[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 2012 Introduced in Senate (IS)]
<DOC>
118th CONGRESS
1st Session
S. 2012
To amend title XVIII of the Social Security Act to provide for coverage
of dental services under the Medicare program.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
June 15, 2023
Mr. Cardin (for himself, Mr. Blumenthal, Mr. Markey, Mr. Merkley, and
Mr. Brown) introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide for coverage
of dental services 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 Benefit Act of
2023''.
SEC. 2. COVERAGE OF DENTAL SERVICES UNDER THE MEDICARE PROGRAM.
(a) Coverage.--Section 1861(s)(2) of the Social Security Act (42
U.S.C. 1395x(s)(2)) is amended--
(1) in subparagraph (II), by striking ``and'' at the end;
(2) in subparagraph (JJ), by adding ``and'' at the end; and
(3) by adding at the end the following new subparagraph:
``(KK) dental and oral health services (as defined in
subsection (nnn));''.
(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:
``Dental and Oral Health Services
``(nnn) The term `dental and oral health services' means services
(as defined by the Secretary) that are necessary to prevent disease and
promote oral health, restore oral structures to health and function,
reduce oral pain, and treat emergency conditions, including--
``(1) routine diagnostic and preventive care such as dental
cleanings, exams, and x-rays;
``(2) basic dental services such as fillings and
extractions;
``(3) major dental services such as root canals, crowns,
and dentures;
``(4) emergency dental care; and
``(5) other necessary services related to dental and oral
health (as defined by the Secretary).''.
(c) Coverage of Routine Diagnostic and Preventive Care as a
Preventive Service.--Section 1861(ddd)(3) of the Social Security Act
(42 U.S.C. 1395x(ddd)(3)) is amended by adding at the end the following
new subparagraph:
``(D) Dental and oral health services described in
paragraph (1) of subsection (nnn), relating to routine
diagnostic and preventive care.''.
(d) 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) by striking ``and'' before ``(HH)''; and
(B) by inserting before the semicolon at the end
the following: ``and (II) with respect to dental and
oral health services (as defined in section 1861(nnn),
other than those services described in paragraph (1) of
such section), the amount paid shall be the payment
amount specified under section 1834(aa).''.
(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:
``(aa) 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(nnn), other than those services described in paragraph (1)
of such section) shall be, subject to paragraph (3), the
applicable percentage (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.
``(2) Applicable percentage.--
``(A) In general.--For purposes of paragraph (1),
subject to subparagraph (B), the applicable percentage
specified in this paragraph is--
``(i) for the first year beginning at least
6 months after the date of the enactment of
this subsection, 0 percent;
``(ii) for the year following the year
specified in subparagraph (A) and each
subsequent year through the seventh year
following the year specified in subparagraph
(A), the applicable percent specified in this
paragraph for the previous year increased by 10
percentage points; and
``(iii) for the eighth year following the
year specified in subparagraph (A) and each
subsequent year, 80 percent.
``(B) Special rule for certain low-income
individuals.--For purposes of paragraph (1), with
respect to dental and oral health services described in
such paragraph that are furnished to an individual who
is a subsidy eligible individual (as defined in section
1860D-14(a)(3)), or who would be a subsidy eligible
individual if the individual were enrolled in a
prescription drug plan or an MA-PD plan under part D,
for the first year beginning at least 6 months after
the date of the enactment of this subsection and each
subsequent year, the applicable percent specified in
this paragraph is 80 percent.
``(3) Limitations and secretarial authority.--
``(A) Frequency.--With respect to dental and oral
health services that are--
``(i) routine dental cleanings, payment may
be made under this part for only two such
cleanings during a 12-month period; and
``(ii) routine exams, payment may be made
under this part for only two such exams during
a 12-month period.
``(B) Secretarial authority.--
``(i) Authority to apply additional
limitations.--The Secretary may apply such
other reasonable limitations on the extent to
which dental and oral services are covered
under this part, including through application
of a prior authorization requirement.
``(ii) Authority to modify coverage.--
Notwithstanding any other provision of this
title, if the Secretary determines appropriate,
the Secretary may modify the coverage under
this part of dental and oral health services to
the extent that such modification is consistent
with the recommendations of the United States
Preventive Services Task Force.
``(iii) Authority to waive frequency
limitations.--The Secretary may waive any
frequency limitation or other limitation as
described in this paragraph for an individual
(or category of individuals) as determined
appropriate by the Secretary.''.
