What This Bill Does
This bill changes Medicare coverage to include certain dental procedures that are medically necessary. The bill allows Medicare part B (the insurance plan that covers doctors and outpatient care) to pay for specific dental services that directly relate to or impact serious medical conditions.
Who It Affects
Medicare beneficiaries (people who receive Medicare benefits) needing dental care related to specific medical conditions.
Key Provisions
• Medicare part B can now pay for dental services that are medically necessary because they directly result from or will directly impact an underlying medical condition, as long as a doctor determines the dental services are medically necessary (Sec. 2(a)(1)(B))
• Dental services qualify as medically necessary if they are provided to patients with a prosthetic heart valve replacement or diagnosed with head or neck cancer, lymphoma, leukemia, or organ transplantation (Sec. 2(p)(1))
• Covered dental services must be provided no later than one year after the date of diagnosis or after the date of related surgical or medical treatment, whichever is later (Sec. 2(p)(2))
What Changes
Medicare will begin covering qualifying dental procedures for patients with specific serious medical conditions, whereas previously Medicare did not cover dental services related to tooth care, treatment, removal, or replacement.
Important Definitions
Medically necessary means a dental service is needed because it directly results from or impacts a serious medical condition, as determined by a doctor.
Effective Date
January 1, 2024.
I
118TH CONGRESS
1ST SESSION
H. R. 831
To amend title XVIII of the Social Security Act to provide for coverage
under part B of the Medicare program for medically necessary dental
procedures.
IN THE HOUSE OF REPRESENTATIVES
FEBRUARY 6, 2023
Mr. COHEN 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 juris-
diction of the committee concerned
A BILL
To amend title XVIII of the Social Security Act to provide
for coverage under part B of the Medicare program
for medically necessary dental procedures.
Be it enacted by the Senate and House of Representa-
1
tives of the United States of America in Congress assembled,
2
SECTION 1. SHORT TITLE; FINDINGS.
3
(a) SHORT TITLE.—This Act may be cited as the
4
‘‘Medicare Medically Necessary Dental Care Act of 2023’’.
5
(b) FINDINGS.—Congress finds the following:
6
VerDate Sep 11 2014
00:10 Mar 02, 2023
Jkt 039200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H831.IH
H831
pbinns on DSKJLVW7X2PROD with $$_JOB
2
•HR 831 IH
(1) Oral and general healths are inseparable,
1
and good dental care is critical to our overall phys-
2
ical health and well-being.
3
(2) A 1999 Institute of Medicine study found
4
that the prevention and management of oral infec-
5
tion have significant health implications when such
6
infection has the potential to increase morbidity in
7
Medicare patients who are at risk of adverse out-
8
comes from underlying health problems.
9
(3) Improved oral health care may reduce mor-
10
tality and morbidity rates of Medicare patients suf-
11
fering from head and neck cancer, leukemia,
12
lymphoma, organ transplantation, and heart valve
13
disease.
14
(4) The Medicare program, from its inception,
15
has excluded coverage for services in connection with
16
the care, treatment, filling, removal, or replacement
17
of teeth or structures directly supporting the teeth.
18
(5) The Centers for Medicare & Medicaid Serv-
19
ices has approved coverage exceptions for limited
20
dental services and proposed additional exceptions
21
based on the argument that oral health services
22
would reduce the risk of infection and other com-
23
plications of medical care.
24
VerDate Sep 11 2014
00:10 Mar 02, 2023
Jkt 039200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H831.IH
H831
pbinns on DSKJLVW7X2PROD with $$_JOB
3
•HR 831 IH
(6) The Institute of Medicine study concluded
1
that it is reasonable for Congress to update the stat-
2
utory language relating to coverage of dental serv-
3
ices for Medicare beneficiaries so that it clearly cov-
4
ers dental care that is effective in preventing or re-
5
ducing oral and systemic complications associated
6
with serious medical conditions and treatments.
7
SEC. 2. MEDICARE COVERAGE OF MEDICALLY NECESSARY
8
DENTAL PROCEDURES.
9
(a) IN GENERAL.—Section 1862 of the Social Secu-
10
rity Act (42 U.S.C. 1395y) is amended—
11
(1) in subsection (a)(12)—
12
(A) by inserting ‘‘(A)’’ after ‘‘except that’’;
13
and
14
(B) by inserting before the semicolon at
15
the end the following: ‘‘, and (B) payment may
16
be made under part B for the provision of such
17
dental services that are medically necessary as
18
a direct result of, or will have a direct impact
19
on, an underlying medical condition if the cov-
20
erage of such services is medically necessary, as
21
determined under subsection (p)’’; and
22
(2) by adding at the end the following new sub-
23
section:
24
VerDate Sep 11 2014
00:10 Mar 02, 2023
Jkt 039200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H831.IH
H831
pbinns on DSKJLVW7X2PROD with $$_JOB
4
•HR 831 IH
‘‘(p) For purposes of subsection (a)(12)(B), dental
1
services shall be considered to be medically necessary if
2
furnished—
3
‘‘(1) in conjunction with treatment of an indi-
4
vidual with a prosthetic heart valve replacement or
5
a diagnosis of cancer of the head or neck,
6
lymphoma, leukemia, and organ transplantation; and
7
‘‘(2) not later than one year after the later of—
8
‘‘(A) the date of such diagnosis; or
9
‘‘(B) the date of the related surgical or
10
medical treatment for that diagnosis.’’.
11
(b) EFFECTIVE DATE.—The amendments made by
12
subsection (a) shall apply to procedures performed on or
13
after January 1, 2024.
14
Æ
VerDate Sep 11 2014
00:10 Mar 02, 2023
Jkt 039200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6301
E:\BILLS\H831.IH
H831
pbinns on DSKJLVW7X2PROD with $$_JOB