Defining Audiology through Occupational and Health Policy Action

Abstract

Many barriers to accessibility exist for Medicare beneficiaries seeking hearing and balance care such as availability of providers, coverage for services, and ability to pay. Other statutory and administrative barriers exist including the need for physician orders to have audiology services covered, the classification of audiologists as suppliers of “other diagnostic tests” under Medicare payer policy, and non-coverage of certain audiologic management and treatment services. Nearly two decades of legislative efforts have not resulted in any substantial changes to U.S. health policy, while the need for audiology services has increased due to a growing demographic of older adults. The Medicare Audiologist Access and Services Act (MAASA) has been introduced in the 116th and 117th Congress and proposes amendments to the Social Security Act that would address statutory barriers to accessing hearing and balance care among Medicare beneficiaries and would recognize audiologists for their scope of practice within the Medicare program. Objectives of the present review are to provide a summary of statutes in the Social Security Act and Standard Occupational Classification system which affect audiologists, audiology services, and Medicare beneficiaries and to discuss previous and current legislative health policy efforts to address these statutory barriers to hearing and balance care access.

Keywords

audiology - Medicare - health policy - healthcare reform - health insurance

Publication History

Article published online:
15 June 2022

• References

• 1 Jerger J. Audiology in the USA. San Diego: Plural Pub; 2009. :xiv, 110pp: illustrations
• 2 Arnold ML, Hyer K, Chisolm T. Medicaid hearing aid coverage for older adult beneficiaries: a state-by-state comparison. Health Aff (Millwood) 2017; 36 (08) 1476-1484
• 3 Jilla AM, Johnson CE, Huntington-Klein N. Hearing aid affordability in the United States. Disabil Rehabil Assist Technol 2020; 1-7
• 4 Willink A, Reed NS, Lin FR. Access to hearing care services among older Medicare beneficiaries using hearing aids. Health Aff (Millwood) 2019; 38 (01) 124-131
• 5 McNeal MH. Say what: The Affordable Care Act, Medicare, and hearing aids. Harvard J Legis 2016; 53: 621
• 6 The Council for Academic Accreditation in Audiology and Speech-Language Pathology. Accreditation Milestones. Accessed July 11, 2021: https://caa.asha.org/about/accreditation-milestones/
• 7 American Speech-Language-Hearing Association. History of ASHA. Accessed July 11, 2021: https://www.asha.org/about/history/
• 8 Academy of Doctors of Audiology. Welcome. Accessed July 11, 2021: https://audiologist.org/
• 9 National Society of Professional Engineers v. United States of America, 435 U.S. 679 (1978). Supreme Court of the United States.
• 10 American Academy of Audiology. About the Academy. Accessed July 11, 2021: https://www.audiology.org/about/
• 11 United States White House: Office of Management and Budget. Statistical Programs and Standards. Accessed July 11, 2021 https://www.whitehouse.gov/omb/information-regulatory-affairs/statistical-programs-standards/
• 12 Loavenbruck A. The Millennium – Crabby Audiologists Learning the Alphabet. Hearing Health Matters blog. February 10, 2015. Accessed July 11, 2021: https://hearinghealthmatters.org/hearingviews/2015/the-millennium-crabby-audiologists-learning-the-alphabet/
• 13 United States Bureau of Labor Statistics. List of SOC Occupations. Accessed July 11, 2021 at: https://www.bls.gov/oes/current/oes_stru.htm#29-0000
• 14 United States Bureau of Labor Statistics. Occupational Employment and Wages: 29–1181 Audiologists. Accessed July 11, 2021: https://www.bls.gov/oes/current/oes291181.htm
• 15 United States Social Security Administration. Major Decisions in the House and Senate on Social Security: 1935–2000. Accessed August 15, 2021: https://www.ssa.gov/history/reports/crsleghist3.html
• 16 Centers for Medicare and Medicaid Services. Medicare Benefit Policy Manual: Chapter 15: Covered Medical and Other Health Services. Accessed July 11, 2021: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c15.pdf
• 17 Centers for Medicare and Medicaid Services. 2020 MIPS Quality Measures List. Accessed March 12, 2021: https://qpp-cm-prod-content.s3.amazonaws.com/uploads/763/2020%20MIPS%20Quality%20Measures%20List.xlsx
