Legislation Introduced to Improve Access to Hearing Health Care Services

audiology medicare access bill introduced senate
March 20, 2018
elizabeth warren audiology patient choice act

Sens. Rand Paul and Elizabeth Warren

WASHINGTON, DC — United States Senators Elizabeth Warren (D-Mass.) and Rand Paul (R-Ky.) today introduced the Audiology Patient Choice Act, a bipartisan bill that ensures seniors and people with disabilities on Medicare have access to a full range of hearing and balance health care services provided by licensed audiologists.

A June 2016 report by the National Academies of Science, Engineering, and Medicine noted that hearing health care is “often expensive and underutilized by many of the people who need it.” Outdated Medicare rules contribute to this problem by creating unnecessary barriers to care for seniors with hearing loss.

According to a press release, Senator Warren said, “This bill will make a life changing difference for the millions of Americans who experience hearing loss but can’t access the care they need because of archaic regulations. I’m glad to work with Senator Paul on this common sense step to bring down costs for our seniors.”


“Our legislation gets government out of the decision-making process so Americans can seek treatment from audiologists more quickly, easily, and affordably. It proves Congress can come together across the aisle to find solutions to improve our health care system.” –Senator Rand Paul (R-Ky.)


Approximately 48 million Americans experience hearing loss, including two-thirds of adults in their seventies. Despite the prevalence of hearing loss, a minority of Americans in their seventies have had a hearing test in the last four years and only about 14 percent of people with hearing loss use assistive hearing technologies.

Medicare already covers a range of hearing health services and audiologists are trained and licensed in all 50 states, all U.S. territories, and the District of Columbia to perform these services. However, Medicare currently does not recognize audiologists as providers of most hearing health-related services and will only allow reimbursement for a narrow set of tests to diagnose a hearing or balance disorder – and only if patients first obtain an order from a physician or nurse practitioner. These rules are far more restrictive than many private and federal insurance plans, even though there is evidence from a peer reviewed 2010 study that direct access to audiology would not pose a safety risk to Medicare beneficiaries complaining of hearing impairment.

In the 2010 study, Mayo Clinic audiologist David Zapala and colleagues concluded there was no convincing evidence that audiologists missed significant symptoms of otologic disease. This study, according to its’ authors, provided compelling evidence that audiologists referred to otolaryngology when appropriate. The aforementioned study can be accessed at https://www.ncbi.nlm.nih.gov/pubmed/20701834.


Audiology Patient Choice Act: Improving Access to Hearing Healthcare


The Audiology Patient Choice Act intends to improve hearing health care for Medicare beneficiaries by allowing audiologists to provide all services already covered by Medicare that are also within an audiologist’s scope of practice.  


The bill includes provisions that would implement the National Academies’ recommendation to allow audiologists to receive Medicare reimbursement for auditory rehabilitation services. The bill would also ensure that Medicare’s treatment of audiologists is consistent with the classification of other health care providers such as dentists, podiatrists, chiropractors, and optometrists.


The Audiology Patient Choice Act makes no changes to the scope of hearing health benefits covered by Medicare or the scope of practice of audiologists. The legislation is endorsed by the Academy of Doctors of Audiology and the Hearing Loss Association of America.

A companion bill was introduced in the House of Representatives by Congressmen Tom Rice (R-S.C.), Matt Cartwright (D-Pa.) and Lynn Jenkins (R-Kan.) last year.

The bill’s language can be viewed here.

  1. Thank you Senators Warren and Paul for recognizing the inequities for Medicare Recipients in need of hearing and balance care. This is most exciting as Senator Paul is a physician, wears amplification and brings first hand knowledge of the expertise Audiologists in championing S.2575

  2. But what exactly does this bill accomplish? If it eliminates the physician referral requirement, that’s fine. But that is not stated. And what are the unintended consequences, the down side, and are H.A. dealers mentioned in this legislation.

      1. Its so obvious that the Bill is biased, totally for the business of audiology. The plan is corrupt as it only benefits a privileged segment of the profession.

        1. In the US there are at least 12K practicing audiologists—more than 60% of them have a doctoral degree. Privileged, only by virtue of the many years they’ve invested in their educations and learning.

          While I have great respect for hearing aid specialists, the HAD profession does not hold its members to the same level of required professional training—states like Alaska and others require almost no formal training to become licensed, whereas audiologists have to have a Masters degree as a bare minimum to practice.

          This legislation takes nothing away from dispensers, rather it makes existing federal rules for Medicare more effective and modernized.

    1. 1) Providing Medicare patients with direct access to audiologists, eliminating the need for a referral from a medical doctor;
      2) Allowing audiologists to be reimbursed for Medicare-covered services that are within their state-defined scope of practice, and
      3) Defining audiologists as limited licensed physicians (LLP) under the Medicare program. This is the same status held by other non-medical doctor providers such as optometrists, dentists, chiropractors and podiatrists.

  3. As the proposal suggests that access to hearing healthcare will be broader and wider, this is a good step for socialized medicine ! It also indicates a political shift to Communism. The winners: Audiologists, with lots of more money to earn. Losers: the Hearing Aid dispensing community, who will be left high and dry, while doing the same job.
    I expect there will be a qualitative drop in dispensing standards due to additional burdens imposed on Audiology. But that is socialism at its best.

    1. Anjan,

      I think you’re misinterpreting this legislation! This will be a boon to the dispensing community at large—getting audiologists out of your specialty, and back into diagnostics and rehab, because they can FINALLY get paid by Medicare for services they do all day anyway and already get paid for by other private insurers. Doesn’t that make more sense?

      Let’s stop having HAD’s and AuD’s competing over hearing aid patients and rather have them focus more on their scope of practice. AuD’s are way too reliant on hearing aids to practice their profession and this bill would allow them to actually be reimbursed by Medicare for the same services they already get paid for by private insurers.


  4. There has been talk of direct access to Audiologist for over 10 years now; lets hope we get some movement this time!

  5. Thank you once again!
    There has been talk of direct access to Audiologist for over 10 years, I hope we see some movement this time!! WAY over due!

  6. This Senate bill is a huge step toward ensuring that Medicare patients have convenient access to hearing/vestibular evaluation and treatment. Thank you Senators Warren and Paul.

  7. While the essence of this proposal is desirable from the service point of action. Will HAD’s be allowed to participate in this regulation. They will not. The crux of this bill is political and designed to serve these two radical politicians who have made it for self aggrandizement. Medicare patients are well served currently. Nothing that audiologists do will improve the outcomes at least in the hearing department. Balance therapy is a good idea though. But most balance issues with seniors are helped with hearing aids anyway! So that leaves a narrow window for their rehabilitative benefits.
    This bill will definitely help these two rascals to make a ton of money and I am sure that AAA has already got the ball rolling on that!

  8. Thank you Senator Warren and Paul for taking this step towards facilitating the hearing healthcare with direct access to Audiologis’s services. It will not only address the hearing care but also address the comorbidoties linked to hearing loss and improve the quality of life of millions of Americans.
    Kind Regards.

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