Sec. 30901. Providing coverage for dental and oral health care under the Medicare program

1,894 words·~9 min read·/bill/117/hr/5376/rh/section-30901

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Section 1861(s)(2) of the Social Security Act ( 42 U.S.C. 1395x(s)(2) ) is amended— in subparagraph (GG), by striking and after the semicolon at the end; in subparagraph (HH), by striking the period at the end and adding ; and ; and by adding at the end the following new subparagraph: dental and oral health services (as defined in subsection (lll)); . Section 1861 of the Social Security Act ( 42 U.S.C. 1395x ) is amended by adding at the end the following new subsection: 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 2028 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— 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 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. The preventive and screening services described in this paragraph are the following: Oral exams. Dental cleanings. Dental x-rays performed in the office of a doctor or professional described in paragraph (1)(A). Fluoride treatments. For 2028 and each subsequent year, the Secretary shall specify— basic treatments (which may include basic tooth restorations, basic periodontal services, tooth extractions, and oral disease management services); and major treatments (which may include major tooth restorations, major periodontal services, bridges, crowns, and root canals); that shall be included as dental and oral health services for such year. 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. . Section 1833(a)(1) of the Social Security Act ( 42 U.S.C. 1395l(a)(1) ), as amended by section 30511(b), is further amended— in subparagraph (N), by inserting and dental and oral health services (as defined in section 1861(lll)) after section 1861(hhh)(1)) ; by striking and before

(EE); and by inserting before the semicolon at the end the following: and

(FF)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) . Section 1834 of the Social Security Act ( 42 U.S.C. 1395m ) is amended by adding at the end the following new subsection: 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 service; or the amount determined under the payment basis determined under section 1848 for the service, or, in lieu of such amount, if determined appropriate by the Secretary, an amount specified by the Secretary for such service under a fee schedule determined appropriate by the Secretary, taking into account fee schedules for such services— under the TRICARE program under chapter 55 of title 10 of the United States Code; under the health insurance program under chapter 89 of title 5 of such Code; under State plans (or waivers of such plans) under title XIX; under Medicare Advantage plans under part C; established by the Secretary of Veterans Affairs; and established by other health care payers. 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— 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 that are major treatments specified for such year pursuant to paragraph (3)(B) of such section— in the case such services are furnished during 2028, 10 percent; in the case such services are furnished during 2029 or a subsequent year before 2032, the applicable percent specified under this subparagraph for the previous year, increased by 10 percentage points; and in the case such services are furnished during 2032 or a subsequent year, 50 percent. With respect to dental and oral health services that are— preventive and screening oral exams, payment may be made under this part for not more than two such exams during a 12-month period; dental cleanings, payment may be made under this part for not more than two such cleanings during a 12-month period; and 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. The Secretary may make payment for dentures and associated professional services, and for any other dental and oral health services, as bundled payments as the Secretary determines appropriate. There shall be no administrative or judicial review under section 1869 or otherwise of— the determination of payment amounts under this subsection for dental and oral health services and under subsection (h)(6) or subsection (z)(4) for dentures; the determination of what services are basic and major services under subparagraphs

(A)and

(B)of section 1861(lll)(3); or the determination of the frequency and circumstance limitations for dental and oral health services under paragraph (3)(C). . 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). Section 1848(q)(1)(C)(ii) of the Social Security Act ( 42 U.S.C. 1395w–4(q)(1)(C)(ii) ) is amended— in subclause (II), by striking or at the end; in subclause (III), by striking the period at the end and inserting ; or ; and by adding at the end the following new subclause: with respect to 2028 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)). . 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: With respect to 2028 and each subsequent year, an oral health professional (as defined in section 1861(lll)(4)). . Section 1861(s)(8) of the Social Security Act ( 42 U.S.C. 1395x(s)(8) ) is amended— by striking (other than dental) ; and by inserting and excluding dental, except for a full or partial set of dentures (as described in section 1834(h)(6)) furnished on or after January 1, 2028 after colostomy care . 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: Payment may be made under this part with respect to an individual for dentures— not more than once during any 5-year period (except in the case that a doctor described in section 1861(lll)(1)(A) determines such dentures do not fit the individual); and only to the extent that such dentures are furnished pursuant to a written order of such a doctor or professional. . Section 1834(h)(1)(H) of the Social Security Act ( 42 U.S.C. 1395m(h)(1)(H) ) is amended— in the subparagraph heading, by inserting after , dentures ; orthotics by inserting , of dentures described in paragraph (2)(D) of such section, after 2011, ; and in clause (i), by inserting , such dentures after orthotics . 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: Dentures described in section 1861(s)(8) for which payment would otherwise be made under section 1834(h). . 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: 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. . Section 1862(a) of the Social Security Act ( 42 U.S.C. 1395y(a) ) is amended— in paragraph (1)— in subparagraph (O), by striking and at the end; in subparagraph (P), by striking the semicolon at the end and inserting , and ; and by adding at the end the following new subparagraph: 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) or under circumstances other than circumstances determined appropriate under subparagraph

(C)of such section; ; and 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) and for dentures under section 1861(s)(8) . 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 30901 (other than subsection (g)) of the Act titled . An Act to provide for reconciliation pursuant to title II of S. Con. Res. 14 and the Government contribution under section 1844(a)(5) Section 1844(a) of such Act ( 42 U.S.C. 1395w(a) ) is amended— in paragraph (4), by striking the period at the end and inserting ; plus ; by adding at the end the following new paragraph: 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 30901 (other than subsection (g)) of the Act titled An Act to provide for reconciliation pursuant to title II of S. Con. Res. 14 . ; and in the flush matter at the end, by striking paragraph

(4)and inserting paragraphs

(4)and

(5). In addition to amounts otherwise available, 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— $20,000,000 for each of fiscal years 2022 through 2028 for purposes of implementing the amendments made by this section; and such sums as determined appropriate by the Secretary for each subsequent fiscal year for purposes of administering the provisions of such amendments. Funds transferred pursuant to subparagraph

(A)shall remain available until expended and may be used, in addition to the purpose specified in subparagraph (A)(i), to implement the amendments made by sections 30902 and 30903. The Secretary may implement, by program instruction or otherwise, any of the provisions of, or amendments made by, this section. Chapter 35 of title 44, United States Code, shall not apply to the provisions of, or the amendments made by, this section.

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