Congress Eyes Medicare Coverage for Aural Rehabilitation, Hearing Aids Medicare has never paid for aural rehabilitation or hearing aids, leaving seniors—who have the highest prevalence of hearing loss—and audiologists out in the cold. But this may change if Congress passes H.R. 2934, the “Medicare Aural Rehabilitation and Hearing Aid Coverage Act of 2001.” In September, Rep. Mark Foley (R-FL) ... Policy Analysis
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Policy Analysis  |   November 01, 2001
Congress Eyes Medicare Coverage for Aural Rehabilitation, Hearing Aids
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Regulatory, Legislative & Advocacy / Policy Analysis
Policy Analysis   |   November 01, 2001
Congress Eyes Medicare Coverage for Aural Rehabilitation, Hearing Aids
The ASHA Leader, November 2001, Vol. 6, 1-17. doi:10.1044/leader.PA1.06202001.1
The ASHA Leader, November 2001, Vol. 6, 1-17. doi:10.1044/leader.PA1.06202001.1
Medicare has never paid for aural rehabilitation or hearing aids, leaving seniors—who have the highest prevalence of hearing loss—and audiologists out in the cold. But this may change if Congress passes H.R. 2934, the “Medicare Aural Rehabilitation and Hearing Aid Coverage Act of 2001.”
In September, Rep. Mark Foley (R-FL) introduced H.R. 2934, which would provide Medicare coverage for a comprehensive audiologic assessment; hearing aid fitting and adjustments; instruction on the use of hearing aids; and aural rehabilitation, including counseling on hearing loss, speech reading, and auditory training.
Federal law currently bans Medicare coverage of hearing aids. H.R. 2934 would repeal that ban and add hearing aids to the list of durable medical equipment covered by Medicare. The bill also would allow beneficiaries to receive new hearing aids every three years, as needed.
A key aspect of H.R. 2934 is that the bill would allow audiologists to “balance bill” for hearing aids beyond what Medicare would agree to pay. Without balance billing, audiologists outside of non-profit settings find it nearly impossible to work with programs of many third-party insurers, including Medicaid, says Dennis Hampton, a New York audiologist and member of ASHA’s Governmental Relations and Public Policy Board.
“It is vital that audiologists maintain the right to balance bill the patient for hearing aid charges beyond what Medicare pays,” Hampton says. “We can’t afford to have a government agency set the allowable charge for hearing aids or hearing aid-related services.”
Foley asked for ASHA’s help in crafting a bill that would provide Medicare coverage for hearing aids. As the bill developed, ASHA proposed revisions to ensure that aural rehabilitation and hearing aid-related services by audiologists were also included.
Patricia Kricos, audiology program director at the University of Florida in Gainesville, says the United States should offer Medicare coverage for these services “because hearing loss affects so many older Americans and because untreated hearing loss has such a negative impact on that population.”
Audiology researchers have amassed evidence clearly showing that hearing loss erodes seniors’ quality of life, Kricos says. A 1999 study by the National Council on Aging showed the detrimental effects of untreated hearing loss on seniors, including significantly increased depression, anxiety, and social withdrawal.
Seniors who purchase hearing aids typically do not receive any organized post-fitting education and support program. “I have heard many older patients state that they cannot afford to pay for aural rehabilitation,” Kricos says. “Audiologists, in turn, have stated that they cannot, do not, or will not provide a service for which they cannot recoup payment.”
ASHA President John Bernthal compares Foley to the legendary Claude Pepper, a Florida legislator who advocated for seniors and fought to expand Medicare to protect people with chronic illness and disabilities from staggering health care costs. Not since Pepper’s time, Bernthal says, “has there been a serious discussion on the need for Medicare to cover necessary services for hearing loss.”
Like Pepper, Foley thinks broadly about the need to strengthen Medicare. This year, Foley sponsored three bills in addition to H.R. 2934 that would increase payment for inpatient hospital services, make outpatient prescription drugs affordable, and provide fair payment for physician pathology services.
While H.R. 2934 offers audiologists the opportunity to do more for people with medically irreversible hearing losses, it’s critical that aural rehabilitation be defined as any activity that lessens the impact of hearing loss on a person’s life, adds Mark Ross, audiology professor emeritus at the University of Connecticut.
Hearing aids alone may not be enough for many Medicare clients, Ross says. “Aural rehabilitation can be traditional speech reading and auditory training, but should go further to include the proper use of hearing aids and all other hearing assistive devices, as well as various coping and communication strategies.”
Although the budget impact of Medicare coverage for hearing aids will likely prevent the legislation from being passed in the near term, Hampton believes pressure from consumer groups and congressional supporters will keep the issue alive. “Whether or not Medicare covers hearing aids and aural rehabilitation services may not be up to us, but there’s one thing that is up to us,” he says. “We can choose to be involved in having an influence on legislation—every step of the way.”
For more information about H.R. 2934, contact Reed Franklin through the Action Center at 800-498-2071, ext. 4473, or by email at rfranklin@asha.org; or contact Jim Potter at ext. 4125 or by email at jpotter@asha.org.
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November 2001
Volume 6, Issue 20