Audiologists, dispensers, and consumers all have a stake in bills before Congress

By David H. Kirkwood

WASHINGTON, DC—After taking two months off to campaign for re-election, the 113rd Congress will finally return to Washington sometime in November for a brief lame duck session. There it will find a slew of bills related to hearing care waiting for them. Barring a miracle, this Congress, which has enacted less legislation to date than any before it, will take no action on any of them.

However, the various hearing-related measures championed by professional, consumer, and business organizations will not disappear. They will almost certainly be re-introduced into the 114th Congress, beginning in January. Should any of the bills become law, the effect on hearing healthcare providers and/or consumers would be significant.

AUDIOLOGY PATIENT CHOICE ACT
The most ambitious of the bills supported by professional organizations is probably the Audiology Patient Choice Act (HR 5304), which was developed by the Academy of Doctors of Audiology and introduced into Congress on July 31, 2014, by Rep. Lynn Jenkins (R-KS) and Rep. Matt Cartwright (D-PA).

Like several bills that ADA, the American Academy of Audiology (AAA), and the American Speech-Language-Hearing Association (ASHA) have supported in the past, HR 5304 would enable Medicare beneficiaries with a suspected hearing or balance disorder to seek treatment directly from an audiologist, rather than having to get a physician’s referral first.

However, this bill would do much more than give seniors direct access to audiologists. The draft legislation, which emerged from ADA’s “18×18 Initiative” to persuade Congress to update Title 18 of the Social Security Act by the year 2018, would also:

(1) Give audiologists limited license status within Medicare. That would allow them the autonomy to make clinical recommendations and practice the full scope of audiology and vestibular care allowed by their state license. Optometrists, dentists, podiatrists, and chiropractors already have limited license status within Medicare.

(2) Allow for expanded coverage to include all Medicare-covered audiologic services that audiologists are licensed to provide, including vestibular rehabilitation, cerumen removal, and aural rehabilitation.

Eric Hagberg

Eric Hagberg, AuD, who was president of ADA when it launched “18×18” in 2012 and is still a leader of the initiative, told this blog, “In developing the legislation, ADA and its partners considered the changes in best practices in the delivery of hearing and balance healthcare services over the past 50 years since Medicare was enacted, the shift toward patient-centered care, the impending shortage of physicians and, the incredible need for audiology services among the Medicare population.”

Mixed reaction from other groups
AAA and ADA have often worked together in lobbying for legislation, and both academies still support a direct access bill. However, in AAA’s view. ADA’s new initiative is not realistic. Deborah Carlson, PhD, who was president of AAA when the ADA initiative was unveiled, told this blog then, “While the Academy philosophically agrees with the policy on which ADA’s 18×18 initiative is based, we feel the expansive nature of this legislation does not align with the current Congressional climate.”

Meanwhile, ASHA has parted company with both ADA and AAA in supporting direct access. Instead, it has joined forces with the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), which has long led the opposition to bills introduced by audiology, including HR 5304, which it contends “would increase healthcare costs and create significant patient safety issues.”

The bill that ASHA and AAO-HNS back, the Medicare Audiology Services Enhancement Act of 2013 (HR 2330), would not give Medicare patients direct access to audiologic care. However, ASHA leaders believe, with the endorsement of AAO-HNS, it has a much better chance of becoming law. Former ASHA president Patricia Prelock, PhD, called introduction of the bill “an important step in making sure Medicare patients are covered for the full range of professional services provided by audiologists.”

Meanwhile, though ADA has not got support from AAA or ASHA for HR 5304, the bill has been endorsed by nine state affiliates of those organizations: the Academies of Audiology of Georgia, Illinois, Kentucky, Louisiana, Maryland, Pennsylvania, South Carolina, and Texas, and the New York State Speech-Language Hearing Association. Salus University has also endorsed the measure.

FIT TO SERVE MOVES AHEAD
Of all the hearing care legislative initiatives, the one that has moved the fastest is probably the International Hearing Society (IHS) Fit to Serve Campaign, which would authorize the Department of Veterans Affairs (VA) to hire hearing aid specialists to provide care for veterans with hearing loss, tinnitus, and related conditions. Recent widespread criticism of VA health care in general has created a receptive mood in Washington to efforts, such as IHS’s, to improve the quality of care that veterans receive.

Last November 15, just nine months after IHS launched Fit to Serve, Rep. Sean Duffy, a Wisconsin Republican, and Rep. Timothy Walz, a Democrat from Minnesota, introduced HR 3508. In March 2014, the House Veterans Affairs Health Subcommittee held a hearing on the bill. In May, Senator Jon Tester, (D, MT) introduced S. 2311, a companion bill.

Both bills are expected to be re-introduced in the new Congress starting in 2015.

MEDICARE COVERAGE FOR HEARING AIDS
The proposed legislation that would most affect people with hearing loss is undoubtedly the Help Extend Auditory Relief Act of 2013 (HR 3150), which would, for the first time, extend Medicare coverage to hearing aids.

Pennsylvania Congressman Matt Cartwright, a sponsor of HR 5304, introduced the bill in September 2013.

Among those championing HR 3150 is the Hearing Loss Association of America (HLAA), which stated, “Seniors with hearing loss should not have to scrimp and save, or go without basic needs, to just be able to hear.”

In addition, Janice S. Lintz, chair of the Hearing Access Program, is collecting signatures for a petition asking Congress to pass the law.

However, in view of the cost to taxpayers of paying for Medicare beneficiaries’ hearing aids, the measure is considered a very long shot for passage in the near future.

TAX CREDIT BILL
In fact, at a time when Congress passes very few laws, even a measure with broad support has trouble getting noticed, let alone passed. Such a case is the Hearing Aid Tax Credit, which was initiated by the Hearing Industries Association more than 10 years ago and is endorsed by some 20 organizations, including AAA, IHS, ASHA, ADA, HLAA, and AARP.

Over the years, House (HR 1317) and Senate (S 1694) bills have attracted dozens of co-sponsors from both parties. What the law would do—provide a tax credit to people who buy hearing aids—is uncontroversial and would cost relatively little. Yet, despite 15 years of lobbying, HIA and its partners have never succeeded in getting the measure included in a bill that might actually come to a vote.

BOTTOM LINE
Getting legislation through Congress has never been easy, especially if the advocates for a measure don’t have lots of money to contribute to the campaigns of key lawmakers. In recent years, when the House, the Senate, and the White House have rarely been able to agree on anything, passing a law has become even harder.

But times change, some bills do get through every year, and, eventually, patience and perseverance pay off. Sometimes.