S. 1996: Medicare Audiology Access Improvement Act of 2025

This bill, known as the Medicare Audiology Access Improvement Act of 2025, proposes several changes to the way audiology services are covered under the Medicare program. Here’s a breakdown of the key points:

1. Coverage of Audiology Services

The bill aims to amend the Social Security Act to specifically include audiology services as a covered benefit under Medicare. This inclusion will allow Medicare to pay for a variety of audiology services provided by qualified audiologists, starting January 1, 2027.

2. Definition of Audiology Services

The term "audiology services" will be defined to encompass hearing and balance assessment services, as well as treatment services provided by qualified audiologists. These services can now be offered without requiring a referral from a physician or being supervised by a physician, thereby improving access to care for patients.

3. Payment Amounts

The bill specifies that Medicare will pay 80% of the lesser of the actual charge for the audiology services or the amount set by the Medicare fee schedule. This aims to ensure that patients pay less out-of-pocket for these services, with the remaining 20% generally being the patient’s responsibility.

4. Assignment-Based Payment

The legislation allows qualified audiologists to participate in the assignment-related payment system, meaning they can receive payment directly from Medicare for the services they provide, without needing to go through another provider.

5. Inclusion of Audiologists in Health Care Provider Categories

The bill also includes provisions for recognizing qualified audiologists as practitioners within Rural Health Clinics (RHC) and Federally Qualified Health Centers (FQHC), expanding the settings where these services can be delivered.

6. Limitations on Service Scope

It is important to note that the bill includes a rule that states it does not expand the types of audiology services beyond those available as of December 31, 2026. This means while access will be improved, the scope of what is covered will remain within previously established limits.

7. Implementation Date

The changes proposed by this bill are set to take effect on January 1, 2027, allowing time for the Medicare system to adjust to the new coverage policies.

Relevant Companies

None found