Medicare Dental Benefit Act of 2021

I 117TH CONGRESS 1ST SESSION H. R. 502 To amend title XVIII of the Social Security Act to provide for coverage of dental services under the Medicare program. IN THE HOUSE OF REPRESENTATIVES JANUARY 28, 2021 Ms. BARRAGA´N (for herself, Ms. KELLY of Illinois, and Mr. KHANNA) intro- duced 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 jurisdiction of the committee concerned 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 VerDate Sep 11 2014 02:33 Feb 18, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H502.IH H502 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 502 IH SEC. 2. COVERAGE OF DENTAL SERVICES UNDER THE 1 MEDICARE PROGRAM. 2 (a) COVERAGE.—Section 1861(s)(2) of the Social Se- 3 curity Act (42 U.S.C. 1395x(s)(2)) is amended— 4 (1) in subparagraph (GG), by striking ‘‘and’’ at 5 the end; 6 (2) in subparagraph (HH), by striking the pe- 7 riod at the end and inserting ‘‘; and’’; and 8 (3) by adding at the end the following new sub- 9 paragraph: 10 ‘‘(II) dental and oral health services (as defined 11 in subsection (lll));’’. 12 (b) DENTAL AND ORAL HEALTH SERVICES DE- 13 FINED.—Section 1861 of the Social Security Act (42 14 U.S.C. 1395x) is amended by adding at the end the fol- 15 lowing new subsection: 16 ‘‘Dental and Oral Health Services 17 ‘‘(lll) The term ‘dental and oral health services’ 18 means services (as defined by the Secretary) that are nec- 19 essary to prevent disease and promote oral health, restore 20 oral structures to health and function, and treat emer- 21 gency conditions, including— 22 ‘‘(1) routine diagnostic and preventive care 23 such as dental cleanings, exams, and x-rays; 24 ‘‘(2) basic dental services such as fillings and 25 extractions; 26 VerDate Sep 11 2014 02:33 Feb 18, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H502.IH H502 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 502 IH ‘‘(3) major dental services such as root canals, 1 crowns, and dentures; 2 ‘‘(4) emergency dental care; and 3 ‘‘(5) other necessary services related to dental 4 and oral health (as defined by the Secretary).’’. 5 (c) COVERAGE OF ROUTINE DIAGNOSTIC AND PRE- 6 VENTIVE CARE AS A PREVENTIVE SERVICE.—Section 7 1861(ddd)(3) of the Social Security Act (42 U.S.C. 8 1395x(ddd)(3)) is amended by adding at the end the fol- 9 lowing new subparagraph: 10 ‘‘(D) Dental and oral health services described 11 in paragraph (1) of subsection (lll), relating to rou- 12 tine diagnostic and preventive care.’’. 13 (d) PAYMENT; COINSURANCE; AND LIMITATIONS.— 14 (1) IN GENERAL.—Section 1833(a)(1) of the 15 Social Security Act (42 U.S.C. 1395l(a)(1)) is 16 amended— 17 (A) by striking ‘‘and’’ before ‘‘(DD)’’; and 18 (B) by inserting before the semicolon at 19 the end the following: ‘‘and (EE) with respect 20 to dental and oral health services (as defined in 21 section 1861(lll), other than those services de- 22 scribed in paragraph (1) of such section), the 23 amount paid shall be the payment amount spec- 24 ified under section 1834(z).’’. 25 VerDate Sep 11 2014 02:33 Feb 18, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H502.IH H502 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 502 IH (2) PAYMENT AND LIMITS SPECIFIED.—Section 1 1834 of the Social Security Act (42 U.S.C. 1395m) 2 is amended by adding at the end the following new 3 subsection: 4 ‘‘(z) PAYMENT AND LIMITS FOR DENTAL AND ORAL 5 HEALTH SERVICES.— 6 ‘‘(1) IN GENERAL.—The payment amount 7 under this part for dental and oral health services 8 (as defined in section 1861(lll), other than those 9 services described in paragraph (1) of such section) 10 shall be, subject to paragraph (3), the applicable 11 percentage (specified in paragraph (2)) of the lesser 12 of the actual charge for the services or the amount 13 determined under the payment basis determined 14 under section 1848. 15 ‘‘(2) APPLICABLE PERCENTAGE.— 16 ‘‘(A) IN GENERAL.—For purposes of para- 17 graph (1), subject to subparagraph (B), the ap- 18 plicable percentage specified in this paragraph 19 is— 20 ‘‘(i) for the first year beginning at 21 least 6 months after the date of the enact- 22 ment of this subsection, 0 percent; 23 ‘‘(ii) for the year following the year 24 specified in subparagraph (A) and each 25 VerDate Sep 11 2014 02:33 Feb 18, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H502.IH H502 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 502 IH subsequent year through the seventh year 1 following the year specified in subpara- 2 graph (A), the applicable percent specified 3 in this paragraph for the previous year in- 4 creased by 10 percentage points; and 5 ‘‘(iii) for the eighth year following the 6 year specified in subparagraph (A) and 7 each subsequent year, 80 percent. 8 ‘‘(B) SPECIAL RULE FOR CERTAIN LOW-IN- 9 COME INDIVIDUALS.