Academy Information on the Audiology Patient Choice Act (H.R. 2276, S. 2575)
Representative Tom Rice (R-SC), along with Representatives Lynn Jenkins (R-KS) and Matt Cartwright (D-PA), introduced the Audiology Patient Choice Act of 2017 (H.R. 2276) in the U.S. House of Representatives. Senators Elizabeth Warren (D-MA) and Rand Paul (R-KY) introduced the companion to the legislation (S. 2575) in the U.S. Senate. If passed, this legislation would amend Title XVIII of the Social Security Act, which established the Medicare and Medicaid Programs, to provide for treatment of audiologists as physicians for purposes of furnishing audiology services under the Medicare program.
Currently, the Medicare Program defines physicians to include the following: chiropractors (DC), doctors of dental surgery (DDS) or dental medicine (DMD), doctors of medicine (MD) and doctors of osteopathy (DO), doctors of optometry (OD), and doctors of podiatry (DPM) or surgical chiropody(DSC) (Medicare Physician Guide, p14). Some of these categories, such as OD and DC, still have restrictions on practice and payment as defined in the Social Security Act. Click here to review the definitions of physicians, including optometrists and chiropractors.
In addition to physicians, the Medicare law also recognizes a number of other practitioners including:
- Anesthesiologist assistants;
- Certified nurse midwives;
- Certified registered nurse anesthetists;
- Certified nurse specialists;
- Clinical psychologists;
- Clinical social workers;
- Nurse practitioners;
- Physician assistants; or
- Registered dieticians or nutrition professionals.
As defined by the Social Security Act, under Medicare, audiology tests are covered as "other diagnostic tests," which is limited to the exclusive diagnostic only areas of hearing and balance healthcare. This means that Medicare 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 non-physician practitioner (NPP) and if the service is deemed medically necessary. These rules are far more restrictive than many private and federal insurance plans. Many private health plans, including most preferred provider organizations (PPOs), allow their enrollees direct access to audiologists.
The Audiology Patient Choice Act purports to make no changes to the scope of practice of audiologists; instead it aims to make access to audiologists easier by eliminating the need for physician referral and reimbursing audiologists for medically necessary, covered diagnostic and treatment services.
If enacted, this legislation would:
- Change the practitioner status of audiologists under Medicare to limited license physicians.
- Eliminate the physician order requirement for Medicare beneficiaries to receive medically necessary, covered audiology and vestibular services.
- May allow for expanded coverage of audiology and vestibular service to include Medicare-covered audiologic services that audiologists are licensed by their states to provide, including medically necessary, covered treatment services.
- NOTE: Changes in coverage for hearing aids and hearing aid related services are not addressed in this legislation; however, any subsequent statutory changes to hearing aid and hearing aid related services would directly impact audiologists.
The Academy recognizes such benefits and stands strongly behind realizing these benefits in successful legislation. However, the Board feels that it has an obligation to the membership to weigh the legislative and regulatory landscape, as well as any potential implications of the bill, just as heavily as the benefits before determining the feasibility of endorsement. Though the Audiology Patient Choice Act may help us to achieve some of these goals, there are aspects of the limited license physician status policy that must be better understood in order to mitigate potential risks to our members. These specific areas include understanding how being included under the umbrella of physicians under Medicare will affect audiology practices, such as increased reporting requirements for physicians under Medicare's new Quality Payment Program and expectations for adoption and usage of electronic health records (EHR) and how to best position members for those changes, as well as the potential impact on Medicare costs, and any subsequent effects on reimbursement for audiology services. As can be seen from the definition of optometrists and chiropractors, there could be limitations on the scope of services audiologists may provide under Medicare, even with recognition as a physician. We plan to address with regulatory and legislative offices the questions we have heard from members and have developed from our analysis.
The Academy strongly supports direct access to audiology services and being recognized and reimbursed for performing our full scope of practice under the Medicare program and across private payers. We view these two goals as critical in supporting the autonomous practice of audiologists, and are eager to pursue both legislative and regulatory strategies that achieve these goals. At this moment, we do not feel that there is legislation that definitively accomplishes these goals without creating potential risks and uncertainties for our members. We are actively investigating a range of strategies that help to achieve these goals while mitigating risks.
Additionally, advancing these two goals reflects an incremental approach that we feel is more politically feasible at this time given the current climate on Capitol Hill, communications with congressional staff, and discussions with other stakeholders, including other audiology professional organizations and hearing health care specialty societies. The Academy plans to convene these stakeholders to discuss a legislative and/or regulatory approach reflective of these goals.
Please refer to the Academy's list of frequently asked questions (FAQS) for more detail on the Academy analysis of the bill and the current legislative environment.