Providing coverage for hearing care under the Medicare program

(a) Provision of audiology services by qualified audiologists and hearing aid examination services by qualified hearing aid professionals (1) In general Section 1861(ll) of the Social Security Act (42 U.S.C. 1395x(ll)) is amended— (A) in paragraph (3)— (i) by inserting (A) after (3); (ii) in subparagraph (A), as added by clause (i) of this subparagraph— (I) by striking means such hearing and balance assessment services and inserting “means— (i) such hearing and balance assessment services and, beginning January 1, 2028, such hearing aid examination services and treatment services (including aural rehabilitation, vestibular rehabilitation, and cerumen management); (II) in clause (i), as added by subclause (I) of this clause, by striking the period at the end and inserting; and; and (III) by adding at the end the following new clause: (ii) beginning January 1, 2028, such hearing aid examination services furnished by a qualified hearing aid professional (as defined in paragraph (4)(C)) as the professional is legally authorized to perform under State law (or the State regulatory mechanism provided by State law), as would otherwise be covered if furnished by a physician.; and (iii) by adding at the end the following new subparagraph: (B) Beginning January 1, 2028, audiology services described in subparagraph (A)(i) shall be furnished without a requirement for an order from a physician or practitioner.; and (B) in paragraph (4), by adding at the end the following new subparagraph: (C) The term qualified hearing aid professional means an individual who— (i) is licensed or registered as a hearing aid dispenser, hearing aid specialist, hearing instrument dispenser, or related professional by the State in which the individual furnishes such services; and (ii) is accredited by the National Board for Certification in Hearing Instrument Sciences or meets such other requirements as the Secretary determines appropriate (including requirements relating to educational certifications or accreditations) taking into account any additional relevant requirements for hearing aid specialists, hearing aid dispensers, and hearing instrument dispensers established by Medicare Advantage organizations under part C, State plans (or waivers of such plans) under title XIX, and group health plans and health insurance issuers (as such terms are defined in section 2791 of the Public Health Service Act).. (2) Payment for qualified hearing aid professionals Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)), as amended by section 402(c)(1), is amended— (A) by striking and before (II); and (B) by inserting before the semicolon at the end the following: and (JJ) with respect to hearing aid examination services (as described in paragraph (3)(A)(ii) of section 1861(ll)) furnished by a qualified hearing aid professional (as defined in paragraph (4)(C) of such section), the amounts paid shall be equal to 80 percent of the lesser of the actual charge for such services or 85 percent of the amount for such services determined under the payment basis determined under section 1848. (3) Inclusion of qualified audiologists and qualified hearing aid professionals as certain practitioners to receive payment on an assignment-related basis (A) Qualified audiologists Section 1842(b)(18)(C) of the Social Security Act (42 U.S.C. 1395u(b)(18)(C)), as amended by section 402(d), is amended by adding at the end the following new clause: (x) Beginning on January 1, 2028, a qualified audiologist (as defined in section 1861(ll)(4)(B)).. (B) Qualified hearing aid professionals Section 1842(b)(18) of the Social Security Act (42 U.S.C. 1395u(b)(18)) is amended— (i) in each of subparagraphs (A) and (B), by striking subparagraph (C) and inserting subparagraph (C) or, beginning on January 1, 2028, subparagraph (E); and (ii) by adding at the end the following new subparagraph: (E) A practitioner described in this subparagraph is a qualified hearing aid professional (as defined in section 1861(ll)(4)(C)).. (b) Coverage of hearing aids (1) 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 1, 2028, to individuals with moderately severe, severe, or profound hearing loss before the semicolon at the end. (2) Payment limitations for hearing aids Section 1834(h) of the Social Security Act (42 U.S.C. 1395m(h)) is amended by adding at the end the following new paragraphs: (6) Payment only on an assignment-related basis Payment for hearing aids for which payment may be made under this part may be made only on an assignment-related basis. The provisions of subparagraphs (A) and (B) of section 1842(b)(18) shall apply to hearing aids in the same manner as they apply to services furnished by a practitioner described in subparagraph (C) of such section. (7) Limitations for hearing aids (A) In general Payment may be made under this part with respect to an individual, with respect to hearing aids furnished by a qualified hearing aid supplier (as defined in subparagraph (C)) on or after January 1, 2028— (i) not more than once per ear during a 5-year period; (ii) only for types of such hearing aids that are determined appropriate by the Secretary; and (iii) 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 defined in subparagraph (C) of such section), physician assistant, nurse practitioner, or clinical nurse specialist. (B) Special rule The payment basis determined under this subsection (including after application of paragraph (1)(H), relating to application of competitive