New Congressional Legislation Could Alter Payment for Your Services Legislation on the congressional docket could change how the treatment you provide is reimbursed—and who can access it. Policy Analysis
Policy Analysis  |   April 01, 2015
New Congressional Legislation Could Alter Payment for Your Services
Author Notes
  • George Lyons Jr., JD, MBA, is director of ASHA government relations and public policy.
    George Lyons Jr., JD, MBA, is director of ASHA government relations and public policy.×
  • Ingrida Lusis is director of ASHA federal and political advocacy.
    Ingrida Lusis is director of ASHA federal and political advocacy.×
Article Information
Regulatory, Legislative & Advocacy / Policy Analysis
Policy Analysis   |   April 01, 2015
New Congressional Legislation Could Alter Payment for Your Services
The ASHA Leader, April 2015, Vol. 20, 28-29. doi:10.1044/leader.PA.20042015.28
The ASHA Leader, April 2015, Vol. 20, 28-29. doi:10.1044/leader.PA.20042015.28
Members of Congress have introduced a number of bills in this session that could affect audiologists and speech-language pathologists. The legislation relates to hearing health care, reimbursement for audiology and speech-language pathology services, and access to care for communication disorders.
Medicare reimbursement levels and policy rules for outpatient therapy services expired March 31, and Congress must either extend the rules or enact new policies.
Therapy caps. The House and Senate are considering the Medicare Access to Rehabilitation Services Act of 2015, introduced in the House by Charles Boustany (R-Louisiana) and in the Senate by Ben Cardin (D-Maryland). The measure would repeal the cap on how much outpatient rehabilitation services a beneficiary may receive in a year (currently $1,950 for combined physical therapy and speech-language treatment; services that exceed that figure require documentation of medical necessity or medical manual review). Similar bipartisan legislation had 225 co-sponsors—more than half of the House—in the previous Congress.
Fee schedule. Closely related to the therapy caps is legislation to repeal the formula used to determine Medicare reimbursement rates for physicians and other health care providers, including audiologists and speech-language pathologists, which had bipartisan support in the previous Congress. That legislation would replace the fee-for-service model with a performance-based merit incentive payment program based on quality, patient outcomes, and participation in alternative payment models and coordinated care, such as accountable care organizations.
Observers predict that Congress will extend the current exceptions process and fee schedule for up to 20 months to allow more time to develop permanent solutions.
Audiology services. Under current law, audiologists may provide only diagnostic services to Medicare beneficiaries. ASHA worked with Rep. Gus Bilirakis (R-Florida) to reintroduce legislation —the Medicare Audiology Services Enhancement Act of 2015, H.R. 1116—that would allow audiologists to bill Medicare for diagnostic and rehabilitation services. Bilirakis is a member of the House Energy and Commerce Committee, which has jurisdiction over Medicare coverage policies, and of its Health Subcommittee. ASHA is working to increase the number of co-sponsors—which will demonstrate support for including the measure in larger Medicare legislation in the future—and to receive an official cost analysis from the Congressional Budget Office, which will demonstrate the measure’s nominal cost to Medicare.
Speech-generating devices. ASHA is supporting H.R. 628, the Steve Gleason Act of 2015, introduced by Rep. Cathy McMorris Rodgers (R-West Virginia). This legislation would allow Medicare beneficiaries who need a speech-generating device to own the prescribed device immediately rather than delay full ownership under the current 13-month rent-to-own policy. The bill would also allow SGDs to have eye-tracking devices that connect to the Internet. The measure has strong support: A letter ASHA circulated last summer calling for changes in SGD regulations garnered signatures from 200 Republican and Democratic senators and congressional representatives. If no one opposes or amends the bill, it will likely be fast-tracked for passage, as the changes it calls for are cost-neutral.
Early Hearing Detection and Intervention Act
EHDI, enacted in 2000, is up for reauthorization this year. The program has increased the number of newborns screened for hearing loss from 44 percent in 2000 to almost 98 percent in 2011. Hearing health organizations, however, are concerned about newborns who fail the screening but do not receive follow-up services, and ASHA is working to encourage Congress to emphasize follow-up provisions in the reauthorization. The bill, introduced in March, will most likely pass Congress very quickly.
Hearing aid tax credit
ASHA and other hearing health organizations support a Senate measure, the Hearing Aid Assistance Tax Credit, which gives a tax credit of $600 for each hearing aid purchased. ASHA opposes a House version of the bill, which would allow the Veterans Administration to appoint “hearing aid specialists” who are not audiologists. A similar bill was defeated last year. More hearing aid specialists—already permitted under VA policies—will not address the VA’s long wait times for hearing health care services from qualified providers. Tax reform will most likely be on the congressional agenda, but individual measures such as this one will be included in wider-reaching bills that address bigger issues—such as mortgage interest and charitable contribution deductibility—that Congress may not be ready to tackle.
Qualified providers
ASHA is working with Rep. John Kline (R-Minnesota), chair of the House Education and the Workforce Committee, to expand the provisions of the Student Success Act (the reauthorization of the Elementary and Secondary Education Act). That legislation does not explicitly include audiologists and SLPs as qualified service providers under federal literacy and reading legislation and programs. ASHA also wants the bill to ensure appropriate funding streams for SLPs working with struggling learners in general education classrooms. Although the House and Senate continue to work on these bills, the education community has many funding-related concerns. Even if the House and Senate can compromise, the legislation would need to satisfy White House concerns to be signed into law.
ASHA supports efforts to recognize audiologists and SLPs as appropriate providers of remote services under Medicare. The 21st Century Cures Initiative—a plan led by House Energy and Commerce Committee Chair Fred Upton (R-Michigan) and Rep. Diane DeGette (D-Colorado) to determine actions Congress can take to promote the use of science and technology in health care—presents an opportunity to advocate for Medicare reimbursement for audiology and speech-language telepractice services.
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April 2015
Volume 20, Issue 4