Federal

SALT Act

Source: Congress.gov · 5,092 words in original text

What This Bill Does

This bill makes three main changes. First, it modifies how high-income individuals can deduct state and local taxes on their tax returns. Second, it adds hearing care coverage to Medicare starting in 2025. Third, it adds vision care coverage to Medicare also starting in 2025. ##

Who It Affects

- Individuals earning $400,000 or more per year (or $200,000 if married filing separately) - Individuals with $1 billion or more in assets (or $500 million if married filing separately) - Estates and trusts - Medicare beneficiaries who need hearing aids, audiology services, eye exams, or contact lenses - Audiologists and hearing aid professionals who serve Medicare patients - Ophthalmologists and optometrists who serve Medicare patients - Rural health clinics and federally qualified health centers ##

Key Provisions

- High-income individuals can deduct only up to $60,000 in state and local taxes per year (or $30,000 if married filing separately), and this limit reduces further as income rises above the $400,000 threshold (Sec. 2(a)) - Individuals with $1 billion or more in assets cannot deduct state and local taxes at all (or $500 million if married filing separately) (Sec. 2(a)) - Starting January 1, 2025, Medicare covers hearing assessments and aural rehabilitation services provided by qualified audiologists and qualified hearing aid professionals (Sec. 3(a)) - Starting January 1, 2025, Medicare covers hearing aids for people with moderately severe, severe, or profound hearing loss, limited to one per ear every five years with a written order from an authorized provider (Sec. 3(b)) - Starting January 1, 2025, Medicare covers routine eye exams and contact lens fitting services provided by ophthalmologists or optometrists (Sec. 4(a), 4(b)) - Starting January 1, 2025, Medicare covers eyeglasses and contact lenses limited to one pair of eyeglasses or a two-year supply of contact lenses every two years, with payment caps of $85 for lenses and $85 for frames in 2025, adjusted annually for inflation (Sec. 4(f)) ##

What Changes

If this bill becomes law, federal tax deductions for state and local taxes will be limited or eliminated for higher-income earners. Medicare will begin paying for hearing services, hearing aids, eye exams, and eyeglasses or contact lenses starting January 1, 2025. Money saved from the tax changes will fund these new Medicare benefits through the Federal Supplementary Medical Insurance Trust Fund. ##

Important Definitions

- **Qualified audiologist**: A person licensed or registered by a state to practice audiology who meets requirements set by the government (Sec. 3(a)) - **Qualified hearing aid professional**: A person licensed or registered by a state as a hearing aid dispenser, hearing aid specialist, or hearing instrument dispenser who meets requirements set by the government (Sec. 3(a)) - **Vision services**: Routine eye exams to determine the refractive state of the eyes (how the eye bends light) and contact lens fitting services (Sec. 4(b)) - **Assets**: All property, real or personal, tangible or intangible, valued the same way as for estate tax purposes (Sec. 2(a)) ##

Effective Date

The tax changes apply to tax years beginning after the bill is signed into law (Sec. 2(b)). The hearing and vision care coverage changes take effect January 1, 2025 (Sec. 3, Sec. 4).

