Health Care Reform for Audiologists and Speech-Language Pathologists

It's important for clinicians to adapt to the changing landscape of health care by learning about major reform initiatives. This resource provides information on the Affordable Care Act (ACA) and other health care reform issues for audiologists, speech-language pathologists (SLPs), and the patients you serve.

Please email reimbursement@asha.org for questions about health care reform and how it relates to audiology and speech-language pathology services.

The Affordable Care Act

At the forefront of health care reform in the U.S. is the Patient Protection and Affordable Care Act (ACA), the comprehensive health care reform law enacted in March 2010. The ACA has three primary goals:

• Make affordable health insurance available to more people—including coverage for pre-existing health conditions—without charging people more. The law also provides consumers with subsidies, called premium tax credits, that lower costs for households with incomes between 100% and 400% of the federal poverty level.
• Expand the Medicaid program to cover adults with income below 138% of the federal poverty level. Not all states have expanded their Medicaid programs.
• Support innovative medical care delivery methods, such as alternative payment models, designed to lower the costs of health care, generally.

Since the ACA's enactment, many states, organizations, and individuals filed federal lawsuits challenging the constitutionality of all or parts of the law. The U.S. Supreme Court heard oral arguments in November 2020 on the constitutionality of the ACA’s individual mandate and is expected to announce a decision in 2021.

Advocacy and Resources

ASHA monitors the ACA and advocates on issues impacting the professions of audiology and speech-language pathology, such as habilitative and rehabilitative services and devices coverage. The following resources provide information on provisions of the ACA that impact audiologists and SLPs.

Health Care Reform Issues

• Learn how the ACA's essential health benefits (EHBs) provide coverage of habilitation and rehabiltiation services and devices.
• Partner with ASHA and your state association to advocate for coverage of audiology and speech-language pathology services as EHBs.
• Find out about value-based care provided under alternative payment models (APMs).
  • Learn more about APMs in this handout [PDF].
  • Get APM tips to help you transition to the value mindset.
  • See some real-world examples of audiology and speech-language pathology services in APMs.

More About the ACA

• Read the full text of the law.
• Learn about consumer rights and protections under the law. 
• Read about Section 1557, the nondiscrimination provision of the law.
  • See reimbursement resources for SLPs providing voice therapy services for gender affirmation services.

Additional Reading

• The ASHA Leader: Show Us the Merit: Alternative payment models are the way of the future. Here’s what you need to know.
• The ASHA Leader: Change Ahead for Medicare Outpatient Quality Reporting and Payment: Medicare payments for outpatient audiology and speech-language services will fundamentally change in 2019. Will you be ready?
• Perspectives: Value-Based Health Care: Adjusting Speech-Language Pathology Practice to Fit the Model
• Medicare's Quality Payment Program (QPP) resources on APMs, including eligibility and participation.
• Center for Medicare & Medicaid Innovation resources on innovative health care payment and service delivery models.