WASHINGTON, D.C. — On Thursday, after months of negotiation, the Biden White House unveiled a $1.75 trillion dollar framework for the president’s signature climate and social spending bill, which they hope will win over Democrat holdouts – Senators Joe Manchin, of West Virginia and Kyrsten Sinema, of Arizona, who have publicly balked at the original $3.5 trillion price tag and some of the provisions included as part of the legislation.
The original proposal included a number of investments in social spending, including the expansion of Medicare to include coverage for dental, vision and hearing. The latest proposal, however, has scaled back to remove dental and vision coverage, but the hearing benefit remains ‘on the table’ as part of the latest negotiated framework.
The White House has earmarked $35 billion towards the Medicare Hearing Benefit.
Medicare Hearing Benefit: What Would it Mean?
The idea of Medicare coverage for hearing services has been something both advocates and professionals have been pushing for over the last few decades. However, there continues to be debate about how the program should cover hearing and balance services vs. hearing aids – with a wide range of different opinions among the various groups.
“What’s important is that we continue to provide members of congress with accurate information about hearing healthcare,” said Brandon Sawalich, President and CEO of Starkey, who has recently spearheaded the ‘Listen Carefully‘ advocacy initiative. “There’s so much misinformation in the media, it’s important that hearing professionals and the industry stay involved in this process.”
HHTM reached out to numerous stakeholders and most were in agreement, whether they support legislative change or not, that expanded Medicare coverage for hearing services would be “game-changing” for both patients and providers in the US.
Many are cautiously optimistic that expanded Medicare can provide greater access to those in need of hearing and balance services.
Medicare Hearing Aid Coverage, Audiology Services as Physician Services and Practitioner Status for Audiologists and Hearing Aid Specialists
Following the latest White House proposal, the House Rules Committee released a draft of the reconciliation text on Thursday afternoon. A number of significant changes to how audiologists and hearing aid specialists would be treated under Medicare are included in the latest draft, including:
“Inclusion of qualified audiologists and qualified hearing aid professionals as RHC and FQHC Practitioners — Section 1861(aa)(1)(B) of the Social Security Act (42 U.S.C. 1395x(aa)(1)(B)) is amended by inserting “or by a qualified audiologist or a qualified hearing aid professional…”
Hearing aid coverage is said to be provided for individuals with severe to profound hearing losses, approximately every 5 years.
INCLUSION OF HEARING AIDS AS PROSTHETIC DEVICES.—Section 1861(s)(8) of the Social Security Act (42 U.S.C. 1395x(s)(8)) is amended by inserting ‘‘, and including hearing aids (as described in section 1834(h)(7)) furnished on or after January 23, 2024, to individuals diagnosed with profound or severe hearing loss’’
[…]LIMITATIONS FOR HEARING AIDS.—Payment may be made under this part with respect to an individual, with respect to hearing aids furnished on or after January 1, 2024— ‘‘(A) not more than once per ear during a 5-year period; ‘‘(B) only for types of such hearing aids that are not over-the-counter hearing aids (as defined in section 520(q)(1) of the Federal Food, Drug, and Cosmetic Act) and that are determined appropriate by the Secretary; and ‘‘(C) only if furnished pursuant to a written order of a physician, qualified audiologist (as defined in section 1861(ll)(4)), qualified hearing aid professional (as so defined), physician assistant, nurse practitioner, or clinical nurse specialist.’’
The text relating to the hearing benefit proposal can be read here.
While it is significant that the Medicare hearing benefit has remained as part of the ongoing negotiations with Congress and the White House, it’s important to note that negotiations are still ongoing.
We will continue to monitor this developing story. Please stay tuned for updates.