I 118TH CONGRESS 1ST SESSION H. R. 1326 To modify the limitation on the deduction by individuals of certain State and local taxes and to provide coverage for hearing and vision care under the Medicare program. IN THE HOUSE OF REPRESENTATIVES MARCH 1, 2023 Ms. PORTER introduced the following bill; which was referred to the Com- mittee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speak- er, in each case for consideration of such provisions as fall within the ju- risdiction of the committee concerned A BILL To modify the limitation on the deduction by individuals of certain State and local taxes and to provide coverage for hearing and vision care 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 ‘‘Supporting Americans 4 with Lower Taxes Act’’ or as the ‘‘SALT Act’’. 5 VerDate Sep 11 2014 01:44 Mar 17, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H1326.IH H1326 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 1326 IH SEC. 2. MODIFICATION OF LIMITATION ON THE DEDUC- 1 TION BY INDIVIDUALS OF CERTAIN STATE 2 AND LOCAL, ETC., TAXES. 3 (a) IN GENERAL.—Section 164(b)(6) of the Internal 4 Revenue Code of 1986 is amended to read as follows: 5 ‘‘(6) LIMITATION ON DEDUCTION BY CERTAIN 6 HIGH-INCOME INDIVIDUALS.— 7 ‘‘(A) IN GENERAL.—In the case of a tax- 8 payer with adjusted gross income which equals 9 or exceeds $400,000 for any taxable year— 10 ‘‘(i) foreign real property taxes shall 11 not be taken into account under subsection 12 (a)(1) (or section 216(a)) for such taxable 13 year, and 14 ‘‘(ii) the aggregate amount of taxes 15 taken into account under paragraphs (1), 16 (2), and (3) of subsection (a) and para- 17 graph (5) of this subsection (and any tax 18 described in any such paragraph taken into 19 account under section 216(a)(1)) for such 20 taxable year shall not exceed $60,000. 21 ‘‘(B) PHASEDOWN OF LIMITATION BASED 22 ON ADJUSTED GROSS INCOME.—The $60,000 23 amount in subparagraph (A)(ii) shall be re- 24 duced (but not below zero) by the dollar 25 VerDate Sep 11 2014 01:44 Mar 17, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1326.IH H1326 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 1326 IH amount which bears the same ratio to $60,000 1 as— 2 ‘‘(i) the excess of the taxpayer’s ad- 3 justed gross income over $400,000, bears 4 to 5 ‘‘(ii) $600,000. 6 ‘‘(C) APPLICATION RESTRICTED TO CER- 7 TAIN TAXPAYERS AND TAXES.— 8 ‘‘(i) APPLICATION TO INDIVIDUALS.— 9 Subparagraph (A) shall only apply to indi- 10 viduals, estates, and trusts. 11 ‘‘(ii) EXCLUSION OF CERTAIN BUSI- 12 NESS TAXES.—Subparagraph (A) shall not 13 apply to any foreign taxes described in 14 subsection (a)(3) or to any taxes described 15 in paragraph (1) and (2) of subsection (a) 16 which are paid or accrued in carrying on 17 a trade or business or an activity described 18 in section 212. 19 ‘‘(D) MARRIED INDIVIDUALS FILING A 20 SEPARATE RETURN.—In the case of a married 21 individual filing a separate return, subpara- 22 graphs (A) and (B) shall be applied— 23 ‘‘(i) by substituting ‘$200,000’ for 24 ‘$400,000’ each place it appears, 25 VerDate Sep 11 2014 01:44 Mar 17, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1326.IH H1326 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 1326 IH ‘‘(ii) by substituting ‘$30,000’ for 1 ‘$60,000’ each place it appears, and 2 ‘‘(iii) by substituting ‘$300,000’ for 3 ‘$600,000’ in subparagraph (B)(ii). 4 ‘‘(E) ESTATES AND TRUSTS.—In the case 5 of an estate or trust, adjusted gross income 6 shall be determined as provided in section 7 67(e). 8 ‘‘(F) DENIAL OF DEDUCTION TO BILLION- 9 AIRES.