Despite pleas from audiologists and audiology organizations across the country, the American-Speech-Language-Hearing Association (ASHA) has shepherded the reintroduction of the Medicare Audiology Services Enhancement Act (H.R. 1116) in the 114th Congress.
The Academy of Doctors of Audiology (ADA), after having carefully reviewed the actual bill language, which was posted by the Government Printing Office on March 6, 2015 has confirmed that the language is unchanged from the language contained in H.R. 2330, the bill that was endorsed by the American Academy of Otolaryngology-Head Neck Surgery in the 113th Congress.
ADA continues to strongly oppose the passage of H.R. 1116 and will work diligently to ensure that Congress does not adopt the legislation now or in the future. H.R. 1116 poses the single biggest threat to the autonomous practice of audiology--and patient access to efficient audiologic services under Medicare--of any legislative initiative in recent history.
We encourage audiologists to contact their federal legislators immediately to encourage them to oppose H.R. 1116. ADA also encourages ASHA members to contact Neil DiSarno, Ph.D., ASHA’s Chief Staff Officer, Audiology, to ensure that ASHA leaders hear directly from ASHA members regarding their opposition to legislation that will diminish their ability to practice effectively.
“ADA is deeply disappointed that ASHA chose to continue to advocate for legislation that is not in the best interests of Medicare beneficiaries, the general public or the Audiology profession,” said ADA President and nationally recognized Medicare expert, Kim Cavitt, Au.D. “Despite the name given to the bill, it will not enhance Medicare Audiology services at all and it will have a number of negative impacts on patients and audiologists.”
The bill, introduced by Rep. Gus Bilirakis, contains provisions that will substantially impede Medicare patient access to safe, efficient audiologic care and create excessive, unwarranted and costly physician involvement in the performance of audiologic services provided by licensed audiologists. These provisions include:
- The omission of tinnitus management and cerumen removal from the legislation. As a result, if this bill were to pass, medically necessary tinnitus management and cerumen removal would still be non-covered if provided by audiologists. Per the National Institute of Deafness or Other Communication Disorders (NIDCD), 25 million Americans are afflicted with tinnitus. A 2008 article in the Journal of Otolaryngology Head and Neck Surgery indicated that prevalence of cerumen impaction is approximately 12 million Americans. Yet, our colleagues at ASHA chose to omit these services from their legislation.
- The inclusion of additional physician oversight within the plan of care requirement. The plan of care must be reviewed and certified by a physician within 30 days of the provision of the treatment services for the service to be a covered benefit. Physician oversight in plan of care requirements do not exist in the provision of treatment services in the private sector. Despite ASHA’s statements to the contrary, H.R. 1116 includes an increase in physician oversight from what currently exists for audiologists working within the traditional Medicare system.
- ASHA, in their statements on H.R. 1116, has stated that the legislation would “require audiologists to conform to Medicare requirements related to treatment services.” ADA could not agree more! Physicians, speech-language pathologists and physical therapists are currently providing the treatment services advocated in this legislation, such as aural and vestibular rehabilitation, for traditional Medicare coverage. The Medicare requirements for treatment services are currently that these services are provided within a therapy cap (section 220). ASHA, by their own admission, cannot, as a result, guarantee that audiology therapy services would not be subject to the therapy cap provisions for treatment services.
“We regret that ASHA, an organization that claims to represent the majority of audiologists in this country, has blatantly disregarded the concerns and desires of so many of those same audiologists in its quest for legislation that will undermine both patient choice and the autonomous practice of audiology,” said Dr. Cavitt. “In 2013, I personally put forth a petition regarding this legislation and, to date, 1221 individuals have indicated their opposition to this specific and particular type of expansion of Medicare coverage."
“ADA will not stand by and allow this arrogant and misguided approach to patient care and the autonomous practice of audiology to go unchallenged. Physician oversight of treatment provided by an audiologist is not required in the private sector and we see no reason why Medicare should require it. Unnecessary oversight creates unnecessary costs and burdens to the patient care process.”
ADA supports a truly comprehensive audiologic benefit under Medicare as part of broader legislation that also includes the addition of audiologists as limited license physicians under Medicare (as consistent with other non-M.D. doctoring professions) and allows Medicare patients to have “direct access” to audiologists, eliminating the need for a physician referral or plan of care requirements. This inclusive legislative approach, named the 18x18 Movement, will best serve the patient, the profession and the taxpayer. ADA is working diligently to ensure that the Audiology Patient Choice Act is reintroduced in the 114th Congress and is ultimately adopted. Please visit www.18x18.org for more information.
ADA must call to your attention to additional recent misstatements made by ASHA regarding H.R. 1116 and regarding proposed 18x18 legislation, contained in the Audiology Patient Choice Act:
- ASHA states: “Audiologists will need to develop a plan of care and submit the plan of care to the ordering physician for periodic review. There will be additional paperwork; it is nothing more than what all other treatment providers are required to do now.”
The truth is: If H.R. 1116 is enacted it will require an additional level of unwarranted and inefficient physician oversight, without the expectation of better patient or system outcomes. In reality, audiologists can already provide treatment services to traditional Medicare beneficiaries (Medicare Part B) without the need for a physician-reviewed plan of care requirement. The issue is that today’s patients are financially responsible to pay for those services when provided by an audiologist.
- ASHA states: “The proposed 18 x 18 legislation that would allow audiologists to bill Medicare for diagnostic and treatment services would also require a plan of care by Medicare.”
The truth is: ASHA leaves out an important caveat. The proposed 18x18 legislation (The Audiology Patient Choice Act), includes a provision that would classify audiologists as limited license physicians under Medicare. So, while a plan of care would be required (as it is for all providers, including physicians now), under the Audiology Patient Choice Act audiologists would not be required to have that plan of care reviewed by another doctoring professional, such as an MD, or a non-physician practitioner, such as a physician assistant or nurse practitioner, nor would the audiologist need a physician’s order to provide medically necessary evaluation and habilitation/rehabilitation services. You can confirm this by reviewing the language of the Audiology Patient Choice Act, as it existed in the 113th Congress, at www.congress.gov/bill/113th-congress/house-bill/5304/text.
- ASHA states: “If audiologists are providing services related to the dispensing of a hearing aid, a plan of care would not be required.”
The truth is: ASHA omits an important piece of information. Medicare does not cover services related to the evaluation, fitting or adjustment of a hearing aid. This bill will not affect that.
- ASHA indicates that H.R. 1116 is consistent with the direction of health care.
The truth is: ASHA has no data to back up this assertion. With the pending Supreme Court ruling on the Affordable Care Act, and the move, through Medicare Advantage, to privatize Medicare, we disagree that ASHA has provided a rationale to support that this bill is consistent with the direction of health care. What we do know is that H.R. 1116 does not align with best business and clinical practices in the provision of audiology services as demonstrated by private insurers, the Federal Employees Health Benefits programs and Medicare Advantage plans.
ASHA’s own statements demonstrate a seeming lack of understanding about the provision of audiology services under Medicare and warrant immediate action by ADA members and the broader audiology community.
ADA encourages its members and constituents to contact Rep. Bilirakis and their own U.S. Representatives to encourage them to not support H.R. 1116 and to instead support a holistic, quality-proven, access-centric and cost-effective approach as contained in the Audiology Patient Choice Act.
For more information about ADA’s legislative initiatives, please contact Stephanie Czuhajewski.
