Medicare Dental Benefit Act of 2019

II 116TH CONGRESS 1ST SESSION S. 22 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 3, 2019 Mr. CARDIN 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 2019’’. 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 05:11 Jan 04, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S22.IS S22 kjohnson on DSK79L0C42 with BILLS 2 •S 22 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 (kkk));’’. 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 ‘‘(kkk) 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 05:11 Jan 04, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S22.IS S22 kjohnson on DSK79L0C42 with BILLS 3 •S 22 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 (kkk), relating to 9 routine 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 ‘‘(CC)’’; and 15 (B) by inserting before the semicolon at 16 the end the following: ‘‘, and (DD) with respect 17 to dental and oral health services (as defined in 18 section 1861(kkk), 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(v)’’. 22 (2) PAYMENT AND LIMITS SPECIFIED.—Section 23 1834 of the Social Security Act (42 U.S.C. 1395m) 24 VerDate Sep 11 2014 05:11 Jan 04, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S22.IS S22 kjohnson on DSK79L0C42 with BILLS 4 •S 22 IS is amended by adding at the end the following new 1 subsection: 2 ‘‘(v) 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(kkk), 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.—For purposes 14 of paragraph (1), the applicable percentage specified 15 in this paragraph is— 16 ‘‘(A) for the first year beginning at least 6 17 months after the date of the enactment of this 18 subsection, 0 percent; 19 ‘‘(B) for the year following the year speci- 20 fied in subparagraph (A) and each subsequent 21 year through the seventh year following the 22 year specified in subparagraph (A), the applica- 23 ble percent specified in this paragraph for the 24 VerDate Sep 11 2014 05:11 Jan 04, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S22.IS S22 kjohnson on DSK79L0C42 with BILLS 5 •S 22 IS previous year increased by 10 percentage 1 points; and 2 ‘‘(C) for the eighth year following the year 3 specified in subparagraph (A) and each subse- 4 quent year, 80 percent. 5 ‘‘(3) LIMITATIONS AND SECRETARIAL AUTHOR- 6 ITY.— 7 ‘‘(A) FREQUENCY.—With respect to dental 8 and oral health services that are— 9 ‘‘(i) routine dental cleanings, payment 10 may be made under this part for only two 11 such cleanings during a 12-month period; 12 and 13 ‘‘(ii) routine exams, payment may be 14 made under this part for only two such 15 exams during a 12-month period. 16 ‘‘(B) SECRETARIAL AUTHORITY.— 17 ‘‘(i) AUTHORITY TO APPLY ADDI- 18 TIONAL LIMITATIONS.—The Secretary may 19 apply such other reasonable limitations on 20 the extent to which dental and oral services 21 are covered under this part, including 22 through application of a prior authoriza- 23 tion requirement. 24 VerDate Sep 11 2014 05:11 Jan 04, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S22.IS S22 kjohnson on DSK79L0C42 with BILLS 6 •S 22 IS ‘‘(ii) AUTHORITY TO MODIFY COV- 1 ERAGE.—Notwithstanding any other provi- 2 sion of this title, if the Secretary deter- 3 mines appropriate, the Secretary may mod- 4 ify the coverage under this part of dental 5 and oral health services to the extent that 6 such modification is consistent with the 7 recommendations of the United States Pre- 8 ventive Services Task Force.’’. 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 05:11 Jan 04, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S22.IS S22 kjohnson on DSK79L0C42 with BILLS 7 •S 22 IS ‘‘(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.—For pur- 9 poses of subparagraph (A), the applicable per- 10 cent specified in this subparagraph is— 11 ‘‘(i) for the first year beginning at 12 least 6 months after the date of the enact- 13 ment of this paragraph, 0 percent; 14 ‘‘(ii) for the year following the year 15 specified in clause (i) and each subsequent 16 year through the seventh year following the 17 year specified in clause (i), the applicable 18 percent specified in this subparagraph for 19 the previous year increased by 10 percent- 20 age points; and 21 ‘‘(iii) for the eighth year following the 22 year specified in clause (i) and each subse- 23 quent year, 80 percent. 24 VerDate Sep 11 2014 05:11 Jan 04, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S22.IS S22 kjohnson on DSK79L0C42 with BILLS 8 •S 22 IS ‘‘(C) LIMITATIONS AND SECRETARIAL AU- 1 THORITY.— 2 ‘‘(i) IN GENERAL.—Payment may be 3 made under this part for an individual 4 for— 5 ‘‘(I) not more than one full upper 6 and one full lower dental prostheses 7 once every five years; and 8 ‘‘(II) not more than one partial 9 upper dental prostheses and one par- 10 tial lower dental prostheses once every 11 five years. 12 ‘‘(ii) SECRETARIAL AUTHORITY.— 13 ‘‘(I) AUTHORITY TO APPLY ADDI- 14 TIONAL LIMITATIONS.—The Secretary 15 may apply such other reasonable limi- 16 tations on the extent to which dental 17 prostheses are covered under this 18 part, including through application of 19 a prior authorization requirement. 20 ‘‘(II) AUTHORITY TO MODIFY 21 COVERAGE.—Notwithstanding any 22 other provision of this title, if the Sec- 23 retary determines appropriate, the 24 Secretary may modify the coverage 25 VerDate Sep 11 2014 05:11 Jan 04, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S22.IS S22 kjohnson on DSK79L0C42 with BILLS 9 •S 22 IS under this part of dental prostheses to 1 the extent that such modification is 2 consistent with the recommendations 3 of the United States Preventive Serv- 4 ices Task Force.’’. 5 (g) REPEAL OF GROUND FOR EXCLUSION.—Section 6 1862(a) of the Social Security Act (42 U.S.C. 1395y) is 7 amended by striking paragraph (12). 8 (h) EFFECTIVE DATE.—The amendments made by 9 this section shall apply to services furnished on or after 10 January 1, 2020. 11 Æ VerDate Sep 11 2014 05:11 Jan 04, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6301 E:\BILLS\S22.IS S22 kjohnson on DSK79L0C42 with BILLS