[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 939 Introduced in Senate (IS)]
<DOC>
119th CONGRESS
1st Session
S. 939
To amend title XVIII of the Social Security Act to provide coverage for
dental and oral health care, hearing care, and vision care under the
Medicare program.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
March 11 (legislative day, March 10), 2025
Mr. Sanders (for himself, Ms. Warren, Mr. Booker, Mr. Welch, Mr.
Markey, Ms. Duckworth, Mr. Merkley, and Mr. Blumenthal) 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 coverage for
dental and oral health care, hearing care, and vision care 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, Hearing, and Vision
Expansion Act of 2025''.
SEC. 2. COVERAGE OF 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 (JJ), by adding ``and'' at the end; and
(2) 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:
``(nnn) Dental and Oral Health Services.--
``(1) In general.--Except as provided in paragraph (2), the
term `dental and oral health services' means the following
items and services that are 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
(3)) on or after January 1, 2027 (or January 1, 2026, in the
case of dentures):
``(A) Preventive and screening services.--
Preventive and screening services, including oral
exams, dental cleanings, dental x-rays, and fluoride
treatments.
``(B) Procedures and treatment services.--Services
to address oral disease, including services such as
restorative services, prosthodontic and endodontic
services, including fillings bridges, crowns, and root
canals, periodontal maintenance, periodontal scaling
and root planing, tooth extractions, therapeutic
pulpotomy, and other related items and services.
``(C) Dentures and dental prosthetics.--Complete
dentures, partial dentures, and implants, including
related items and services.
``(2) Exclusions.--Such term does not include items and
services for which, as of the date of the enactment of this
subsection, coverage was permissible under section 1862(a)(12)
and cosmetic services not otherwise covered under section
1862(a)(10).
``(3) Oral health professional.--The term `oral health
professional' means, with respect to dental and oral health
services, a health professional (other than a doctor of dental
surgery or of dental medicine (as described in subsection
(r)(2))) 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(nnn))'' after ``section 1861(hhh)(1))'';
(B) by striking ``and'' before ``(HH)''; and
(C) 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)),
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) Payment.--The payment amount under this part for
dental and oral health services (as defined in section
1861(nnn)) shall be, subject to paragraphs (3) and (4), 80
percent (or 100 percent, in the case of preventive and
screening services described in section 1861(nnn)(1)(A)) of the
lesser of--
``(A) the actual charge for the service; or
``(B)(i) in the case of such services furnished by
a doctor of dental surgery or of dental medicine (as
described in section 1861(r)(2)), the amount determined
under the fee schedule established under paragraph (2);
or
``(ii) in the case of such services furnished by an
oral health professional (as defined in section
1861(nnn)(3)), 85 percent of the amount determined
under the fee schedule established under paragraph (2).
``(2) Establishment of fee schedule for dental and oral
health services.--
``(A) Establishment.--
``(i) In general.--The Secretary shall
establish a fee schedule for dental and oral
health services furnished in 2027 (or 2026, in
the case of dentures) and subsequent years. The
fee schedule amount for a dental or oral health
service shall be equal to 70 percent of the
national median fee (as determined under
subparagraph (B)) for the service or a similar
service for the year (or, in the case of
dentures, at the bundled payment amount under
clause (iv) of such subparagraph), adjusted by
the geographic adjustment factor established
under section 1848(e)(2) for the area for the
year.
``(ii) Consultation.--In carrying out this
paragraph, the Secretary shall consult annually
with organizations representing dentists and
other providers who furnish dental and oral
health services and shall share with such
providers the data and data analysis used to
determine fee schedule amounts under this
paragraph.
``(B) Determination of national median fee.--
``(i) In general.--For purposes of
subparagraph (A), the Secretary shall apply the
national median fee for a dental or oral health
service for 2027 (or 2026, in the case of
dentures) and subsequent years in accordance
with this subparagraph.
``(ii) Use of 2020 dental fee survey.--
``(I) In general.--Except as
provided in clause (iii) and clause
(iv), the national median fee for a
dental or oral health service shall be
equal to--
``(aa) for 2027 (or 2026,
in the case of dentures), the
median fee for the service in
the table titled `General
Practitioners-National' of the
`2020 Survey of Dental Fees'
published by the American
Dental Association, increased
by the applicable percent
increase for the year
determined under subclause
(II), as reduced by the
productivity adjustment under
subclause (III); and
``(bb) for 2028 (or 2027,
in the case of dentures) and
subsequent years, the amount
determined under this subclause
for the preceding year, updated
pursuant to subparagraph
(C)(i).
