November 09, 2023

ICYMI: Senator Warren Secures Commitments on Hearing Health and Medicare Advantage Priorities During Senate Finance Committee Markup of Health Care Package

Washington, D.C. — At a Senate Finance Committee markup of the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act, U.S. Senator Elizabeth Warren (D-Mass.) highlighted the need to do more to prioritize hearing health for our seniors and strengthen transparency in Medicare Advantage, and secured commitments from Senate Finance Committee leadership to prioritize these proposals in future packages. 

Senator Warren highlighted her legislation with Senators Rand Paul (R-Ky.) and Chuck Grassley (R-Iowa), the Medicare Audiology Access Improvement Act, which would ensure that seniors and people with disabilities on Medicare are able to access 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, including the District of Columbia. 

“There is substantial research linking hearing health with mental health,” said Senator Warren. “If we are working to strengthen support for seniors’ mental health and mental acuity, then we should include access to health care aimed at treating hearing and balance disorders.”

Senator Warren also spoke about the need for greater transparency in Medicare Advantage, including her amendment to require the Centers for Medicare and Medicaid Services to collect and publish data from Medicare Advantage plans on their prior authorization practices.

“Currently, there are no data on the number of prior authorization requests, denials, and appeals by type of service,” said Senator Warren. “I look forward to working…with our Chairman and our Ranking Member to close these data gaps in Medicare Advantage so that seniors have the information they need to get the coverage that works best for them.”

Statement: U.S. Senate Finance Committee Markup of Better Mental Health Care, Lower-Cost Drugs, and Extenders Act
U.S. Senate Finance Committee
Wednesday, November 8, 2023

Senator Elizabeth Warren: This is important. This is about removing the outdated rules in Medicare that prevent seniors and people with disabilities from accessing the full range of hearing and balance health care services provided by licensed audiologists. My bill with Senator Paul and Senator Grassley, called the Medicare Audiology Access Improvement Act, would allow audiologists to provide all the services that are already covered by Medicare that are also within an audiologist’s scope of practice. It would also remove barriers to care that currently force Medicare beneficiaries to jump through more hoops than people who receive their health care coverage through the VA, or the Federal Employees Health Benefits Program, or commercial insurance. 

This matters because adequate care for hearing loss is an important part of supporting our seniors. There is substantial research linking hearing health with mental health. 

  • Untreated hearing loss has been shown to lead to depression, anxiety, loneliness, and social isolation.
  • Studies also suggest that hearing loss may be one of the greatest risk factors for developing dementia. 
  • Seniors with hearing loss experience cognitive decline up to 40 percent faster than those with normal hearing, and 
  • Older adults with moderate or severe hearing loss are three and five times more likely, respectively, to develop dementia.

If we are working to strengthen support for seniors’ mental health and mental acuity, then we should include access to health care aimed at treating hearing and balance disorders.

I am going to withdraw my amendment because it does not meet the germaneness standard that the Committee has adopted for this mark-up, but Mr. Chairman and Mr. Ranking Member, I’m asking for your commitment to work with me and Senator Grassley to advance this common-sense, bipartisan bill in future legislation. 

Senator Wyden: You know, I was just trying to get from the staff a little bit of an update on what is actually out there now. Other than the cochlear implants, there is very little. I will just tell my colleagues a 10 second story. When I taught gerontology and got a few hundred dollars coming in to do the Gray Panthers, I would give on an exam what Medicare covered, and people would always say it’s only half a loaf because it does not cover hearing and many other kinds of services. You’re spot on and the answer is yes and Senator Crapo has indicated to me and I will let him speak that he wants to work with us too.

Senator Crapo: Definitely. As I mentioned yesterday when we spoke, I completely agree with your observations about the need to deal with this issue. I look forward to working with you to see if we can get this done.

Senator Elizabeth Warren: Good. I so appreciate this. I just want to say, frankly, I think we should do more to prioritize hearing health for our seniors, including by expanding Medicare hearing coverage. But, I’m sticking with the subject that we are talking about today, and at a minimum, we should ensure that Medicare beneficiaries can readily access the full range of hearing services that Medicare already covers. 

Next, I’d like to turn to the Medicare Advantage program. I want to echo Senator Cortez Masto’s support for our amendment with Senator Cassidy to improve Medicare Advantage encounter data, and I hope we can keep working on this in future packages. I appreciate her leadership on this.

I’d also like to offer Warren-Cassidy #2, which would require CMS to collect and publish data from Medicare Advantage plans on their prior authorization practices. Currently, there are no data on the number of prior authorization requests, denials, and appeals by type of service – including mental health and substance use disorder services. 

This means we can’t answer basic questions like are denials are more common for certain kinds of services, or certain Medicare Advantage plans are improperly denying care more than others. Let me be clear: I strongly believe these data should be available for all types of services – both physical and behavioral health, but as the Committee rightly focuses on behavioral health in this mark-up, I hope we can all agree that this is a step in the right direction. 

While I am withdrawing this amendment, I look forward to working with the Committee, working with our Chairman and our Ranking Member to close these data gaps in Medicare Advantage so that seniors have the information they need to get the coverage that works best for them.

Senator Wyden: My colleague is talking about a very important issue. We talked a little bit about related matters when Senator Bennet’s issue came up with respect to the [ghost networks], and I know you have been going after them rightfully, in my view, as I have been. Insurance companies are burying the hospitals and the doctors and patients in mounds of red tape. I am actually doing an investigation now on how insurers are overusing prior authorizations in Medicaid and the Inspector General has reported on some very serious practices going on in these government programs. I am going to work closely with you to deal with what are very obviously barriers to care for vulnerable people. Senator Crapo?

Senator Crapo: I agree. I will also be glad to work with you on this. As you know, I am a big proponent of Medicare Advantage, but that does not mean that I like the prior authorization process and that I do not see some problems here that need to be solved. I would be glad to work with you on that.

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