Sec. 2. Dental and oral health care
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Section 1861(s)(2) of the Social Security Act ( 42 U.S.C. 1395x(s)(2) ) is amended— in subparagraph (II), by striking and after the semicolon at the end; in subparagraph (JJ), by adding and after the semicolon at the end; and by adding at the end the following new subparagraph: dental and oral health services (as defined in subsection (nnn)); . 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— preventative and screening services, such as oral exams, dental cleanings, dental x-rays, and fluoride treatments; basic dental services, such as tooth restorations, basic periodontics services, tooth extractions, and oral disease management services; major dental services, such as major tooth restorations, major periodontics services, bridges, crowns, root canals, and extractions; emergency dental care; and other necessary services related to dental or oral health (as defined by the Secretary). .
Section 1833(a)(1) of the Social Security Act ( 42 U.S.C. 1395l(a)(1) ) is amended— by striking and before
(GG); and by inserting before the semicolon at the end the following: , and
(HH)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(aa) . 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(nnn)) 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. For purposes of paragraph (1), except as provided in subparagraph (B), the applicable percent specified in this paragraph is— with respect to services described in section 1861(nnn)(1) furnished during 2024 or a subsequent year, 100 percent; and with respect to services not described in clause (i)— for a year before 2025, 0 percent; for 2025, 30 percent; for 2026, 60 percent; and for 2027 and each subsequent year, 80 percent. For purposes of paragraph (1), the applicable percent specified in this paragraph is, with respect to services 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 MA–PD plan— with respect to services described in section 1861(nnn)(1), for 2024 and each subsequent year, 100 percent; and with respect to services not described in clause (i), for 2025 and each subsequent year, 80 percent. With respect to dental and oral health services that are— routine dental cleanings, payment may be made under this part for only two such cleanings during a 12-month period; and routine exams, payment may be made under this part for only two such exams during a 12-month period. 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. 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. Notwithstanding subparagraph (A), the Secretary may waive any frequency limitation under such subparagraph for an individual (or category of individuals) if determined appropriate by the Secretary. . Section 1848(j)(3) of the Social Security Act ( 42 U.S.C. 1395w–4(j)(3) ) is amended by inserting (2)(KK), before
(3). Section 1861(s)(8) of the Social Security Act ( 42 U.S.C. 1395x(s)(8) ) is amended— by striking (other than dental) and inserting (including dentures) ; and by striking internal body . 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: The payment amount under this part for dentures shall be, subject to subparagraph (C), the applicable percent (specified in subparagraph (B)) of the amount otherwise payable for such dentures under this section. For purposes of subparagraph (A), the applicable percent specified in this subparagraph is— for a year before 2025, 0 percent; and for 2025 and each subsequent year, 80 percent. Payment may be made under this part for an individual for— not more than one full upper and one full lower denture once every five years; and not more than one partial upper denture and one partial lower denture once every five years. The Secretary may apply such other reasonable limitations on the extent to which dentures are covered under this part, including through application of a prior authorization requirement. Notwithstanding any other provision of this title, if the Secretary determines appropriate, the Secretary may modify the coverage under this part of dentures to the extent that such modification is consistent with the recommendations of the United States Preventive Services Task Force. Notwithstanding clause (i), the Secretary may waive any frequency limitation under such clause for an individual (or category of individuals) if determined appropriate by the Secretary. . Section 1862(a) of the Social Security Act ( 42 U.S.C. 1395y ) is amended by striking paragraph (12). The amendments made by this section shall apply to services furnished on or after January 1, 2024.
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- 42 USC 1395w–4(j)(3)
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Sec. 2
Dental and oral health care
Cite42 USC 1395w–4(j)(3)
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