``(II) Applicable percent
increase.--The applicable percent
increase determined under this
subclause for a year is an amount equal
to the percentage increase between--
``(aa) the consumer price
index for all urban consumers
(United States city average)
ending with June of the
previous year; and
``(bb) the consumer price
index for all urban consumers
(United States city average)
ending with June of 2026 (or
2025, in the case of dentures).
``(III) Productivity adjustment.--
After determining the applicable
percentage increase under subclause
(II) for a year, the Secretary shall
reduce such percentage increase by the
productivity adjustment described in
section 1886(b)(3)(B)(xi)(II).
``(iii) Determination if insufficient
survey data.--If the Secretary determines there
is insufficient data under the Survey described
in clause (ii) with respect to a dental or oral
health service, the national median fee for the
service for a year shall be equal to an amount
established for the service using 1 or more of
the following methods, as determined
appropriate by the Secretary:
``(I) The payment basis determined
under section 1848.
``(II) Fee schedules for dental and
oral health services which shall
include, as practicable, fee
schedules--
``(aa) under Medicare
Advantage plans under part C;
``(bb) under State plans
(or waivers of such plans)
under title XIX; and
``(cc) established by other
health care payers.
``(iv) Special rule for dentures.--
``(I) In general.--The Secretary
shall make payment for dentures and
associated professional services as a
bundled payment as determined by the
Secretary.
``(II) Payment considerations.--In
establishing such bundled payment, the
Secretary shall consider the national
median fee for the service for the year
determined under clause (ii) or (iii)
and the rate determined for such
dentures under the Federal Supply
Schedule of the General Services
Administration, as published by such
Administration in 2021, updated to the
year involved using the applicable
percent increase for the year
determined under clause (ii)(II), as
reduced by the productivity adjustment
under clause (ii)(III), and shall
ensure that the payment component for
dentures under such bundled payment
does not exceed the maximum rate
determined for such dentures under the
Federal Supply Schedule, as so
published and updated to the year
involved.
``(C) Annual update and adjustments.--
``(i) Annual update.--The Secretary shall
update payment amounts determined under the fee
schedule from year to year beginning in 2028
(or 2027, in the case of dentures) by
increasing such amounts from the prior year by
the percentage increase in the consumer price
index for all urban consumers (United States
city average) for the 12-month period ending
with June of the preceding year, reduced by the
productivity adjustment described in section
1886(b)(3)(B)(xi)(II).
``(ii) Adjustments.--
``(I) In general.--The Secretary
shall, to the extent the Secretary
determines to be necessary and subject
to subclause (II), adjust the amounts
determined under the fee schedule
established under this paragraph for
2028 (or 2027, in the case of dentures)
and subsequent years to take into
account changes in dental practice,
coding changes, new data on work,
practice, or malpractice expenses, or
the addition of new procedures.
``(II) Limitation on annual
adjustments.--The adjustments under
subclause (I) for a year shall not
cause the amount of expenditures under
this part for the year to differ by
more than $20,000,000 from the amount
of expenditures under this part that
would have been made if such
adjustments had not been made.
``(3) Limitations.--With respect to dental and oral health
services that are preventive and screening services described
in paragraph (1)(A) of section 1861(nnn)--
``(A) payment shall be made under this part for--
``(i) not more than 2 oral exams in a year;
``(ii) not more than 2 dental cleanings in
a year;
``(iii) not more than 1 fluoride treatment
in a year; and
``(iv) not more than 1 full-mouth series of
x-rays as part of a preventive and screening
oral exam every 3 years; and
``(B) in the case of preventive and screening
services not described in subparagraph (A), payment
shall be made under this part only at such frequencies
determined appropriate by the Secretary.
``(4) Incentives for rural providers.--In the case of
dental and oral health services furnished by a doctor of dental
surgery or of dental medicine (as described in section
1861(r)(2)) or an oral health professional (as defined in
section 1861(nnn)(3)) who predominantly furnishes such services
under this part in an area that is designated by the Secretary
(under section 332(a)(1)(A) of the Public Health Service Act)
as a health professional shortage area, in addition to the
amount of payment that would otherwise be made for such
services under this subsection, there also shall be paid an
amount equal to 10 percent of the payment amount for the
service under this subsection for such doctor or professional.
