Hearing services under Medicare

(a) Coverage (1) In general Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)), as amended by sections 2(a) and 3(a), is amended— (A) in subparagraph (KK), by striking and after the semicolon at the end; (B) in subparagraph (LL), by inserting and after the semicolon at the end; and (C) by adding at the end the following new subparagraph: (MM) audiology services (as defined in subsection (ll)(3)) and hearing services (as defined in subsection (ll)(5));. (2) Hearing services defined Section 1861(ll) of the Social Security Act (42 U.S.C. 1395x(ll)) is amended— (A) in the subsection heading, by inserting; Hearing Services after Audiology Services; and (B) by adding at the end the following new paragraph: (5) The term hearing services means— (A) routine hearing exams and exams for hearing aids; and (B) other necessary services related to hearing health (as defined by the Secretary).. (b) Payment; coinsurance; and limitations (1) In general Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)), as amended by sections 2(c)(1) and 3(c)(1), is amended— (A) by striking and before (JJ); and (B) by inserting before the semicolon at the end the following:, and (KK) with respect to audiology services (as defined in section 1861(ll)(3)) and hearing services (as defined in section 1861(ll)(5)), the amount paid shall be the payment amount specified under section 1834(cc). (2) Payment and limits specified Section 1834 of the Social Security Act (42 U.S.C. 1395m), as amended by sections 2(c)(2) and 3(c)(2), is amended by adding at the end the following new subsection: (cc) Payment and limits for hearing services (1) In general The payment amount under this part for audiology services (as defined in section 1861(ll)(3)) and hearing services (as defined in section 1861(ll)(5)), shall be, subject to paragraph (3), the applicable percent (specified in paragraph (2)) of the lesser of the actual charge for the services or the amount determined under the payment basis determined under section 1848. (2) Applicable percent For purposes of paragraph (1), the applicable percent specified in this paragraph is— (A) for the first year beginning at least 6 months after the date of the enactment of this subsection, 0 percent; (B) for the year following the year specified in subparagraph (A) and each subsequent year through the seventh year following the year specified in subparagraph (A), the applicable percent specified in this paragraph for the previous year increased by 10 percentage points; and (C) for the eighth year following the year specified in subparagraph (A) and each subsequent year, 80 percent. (3) Secretarial authority (A) Authority to apply limitations The Secretary may apply reasonable limitations on the extent to which audiology services and hearing services are covered under this part, including through application of a prior authorization requirement. (B) Authority to modify coverage Notwithstanding any other provision of this title, if the Secretary determines appropriate, the Secretary may modify the coverage under this part of audiology services and hearing services to the extent that such modification is consistent with the recommendations of the United States Preventive Services Task Force.. (c) Payment under the physician fee schedule Section 1848(j)(3) of the Social Security Act (42 U.S.C. 1395w–4(j)(3)), as amended by sections 2(d) and 3(d), is amended by inserting (2)(MM), after (2)(LL),. (d) Hearing aids (1) Repeal of ground for exclusion Section 1862(a)(7) of the Social Security Act (42 U.S.C. 1395y(a)(7)), as amended by section 3(g), is amended by striking, hearing aids or examinations therefor,. (2) Definition of durable medical equipment to include hearing aids Section 1861(n) of the Social Security Act (42 U.S.C. 1395x(n)), as amended by section 3(f), is amended by inserting hearing aids, before and eyeglass lenses. (3) Special payment rules for hearing aids Section 1834(a) of the Social Security Act (42 U.S.C. 1395m(a)), as amended by sections 2(e)(2) and 3(e), is amended by adding at the end the following new paragraph: (26) Payment and limits for hearing aids (A) In general The payment amount under this part for hearing aids shall be, subject to subparagraph (C), the applicable percent (specified in subparagraph (B)) of the amount otherwise payable for hearing aids under this section. (B) Applicable percent For purposes of subparagraph (A), the applicable percent specified in this subparagraph is— (i) for the first year beginning at least 6 months after the date of the enactment of this paragraph, 0 percent; (ii) for the year following the year specified in clause (i) and each subsequent year through the seventh year following the year specified in clause (i), the applicable percent specified in this subparagraph for the previous year increased by 10 percentage points; and (iii) for the eighth year following the year specified in clause (i) and each subsequent year, 80 percent. (C) Limitations and Secretarial authority (i) In general Payment may be made under this part for an individual for not more than one hearing aid per ear during a 48-month period. (ii) Secretarial authority (I) Authority to apply additional limitations The Secretary may apply additional limitations on the extent to which hearing aids are covered under this part, including through application of a prior authorization requirement and through application of criteria for a minimum level of hearing loss for coverage of an initial or replacement hearing aid. (II) Authority to modify coverage Notwithstanding any other provision of this title, if the Secretary determines appropriate, the Secretary may modify the coverage under this part of hearing aids to the extent that such modification is consistent with the recommendations of the United States Preventive Services Task Force.. (e) Effective date The amendments made by this section shall apply to services furnished on or after January 1 of the first year beginning at least six months after the date of the enactment of this Act.