Medicare Dental Benefit Act of 2021

II 117TH CONGRESS 1ST SESSION S. 97 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 JANUARY 28, 2021 Mr. CARDIN (for himself, Mr. BROWN, Mr. MERKLEY, Mr. VAN HOLLEN, Mr. BLUMENTHAL, and Mr. CASEY) 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 Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Medicare Dental Ben- 4 efit Act of 2021’’. 5 SEC. 2. COVERAGE OF DENTAL SERVICES UNDER THE 6 MEDICARE PROGRAM. 7 (a) COVERAGE.—Section 1861(s)(2) of the Social Se- 8 curity Act (42 U.S.C. 1395x(s)(2)) is amended— 9 VerDate Sep 11 2014 22:42 Feb 14, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S97.IS S97 pamtmann on DSKBC07HB2PROD with BILLS 2 •S 97 IS (1) in subparagraph (GG), by striking ‘‘and’’ at 1 the end; 2 (2) in subparagraph (HH), by striking the pe- 3 riod at the end and inserting ‘‘; and’’; and 4 (3) by adding at the end the following new sub- 5 paragraph: 6 ‘‘(II) dental and oral health services (as defined 7 in subsection (lll));’’. 8 (b) DENTAL AND ORAL HEALTH SERVICES DE- 9 FINED.—Section 1861 of the Social Security Act (42 10 U.S.C. 1395x) is amended by adding at the end the fol- 11 lowing new subsection: 12 ‘‘Dental and Oral Health Services 13 ‘‘(lll) The term ‘dental and oral health services’ 14 means services (as defined by the Secretary) that are nec- 15 essary to prevent disease and promote oral health, restore 16 oral structures to health and function, and treat emer- 17 gency conditions, including— 18 ‘‘(1) routine diagnostic and preventive care 19 such as dental cleanings, exams, and x-rays; 20 ‘‘(2) basic dental services such as fillings and 21 extractions; 22 ‘‘(3) major dental services such as root canals, 23 crowns, and dentures; 24 ‘‘(4) emergency dental care; and 25 VerDate Sep 11 2014 22:42 Feb 14, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S97.IS S97 pamtmann on DSKBC07HB2PROD with BILLS 3 •S 97 IS ‘‘(5) other necessary services related to dental 1 and oral health (as defined by the Secretary).’’. 2 (c) COVERAGE OF ROUTINE DIAGNOSTIC AND PRE- 3 VENTIVE CARE AS A PREVENTIVE SERVICE.—Section 4 1861(ddd)(3) of the Social Security Act (42 U.S.C. 5 1395x(ddd)(3)) is amended by adding at the end the fol- 6 lowing new subparagraph: 7 ‘‘(D) Dental and oral health services described 8 in paragraph (1) of subsection (lll), relating to rou- 9 tine diagnostic and preventive care.’’. 10 (d) PAYMENT; COINSURANCE; AND LIMITATIONS.— 11 (1) IN GENERAL.—Section 1833(a)(1) of the 12 Social Security Act (42 U.S.C. 1395l(a)(1)) is 13 amended— 14 (A) by striking ‘‘and’’ before ‘‘(DD)’’; and 15 (B) by inserting before the semicolon at 16 the end the following: ‘‘and (EE) with respect 17 to dental and oral health services (as defined in 18 section 1861(lll), other than those services de- 19 scribed in paragraph (1) of such section), the 20 amount paid shall be the payment amount spec- 21 ified under section 1834(z).’’. 22 (2) PAYMENT AND LIMITS SPECIFIED.—Section 23 1834 of the Social Security Act (42 U.S.C. 1395m) 24 VerDate Sep 11 2014 22:42 Feb 14, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S97.IS S97 pamtmann on DSKBC07HB2PROD with BILLS 4 •S 97 IS is amended by adding at the end the following new 1 subsection: 2 ‘‘(z) PAYMENT AND LIMITS FOR DENTAL AND ORAL 3 HEALTH SERVICES.— 4 ‘‘(1) IN GENERAL.—The payment amount 5 under this part for dental and oral health services 6 (as defined in section 1861(lll), other than those 7 services described in paragraph (1) of such section) 8 shall be, subject to paragraph (3), the applicable 9 percentage (specified in paragraph (2)) of the lesser 10 of the actual charge for the services or the amount 11 determined under the payment basis determined 12 under section 1848. 13 ‘‘(2) APPLICABLE PERCENTAGE.— 14 ‘‘(A) IN GENERAL.—For purposes of para- 15 graph (1), subject to subparagraph (B), the ap- 16 plicable percentage specified in this paragraph 17 is— 18 ‘‘(i) for the first year beginning at 19 least 6 months after the date of the enact- 20 ment of this subsection, 0 percent; 21 ‘‘(ii) for the year following the year 22 specified in subparagraph (A) and each 23 subsequent year through the seventh year 24 following the year specified in subpara- 25 VerDate Sep 11 2014 22:42 Feb 14, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S97.IS S97 pamtmann on DSKBC07HB2PROD with BILLS 5 •S 97 IS graph (A), the applicable percent specified 1 in this paragraph for the previous year in- 2 creased by 10 percentage points; and 3 ‘‘(iii) for the eighth year following the 4 year specified in subparagraph (A) and 5 each subsequent year, 80 percent. 