—For purposes of para- 10 graph (1), with respect to dental and oral 11 health services described in such paragraph that 12 are furnished to an individual who is a subsidy 13 eligible individual (as defined in section 1860D– 14 14(a)(3)), or who would be a subsidy eligible in- 15 dividual if the individual were enrolled in a pre- 16 scription drug plan or an MA–PD plan under 17 part D, for the first year beginning at least 6 18 months after the date of the enactment of this 19 subsection and each subsequent year, the appli- 20 cable percent specified in this paragraph is 80 21 percent. 22 ‘‘(3) LIMITATIONS AND SECRETARIAL AUTHOR- 23 ITY.— 24 VerDate Sep 11 2014 02:33 Feb 18, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H502.IH H502 kjohnson on DSK79L0C42PROD with BILLS 6 •HR 502 IH ‘‘(A) FREQUENCY.—With respect to dental 1 and oral health services that are— 2 ‘‘(i) routine dental cleanings, payment 3 may be made under this part for only two 4 such cleanings during a 12-month period; 5 and 6 ‘‘(ii) routine exams, payment may be 7 made under this part for only two such 8 exams during a 12-month period. 9 ‘‘(B) SECRETARIAL AUTHORITY.— 10 ‘‘(i) AUTHORITY TO APPLY ADDI- 11 TIONAL LIMITATIONS.—The Secretary may 12 apply such other reasonable limitations on 13 the extent to which dental and oral services 14 are covered under this part, including 15 through application of a prior authoriza- 16 tion requirement. 17 ‘‘(ii) AUTHORITY TO MODIFY COV- 18 ERAGE.—Notwithstanding any other provi- 19 sion of this title, if the Secretary deter- 20 mines appropriate, the Secretary may mod- 21 ify the coverage under this part of dental 22 and oral health services to the extent that 23 such modification is consistent with the 24 VerDate Sep 11 2014 02:33 Feb 18, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H502.IH H502 kjohnson on DSK79L0C42PROD with BILLS 7 •HR 502 IH recommendations of the United States Pre- 1 ventive Services Task Force. 2 ‘‘(iii) AUTHORITY TO WAIVE FRE- 3 QUENCY LIMITATIONS.—The Secretary 4 may waive any frequency limitation or 5 other limitation as described in this para- 6 graph for an individual (or category of in- 7 dividuals) as determined appropriate by 8 the Secretary.’’. 9 (e) PAYMENT UNDER PHYSICIAN FEE SCHEDULE.— 10 Section 1848(j)(3) of the Social Security Act (42 U.S.C. 11 1395w–4(j)(3)) is amended by striking ‘‘risk assessment) 12 ,’’ and inserting ‘‘risk assessment), (2)(II),’’. 13 (f) DENTAL PROSTHESES.— 14 (1) IN GENERAL.—Section 1861(s)(8) of the 15 Social Security Act (42 U.S.C. 1395x(s)(8)) is 16 amended— 17 (A) by striking ‘‘(other than dental)’’ and 18 inserting ‘‘(including dental)’’; and 19 (B) by striking ‘‘internal body’’. 20 (2) SPECIAL PAYMENT RULES.—Section 21 1834(a) of the Social Security Act (42 U.S.C. 22 1395m(a)) is amended by adding at the end the fol- 23 lowing new paragraph: 24 VerDate Sep 11 2014 02:33 Feb 18, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H502.IH H502 kjohnson on DSK79L0C42PROD with BILLS 8 •HR 502 IH ‘‘(23) PAYMENT AND LIMITS FOR DENTAL 1 PROSTHESES.— 2 ‘‘(A) IN GENERAL.—The payment amount 3 under this part for dental prostheses shall be, 4 subject to subparagraph (C), the applicable per- 5 cent (specified in subparagraph (B)) of the 6 amount otherwise payable for such dental pros- 7 theses under this section. 8 ‘‘(B) APPLICABLE PERCENT.— 9 ‘‘(i) IN GENERAL.—For purposes of 10 subparagraph (A), subject to clause (ii), 11 the applicable percent specified in this sub- 12 paragraph is— 13 ‘‘(I) for the first year beginning 14 at least 6 months after the date of the 15 enactment of this paragraph, 0 per- 16 cent; 17 ‘‘(II) for the year following the 18 year specified in clause (i) and each 19 subsequent year through the seventh 20 year following the year specified in 21 clause (i), the applicable percent spec- 22 ified in this subparagraph for the pre- 23 vious year increased by 10 percentage 24 points; and 25 VerDate Sep 11 2014 02:33 Feb 18, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H502.IH H502 kjohnson on DSK79L0C42PROD with BILLS 9 •HR 502 IH ‘‘(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 02:33 Feb 18, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H502.IH H502 kjohnson on DSK79L0C42PROD with BILLS 10 •HR 502 IH ‘‘(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 02:33 Feb 18, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H502.IH H502 kjohnson on DSK79L0C42PROD with BILLS 11 •HR 502 IH 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 02:33 Feb 18, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H502.IH H502 kjohnson on DSK79L0C42PROD with BILLS 12 •HR 502 IH 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 02:33 Feb 18, 2021 Jkt 019200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6301 E:\BILLS\H502.IH H502 kjohnson on DSK79L0C42PROD with BILLS