As audiology and hearing care professionals and patients look to telehealth during the COVID-19 pandemic, barriers in insurance coverage have left many with complex concerns and limited options.
While the Centers for Medicare and Medicaid Services (CMS) has expanded access to Medicare telehealth services to allow more patients access to virtual health services, such expansion did not include coverage for remote audiology services. The recent move by major private insurance companies—UnitedHealthcare, Cigna, and Tricare—to expand insurance coverage to include telehealth speech-language pathology services, is hoped to be a strong impetus for CMS and other insurance providers to follow.
The American Speech-Language-Hearing Association (ASHA) has been at the forefront in the advocacy for nationwide telehealth coverage for audiology services, having initiated efforts that include calling on the U.S. Congress and the CMS for this mandate. With the recent passage of the historic Coronavirus Aid, Relief, and Economic Security (CARES) Act, the audiology community is looking to get a signification response soon.
To understand the challenges involved in changing this policy amid evolving state and federal regulations, Tim Nanof, MSW, the director of health care and education policy at ASHA, explains: "The biggest barrier is the limitation on covered professionals in Medicare statute (Sec. 1834 m) of the Title 18 of the Social Security Act. ASHA advocated successfully for CMS to have the authority to waive all restrictions on telehealth coverage. The waiver was included in the CARES Act (Public Law 116-136) that Congress passed recently,"
"Now that CMS has the authority to expand coverage to additional providers, the challenge is ensuring that CMS understands the services audiologists can effectively provide via telehealth," he said, adding that ASHA has provided the CMS and all Medicaid and private health plan medical directors a set of recommendations for implementing coverage of audiology and speech-language pathology services.
Despite coverage limitations that vary across different U.S. states, hearing care professionals have been exploring creative and responsible ways to serve patients, said Tricia Ashby-Scabis, AuD, CCC-A, the director of audiology practices at ASHA.
"Some practices that are open are having patients drop hearing aids off curbside or at front desks (and waiting in their cars rather than the office); leaving office doors open so people aren't touching surfaces; disinfecting, using the best infection control measures they can; and having staff, including themselves, and patients wear masks—provided masks are available," Ashby-Scabis told The Hearing Journal, while also pointing out that wearing a mask may not be ideal when dealing with patients with hearing loss who need/want visual cues.
Many audiologists are also in the process of determining which services are critical or "essential" in each facility or office.
While waiting for updates from the CMS, ASHA is encouraging members to advocate for increased coverage of telehealth and to expand their telehealth capabilities, said Ashby-Scabis.
"Both activities are extremely important. Although some hearing aid and cochlear implant programming can be done remotely, audiologists' services cannot be done remotely in many cases because the services are diagnostic test-driven and require audiologists to be where patients are to assess and treat them.
"We do want audiologists to note the option to provide telehealth for private pay until CMS covers the benefit for audiologists. They can also stay informed of the status of coverage for Medicaid Programs and State Mandates through ASHA's tracking resource, and also Commercial Plans," she added.
For more resources, including links to ASHA's template letter for individual member self-advocacy, visit https://www.asha.org/About/Coronavirus-Updates/.
While the Centers for Medicare and Medicaid Services (CMS) has expanded access to Medicare telehealth services to allow more patients access to virtual health services, such expansion did not include coverage for remote audiology services. The recent move by major private insurance companies—UnitedHealthcare, Cigna, and Tricare—to expand insurance coverage to include telehealth speech-language pathology services, is hoped to be a strong impetus for CMS and other insurance providers to follow.
The American Speech-Language-Hearing Association (ASHA) has been at the forefront in the advocacy for nationwide telehealth coverage for audiology services, having initiated efforts that include calling on the U.S. Congress and the CMS for this mandate. With the recent passage of the historic Coronavirus Aid, Relief, and Economic Security (CARES) Act, the audiology community is looking to get a signification response soon.
To understand the challenges involved in changing this policy amid evolving state and federal regulations, Tim Nanof, MSW, the director of health care and education policy at ASHA, explains: "The biggest barrier is the limitation on covered professionals in Medicare statute (Sec. 1834 m) of the Title 18 of the Social Security Act. ASHA advocated successfully for CMS to have the authority to waive all restrictions on telehealth coverage. The waiver was included in the CARES Act (Public Law 116-136) that Congress passed recently,"
"Now that CMS has the authority to expand coverage to additional providers, the challenge is ensuring that CMS understands the services audiologists can effectively provide via telehealth," he said, adding that ASHA has provided the CMS and all Medicaid and private health plan medical directors a set of recommendations for implementing coverage of audiology and speech-language pathology services.
Despite coverage limitations that vary across different U.S. states, hearing care professionals have been exploring creative and responsible ways to serve patients, said Tricia Ashby-Scabis, AuD, CCC-A, the director of audiology practices at ASHA.
"Some practices that are open are having patients drop hearing aids off curbside or at front desks (and waiting in their cars rather than the office); leaving office doors open so people aren't touching surfaces; disinfecting, using the best infection control measures they can; and having staff, including themselves, and patients wear masks—provided masks are available," Ashby-Scabis told The Hearing Journal, while also pointing out that wearing a mask may not be ideal when dealing with patients with hearing loss who need/want visual cues.
Many audiologists are also in the process of determining which services are critical or "essential" in each facility or office.
While waiting for updates from the CMS, ASHA is encouraging members to advocate for increased coverage of telehealth and to expand their telehealth capabilities, said Ashby-Scabis.
"Both activities are extremely important. Although some hearing aid and cochlear implant programming can be done remotely, audiologists' services cannot be done remotely in many cases because the services are diagnostic test-driven and require audiologists to be where patients are to assess and treat them.
"We do want audiologists to note the option to provide telehealth for private pay until CMS covers the benefit for audiologists. They can also stay informed of the status of coverage for Medicaid Programs and State Mandates through ASHA's tracking resource, and also Commercial Plans," she added.
For more resources, including links to ASHA's template letter for individual member self-advocacy, visit https://www.asha.org/About/Coronavirus-Updates/.
Published: 4/2/2020 4:23:00 PM
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