``(5) Limitation on beneficiary liability.--The provisions
of section 1848(g) shall apply to a nonparticipating doctor of
dental surgery or of dental medicine (as described in section
1861(r)(2)) who does not accept payment on an assignment-
related basis for dental and oral health services furnished
with respect to an individual enrolled under this part in the
same manner as such provisions apply with respect to a
physician's service.
``(6) Establishment of dental administrator.--The Secretary
shall designate 1 or more (not to exceed 4) medicare
administrative contractors under section 1874A to establish
coverage policies and establish such policies and process
claims for payment for dental and oral health services, as
determined appropriate by the Secretary.''.
(d) 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:
``(ix) With respect to 2028 and each subsequent year, an
oral health professional (as defined in section
1861(nnn)(3)).''.
(e) 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(nnn)) for which a limitation is
applicable under section 1834(aa)(3), which are furnished more
frequently than is provided under such section;''; and
(2) in paragraph (12), by inserting before the semicolon at
the end the following: ``and except that payment shall be made
under part B for dental and oral health services that are
covered under section 1861(s)(2)(KK)''.
(f) Inclusion as Excepted Medical Treatment.--Section 1821(b)(5)(A)
of the Social Security Act (42 U.S.C. 1395i-5(b)(5)(A)) is amended--
(1) in clause (ii), by striking ``or'' at the end;
(2) in clause (iii), by striking the period and inserting
``, or''; and
(3) by adding at the end the following new clause:
``(iv) consisting of dental and oral health
services (as defined in subsection (mmm) of
section 1861) that are payable under part B as
a result of the amendments made by the Medicare
Dental, Hearing, and Vision Expansion Act of
2025.''.
(g) Rural Health Clinics and Federally Qualified Health Centers.--
(1) Coverage of dental and oral health services.--Section
1861(aa) of the Social Security Act (42 U.S.C. 1395x(aa)), is
amended--
(A) in paragraph (1)--
(i) in subparagraph (C), by striking
``and'' at the end;
(ii) in subparagraph (D), by inserting
``and'' after the comma at the end; and
(iii) by inserting after subparagraph (D)
the following new subparagraph:
``(E) dental and oral health services (as defined
in subsection (nnn)) 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 subsection (nnn)(3)) who is employed by or
working under contract with a rural health clinic if
such rural health clinic furnishes such services,'';
and
(B) in paragraph (3)(A), by striking ``(D)'' and
inserting ``(E)''.
(2) Temporary payment rates for certain services under the
rhc air and fqhc pps.--
(A) AIR.--Section 1833 of the Social Security Act
(42 U.S.C. 1395l) is amended--
(i) in subsection (a)(3)(A), by inserting
``(which shall, in the case of dental and oral
health services (as defined in section
1861(nnn)), in lieu of any limits on reasonable
costs otherwise applicable, be based on the
rates payable for such services under the
payment basis determined under section 1848
until such time as the Secretary determines
sufficient data has been collected to otherwise
apply such limits (or January 1, 2031, if no
such determination has been made as of such
date))'' after ``may prescribe in
regulations''; and
(ii) by adding at the end the following new
subsection:
``(ee) Disregard of Costs Attributable to Certain Services From
Calculation of RHC AIR.--Payments for rural health clinic services
other than dental and oral health services (as defined in section
1861(nnn)) under the methodology for all-inclusive rates (established
by the Secretary) under subsection (a)(3) shall not take into account
the costs of such services while rates for such services are based on
rates payable for such services under the payment basis established
under section 1848.''.
(B) PPS.--Section 1834(o) of the Social Security
Act (42 U.S.C. 1395m(o)) is amended by adding at the
end the following new paragraph:
``(6) Temporary payment rates based on pfs for certain
services.--The Secretary shall, in establishing payment rates
for dental and oral health services (as defined in section
1861(nnn)) that are Federally qualified health center services
under the prospective payment system established under this
subsection, in lieu of the rates otherwise applicable under
such system, base such rates on rates payable for such services
under the payment basis established under section 1848 until
such time as the Secretary determines sufficient data has been
collected to otherwise establish rates for such services under
such system (or January 1, 2031, if no such determination has
been made as of such date). Payments for Federally qualified
health center services other than such dental and oral health
services under such system shall not take into account the
costs of such services while rates for such services are based
on rates payable for such services under the payment basis
established under section 1848.''.
(h) Implementation.--In addition to amounts otherwise available,
there is appropriated to the Secretary of Health and Human Services for
fiscal year 2025, out of any money in the Treasury not otherwise
appropriated, $900,000,000, to remain available until expended, for
purposes of implementing the amendments made by this section during the
period beginning on January 1, 2025, and ending on September 30, 2034.
