[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4650 Introduced in House (IH)]
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117th CONGRESS
1st Session
H. R. 4650
To amend title XVIII of the Social Security Act to provide for dental
and oral health care benefits under the Medicare program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 22, 2021
Ms. Kelly of Illinois (for herself, Mr. Horsford, Mr. Butterfield, Mr.
Payne, and Mr. Welch) introduced the following bill; which was referred
to the Committee on Energy and Commerce, and in addition to the
Committee on Ways and Means, for a period to be subsequently determined
by the Speaker, in each case for consideration of such provisions as
fall within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide for dental
and oral health care benefits under the Medicare program.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Medicare Dental Coverage Act of
2021''.
SEC. 2. DENTAL AND ORAL HEALTH CARE.
(a) Coverage.--Section 1861(s)(2) of the Social Security Act (42
U.S.C. 1395x(s)(2)) is amended--
(1) in subparagraph (GG), by striking ``and'' after the
semicolon at the end;
(2) in subparagraph (HH), by striking the period at the end
and adding ``; and''; and
(3) by adding at the end the following new subparagraph:
``(II) dental and oral health services (as defined in
subsection (lll));''.
(b) Dental and Oral Health Services Defined.--Section 1861 of the
Social Security Act (42 U.S.C. 1395x) is amended by adding at the end
the following new subsection:
``(lll) Dental and Oral Health Services.--
``(1) In general.--The term `dental and oral health
services' means items and services (other than such items and
services for which payment may be made under part A as
inpatient hospital services) that are furnished during 2025 or
a subsequent year, for which coverage was not provided under
part B as of the date of the enactment of this subsection, and
that are--
``(A) the preventive and screening services
described in paragraph (2) furnished by a doctor of
dental surgery or of dental medicine (as described in
subsection (r)(2)) or an oral health professional (as
defined in paragraph (4)); or
``(B) the basic treatments specified for such year
by the Secretary pursuant to paragraph (3)(A) and the
major treatments specified for such year by the
Secretary pursuant to paragraph (3)(B) furnished by
such a doctor or such a professional.
``(2) Preventive and screening services.--The preventive
and screening services described in this paragraph are the
following:
``(A) Oral exams.
``(B) Dental cleanings.
``(C) Dental x-rays performed in the office of a
doctor or professional described in paragraph (1)(A).
``(D) Fluoride treatments.
``(3) Basic and major treatments.--For 2025 and each
subsequent year, the Secretary shall specify--
``(A) basic treatments (which may include basic
tooth restorations, basic periodontic services, tooth
extractions, and oral disease management services); and
``(B) major treatments (which may include major
tooth restorations, major periodontic services,
bridges, crowns, and root canals);
that shall be included as dental and oral health services for
such year.
``(4) Oral health professional.--The term `oral health
professional' means, with respect to dental and oral health
services, a health professional who is licensed to furnish such
services, acting within the scope of such license, by the State
in which such services are furnished.''.
(c) Payment; Coinsurance; and Limitations.--
(1) In general.--Section 1833(a)(1) of the Social Security
Act (42 U.S.C. 1395l(a)(1)) is amended--
(A) in subparagraph (N), by inserting ``and dental
and oral health services (as defined in section
1861(lll))'' after ``section 1861(hhh)(1))'';
(B) by striking ``and'' before ``(DD)''; and
(C) by inserting before the semicolon at the end
the following: ``, and (EE) with respect to dental and
oral health services (as defined in section 1861(lll)),
the amount paid shall be the payment amount specified
under section 1834(z)''.
(2) Payment and limits specified.--Section 1834 of the
Social Security Act (42 U.S.C. 1395m) is amended by adding at
the end the following new subsection:
``(z) Payment and Limits for Dental and Oral Health Services.--
``(1) In general.--The payment amount under this part for
dental and oral health services (as defined in section
1861(lll)) shall be, subject to paragraph (3), the applicable
percent (specified in paragraph (2)) of the lesser of the
actual charge for the services or the amount determined under
the payment basis determined under section 1848. In determining
such amounts determined under such payment basis, the Secretary
shall consider payment rates paid to dentists for comparable
services under State plans under title XIX, under the TRICARE
program under chapter 55 of title 10 of the United States Code,
and by other health care payers, such as Medicare Advantage
plans under part C.
``(2) Applicable percent.--For purposes of paragraph (1),
the applicable percent specified in this paragraph is, with
respect to dental and oral health services (as defined in
section 1861(lll)) furnished in a year--
``(A) that are preventive and screening services
described in paragraph (2) or basic treatments
specified for such year pursuant to paragraph (3)(A) of
such section, 80 percent; and
``(B) that are major treatments specified for such
year pursuant to paragraph (3)(B) of such section--
``(i) in the case such services are
furnished during 2025, 10 percent;
``(ii) in the case such services are
furnished during 2026 or a subsequent year
before 2029, the applicable percent specified
under this subparagraph for the previous year,
increased by 10 percentage points; and
``(iii) in the case such services are
furnished during 2029 or a subsequent year, 50
percent.