—Unless the taxpayer has less than 10 $1,000,000,000 ($500,000,000 in the case of a 11 married individual filing a separate return) in 12 assets as of the close of the taxable year (and 13 attests to such fact under penalty of perjury at 14 such time and in such manner as the Secretary 15 may provide)— 16 ‘‘(i) subparagraph (A) shall be ap- 17 plied— 18 ‘‘(I) by substituting ‘zero’ for 19 ‘$400,000’, and 20 ‘‘(II) by substituting ‘zero’ for 21 ‘$60,000’, and 22 ‘‘(ii) subparagraphs (B) and (D) shall 23 not apply. 24 VerDate Sep 11 2014 01:44 Mar 17, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1326.IH H1326 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 1326 IH For purposes of this subparagraph, the term 1 ‘assets’ means all property, real or personal, 2 tangible or intangible, wherever situated (within 3 the meaning of section 2031) and such property 4 shall be valued in the same manner as for pur- 5 poses of part III of subchapter A of chapter 6 11.’’. 7 (b) EFFECTIVE DATE.—The amendment made by 8 subsection (a) shall apply to taxable years beginning after 9 the date of the enactment of this Act. 10 (c) APPROPRIATIONS TO FEDERAL SUPPLEMENTARY 11 MEDICAL INSURANCE TRUST FUND.— 12 (1) IN GENERAL.—There are hereby appro- 13 priated to the Federal Supplementary Medical Insur- 14 ance Trust Fund amounts equivalent to the amounts 15 received in the Treasury by reason of the amend- 16 ment made by subsection (a). Rules similar to the 17 rules of section 9601 of the Internal Revenue Code 18 of 1986 shall apply with respect to transfers made 19 by reason of the preceding sentence. 20 (2) CONFORMING AMENDMENT.—Section 21 1841(a) of the Social Security Act (42 U.S.C. 22 1395t) is amended by inserting ‘‘, or section 2(b) of 23 the SALT Act,’’ after ‘‘this part’’. 24 VerDate Sep 11 2014 01:44 Mar 17, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1326.IH H1326 kjohnson on DSK79L0C42PROD with BILLS 6 •HR 1326 IH SEC. 3. PROVIDING COVERAGE FOR HEARING CARE UNDER 1 THE MEDICARE PROGRAM. 2 (a) PROVISION OF AUDIOLOGY SERVICES BY QUALI- 3 FIED AUDIOLOGISTS AND QUALIFIED HEARING AID PRO- 4 FESSIONALS.— 5 (1) IN GENERAL.—Section 1861(ll) of the So- 6 cial Security Act (42 U.S.C. 1395x(ll)) is amend- 7 ed— 8 (A) in paragraph (3)— 9 (i) by inserting ‘‘(and, beginning Jan- 10 uary 1, 2025, such aural rehabilitation and 11 treatment services)’’ after ‘‘assessment 12 services’’; 13 (ii) by inserting ‘‘, and, beginning on 14 January 1, 2025, such hearing assessment 15 services furnished by a qualified hearing 16 aid professional,’’ after ‘‘by a qualified au- 17 diologist’’; and 18 (iii) by striking ‘‘the audiologist’’ and 19 inserting ‘‘the audiologist or qualified hear- 20 ing aid professional’’; and 21 (B) in paragraph (4), by adding at the end 22 the following new subparagraph: 23 ‘‘(C) The term ‘qualified hearing aid profes- 24 sional’ means, with respect to hearing assessment 25 VerDate Sep 11 2014 01:44 Mar 17, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H1326.IH H1326 kjohnson on DSK79L0C42PROD with BILLS 7 •HR 1326 IH services described in paragraph (3), an individual 1 who— 2 ‘‘(i) is licensed or registered as a hearing 3 aid dispenser, hearing aid specialist, hearing in- 4 strument dispenser, or related professional by 5 the State in which the individual furnishes such 6 services; and 7 ‘‘(ii) meets such other requirements as the 8 Secretary determines appropriate (including re- 9 quirements relating to educational certifications 10 or accreditations), taking into account any addi- 11 tional requirements for hearing aid specialists, 12 hearing aid dispensers, and hearing instrument 13 dispensers established by Medicare Advantage 14 organizations under part C, State plans (or 15 waivers of such plans) under title XIX, and the 16 group health plans and health insurance issuers 17 (as such terms are defined in section 2791 of 18 the Public Health Service Act).’’