ADA Opposes ‘Fit to Serve’ Legislation

ADA is committed to best practices in the delivery of hearing health services and strives to ensure that the scope of practice and licensure requirements for hearing healthcare providers are commensurate with their education and training.

As such, the ADA Board of Directors, after careful consideration and a thorough investigation, announces its strong opposition to the Veterans Hearing Aid Access and Assistance Act (HR 353/S 564). We encourage ADA members to contact their legislators today to oppose this legislation. Contact your legislator here.
 
Background on the Bill
In 2013, in the 113th Congress, the International Hearing Society first shepherded the introduction of a bill that would Amend title 38, United States Code, to clarify the qualifications of hearing aid specialists of the Veterans Health Administration of the Department of Veterans Affairs, and for other purposes (HR 3508) https://www.govtrack.us/congress/bills/113/hr3508/text. This bill came to be known in the hearing healthcare arena as Fit to Serve

ADA, the American Speech Language Hearing Association (ASHA) and the American Academy of Otolaryngology (AAO-HNS) worked closely with IHS at that time to recommend substantial revisions to HR 3508 to eliminate language that would potentially allow hearing aid specialists to perform services clearly outside their scope of practice such as diagnostic testing, including compensation and pension examinations that should be performed only by audiologists or medical doctors.
 
As a result of these discussions, IHS and the bill sponsors made many requested revisions to the bill prior to its introduction in the U.S. Senate as S. 2311: https://www.govtrack.us/congress/bills/113/s2311/text. Among the revisions was the removal of language identifying an ‘apprenticeship program’ as a qualification for appointment as a hearing aid specialist under the legislation as well as other language, which would seemingly qualify a hearing aid specialist at the federal level.
 
Despite the significant modification to the bill text during the 113th Congress, ASHA, the American Academy of Audiology (AAA) and the Association of Veterans Administration Audiologists (AVAA) came out in opposition to the legislation. AAO-HNS expressed qualified support for the legislation.
 
ADA took no position on the legislation and continued to research both the implications of the bill and the potential impact that taking any position might have on ADA’s ability to foster the advancement of the Audiology Patient Choice Act. ADA commissioned a review from both its legal counsel and lobbyist.  At that time, the ADA Board was advised not to take a position on the Fit to Serve legislation unless there was a clear and compelling reason to do so.
 
It was determined that a perceived attempt to unnecessarily restrict access to hearing aid specialists by veterans for hearing aid dispensing services (which they are licensed to provide) could be construed by members of Congress as a conflict with the rationale for the Audiology Patient Choice Act (HR 2519): https://www.govtrack.us/congress/bills/114/hr2519, which seeks only to allow Medicare to recognize audiologists for their state defined scope of care (which they are licensed to provide).
 
The Fit to Serve legislation was re-introduced in the 114th Congress as the Veterans Hearing Aid Access and Assistance Act of 2015 (HR 353/S 564): https://www.govtrack.us/congress/bills/114/hr353/text and https://www.govtrack.us/congress/bills/114/s564/text.
 
New Information
Throughout the past two years, ADA has been working on behalf of members to gather as much information as possible, from as many sources as possible, on HR 353/S 564, before taking any formal position on the bill.
 
In recent weeks, it has come to our attention that IHS has sought and gained certification by the U.S. Department of Labor (DOL) for new National Guidelines for Apprenticeship Standards (National Guideline Standards) for the occupation of Hearing Aid Specialists.

These National Guideline Standards include services that fall well outside the bounds of licensure for hearing aid specialists in any state. ADA has requested that the DOL rescind its certification of the IHS apprenticeship program, which ADA believes could harm patients, apprentices and journey workers alike. In ADA’s view, based on the IHS submission to DOL, along with supporting commentary and social media communications from IHS and its members, the attempt to garner certification from DOL for the National Guideline Standards is a blatant attempt by IHS and hearing aid specialists to expand their scope of practice into that of an audiologist or physician, without commensurate academic and clinical education.
 
ADA informed you last week of the perils associated with the IHS Apprenticeship Program through the DOL and of ADA’s response. In light of this new information, ADA now believes that the Veterans Hearing Aid Access and Assistance Act, conceived and shepherded by IHS, is another mechanism for gaining federal recognition in order to improperly expand the scope of practice for hearing aid specialists.
 
Conclusion
ADA firmly believes that hearing aid specialists have the right to dispense hearing aids to veterans as is consistent with their current state defined scope of practice. We have no desire to unduly restrict their existing scope of practice.
 
However, we will remain vigilant in our opposition to initiatives that could pose patient harm through unwarranted recognition and scope expansion by hearing aid specialists at the federal or state level.
 
Hearing aid specialists already have the right to be hired by the Veteran’s Administration (as Health Technicians) and to have veterans referred to them through the VA Contract Services and/or Fee Basis programs for the services that they are licensed to provide. 
 
Based on information obtained by ADA, we do not view the Veterans Hearing Aid Access and Assistance Act as a pathway to better access to hearing healthcare for veterans, but rather as a pathway to support IHS’ goal for expanded scope of practice for hearing aid specialists, without additional training or education. Therefore, we urge you to contact your legislator to oppose the Veterans Hearing Aid Access and Assistance Act today!