SEC. 3. PROVIDING COVERAGE FOR HEARING CARE UNDER THE MEDICARE PROGRAM.
(a) Provision of Audiology Services by Qualified Audiologists and
Hearing Aid Examination Services by Qualified Hearing Aid
Professionals.--
(1) In general.--Section 1861(ll) of the Social Security
Act (42 U.S.C. 1395x(ll)) is amended--
(A) in paragraph (3)--
(i) by inserting ``(A)'' after ``(3)'';
(ii) in subparagraph (A), as added by
clause (i) of this subparagraph--
(I) by striking ``means such
hearing and balance assessment
services'' and inserting ``means--
``(i) such hearing and balance assessment
services and, beginning January 1, 2027, such
hearing aid examination services and treatment
services (including aural rehabilitation,
vestibular rehabilitation, and cerumen
management)'';
(II) in clause (i), as added by
subclause (I) of this clause, by
striking the period at the end and
inserting ``; and''; and
(III) by adding at the end the
following new clause:
``(ii) beginning January 1, 2027, such
hearing aid examination services furnished by a
qualified hearing aid professional (as defined
in paragraph (4)(C)) as the professional is
legally authorized to perform under State law
(or the State regulatory mechanism provided by
State law), as would otherwise be covered if
furnished by a physician.''; and
(iii) by adding at the end the following
new subparagraph:
``(B) Beginning January 1, 2027, audiology services
described in subparagraph (A)(i) shall be furnished
without a requirement for an order from a physician or
practitioner.''; and
(B) in paragraph (4), by adding at the end the
following new subparagraph:
``(C) The term `qualified hearing aid professional'
means an individual who--
``(i) is licensed or registered as a
hearing aid dispenser, hearing aid specialist,
hearing instrument dispenser, or related
professional by the State in which the
individual furnishes such services; and
``(ii) is accredited by the National Board
for Certification in Hearing Instrument
Sciences or meets such other requirements as
the Secretary determines appropriate (including
requirements relating to educational
certifications or accreditations) taking into
account any additional relevant requirements
for hearing aid specialists, hearing aid
dispensers, and hearing instrument dispensers
established by Medicare Advantage organizations
under part C, State plans (or waivers of such
plans) under title XIX, and group health plans
and health insurance issuers (as such terms are
defined in section 2791 of the Public Health
Service Act).''.
(2) Payment for qualified hearing aid professionals.--
Section 1833(a)(1) of the Social Security Act (42 U.S.C.
1395l(a)(1)), as amended by section 2(c)(1), is amended--
(A) by striking ``and'' before ``(II)''; and
(B) by inserting before the semicolon at the end
the following: ``and (JJ) with respect to hearing aid
examination services (as described in paragraph
(3)(A)(ii) of section 1861(ll)) furnished by a
qualified hearing aid professional (as defined in
paragraph (4)(C) of such section), the amounts paid
shall be equal to 80 percent of the lesser of the
actual charge for such services or 85 percent of the
amount for such services determined under the payment
basis determined under section 1848''.
(3) Inclusion of qualified audiologists and qualified
hearing aid professionals as certain practitioners to receive
payment on an assignment-related basis.--
(A) Qualified audiologists.--Section 1842(b)(18)(C)
of the Social Security Act (42 U.S.C. 1395u(b)(18)(C)),
as amended by section 2(d), is amended by adding at the
end the following new clause:
``(x) Beginning on January 1, 2027, a qualified audiologist
(as defined in section 1861(ll)(4)(B)).''.
(B) Qualified hearing aid professionals.--Section
1842(b)(18) of the Social Security Act (42 U.S.C.
1395u(b)(18)) is amended--
(i) in each of subparagraphs (A) and (B),
by striking ``subparagraph (C)'' and inserting
``subparagraph (C) or, beginning on January 1,
2027, subparagraph (E)''; and
(ii) by adding at the end the following new
subparagraph:
``(E) A practitioner described in this subparagraph is a qualified
hearing aid professional (as defined in section 1861(ll)(4)(C)).''.
(b) Coverage of Hearing Aids.--
(1) Inclusion of hearing aids as prosthetic devices.--
Section 1861(s)(8) of the Social Security Act (42 U.S.C.
1395x(s)(8)) is amended by inserting ``, and including hearing
aids (as described in section 1834(h)(7)) furnished on or after
January 1, 2027, to individuals with moderately severe, severe,
or profound hearing loss'' before the semicolon at the end.