acquisition) for hearing aids furnished by a qualified hearing aid supplier on or after January 1, 2028, shall not exceed the rate determined for such hearing aids under the Federal Supply Schedule of the General Services Administration, as published by such Administration in 2021, updated to the year involved using the applicable percent increase for the year. (C) Definitions In this subsection: (i) Hearing aid The term hearing aid means the item and related services including selection, fitting, adjustment, and patient education and training. (ii) Qualified hearing aid supplier The term qualified hearing aid supplier means— (I) a qualified audiologist; (II) a physician (as defined in section 1861(r)(1)); (III) a physician assistant, nurse practitioner, or clinical nurse specialist; (IV) a qualified hearing aid professional (as defined in section 1861(ll)(4)(C)); and (V) other suppliers as determined by the Secretary.. (3) Application of competitive acquisition (A) In general Section 1834(h)(1)(H) of the Social Security Act (42 U.S.C. 1395m(h)(1)(H)) is amended— (i) in the header, by inserting and hearing aids after orthotics; (ii) in the matter preceding clause (i), by inserting or of hearing aids described in paragraph (2)(E) of such section, after 2011,; and (iii) in clause (i), by inserting or such hearing aids after such orthotics. (B) Conforming amendments (i) In general Section 1847(a)(2) of the Social Security Act (42 U.S.C. 1395w–3(a)(2)) is amended by adding at the end the following new subparagraph: (E) Hearing aids Hearing aids described in section 1861(s)(8) for which payment would otherwise be made under section 1834(h).. (ii) Exemption of certain items from competitive acquisition Section 1847(a)(7) of the Social Security Act (42 U.S.C. 1395w–3(a)(7)) is amended by adding at the end the following new subparagraph: (C) Certain hearing aids Those items and services described in paragraph (2)(E) if furnished by a physician or other practitioner (as defined by the Secretary) to the physician's or practitioner's own patients as part of the physician's or practitioner's professional service.. (iii) Implementation Section 1847(a) of the Social Security Act (42 U.S.C. 1395w–3(a)) is amended by adding at the end the following new paragraph: (8) Competition with respect to hearing aids Not later than January 1, 2031, the Secretary shall begin the competition with respect to the items and services described in paragraph (2)(E).. (4) Physician self-referral law Section 1877(b) of the Social Security Act (42 U.S.C. 1395nn(b)) is amended by adding at the end the following new paragraph: (6) Hearing aids and services In the case of hearing aid examination services and hearing aids— (A) furnished on or after January 1, 2028, and before January 1, 2030; and (B) furnished on or after January 1, 2030, if the financial relationship specified in subsection (a)(2) meets such requirements the Secretary imposes by regulation to protect against program or patient abuse.. (c) Exclusion modification Section 1862(a)(7) of the Social Security Act (42 U.S.C. 1395y(a)(7)) is amended by inserting (except such hearing aids or examinations therefor as described in and otherwise allowed under section 1861(s)(8)) after hearing aids or examinations therefor. (d) Inclusion as excepted medical treatment Section 1821(b)(5)(A)(iv) of the Social Security Act (42 U.S.C. 1395i–5(b)(5)(A)(iv)), as added by section 402(f), is amended by inserting, audiology services described in subsection (ll)(3) of such section, or hearing aids described in subsection (s)(8) of such section after section 1861). (e) Rural health clinics and federally qualified health centers (1) Clarifying coverage of audiology services as physicians' services Section 1861(aa)(1)(A) of the Social Security Act (42 U.S.C. 1395x(aa)(1)(A)) is amended by inserting (including audiology services (as defined in subsection (ll)(3))) after physicians' services. (2) 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 (as such terms are defined in subsection (ll)), after (as defined in subsection (hh)(1)),. (3) Temporary payment rates for certain services under the RHC AIR and FQHC PPS (A) AIR Section 1833 of the Social Security Act (42 U.S.C. 1395l), as amended by section 402(g)(2)(A), is amended— (i) in subsection (a)(3)(A), by inserting or audiology services (as defined in section 1861(ll)(3)) after (as defined in section 1861(ooo)); and (ii) in subsection (ee), by inserting or audiology services (as defined in section 1861(ll)(3)) after (as defined in section 1861(ooo)). (B) PPS Section 1834(o)(6) of the Social Security Act (42 U.S.C. 1395m(o)(6)), as added by section 402(g)(2)(B), is amended— (i) in the first sentence, by inserting or audiology services (as defined in section 1861(ll)(3)) after (as defined in section 1861(ooo)); and (ii) in the second sentence, by inserting or such audiology services after such dental and oral health services. (f) Expediting implementation The Secretary of Health and Human Services shall implement this section for 2028 and 2029 through program instruction or other forms of program guidance. (g) Funding In addition to amounts otherwise available, there is appropriated to the Secretary of Health and Human Services for fiscal year 2026, out of any money in the Treasury not otherwise appropriated, $370,000,000, to remain available until expended, for purposes of implementing the amendments made by this section during the period beginning on January 1, 2027, and ending on September 30, 2036.