Is H.R. 2330 Good or Bad for Audiologists?
By John Williams
An unfortunate controversy is raging in the audiology community regarding a bill introduced this year in the U.S. House of Representatives at the request of the American Speech-Language-Hearing Association (ASHA). The bill – H.R. 2330 – has drawn fierce opposition from the American Academy of Audiology (AAA) and the Academy of Doctors of Audiology (ADA).
At its most recent meeting, the TAASLP Executive Council discussed this controversy and decided that the best thing to do is to provide accurate information to its members about the legislation and let them decide whether to support or oppose H.R. 2330. I have reviewed the legislation and the “talking points” of the various audiology groups. Hopefully, my article will help TAASLP members “separate the wheat from the chaff” regarding H.R. 2330.
What the Bill Does
H.R. 2330 is entitled the Medicare Audiology Services Enhancement Act. As its title suggests, the purpose of the bill is to broaden the range of audiology services for which audiologists may receive payment when those services are provided to Medicare patients.
Under current law, the term “audiology services” is defined to mean “hearing and balance assessment services” that an audiologist is allowed to perform under state law. (42 U.S.C. § 1395x (ll)(3)). H.R. 2330 would expand the definition of “audiology services” to include (in addition to hearing and balance assessment services) the following services:
While broadening the range of audiology services covered under Medicare, H.R. 2330 would also add the following language to this section of the statute: “pursuant to an order or referral by a physician.” The inclusion of this language would mean that Medicare payment would not be made to an audiologist unless a physician had referred the patient to the audiologist for the provision of those services. Under the current statute, the provision of “hearing and balance assessment services” (which are considered “diagnostic tests”) by an audiologist is not paid for by Medicare unless the “diagnostic test” has been ordered for that patient by a physician. So H.R. 2330’s inclusion of this language in the statute would not alter the current requirement for a physician order for diagnostic testing by an audiologist, but it would introduce this language into the statute for all services provided by audiologists.
H.R. 2330 would also make Medicare payment to an audiologist contingent on the following requirement:
“in the case of outpatient audiology services, (i) such services are or were required because the individual needed the specialized services of a physician or qualified audiologist to furnish such audiology services, (ii) a plan of care for furnishing such services has been established by the physician or qualified audiologist and is submitted to and periodically reviewed by the referring or ordering physician, and (iii) such services are or were furnished while the individual is or was under the care of a physician.”
This language is not in the current statute. It is intended to mandate more extensive involvement by a physician in the treatment of every Medicare patient who is evaluated or treated by an audiologist.
The Position of ASHA
ASHA supports H.R. 2330 because it would allow audiologists to be paid by Medicare for the full range of services provided by audiologists (not just diagnostic services). ASHA does not object to the bill’s requirement of increased physician involvement because ASHA believes a physician-approved plan of care for a patient will be necessary under anticipated future payment systems that take into account patient outcomes, quality and efficiency. ASHA also believes that coordination of care by a team of providers (including physicians) is the future of health care.
Because H.R. 2330 would require a physician referral to an audiologist in all cases before Medicare pays for that audiologist’s services, the American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS) is supporting the bill.
In sum, ASHA supports H.R. 2330 because it would enable audiologists to be paid by Medicare for providing both diagnostic and treatment services.
The Position of AAA and ADA
AAA opposes H.R. 2330 because it would not allow Medicare patients to have direct access to audiologists. In fact, H.R. 2330 would increase the level of physician oversight of audiologists by requiring Medicare patients to be referred to an audiologist by a physician in all cases and by requiring every Medicare patient seen by an audiologist to have a plan of care certified by a physician.
ADA bases its opposition to H.R. 2330 on the lack of a “direct access” provision, as well as the failure of the bill to allow audiologists to receive Medicare payment for the performance of tinnitus rehabilitation and cerumen removal.
Both groups contend that the increased physician oversight required by H.R. 2330 would make the provision of care more time intensive and more expensive, would create more paperwork, and would reduce patient access to audiologists.
More information about H.R. 2330 is available at the following websites:
Please contact your congress person to voice your opinion about this important issue!