• 18 Centers for Medicare and Medicaid Services. Audiology Services. Accessed July 11, 2021: https://www.cms.gov/audiology-services
• 19 Chisolm TH, Johnson CE, Danhauer JL. et al. A systematic review of health-related quality of life and hearing aids: final report of the American Academy of Audiology Task Force On the Health-Related Quality of Life Benefits of Amplification in Adults. J Am Acad Audiol 2007; 18 (02) 151-183
• 20 Luxon L. Working Party on the Provision of Audiological Medicine. Hearing and balance disorders: a new approach. Clin Med (Lond) 2007; 7 (04) 318-320
• 21 Willink A, Hernando MA, Steege S. Why State Medicaid programs should cover hearing aids for adults. JAMA Otolaryngol Head Neck Surg 2019; 145 (11) 999-1000
• 22 Hearing Health Accessibility Act of 2003, H.R.2821, 108 Congress (2003–2004).
• 23 Hearing Health Accessibility Act of 2003, S.1647, 108 Congress (2003–2004).
• 24 Zapala DA, Stamper GC, Shelfer JS. et al. Safety of audiology direct access for Medicare patients complaining of impaired hearing. J Am Acad Audiol 2010; 21 (06) 365-379
• 25 Kirkwood DH. ASHA, AAA, and ADA Clash Over Legislative Strategy. Hearing Review blog. July 24, 2013. Accessed July 11, 2021: https://www.hearingreview.com/inside-hearing/organizations/asha-aaa-and-ada-clash-over-legislative-strategy
• 26 Access to Hearing Healthcare Act of 2014, H.R.4035, 113 Congress (2013–2014).
• 27 Access to Hearing Healthcare Act of 2014, S.2046, 113 Congress (2013–2014).
• 28 Medicare Audiology Services Enhancement Act of 2013, H.R.2330, 113 Congress (2013–2014).
• 29 Denneny JC. Letter from the American Academy of Otolaryngology–Head and Neck Surgery to United States House of Representatives Speaker, John Boehner. American Academy of Otolaryngology–Head and Neck Surgery. Accessed July 11, 2021.: https://www.entnet.org/wp-content/uploads/files/SOP.8.6.2014.AAO-HNS%20Letter.pdf
• 30 Denneny JC. Letter from the American Academy of Otolaryngology–Head and Neck Surgery to Representative Gus Bilirakis. American Academy of Otolaryngology–Head and Neck Surgery. Accessed July 11, 2021 https://www.entnet.org/wp-content/uploads/files/scope_aao-hns_letter.pdf
• 31 Medicare Audiology Services Enhancement Act of 2015, H.R.1116, 114 Congress (2015).
• 32 ADA Launches 18 × 18 Initiative at Convention – January 2013. Hearing Review blog. Published January 15, 2013. Accessed July 11, 2021: https://www.hearingreview.com/hearing-loss/vestibular-care/ada-launches-18x18-initiative-at-convention-january-2013-hearing-review
• 33 Audiology Patient Choice Act of 2014, H.R.5304, 115 Congress (2017–2018).
• 34 No. 5: Victory! 22-year battle for Medicare parity succeeds. News from the American Optometric Association blog. May 7, 2013. Accessed July 11, 2021: https://newsfromaoa.wordpress.com/2013/05/07/no-5-victory-22-year-battle-for-medicare-parity-succeeds/
• 35 Omnibus Budget Reconciliation Act of 1986, P.L. 99–509, 100 Stat. (1874).
• 36 Centers for Medicare and Medicaid Services. Medicare General Information, Eligibility, and Entitlement: Chapter 5 - Definitions, Section 70 - Physician defined. Accessed July 11, 2021: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/ge101c05.pdf
• 37 Medicare Audiologist Access and Services Act of 2019, H.R.4056, 116 Congress (2019–2020).
• 38 Medicare Audiologist Access and Services Act of 2019, S.2446, 116 Congress (2019–2020).
• 39 Medicare Audiologist Access and Services Act of 2021, H.R.1587, 117 Congress (2021–2022).
• 40 Medicare Audiologist Access and Services Act of 2021, S.1731, Medicare Audiologist Access and Services Act of 2021, 117 Congress (2021–2022).
• 41 Academy of Doctors of Audiology. What is the Medicare Audiologist Access and Services Act?. Accessed July 11, 2021: https://www.chooseaudiology.org/about-maasa/general-information
• 42 American Academy of Otolaryngology–Head and Neck Surgery. Audiology Groups Announce Joint Effort to Pass Direct Access Legislation. Accessed July 11, 2021: https://www.entnet.org/wp-content/uploads/files/march_advocate_final.pdf
• 43 Dobson A, El-Gamil A, Shimer M, Pick A, DaVanzo JE. Determining Potential Medicare Savings by Streamlining Beneficiary Access to Audiology Services: Projected Impact of Direct Access for Audiologists. Accessed July 11, 2021: www.dobsondavanzo.com