. 19 (2) PAYMENT FOR QUALIFIED HEARING AID 20 PROFESSIONALS.—Section 1833(a)(1) of the Social 21 Security Act (42 U.S.C. 1395l(a)(1)) is amended— 22 (A) by striking ‘‘and’’ before ‘‘(HH)’’; and 23 (B) by inserting before the semicolon at 24 the end the following: ‘‘and (II) with respect to 25 VerDate Sep 11 2014 01:44 Mar 17, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1326.IH H1326 kjohnson on DSK79L0C42PROD with BILLS 8 •HR 1326 IH hearing assessment services (as described in 1 paragraph (3) of section 1861(ll)) furnished by 2 a qualified hearing aid professional (as defined 3 in paragraph (4)(C) of such section), the 4 amounts paid shall be equal to 80 percent of 5 the lesser of the actual charge for such services 6 or 85 percent of the amount for such services 7 determined under the payment basis determined 8 under section 1848’’. 9 (b) COVERAGE OF HEARING AIDS.— 10 (1) INCLUSION OF HEARING AIDS AS PROS- 11 THETIC DEVICES.—Section 1861(s)(8) of the Social 12 Security Act (42 U.S.C. 1395x(s)(8)) is amended by 13 inserting ‘‘, and including hearing aids (as described 14 in section 1834(h)(7)) furnished on or after January 15 1, 2025, to individuals diagnosed with moderately 16 severe, severe, or profound hearing loss’’ before the 17 semicolon at the end. 18 (2) PAYMENT LIMITATIONS FOR HEARING 19 AIDS.—Section 1834(h) of the Social Security Act 20 (42 U.S.C. 1395m(h)) is amended by adding at the 21 end the following new paragraphs: 22 ‘‘(6) PAYMENT ONLY ON AN ASSIGNMENT-RE- 23 LATED BASIS.—Payment for hearing aids for which 24 payment may be made under this part may be made 25 VerDate Sep 11 2014 01:44 Mar 17, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H1326.IH H1326 kjohnson on DSK79L0C42PROD with BILLS 9 •HR 1326 IH only on an assignment-related basis. The provisions 1 of section 1842(b)(18)(B) shall apply to hearing aids 2 in the same manner as they apply to services fur- 3 nished by a practitioner described in subsection 4 (b)(18)(C). 5 ‘‘(7) LIMITATIONS FOR HEARING AIDS.—Pay- 6 ment may be made under this part with respect to 7 an individual, with respect to hearing aids furnished 8 on or after January 1, 2025— 9 ‘‘(A) not more than once per ear during a 10 5-year period; 11 ‘‘(B) only for types of such hearing aids 12 that are determined appropriate by the Sec- 13 retary; and 14 ‘‘(C) only if furnished pursuant to a writ- 15 ten order of a physician, qualified audiologist 16 (as defined in section 1861(ll)(4)), qualified 17 hearing aid professional (as so defined), physi- 18 cian assistant, nurse practitioner, or clinical 19 nurse specialist.’’. 20 (3) APPLICATION OF COMPETITIVE ACQUISI- 21 TION.— 22 (A) IN GENERAL.—Section 1834(h)(1)(H) 23 of the Social Security Act (42 U.S.C. 24 1395m(h)(1)(H)) is amended— 25 VerDate Sep 11 2014 01:44 Mar 17, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H1326.IH H1326 kjohnson on DSK79L0C42PROD with BILLS 10 •HR 1326 IH (i) in the header, by inserting ‘‘AND 1 HEARING AIDS’’ after ‘‘ORTHOTICS’’; 2 (ii) by inserting ‘‘, or of hearing aids 3 described in paragraph (2)(D) of such sec- 4 tion,’’ after ‘‘2011,’’; and 5 (iii) in clause (i), by inserting ‘‘or 6 such hearing aids’’ after ‘‘such orthotics’’. 7 (B) CONFORMING AMENDMENT.— 8 (i) IN GENERAL.—Section 1847(a)(2) 9 of the Social Security Act (42 U.S.C. 10 1395w–3(a)(2)) is amended by adding at 11 the end the following new subparagraph: 12 ‘‘(D) HEARING AIDS.