Providing coverage for hearing care under the Medicare program

(a) Provision of audiology services by qualified audiologists and 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 (and, beginning January 1, 2028, such aural rehabilitation and treatment services) after assessment services; (ii) by inserting, and, beginning on January 1, 2028, such hearing assessment services furnished by a qualified hearing aid professional, after by a qualified audiologist; and (iii) by striking the audiologist and inserting the audiologist or qualified hearing aid professional; and (B) in paragraph (4), by adding at the end the following new subparagraph: (C) The term qualified hearing aid professional means, with respect to hearing assessment services described in paragraph (3), 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) meets such other requirements as the Secretary determines appropriate (including requirements relating to educational certifications or accreditations), taking into account any additional 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 the 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)) is amended— (A) by striking and before (HH); and (B) by inserting before the semicolon at the end the following: and (II) with respect to hearing assessment services (as described in paragraph (3) 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. (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 diagnosed 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 section 1842(b)(18)(B) shall apply to hearing aids in the same manner as they apply to services furnished by a practitioner described in subsection (b)(18)(C). (7) Limitations for hearing aids Payment may be made under this part with respect to an individual, with respect to hearing aids furnished on or after January 1, 2028— (A) not more than once per ear during a 5-year period; (B) only for types of such hearing aids that are determined appropriate by the Secretary; and (C) 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 so defined), physician assistant, nurse practitioner, or clinical nurse specialist.. (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 amendment (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.. (4) Inclusion of qualified audiologists and qualified hearing aid professionals as certain practitioners to receive payment on an assignment-related basis Section 1842(b)(18)(C) of the Social Security Act (42 U.S.C. 1395u(b)(18)(C)), is amended by adding at the end the following new clauses: (ix) Beginning on January 1, 2028, a qualified audiologist (as defined in section 1861(ll)(4)(B)). (x) A qualified hearing aid professional (as defined in section 1861(ll)(4)(C)).. (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) of the Social Security Act (42 U.S.C. 1395i–5(b)(5)(A)) is amended— (1) in clause (ii), by striking or; (2) in clause (iii), by striking the period and inserting, or; and (3) by adding at the end the following new clause: (iv) consisting of audiology services described in subsection (ll)(3) of section 1861, or hearing aids described in subsection (s)(8) of such section, that are payable under part B as a result of the amendments made by the Health CARE Act of 2026.. (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) is amended— (i) in subsection (a)(3)(A), by inserting (which shall, in the case of audiology services (as defined in section 1861(ll)(3)), in lieu of any limits on reasonable charges otherwise applicable, be based on the rates payable for such services under the payment basis determined under section 1848 until such time as the Secretary determines sufficient data has been collected to otherwise apply such limits (or January 1, 2034, if no such determination has been made as of such date)) after may prescribe in regulations; and (ii) by adding at the end the following new subsection: (ee) Disregard of costs attributable to certain services from calculation of RHC AIR Payments for rural health clinic services other than audiology services (as defined in section 1861(ll)(3)) under the methodology for all-inclusive rates (established by the Secretary) under subsection (a)(3) shall not take into account the costs of such services while rates for such services are based on rates payable for such services under the payment basis established under section 1848.. (B) PPS Section 1834(o) of the Social Security Act (42 U.S.C. 1395m(o)) is amended by adding at the end the following new paragraph: (6) Temporary payment rates based on PFS for certain services The Secretary shall, in establishing payment rates for audiology services (as defined in section 1861(ll)(3)) that are Federally qualified health center services under the prospective payment system established under this subsection, in lieu of the rates otherwise applicable under such system, base such rates on rates payable for such services under the payment basis established under section 1848 until such time as the Secretary determines sufficient data has been collected to otherwise establish rates for such services under such system (or January 1, 2034, if no such determination has been made as of such date). Payments for Federally qualified health center services other than such audiology services under such system shall not take into account the costs of such services while rates for such services are based on rates payable for such services under the payment basis established under section 1848.. (f) Implementation (1) In general In addition to amounts otherwise available, there is appropriated to the Secretary of Health and Human Services for fiscal year 2027, 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. (2) Program instruction The Secretary of Health and Human Services shall implement the provisions of, and the amendments made by, this section for 2027 and 2028 by program instruction.