May 19, 2021

At Finance Hearing, Warren Urges Senate to Pass Bipartisan Bill to Ensure Better Access to Hearing Health Care Services

Today, Warren reintroduced the bipartisan Medicare Audiologist Access and Services Act to tackle outdated Medicare rules creating barriers to audiology care

Washington, DC - At today's Senate Finance Committee hearing, United States Senator Elizabeth Warren (D-Mass.) made the case for passing the Medicare Audiologist Access and Services Act, which she reintroduced today with Senators Chuck Grassley (R-Iowa) and Rand Paul (R-Ky.). The bipartisan bill would ensure seniors and people with disabilities on Medicare have access to a full range of hearing and balance health care services provided by licensed audiologists, who are trained and licensed in all 50 states and U.S. territories, and the District of Columbia. Senators Jeanne Shaheen (D-N.H.), Sherrod Brown (D-Ohio), and Kyrsten Sinema (D-Ariz.) joined as original co-sponsors.

"It seems to me that the COVID-19 pandemic has forced us all to reconsider bureaucratic limitations to health care-including hearing care. So I believe that the Senate should prioritize the passage of our bill to help seniors get the care that they need," said Senator Warren.

Hearing loss affects 48 million Americans. On average, it takes seven years for patients to seek treatment for hearing issues pre-pandemic. COVID-19 only added additional hurdles to accessing care. During the pandemic, the Centers for Medicare & Medicaid Services (CMS) made it easier for providers, like audiologists, to offer hearing services remotely. During the hearing, Jessica Farb, the Director of Health Care at the U.S. Government Accountability Office, described efforts by CMS to include audiologists in its expansion of telehealth services during the pandemic. For example, audiologists could bill for services like tone decay tests and assessments of tinnitus.

Though Medicare already covers a range of hearing health services, Medicare currently does not recognize audiologists as providers of most hearing health-related services and will only allow reimbursement for a narrow set of tests to diagnose a hearing or balance disorder-and only if patients first obtain an order from a physician or nurse practitioner. Medicare's rules are far more restrictive than many private and federal insurance plans. Making it easier for patients to access audiology services could expand access to hearing health. During the hearing, Dr. Linda V. DeCherrie, the Clinical Director at Mount Sinai at Home and Professor of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai, said there are "numerous studies that have shown reduced risk of falls, improved mood, improved memory, all by being able to hear better."

That is why Senator Warren, Senator Paul, and Senator Grassley reintroduced the Medicare Audiologist Access and Services Act, a bill that Representative Rice (R-S.C.) has reintroduced in the House. The bill:

Amends the definition of "audiology services" in the Medicare statute, which specifies the services that audiologists may provide, to include all services already covered by Medicare that are also within an audiologist's scope of practice;
Amends the Medicare definition of practitioner to include audiologists, which improves beneficiary access to audiologic and vestibular care, a change that is consistent with Medicare's classification of similar health care providers such as clinical social workers and clinical psychologists;
Makes technical changes to the classification of audiology services in the Medicare system as "other diagnostic tests" to remove the pre-treatment order requirement, which does not exist with any other federal or commercial payer; and
Makes no changes to the scope of hearing health benefits covered by Medicare or the scope of practice of audiologists.

The transcript from today's hearing is below.

Hearing Transcript: COVID-19 Health Care Flexibilities: Perspectives, Experiences, and Lessons Learned
U.S. Senate Finance Committee
Wednesday, May 19, 2021

Senator Warren: So when coronavirus hit, patients still needed access to basic health services, like primary care and mental health visits. But COVID made it harder for patients to get the care that they needed. On top of the usual struggles-like taking off time for work-people now had to keep themselves safe from infection. Services that were already difficult to manage, even in the best of times, became much harder to get.

Take hearing loss, which affects 48 million Americans. On average, it takes seven years for patients to seek treatment for hearing issues-even when we're not in a global pandemic. And COVID-19 only added to additional hurdles.

So that's a key reason why the Centers for Medicare & Medicaid Services made it easier for providers, like audiologists, to offer hearing services remotely during the pandemic.

Ms. Farb, what steps has CMS taken during the pandemic to make it easier for patients to access care from audiologists through telehealth during this pandemic?

Ms. Farb: Well, Senator, as you pointed out, CMS initially expanded the types of providers that can furnish telehealth services to include all those eligible to bill which included physical therapists, and speech-language pathologists as well as audiologists. At the beginning they were able to bill for certain codes starting in March of 2020 and some of those codes are not typically the codes that are billed by audiologists, but CMS added additional codes to the list at the end of March of 2021 and that coverage is effective retroactively back to January of 2021. The list included services such as tone decay tests and assessments of tinnitus and so that, that expanded sort of the ability for audiologists to provide those services. We spoke with ASHA, the association that covers speech-language pathologists as well as audiologists and they were very supportive of those changes.

Senator Warren: So Ms. Farb, if I can just summarize. CMS considered audiologists to be important enough to include in the response to the pandemic. But audiologists usually aren't treated equally in the Medicare program. Despite their years of schooling and training, audiologists are considered "suppliers"-not "practitioners"-in the program. And outdated Medicare rules require patients to get their doctors' permission to see an audiologist, rather than letting patients make the decisions they need to improve their hearing.

So let me ask. Dr. DeCherrie, why is it so important that seniors with hearing loss can access the providers they need, including audiologists, without bureaucratic limitations that make it harder for them to get care?

Dr. DeCherrie: Thank you for that question. Yes. I mean, being able to hear is so important, especially for our elderly patients. There have been numerous studies that have shown reduced risk of falls, improved mood, improved memory, all by being able to hear better. We see this every day on, you know, home visits now, where we're trying to do something by video. They can't hear. Just turning up the volume doesn't always, doesn't work. So these patients really do need their hearing assessed and then potentially a hearing aid or whatever is needed.

Senator Warren: In other words, audiologists provide critical services to people with hearing loss. That's why I'm joining Senator Paul and Senator Grassley in reintroducing the Medicare Audiologist Access and Services Act. This is a bill that would expand seniors' access to hearing services by reclassifying audiologists as practitioners in the Medicare program, and that will allow them to bill for services without a physician referral and to provide patients with both the kind of diagnostic and treatment services that are within an audiologists' scope of practice. It seems to me that the COVID-19 pandemic has forced us all to reconsider bureaucratic limitations to health care-including hearing care. So I believe that the Senate should prioritize the passage of our bill to help seniors get the care that they need.

Thank you, Mr. Chairman.

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