(2) Payment limitations for hearing aids.--Section 1834(h)
of the Social Security Act (42 U.S.C. 1395m(h)) is amended by
adding at the end the following new paragraphs:
``(6) Payment only on an assignment-related basis.--Payment
for hearing aids for which payment may be made under this part
may be made only on an assignment-related basis. The provisions
of subparagraphs (A) and (B) of section 1842(b)(18) shall apply
to hearing aids in the same manner as they apply to services
furnished by a practitioner described in subparagraph (C) of
such section.
``(7) Limitations for hearing aids.--
``(A) In general.--Payment may be made under this
part with respect to an individual, with respect to
hearing aids furnished by a qualified hearing aid
supplier (as defined in subparagraph (C)) on or after
January 1, 2027--
``(i) not more than once per ear during a
5-year period;
``(ii) only for types of such hearing aids
that are determined appropriate by the
Secretary; and
``(iii) only if furnished pursuant to a
written order of a physician, qualified
audiologist (as defined in section
1861(ll)(4)), qualified hearing aid
professional (as defined in subparagraph (C) of
such section), physician assistant, nurse
practitioner, or clinical nurse specialist.
``(B) Special rule.--The payment basis determined
under this subsection (including after application of
paragraph (1)(H), relating to application of
competitive acquisition) for hearing aids furnished by
a qualified hearing aid supplier on or after January 1,
2027, shall not exceed the rate determined for such
hearing aids under the Federal Supply Schedule of the
General Services Administration, as published by such
Administration in 2021, updated to the year involved
using the applicable percent increase for the year.
``(C) Definitions.--In this subsection:
``(i) Hearing aid.--The term `hearing aid'
means the item and related services including
selection, fitting, adjustment, and patient
education and training.
``(ii) Qualified hearing aid supplier.--The
term `qualified hearing aid supplier' means--
``(I) a qualified audiologist;
``(II) a physician (as defined in
section 1861(r)(1));
``(III) a physician assistant,
nurse practitioner, or clinical nurse
specialist;
``(IV) a qualified hearing aid
professional (as defined in section
1861(ll)(4)(C)); and
``(V) other suppliers as determined
by the Secretary.''.
(3) Application of competitive acquisition.--
(A) 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 header, by inserting ``and
hearing aids'' after ``orthotics'';
(ii) in the matter preceding clause (i), by
inserting ``or of hearing aids described in
paragraph (2)(D) of such section,'' after
``2011,''; and
(iii) in clause (i), by inserting ``or such
hearing aids'' after ``such orthotics''.
(B) Conforming amendments.--
(i) In general.--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:
``(E) Hearing aids.--Hearing aids described in
section 1861(s)(8) for which payment would otherwise be
made under section 1834(h).''.
(ii) 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 hearing aids.--Those items and
services described in paragraph (2)(E) 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.''.
(iii) Implementation.--Section 1847(a) of
the Social Security Act (42 U.S.C. 1395w-3(a))
is amended by adding at the end the following
new paragraph:
``(8) Competition with respect to hearing aids.--Not later
than January 1, 2031, the Secretary shall begin the competition
with respect to the items and services described in paragraph
(2)(E).''.
(4) Physician self-referral law.--Section 1877(b) of the
Social Security Act (42 U.S.C. 1395nn(b)) is amended by adding
at the end the following new paragraph:
``(6) Hearing aids and services.--In the case of hearing
aid examination services and hearing aids--
``(A) furnished on or after January 1, 2027, and
before January 1, 2029; and
``(B) furnished on or after January 1, 2029, if the
financial relationship specified in subsection (a)(2)
meets such requirements the Secretary imposes by
regulation to protect against program or patient
abuse.''.
(c) Exclusion Modification.--Section 1862(a)(7) of the Social
Security Act (42 U.S.C. 1395y(a)(7)) is amended by inserting ``(except
such hearing aids or examinations therefor as described in and
otherwise allowed under section 1861(s)(8))'' after ``hearing aids or
examinations therefor''.
(d) Inclusion as Excepted Medical Treatment.--Section
1821(b)(5)(A)(iv) of the Social Security Act (42 U.S.C. 1395i-
5(b)(5)(A)(iv)), as added by section 2(f), is amended by inserting ``,
audiology services described in subsection (ll)(3) of such section, or
hearing aids described in subsection (s)(8) of such section'' after
``section 1861)''.
