, supported the legislation, for its expanded access to coverage. Currently, Medicare requires a physician order for patients to see an audiologist—and covers only diagnostic services provided by the audiologist without allowing for follow-up treatment or a plan of care.

“It is imperative that Congress move this legislation through quickly to ensure that Medicare beneficiaries have timely access to audiologists’ diagnostic and therapeutic services for hearing and balance conditions,” said ASHA President Shari Robertson, PhD. “Untreated hearing loss can adversely affect quality of life and lead to other conditions, such as cognitive decline, depression, anxiety, and social isolation.”

Direct access bills usually enjoy strong support from most audiologists, but have had a well-documented history of controversy, with the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) and the International Hearing Society (IHS) generally opposing the legislation—making it more difficult for the it to gain traction in Congress. In 2014, AAA ended up giving the ADA’s 18×18 initiative its support, but also pursued its own Access to Hearing Health Care Act before eventually endorsing the Audiology Patient Choice Act in May 2015. In 2018, the AAA Academy Membership Meeting revealed that the AAA Board of Directors agreed with most facets of the bill, but were wary of its unintended consequences.