All About MAASA: the Medicare Audiologist Access and Services

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On Capitol Hill it’s officially known as H.R. 4056/S. 2446 – but the Medicare Audiologist Access and Services Act of 2019 (MAASA) is more widely referred to as an empowering piece of legislation that puts patients first. Specifically, senior patients who use Medicare Part B for their hearing and balance health needs.

Read on for everything you need to know about MAASA.

We spoke to audiologists and captioned phone professionals to learn more about how this important legislation can positively affect patients. The Medicare Audiologist Access and Services Act (MAASA) has had a collaborative history. It was first introduced in the House of Representatives by Rep. Tom Rice (SC) on July 25, 2019 and in the Senate by Sen. Elizabeth Warren (MA) on September 9, 2019.

The legislation was drafted together by the Academy of Doctors of Audiology (ADA), American Academy of Audiology (AAA), and American Speech-Language-Hearing Association (ASHA). Many pieces of the legislation were introduced by AAA, ADA, and/or ASHA as stand-alone legislation for the past few decades; however, this Congressional Session, all three organizations united and are supporting this single piece of legislation.

Kim McRae, Customer Relationship Manager at CapTel by T-Mobile, says that Lobby Day was an incredible opportunity for CapTel by T-Mobile to work alongside passionate professionals in support of a better tomorrow for hearing healthcare. McRae spoke at Lobby Day in order to share just how important effective communication is to all Americans and how the life quality of millions of people could advance significantly.

“CapTel by T-Mobile was the only provider in the furrows alongside ADA and AAA professionals lobbying for the long-overdue change being sought after in hearing health care.”

The Need for MAASA

When enacted, this legislation will amend Title 18 of the Social Security Act. There are three main tenets of the legislation:

  1. Allowing Medicare Part B beneficiaries to see an audiologist for medically necessary diagnostic testing without the need for a physician order.
  2. Provide coverage for treatment services when provided by an audiologist as allowed by state licensure. These treatment services are already covered under Medicare when provided by another provider.
  3. Reclassify audiologists as ‘Practitioners’ under Medicare.

As one can imagine from reading these three tenants, Medicare Part B has not kept pace with modern medicine when it comes to services.

Currently, “traditional” Medicare patients are required to obtain an order from a physician (it cannot be solicited from the audiologist) prior to any diagnostic hearing or balance testing.

If treatment services are required, Medicare Part B patients are presented with two options: either pay for the services out-of-pocket and have them completed by the audiologist, or go to another provider to have the treatment covered by their Medicare insurance.

In the majority of cases, audiologists are licensed to provide the treatment services, yet Medicare does not cover the costs when provided by an audiologist.

Finally, reclassifying audiologists from ‘Diagnostic Supplier’ to ‘Practitioner’ under the Medicare system will allow audiologists to move forward with any changes to the system, including but not limited to providing telehealth services and participating in quality outcomes reporting (e.g. MIPS).

The passage of this legislation does not:

  • Change, expand and/or enhance the scope of practice outlined in any state audiology licensure law.
  • Change the practitioner status to a limited license physician at the state level.
  • Allow for prescriptive rights.
  • Allow for ordering rights.
  • Include a provision for hearing aid coverage by Medicare.

The Audiology Perspective

According to Alicia D.D. Spoor, Au.D., often times, when Medicare Part B beneficiaries contact an audiology office, they are informed that a physician order is required for the diagnostic testing. If the patient was referred by a family physician and an order was provided/faxed, the patient is scheduled for the testing.

However, if the patient self-initiated the appointment, s/he is informed that an order for an ‘audiologic-vestibular evaluation’ is required. Sometimes this order can be confusing for the prospective patient and/or physician office, since audiology is one of the only clinical doctorate professions that still requires a physician order under Medicare Part B for coverage of the testing.

Then, after the testing is completed (or before it can begin, in the case of wax impaction), the patient is informed of treatment services that can be provided by the audiologist, many times at the same visit. However, the patient must also be informed that Medicare will not provide coverage and therefore, the patient must then decide whether to pay out-of-pocket for timely treatment or to go to another provider to have the treatment completed.

Non-Medicare Part B patients (e.g. Medicare Advantage, BCBS, UHC, Cigna, Aetna) can self-refer to an audiologist and present to the office for medically necessary hearing and balance testing. [No order requirements.] Then, treatment services can be provided, often at the same appointment, with coverage. These systems truly utilize audiologists most efficiently within Medicare and simplify patients’ ability to obtain quality hearing and balance healthcare.

Patient Hurdles

As one can see from the above, the additional order requirement from Medicare Part B requires a significant amount of work: phone calls, time, faxes, etc. just to see a Doctor of Audiology for diagnostic testing. Additionally, coverage for treatment services excludes audiologists and patients are then in a predicament – they must either pay out-of-pocket for treatment immediately or go to another provider for the coverage of the service.

Judy Huch, Au.D. and Arizona State Commissioner for the Deaf and Hard of Hearing, sees the frustration in patients when going through the current process. “They are confused and angry since Medicare is supposed to be, in their mind, a referral free process. MAASA would allow audiologists to have the autonomy or independence to put into practice what we (audiologists) are trained to do, and do it much faster for the patient.”

What You Can Do

According to McRae, “The lobbying efforts are ongoing. Even though support from professionals within the AAA and ADA is solid, you can help by reaching out to your legislators to support the MAASA bill.”

Bookmark this link on to see the latest progress. The Medicare Audiologist Access and Services Act must first pass the House, then pass the Senate, then go to the President to be signed into law.

Thank you to Dr. Spoor (Highland, MD) and Dr. Huch (Tuscon, AZ) for contributing to this article.