6 ‘‘(B) SPECIAL RULE FOR CERTAIN LOW-IN- 7 COME INDIVIDUALS.—For purposes of para- 8 graph (1), with respect to dental and oral 9 health services described in such paragraph that 10 are furnished to an individual who is a subsidy 11 eligible individual (as defined in section 1860D– 12 14(a)(3)), or who would be a subsidy eligible in- 13 dividual if the individual were enrolled in a pre- 14 scription drug plan or an MA–PD plan under 15 part D, for the first year beginning at least 6 16 months after the date of the enactment of this 17 subsection and each subsequent year, the appli- 18 cable percent specified in this paragraph is 80 19 percent. 20 ‘‘(3) LIMITATIONS AND SECRETARIAL AUTHOR- 21 ITY.— 22 ‘‘(A) FREQUENCY.—With respect to dental 23 and oral health services that are— 24 VerDate Sep 11 2014 22:42 Feb 14, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S97.IS S97 pamtmann on DSKBC07HB2PROD with BILLS 6 •S 97 IS ‘‘(i) routine dental cleanings, payment 1 may be made under this part for only two 2 such cleanings during a 12-month period; 3 and 4 ‘‘(ii) routine exams, payment may be 5 made under this part for only two such 6 exams during a 12-month period. 7 ‘‘(B) SECRETARIAL AUTHORITY.— 8 ‘‘(i) AUTHORITY TO APPLY ADDI- 9 TIONAL LIMITATIONS.—The Secretary may 10 apply such other reasonable limitations on 11 the extent to which dental and oral services 12 are covered under this part, including 13 through application of a prior authoriza- 14 tion requirement. 15 ‘‘(ii) AUTHORITY TO MODIFY COV- 16 ERAGE.—Notwithstanding any other provi- 17 sion of this title, if the Secretary deter- 18 mines appropriate, the Secretary may mod- 19 ify the coverage under this part of dental 20 and oral health services to the extent that 21 such modification is consistent with the 22 recommendations of the United States Pre- 23 ventive Services Task Force. 24 VerDate Sep 11 2014 22:42 Feb 14, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S97.IS S97 pamtmann on DSKBC07HB2PROD with BILLS 7 •S 97 IS ‘‘(iii) AUTHORITY TO WAIVE FRE- 1 QUENCY LIMITATIONS.—The Secretary 2 may waive any frequency limitation or 3 other limitation as described in this para- 4 graph for an individual (or category of in- 5 dividuals) as determined appropriate by 6 the Secretary.’’. 7 (e) PAYMENT UNDER PHYSICIAN FEE SCHEDULE.— 8 Section 1848(j)(3) of the Social Security Act (42 U.S.C. 9 1395w–4(j)(3)) is amended by striking ‘‘risk assessment) 10 ,’’ and inserting ‘‘risk assessment), (2)(II),’’. 11 (f) DENTAL PROSTHESES.— 12 (1) IN GENERAL.—Section 1861(s)(8) of the 13 Social Security Act (42 U.S.C. 1395x(s)(8)) is 14 amended— 15 (A) by striking ‘‘(other than dental)’’ and 16 inserting ‘‘(including dental)’’; and 17 (B) by striking ‘‘internal body’’. 18 (2) SPECIAL PAYMENT RULES.—Section 19 1834(a) of the Social Security Act (42 U.S.C. 20 1395m(a)) is amended by adding at the end the fol- 21 lowing new paragraph: 22 ‘‘(23) PAYMENT AND LIMITS FOR DENTAL 23 PROSTHESES.— 24 VerDate Sep 11 2014 22:42 Feb 14, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S97.IS S97 pamtmann on DSKBC07HB2PROD with BILLS 8 •S 97 IS ‘‘(A) IN GENERAL.—The payment amount 1 under this part for dental prostheses shall be, 2 subject to subparagraph (C), the applicable per- 3 cent (specified in subparagraph (B)) of the 4 amount otherwise payable for such dental pros- 5 theses under this section. 6 ‘‘(B) APPLICABLE PERCENT.— 7 ‘‘(i) IN GENERAL.—For purposes of 8 subparagraph (A), subject to clause (ii), 9 the applicable percent specified in this sub- 10 paragraph is— 11 ‘‘(I) for the first year beginning 12 at least 6 months after the date of the 13 enactment of this paragraph, 0 per- 14 cent; 15 ‘‘(II) for the year following the 16 year specified in clause (i) and each 17 subsequent year through the seventh 18 year following the year specified in 19 clause (i), the applicable percent spec- 20 ified in this subparagraph for the pre- 21 vious year increased by 10 percentage 22 points; and 23 VerDate Sep 11 2014 22:42 Feb 14, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S97.IS S97 pamtmann on DSKBC07HB2PROD with BILLS 9 •S 97 IS ‘‘(III) for the eighth year fol- 1 lowing the year specified in clause (i) 2 and each subsequent year, 80 percent. 