(e) Rural Health Clinics and Federally Qualified Health Centers.--
(1) Clarifying coverage of audiology services as
physicians' services.--Section 1861(aa)(1)(A) of the Social
Security Act (42 U.S.C. 1395x(aa)(1)(A)) is amended by
inserting ``(including audiology services (as defined in
subsection (ll)(3)))'' after ``physicians' services''.
(2) Inclusion of qualified audiologists and qualified
hearing aid professionals as rhc and fqhc practitioners.--
Section 1861(aa)(1)(B) of the Social Security Act (42 U.S.C.
1395x(aa)(1)(B)) is amended by inserting ``or by a qualified
audiologist or a qualified hearing aid professional (as such
terms are defined in subsection (ll)),'' after ``(as defined in
subsection (hh)(1)),''.
(3) Temporary payment rates for certain services under the
rhc air and fqhc pps.--
(A) AIR.--Section 1833 of the Social Security Act
(42 U.S.C. 1395l), as amended by section 2(g)(2)(A), is
amended--
(i) in subsection (a)(3)(A), by inserting
``or audiology services (as defined in section
1861(ll)(3))'' after ``(as defined in section
1861(nnn)''; and
(ii) in subsection (ee), by inserting ``or
audiology services (as defined in section
1861(ll)(3))'' after ``(as defined in section
1861(nnn)''.
(B) PPS.--Section 1834(o)(6) of the Social Security
Act (42 U.S.C. 1395m(o)(6)), as added by section
2(g)(2)(B), is amended--
(i) in the first sentence, by inserting
``or audiology services (as defined in section
1861(ll)(3))'' after ``(as defined in section
1861(nnn))''; and
(ii) in the second sentence, by inserting
``or such audiology services'' after ``such
dental and oral health services''.
(f) Expediting Implementation.--The Secretary of Health and Human
Services shall implement this section for 2027 and 2028 through program
instruction or other forms of program guidance.
(g) Funding.--In addition to amounts otherwise available, there is
appropriated to the Secretary of Health and Human Services for fiscal
year 2025, out of any money in the Treasury not otherwise appropriated,
$370,000,000, to remain available until expended, for purposes of
implementing the amendments made by this section during the period
beginning on January 1, 2026, and ending on September 30, 2035.
SEC. 4. PROVIDING COVERAGE FOR VISION CARE UNDER THE MEDICARE PROGRAM.
(a) Coverage.--Section 1861(s)(2) of the Social Security Act (42
U.S.C. 1395x(s)(2)), as amended by section 2(a), is amended--
(1) in subparagraph (JJ), by striking ``and'' after the
semicolon at the end;
(2) in subparagraph (KK), by striking the period at the end
and adding ``; and''; and
(3) by adding at the end the following new subparagraph:
``(LL) vision services (as defined in subsection (ooo));''.
(b) Vision Services Defined.--Section 1861 of the Social Security
Act (42 U.S.C. 1395x), as amended by section 2(b), is amended by adding
at the end the following new subsection:
``(ooo) Vision Services.--The term `vision services' means routine
eye examinations to determine the refractive state of the eyes,
including procedures performed during the course of such examination,
furnished on or after January 1, 2027, by or under the direct
supervision of an ophthalmologist or optometrist who is legally
authorized to furnish such examinations or procedures (as applicable)
under State law (or the State regulatory mechanism provided by State
law) of the State in which the examinations or procedures are
furnished.''.
(c) Payment Limitations.--Section 1834 of the Social Security Act
(42 U.S.C. 1395m), as amended by section 2(c)(2), is amended by adding
at the end the following new subsection:
``(bb) Limitation for Vision Services.--With respect to vision
services (as defined in section 1861(ooo)) and an individual, payment
shall be made under this part for only 1 routine eye examination
described in such subsection during a 2-year period.''.
(d) 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
inserting ``(2)(LL),'' before ``(3)''.
(e) Coverage of Conventional Eyeglasses.--Section 1861(s)(8) of the
Social Security Act (42 U.S.C. 1395x(s)(8)), as amended by section
3(b)(1), is amended by striking ``, and including one pair of
conventional eyeglasses or contact lenses furnished subsequent to each
cataract surgery with insertion of an intraocular lens'' and inserting
``, including 1 pair of conventional eyeglasses or contact lenses
furnished subsequent to each cataract surgery with insertion of an
intraocular lens, if furnished before January 1, 2027, and including
conventional eyeglasses (as described in section 1834(h)(8)), whether
or not furnished subsequent to such a surgery, if furnished on or after
January 1, 2027''.
