Hearing Device Coverage Clarification Act
The Hearing Device Coverage Clarification Act would require the Administrator of the Centers for Medicare & Medicaid Services (CMS) to issue a formal clarification within 60 days of enactment. The clarification would state that implanted active middle-ear hearing devices are prosthetics, not hearing aids, and therefore are not subject to the Medicare hearing aid coverage exclusion found in section 1862(a)(7) of the Social Security Act. The bill also defines “prosthetic” by reference to the regulation at 42 C.F.R. 414.202. In short, the bill aims to remove the barrier that treats implanted active middle-ear devices as excluded from coverage simply because they are associated with hearing loss, by reclassifying them as prosthetics for Medicare purposes.
Key Points
- 1The bill directs CMS to clarify within 60 days that implanted active middle-ear hearing devices are prosthetics and not covered by the hearing aid coverage exclusion.
- 2The policy lever is the Medicare “hearing aid coverage exclusion” in 1862(a)(7); the bill seeks to exempt implanted devices from this exclusion by classifying them as prosthetics.
- 3The term “prosthetic” in the bill is defined by reference to 42 C.F.R. 414.202 (or successor regulation).
- 4The change would affect Medicare coverage determinations by aligning implanted middle-ear devices with prosthetics coverage rather than hearing aids.
- 5The bill does not mandate automatic coverage for all implants; it requires a CMS clarification that could influence coverage decisions under existing prosthetic rules and medical necessity requirements.