3 ‘‘(ii) SPECIAL RULE FOR CERTAIN 4 LOW-INCOME INDIVIDUALS.—For purposes 5 of subparagraph (A), with respect to den- 6 tal prostheses furnished to an individual 7 who is a subsidy eligible individual (as de- 8 fined in section 1860D–14(a)(3)), or who 9 would be a subsidy eligible individual if the 10 individual were enrolled in a prescription 11 drug plan or an MA–PD plan under part 12 D, for the first year beginning at least 6 13 months after the date of the enactment of 14 this paragraph and each subsequent year, 15 the applicable percent specified in this sub- 16 paragraph is 80 percent. 17 ‘‘(C) LIMITATIONS AND SECRETARIAL AU- 18 THORITY.— 19 ‘‘(i) IN GENERAL.—Payment may be 20 made under this part for an individual 21 for— 22 ‘‘(I) not more than one full upper 23 and one full lower dental prostheses 24 once every five years; and 25 VerDate Sep 11 2014 22:42 Feb 14, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S97.IS S97 pamtmann on DSKBC07HB2PROD with BILLS 10 •S 97 IS ‘‘(II) not more than one partial 1 upper dental prostheses and one par- 2 tial lower dental prostheses once every 3 five years. 4 ‘‘(ii) SECRETARIAL AUTHORITY.— 5 ‘‘(I) AUTHORITY TO APPLY ADDI- 6 TIONAL LIMITATIONS.—The Secretary 7 may apply such other reasonable limi- 8 tations on the extent to which dental 9 prostheses are covered under this 10 part, including through application of 11 a prior authorization requirement. 12 ‘‘(II) AUTHORITY TO MODIFY 13 COVERAGE.—Notwithstanding any 14 other provision of this title, if the Sec- 15 retary determines appropriate, the 16 Secretary may modify the coverage 17 under this part of dental prostheses to 18 the extent that such modification is 19 consistent with the recommendations 20 of the United States Preventive Serv- 21 ices Task Force. 22 ‘‘(III) AUTHORITY TO WAIVE 23 FREQUENCY LIMITATIONS.—The Sec- 24 retary may waive any frequency limi- 25 VerDate Sep 11 2014 22:42 Feb 14, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S97.IS S97 pamtmann on DSKBC07HB2PROD with BILLS 11 •S 97 IS tation or other limitation as described 1 in this subparagraph for an individual 2 (or category of individuals) as deter- 3 mined appropriate by the Secretary’’. 4 (g) REPEAL OF GROUND FOR EXCLUSION.—Section 5 1862(a) of the Social Security Act (42 U.S.C. 1395y) is 6 amended by striking paragraph (12). 7 (h) EFFECTIVE DATE.—The amendments made by 8 this section shall apply to services furnished on or after 9 January 1, 2022. 10 SEC. 3. INCREASED FMAP FOR ADDITIONAL EXPENDI- 11 TURES FOR MEDICARE COST-SHARING FOR 12 DENTAL AND ORAL HEALTH SERVICES. 13 Section 1905 of the Social Security Act (42 U.S.C. 14 1396d) is amended— 15 (1) in subsection (b), by striking ‘‘and (ff)’’ and 16 inserting ‘‘(ff), and (ii)’’; and 17 (2) by adding at the end the following new sub- 18 section: 19 ‘‘(ii) INCREASED FMAP FOR ADDITIONAL EXPENDI- 20 TURES FOR MEDICARE COST-SHARING FOR DENTAL AND 21 ORAL HEALTH SERVICES.—Notwithstanding subsection 22 (b), with respect to the portion of the amounts expended 23 by a State for medical assistance for medicare cost-sharing 24 (as defined in subsection (p)(3)) for qualified medicare 25 VerDate Sep 11 2014 22:42 Feb 14, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S97.IS S97 pamtmann on DSKBC07HB2PROD with BILLS 12 •S 97 IS beneficiaries described in subsection (p)(1) that is attrib- 1 utable to the coverage under part B of title XVIII of den- 2 tal and oral health services (as defined in section 3 1861(lll)), as determined by the Secretary, the Federal 4 medical assistance percentage for a State that is one of 5 the 50 States or the District of Columbia shall be equal 6 to 100 percent.’’. 7 SEC. 4. PREVENTIVE SERVICES TASKFORCE. 8 (a) IN GENERAL.—Section 915(a)(1) of the Public 9 Health Service Act (42 U.S.C. 299b–4(a)(1)) is amended, 10 in the first sentence, by inserting ‘‘, including at least 1 11 oral health professional’’ after ‘‘expertise’’. 12 (b) EFFECTIVE DATE.—The amendment made by 13 subsection (a) shall take effect January 1, 2022. 14 Æ VerDate Sep 11 2014 22:42 Feb 14, 2021 Jkt 019200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6301 E:\BILLS\S97.IS S97 pamtmann on DSKBC07HB2PROD with BILLS