—Hearing aids de- 13 scribed in section 1861(s)(8) for which payment 14 would otherwise be made under section 15 1834(h).’’. 16 (ii) EXEMPTION OF CERTAIN ITEMS 17 FROM COMPETITIVE ACQUISITION.—Sec- 18 tion 1847(a)(7) of the Social Security Act 19 (42 U.S.C. 1395w–3(a)(7)) is amended by 20 adding at the end the following new sub- 21 paragraph: 22 ‘‘(C) CERTAIN HEARING AIDS.—Those 23 items and services described in paragraph 24 (2)(D) if furnished by a physician or other 25 VerDate Sep 11 2014 01:44 Mar 17, 2023 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H1326.IH H1326 kjohnson on DSK79L0C42PROD with BILLS 11 •HR 1326 IH practitioner (as defined by the Secretary) to the 1 physician’s or practitioner’s own patients as 2 part of the physician’s or practitioner’s profes- 3 sional service.’’. 4 (4) INCLUSION OF QUALIFIED AUDIOLOGISTS 5 AND QUALIFIED HEARING AID PROFESSIONALS AS 6 CERTAIN PRACTITIONERS TO RECEIVE PAYMENT ON 7 AN ASSIGNMENT-RELATED BASIS.—Section 8 1842(b)(18)(C) of the Social Security Act (42 9 U.S.C. 1395u(b)(18)(C)), is amended by adding at 10 the end the following new clauses: 11 ‘‘(ix) Beginning on January 1, 2025, 12 a qualified audiologist (as defined in sec- 13 tion 1861(ll)(4)(B)). 14 ‘‘(x) A qualified hearing aid profes- 15 sional (as defined in section 16 1861(ll)(4)(C)).’’. 17 (c) EXCLUSION MODIFICATION.—Section 1862(a)(7) 18 of the Social Security Act (42 U.S.C. 1395y(a)(7)) is 19 amended by inserting ‘‘(except such hearing aids or exami- 20 nations therefor as described in and otherwise allowed 21 under section 1861(s)(8))’’ after ‘‘hearing aids or exami- 22 nations therefor’’. 23 VerDate Sep 11 2014 01:44 Mar 17, 2023 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H1326.IH H1326 kjohnson on DSK79L0C42PROD with BILLS 12 •HR 1326 IH (d) INCLUSION AS EXCEPTED MEDICAL TREAT- 1 MENT.—Section 1821(b)(5)(A) of the Social Security Act 2 (42 U.S.C. 1395i–5(b)(5)(A)) is amended— 3 (1) in clause (i), by striking ‘‘or’’; 4 (2) in clause (ii), by striking the period and in- 5 serting ‘‘, or’’; and 6 (3) by adding at the end the following new 7 clause: 8 ‘‘(iii) consisting of audiology services 9 described in subsection (ll)(3) of section 10 1861, or hearing aids described in sub- 11 section (s)(8) of such section, that are pay- 12 able under part B as a result of the 13 amendments made by the SALT Act.’’. 14 (e) RURAL HEALTH CLINICS AND FEDERALLY 15 QUALIFIED HEALTH CENTERS.— 16 (1) CLARIFYING COVERAGE OF AUDIOLOGY 17 SERVICES AS PHYSICIANS’ SERVICES.—Section 18 1861(aa)(1)(A) of the Social Security Act (42 19 U.S.C. 1395x(aa)(1)(A)) is amended by inserting 20 ‘‘(including audiology services (as defined in sub- 21 section (ll)(3)))’’ after ‘‘physicians’ services’’. 22 (2) INCLUSION OF QUALIFIED AUDIOLOGISTS 23 AND QUALIFIED HEARING AID PROFESSIONALS AS 24 RHC AND FQHC PRACTITIONERS.—Section 25 VerDate Sep 11 2014 01:44 Mar 17, 2023 Jkt 039200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H1326.IH H1326 kjohnson on DSK79L0C42PROD with BILLS 13 •HR 1326 IH 1861(aa)(1)(B) of the Social Security Act (42 1 U.S.C. 1395x(aa)(1)(B)) is amended by inserting 2 ‘‘or by a qualified audiologist or a qualified hearing 3 aid professional (as such terms are defined in sub- 4 section (ll)),’’ after ‘‘(as defined in subsection 5 (hh)(1)),’’. 6 (3) TEMPORARY PAYMENT RATES FOR CERTAIN 7 SERVICES UNDER THE RHC AIR AND FQHC PPS.— 8 (A) AIR.—Section 1833 of the Social Se- 9 cur [Text truncated for display. Full text available on Congress.gov.]

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