ADA Opposes H.R. 2330: The Medicare Audiology Services Enhancement Act of 2013

View letter from American Academy of Otolaryngology to its members regarding H.R. 2330

The Academy of Doctors of Audiology (ADA), after having carefully reviewed H.R. 2330, the Medicare Audiology Services Enhancement Act of 2013, regrets that it must strongly oppose the bill's passage. ADA will work diligently to ensure that the bill is not adopted by Congress now or in the future.

ADA is deeply disappointed that the American Speech-Language Hearing Association (ASHA) chose to advocate for legislation that is not in the best interests of Medicare beneficiaries, the general public or the Audiology profession. Despite the name given to the bill, it will not enhance Medicare Audiology services at all and it will have a number of negative impacts on patients and audiologists.

The bill, introduced by Rep. Gus Bilirakis, with the support of ASHA and the American Academy of Otolaryngology Head-Neck Surgery (AAO-HNS), contains provisions that will substantially impede Medicare patient access to safe, efficient audiologic care and create excessive, unwarranted and costly physician involvement in the performance of audiologic services provided by licensed audiologists.

“We are disappointed that ASHA, an organization that claims to represent audiologists, would be so supportive of legislation that will undermine both patient choice and the autonomous practice of audiology,” said ADA President Nancy Green, Au.D. “ADA will not stand by and allow this egregious and misguided assault on our patients and our doctoring profession to go unchallenged.”

H.R. 2330, if enacted, will not only enlarge the outdated physician referral requirement for audiologic services, it will also mandate additional physician oversight, including a requirement for a physician plan of care that will necessitate periodic review and approval by the ordering physician. Further, this ill-conceived bill will help ensure that audiology services not currently contained under the long-criticized “therapy cap” can be contained there in the future--keeping patients from receiving all the services they really need.

ASHA has noted that the legislation contains a provision that it claims would allow audiologists to opt-out of Medicare altogether. But ADA finds the language contained in this “opt-out” provision to be both vaguely worded and ripe for misinterpretation.

Finally, the audiologic services that are included in H.R. 2330, are constrictive and fall short of allowing audiologists to be reimbursed under Medicare for their full scope of practice as defined and dictated by their state licensure. Listing only a specific, narrow list of services for inclusion restricts audiologic care today and will make it very difficult to add additional services in the future. In particular, the bill excludes vital tinnitus and cerumen removal services from coverage and there are a number of other significant exclusions as well.

Two examples come immediately to mind regarding how the bill's new requirements would harm patients and increase costs: The requirements that aural rehabilitation by an audiologist following a cochlear implant and canalith repositioning by an audiologist following a BPPV diagnosis would require a physician-approved and regularly reviewed plan of care, although physicians have little training or experience in such rehabilitations and therapies. There are no doubt many other such examples.

ADA supports a truly comprehensive audiologic benefit under Medicare as part of broader legislation that also includes the addition of audiologists as limited license physicians under Medicare (as consistent with other non-M.D. doctoring professions) and allows Medicare patients to have “direct access” to audiologists, eliminating the need for a physician referral. This inclusive legislative approach, named the 18x18 Movement, will best serve the patient, the profession and the tax payer. ADA is working diligently to ensure that the 18x18 legislation is also introduced in the 113th Congress and is ultimately adopted. Please visit for more information.

Meanwhile, ADA encourages its members and constituents to contact their U.S. Representatives to encourage them to not support H.R. 2330 and to instead support a holistic, access-centric and cost-effective approach as contained in the draft 18x18 legislation.