(e) Payment Under Physician Fee Schedule.--Section 1848(j)(3) of
the Social Security Act (42 U.S.C. 1395w-4(j)(3)) is amended by
striking ``risk assessment) ,'' and inserting ``risk assessment),
(2)(KK),''.
(f) Dental Prostheses.--
(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
inserting ``(including dental)''; and
(B) by striking ``internal body''.
(2) Special payment rules.--Section 1834(a) of the Social
Security Act (42 U.S.C. 1395m(a)) is amended by adding at the
end the following new paragraph:
``(23) Payment and limits for dental prostheses.--
``(A) In general.--The payment amount under this
part for dental prostheses shall be, subject to
subparagraph (C), the applicable percent (specified in
subparagraph (B)) of the amount otherwise payable for
such dental prostheses under this section.
``(B) Applicable percent.--
``(i) In general.--For purposes of
subparagraph (A), subject to clause (ii), the
applicable percent specified in this
subparagraph is--
``(I) for the first year beginning
at least 6 months after the date of the
enactment of this paragraph, 0 percent;
``(II) for the year following the
year specified in clause (i) and each
subsequent year through the seventh
year following the year specified in
clause (i), the applicable percent
specified in this subparagraph for the
previous year increased by 10
percentage points; and
``(III) for the eighth year
following the year specified in clause
(i) and each subsequent year, 80
percent.
``(ii) Special rule for certain low-income
individuals.--For purposes of subparagraph (A),
with respect to dental prostheses furnished to
an individual who is a subsidy eligible
individual (as defined in section 1860D-
14(a)(3)), or who would be a subsidy eligible
individual if the individual were enrolled in a
prescription drug plan or an MA-PD plan under
part D, for the first year beginning at least 6
months after the date of the enactment of this
paragraph and each subsequent year, the
applicable percent specified in this
subparagraph is 80 percent.
``(C) Limitations and secretarial authority.--
``(i) In general.--Payment may be made
under this part for an individual for--
``(I) not more than one full upper
and one full lower dental prostheses
once every five years; and
``(II) not more than one partial
upper dental prostheses and one partial
lower dental prostheses once every five
years.
``(ii) Secretarial authority.--
``(I) Authority to apply additional
limitations.--The Secretary may apply
such other reasonable limitations on
the extent to which dental prostheses
are covered under this part, including
through application of a prior
authorization requirement.
``(II) Authority to modify
coverage.--Notwithstanding any other
provision of this title, if the
Secretary determines appropriate, the
Secretary may modify the coverage under
this part of dental prostheses to the
extent that such modification is
consistent with the recommendations of
the United States Preventive Services
Task Force.
``(III) Authority to waive
frequency limitations.--The Secretary
may waive any frequency limitation or
other limitation as described in this
subparagraph for an individual (or
category of individuals) as determined
appropriate by the Secretary''.
(g) Repeal of Ground for Exclusion.--Section 1862(a) of the Social
Security Act (42 U.S.C. 1395y) is amended by striking paragraph (12).
(h) Effective Date.--The amendments made by this section shall
apply to services furnished on or after January 1, 2025.
SEC. 3. INCREASED FMAP FOR ADDITIONAL EXPENDITURES FOR MEDICARE COST-
SHARING FOR DENTAL AND ORAL HEALTH SERVICES.
Section 1905 of the Social Security Act (42 U.S.C. 1396d) is
amended--
(1) in subsection (b), by striking ``and (ii)'' and
inserting ``(ii), and (jj)''; and
(2) by adding at the end the following new subsection:
``(jj) Increased FMAP for Additional Expenditures for Medicare
Cost-Sharing for Dental and Oral Health Services.--Notwithstanding
subsection (b), with respect to the portion of the amounts expended by
a State for medical assistance for medicare cost-sharing (as defined in
subsection (p)(3)) for qualified medicare beneficiaries described in
subsection (p)(1) that is attributable to the coverage under part B of
title XVIII of dental and oral health services (as defined in section
1861(nnn)), as determined by the Secretary, the Federal medical
assistance percentage for a State that is one of the 50 States or the
District of Columbia shall be equal to 100 percent.''.
SEC. 4. PREVENTIVE SERVICES TASKFORCE.
(a) In General.--Section 915(a)(1) of the Public Health Service Act
(42 U.S.C. 299b-4(a)(1)) is amended, in the first sentence, by
inserting ``, including at least 1 oral health professional'' after
``expertise''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect January 1, 2025.
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