(f) Special Payment Rules for Eyeglasses.--
(1) Limitations.--Section 1834(h) of the Social Security
Act (42 U.S.C. 1395m(h)), as amended by section 3(b)(2), is
amended by adding at the end the following new paragraph:
``(8) Payment limitations for eyeglasses.--
``(A) In general.--With respect to conventional
eyeglasses furnished to an individual on or after
January 1, 2027, subject to subparagraph (B), payment
shall be made under this part only during a 2-year
period, for 1 pair of eyeglasses (including lenses and
the frame).
``(B) Exception.--With respect to a 2-year period
described in subparagraph (A), in the case of an
individual who receives cataract surgery with insertion
of an intraocular lens, payment shall be made under
this part for 1 pair of conventional eyeglasses
furnished subsequent to such cataract surgery during
such period.
``(C) Special rule.--The payment basis determined
under this subsection (including after application of
paragraph (1)(H), relating to application of
competitive acquisition) for conventional eyeglasses
furnished to an individual on or after January 1, 2027,
shall not exceed the rate determined for such
eyeglasses under the Federal Supply Schedule of the
General Services Administration, as published by such
Administration in 2021, updated to the year involved
using the applicable percent increase for the year.
``(D) No coverage of certain items.--Payment shall
not be made under this part for deluxe eyeglasses or
conventional reading glasses.''.
(2) Application of competitive acquisition.--
(A) In general.--Section 1834(h)(1)(H) of the
Social Security Act (42 U.S.C. 1395m(h)(1)(H)), as
amended by section 3(b)(3)(A), is amended--
(i) in the heading, by striking ``and
hearing aids'' and inserting ``hearing aids,
and eyeglasses'';
(ii) in the matter preceding clause (i)--
(I) by striking ``or of hearing
aids'' and inserting ``of hearing
aids''; and
(II) by inserting ``or of
eyeglasses described in paragraph
(2)(E) of such section,'' after
``paragraph (2)(D) of such section,'';
and
(iii) in clause (i), by striking ``or such
hearing aids'' and inserting ``, such hearing
aids, or such eyeglasses''.
(B) Conforming amendment.--Section 1847(a)(2) of
the Social Security Act (42 U.S.C. 1395w-3(a)(2)), as
amended by section 3(b)(3)(B)(i), is amended by adding
at the end the following new subparagraph:
``(F) Eyeglasses.--Eyeglasses described in section
1861(s)(8) for which payment would otherwise be made
under section 1834(h).''.
(C) Implementation.--Section 1847(a) of the Social
Security Act (42 U.S.C. 1395w-3(a)), as amended by
section 3(b)(3)(B)(iii), is amended by adding at the
end the following new paragraph:
``(9) Competition with respect to eyeglasses.--Not later
than January 1, 2030, the Secretary shall begin the competition
with respect to the items and services described in paragraph
(2)(F).''.
(g) Exclusion Modifications.--Section 1862(a) of the Social
Security Act (42 U.S.C. 1395y(a)), as amended by section 2(e), is
amended--
(1) in paragraph (1)--
(A) in subparagraph (P), by striking ``and'' at the
end;
(B) in subparagraph (Q), by striking the semicolon
at the end and inserting ``, and''; and
(C) by adding at the end the following new
subparagraph:
``(R) in the case of vision services (as defined in section
1861(ooo)) that are routine eye examinations as described in
such section, which are furnished more frequently than once
during a 2-year period;''; and
(2) in paragraph (7)--
(A) by inserting ``(other than such an examination
that is a vision service that is covered under section
1861(s)(2)(LL))'' after ``eye examinations''; and
(B) by inserting ``(other than such a procedure
that is a vision service that is covered under section
1861(s)(2)(LL))'' after ``refractive state of the
eyes''.
(h) Inclusion as Excepted Medical Treatment.--Section
1821(b)(5)(A)(iv) of the Social Security Act (42 U.S.C. 1395i-
5(b)(5)(A)(iv)), as added by section 2(f) and amended by section 3(d),
is amended--
(1) by striking ``or hearing aids'' and inserting ``hearing
aids''; and
(2) by inserting ``, or vision services (as defined in
subsection (ooo) of such section)'' after ``subsection (s)(8)
of such section''.
(i) Rural Health Clinics and Federally Qualified Health Centers.--
(1) Clarifying coverage of vision services as physicians'
services.--Section 1861(aa)(1)(A) of the Social Security Act
(42 U.S.C. 1395x(aa)(1)(A)), as amended by section 3(e)(1), is
amended by inserting ``and vision services (as defined in
subsection (ooo))'' after ``(as defined in subsection
(ll)(3))''.