``(3) Limitations.--With respect to dental and oral health
services that are--
``(A) preventive and screening oral exams, payment
may be made under this part for not more than two such
exams during a 12-month period;
``(B) dental cleanings, payment may be made under
this part for not more than two such cleanings during a
12-month period; and
``(C) not described in subparagraph (A) or (B),
payment may be made under this part only at such
frequencies and under such circumstances determined
appropriate by the Secretary.''.
(d) Payment Under Physician Fee Schedule.--
(1) In general.--Section 1848(j)(3) of the Social Security
Act (42 U.S.C. 1395w-4(j)(3)) is amended by inserting
``(2)(II),'' before ``(3)''.
(2) Exclusion from mips.--Section 1848(q)(1)(C)(ii) of the
Social Security Act (42 U.S.C. 1395w-4(q)(1)(C)(ii)) is
amended--
(A) in subclause (II), by striking ``or'' at the
end;
(B) in subclause (III), by striking the period at
the end and inserting ``; or''; and
(C) by adding at the end the following new
subclause:
``(IV) with respect to 2025 and
each subsequent year, is a doctor of
dental surgery or of dental medicine
(as described in section 1861(r)(2)) or
is an oral health professional (as
defined in section 1861(lll)(4)).''.
(3) Inclusion of oral health professionals as certain
practitioners.--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 clause:
``(vii) With respect to 2025 and each subsequent year, an
oral health professional (as defined in section
1861(lll)(4)).''.
(e) Dentures.--
(1) In general.--Section 1861(s)(8) of the Social Security
Act (42 U.S.C. 1395x(s)(8)) is amended--
(A) by striking ``(other than dental)''; and
(B) by inserting ``and excluding dental, except for
a full or partial set of dentures furnished on or after
January 1, 2025'' after ``colostomy care''.
(2) Special payment rules.--
(A) Limitations.--Section 1834(h) of the Social
Security Act (42 U.S.C. 1395m(h)) is amended by adding
at the end the following new paragraph:
``(6) Special payment rule for dentures.--Payment may be
made under this part with respect to an individual for
dentures--
``(A) not more than once during any 5-year period
(except in the case that a doctor or professional
described in section 1861(lll)(1)(A) determines such
dentures do not fit the individual); and
``(B) only to the extent that such dentures are
furnished pursuant to a written order of such a doctor
or professional.''.
(B) Application of competitive acquisition.--
(i) 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 subparagraph heading, by
inserting ``, dentures'' after
``orthotics'';
(II) by inserting ``, of dentures
described in paragraph (2)(D) of such
section,'' after ``2011,''; and
(III) in clause (i), by inserting
``, such dentures'' after
``orthotics''.
(ii) Conforming amendment.--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:
``(D) Dentures.--Dentures described in section
1861(s)(8) for which payment would otherwise be made
under section 1834(h).''.
(iii) 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 dentures.--Those items and services
described in paragraph (2)(D) 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.''.
(f) Exclusion Modifications.--Section 1862(a) of the Social
Security Act (42 U.S.C. 1395y(a)) is amended--
(1) in paragraph (1)--
(A) in subparagraph (O), by striking ``and'' at the
end;
(B) in subparagraph (P), by striking the semicolon
at the end and inserting ``, and''; and
(C) by adding at the end the following new
subparagraph:
``(Q) in the case of dental and oral health services (as
defined in section 1861(lll)) that are preventive and screening
services described in paragraph (2) of such section, which are
furnished more frequently than provided under section
1834(z)(3) and under circumstances other than circumstances
determined appropriate under such section;''; and
(2) in paragraph (12), by inserting before the semicolon at
the end the following: ``and except that payment may be made
under part B for dental and oral health services that are
covered under section 1861(s)(2)(II)''.
(g) Certain Non-Application.--
(1) In general.--Paragraphs (1) and (4) of section 1839(a)
of the Social Security Act (42 U.S.C. 1395r(a)) are amended by
adding at the end of each such paragraphs the following: ``In
applying this paragraph there shall not be taken into account
benefits and administrative costs attributable to the
amendments made by section 2 (other than subsection (g)) of the
Medicare Dental Coverage Act of 2021 and the Government
contribution under section 1844(a)(5).''.
(2) Payment.--Section 1844(a) of such Act (42 U.S.C.
1395w(a)) is amended--
(A) in paragraph (4), by striking the period at the
end and inserting ``; plus''; and
(B) by adding at the end the following new
paragraph:
``(5) a Government contribution equal to the amount that is
estimated to be payable for benefits and related administrative
costs incurred that are attributable to the amendments made by
section 2 (other than subsection (g)) of the Medicare Dental
Coverage Act of 2021.''.
(h) Implementation Funding.--
(1) In general.--The Secretary of Health and Human Services
(in this subsection referred to as the ``Secretary'') shall
provide for the transfer from the Federal Supplementary Medical
Insurance Trust Fund under section 1841 of the Social Security
Act (42 U.S.C. 1395t) to the Centers for Medicare & Medicaid
Services Program Management Account of--
(A) $20,000,000 for each of fiscal years 2022
through 2027 for purposes of implementing the
amendments made by this section; and
(B) such sums as determined appropriate by the
Secretary for each subsequent fiscal year for purposes
of administering the provisions of such amendments.
(2) Availability.--Funds transferred pursuant to paragraph
(1) shall remain available until expended.
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