(2) Temporary payment rates for certain services under the
rhc air and fqhc pps.--
(A) AIR.--Section 1833 of the Social Security Act
(42 U.S.C. 1395l), as amended by sections 2(g)(2)(A)
and 3(e)(3)(A), is amended--
(i) in subsection (a)(3)(A)--
(I) by striking ``or audiology''
and inserting ``, audiology''; and
(II) by inserting ``, or vision
services (as defined in section
1861(ooo))'' after ``(as defined in
section 1861(ll)(3))''; and
(ii) in subsection (ee)--
(I) by striking ``or audiology''
and inserting ``, audiology''; and
(II) by inserting ``, or vision
services (as defined in section
1861(ooo))'' after ``(as defined in
section 1861(ll)(3))''.
(B) PPS.--Section 1834(o)(6) of the Social Security
Act (42 U.S.C. 1395m(o)(6)), as added by section
2(g)(2)(B) and amended by section 3(e)(3)(B), is
amended--
(i) in the first sentence--
(I) by striking ``or audiology''
and inserting ``, audiology''; and
(II) by inserting ``, or vision
services (as defined in section
1861(ooo))'' after ``(as defined in
section 1861(ll)(3))''; and
(ii) in the second sentence, by striking
``or such audiology services'' and inserting
``, such audiology services, or such vision
services''.
(j) Expediting Implementation.--The Secretary of Health and Human
Services shall implement this section for 2027 and 2028 through program
instruction or other forms of program guidance.
(k) Funding.--In addition to amounts otherwise available, there is
appropriated to the Secretary of Health and Human Services for fiscal
year 2025, out of any money in the Treasury not otherwise appropriated,
$500,000,000, to remain available until expended, for purposes of
implementing the amendments made by this section during the period
beginning on January 1, 2026, and ending on September 30, 2034.
SEC. 5. PHASE-IN OF IMPACT OF DENTAL AND ORAL HEALTH COVERAGE ON PART B
PREMIUMS.
Section 1839(a) of the Social Security Act (42 U.S.C. 1395r(a)) is
amended--
(1) in the second sentence of paragraph (1), by striking
``and (7)'' and inserting ``(7), and (8)'';
(2) in paragraph (3), by striking ``The Secretary'' and
inserting ``Subject to paragraph (8)(C), the Secretary''; and
(3) by adding at the end the following:
``(8) Special rule for 2026 through 2030.--
``(A) Determination of alternative monthly
actuarial rate for each of 2026 through 2030.--For each
of 2026 through 2030, the Secretary shall, at the same
time as and in addition to the determination of the
monthly actuarial rate for enrollees age 65 and over
determined in each of 2025 through 2029 for the
succeeding calendar year according to paragraph (1),
determine an alternative monthly actuarial rate for
enrollees age 65 and over for the year as described in
subparagraph (B).
``(B) Alternative monthly actuarial rate
described.--
``(i) In general.--The alternative monthly
actuarial rate described in this subparagraph
is--
``(I) for 2026 and 2027, the
monthly actuarial rate for enrollees
age 65 and over for the year,
determined as if the amendments made by
section 2 of the Medicare Dental,
Hearing, and Vision Expansion Act of
2025 did not apply; and
``(II) for 2028, 2029, and 2030,
the monthly actuarial rate for
enrollees age 65 and over for the year,
determined as if the amendments made by
such section 2 did not apply, plus the
applicable percent of the amount by
which--
``(aa) the monthly
actuarial rate for enrollees
age 65 and over for the year
determined according to
paragraph (1); exceeds
``(bb) the monthly
actuarial rate for enrollees
age 65 and over for the year,
determined as if the amendments
made by such section 2 did not
apply.
``(ii) Definition of applicable percent.--
For purposes of this subparagraph, the term
`applicable percent' means--
``(I) for 2028, 25 percent;
``(II) for 2029, 50 percent; and
``(III) for 2030, 75 percent.
``(C) Application to part b premium and other
provisions of this part.--For each of 2026 through
2030, the Secretary shall use the alternative monthly
actuarial rate for enrollees age 65 and over for the
year determined under subparagraph (A), in lieu of the
monthly actuarial rate for such enrollees for the year
determined according to paragraph (1), when determining
the monthly premium rate for the year under paragraph
(3) and subsection (j), the part B deductible under
section 1833(b), and the premium subsidy and monthly
adjustment amount under subsection (i).''.
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