Medicare and Medicaid Dental, Vision, and Hearing Benefit Act of 2019

II 116TH CONGRESS 1ST SESSION S. 1423 To amend titles XVIII and XIX of the Social Security Act to provide for coverage of dental, vision, and hearing care under the Medicare and Medicaid programs. IN THE SENATE OF THE UNITED STATES MAY 13, 2019 Mr. CASEY (for himself and Mr. CARDIN) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend titles XVIII and XIX of the Social Security Act to provide for coverage of dental, vision, and hearing care under the Medicare and Medicaid programs. 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 and Medicaid 4 Dental, Vision, and Hearing Benefit Act of 2019’’. 5 SEC. 2. DENTAL AND ORAL HEALTH CARE UNDER MEDI- 6 CARE. 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 19:06 May 21, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1423.IS S1423 pamtmann on DSKBFK8HB2PROD with BILLS 2 •S 1423 IS (1) in subparagraph (GG), by striking ‘‘and’’ 1 after the semicolon at the end; 2 (2) in subparagraph (HH), by adding ‘‘and’’ 3 after the semicolon at the end; 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— 15 ‘‘(1) routine dental cleanings and exams; 16 ‘‘(2) basic dental services, such as fillings and 17 crowns; 18 ‘‘(3) major dental services, such as root canals, 19 and extractions; 20 ‘‘(4) emergency dental care; and 21 ‘‘(5) other necessary services related to dental 22 or oral health (as defined by the Secretary).’’. 23 (c) PAYMENT; COINSURANCE; AND LIMITATIONS.— 24 VerDate Sep 11 2014 19:06 May 21, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1423.IS S1423 pamtmann on DSKBFK8HB2PROD with BILLS 3 •S 1423 IS (1) IN GENERAL.—Section 1833(a)(1) of the 1 Social Security Act (42 U.S.C. 1395l(a)(1)) is 2 amended— 3 (A) by striking ‘‘and’’ before ‘‘(CC)’’; and 4 (B) by inserting before the semicolon at 5 the end the following: ‘‘, and (DD) with respect 6 to dental and oral health services (as defined in 7 section 1861(kkk)), the amount paid shall be 8 the payment amount specified under section 9 1834(x)’’. 10 (2) PAYMENT AND LIMITS SPECIFIED.—Section 11 1834 of the Social Security Act (42 U.S.C. 1395m) 12 is amended by adding at the end the following new 13 subsection: 14 ‘‘(x) PAYMENT AND LIMITS FOR DENTAL AND ORAL 15 HEALTH SERVICES.— 16 ‘‘(1) IN GENERAL.—The payment amount 17 under this part for dental and oral health services 18 (as defined in section 1861(kkk)) shall be, subject to 19 paragraph (3), the applicable percent (specified in 20 paragraph (2)) of the lesser of the actual charge for 21 the services or the amount determined under the 22 payment basis determined under section 1848. 23 VerDate Sep 11 2014 19:06 May 21, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1423.IS S1423 pamtmann on DSKBFK8HB2PROD with BILLS 4 •S 1423 IS ‘‘(2) APPLICABLE PERCENT.—For purposes of 1 paragraph (1), the applicable percent specified in 2 this paragraph is— 3 ‘‘(A) for the first year beginning at least 6 4 months after the date of the enactment of this 5 subsection, 0 percent; 6 ‘‘(B) for the year following the year speci- 7 fied in subparagraph (A) and each subsequent 8 year through the seventh year following the 9 year specified in subparagraph (A), the applica- 10 ble percent specified in this paragraph for the 11 previous year increased by 10 percentage 12 points; and 13 ‘‘(C) for the eighth year following the year 14 specified in subparagraph (A) and each subse- 15 quent year, 80 percent. 16 ‘‘(3) LIMITATIONS AND SECRETARIAL AUTHOR- 17 ITY.— 18 ‘‘(A) FREQUENCY.—With respect to dental 19 and oral health services that are— 20 ‘‘(i) routine dental cleanings, payment 21 may be made under this part for only two 22 such cleanings during a 12-month period; 23 and 24 VerDate Sep 11 2014 19:06 May 21, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1423.IS S1423 pamtmann on DSKBFK8HB2PROD with BILLS 5 •S 1423 IS ‘‘(ii) routine exams, payment may be 1 made under this part for only two such 2 exams during a 12-month period. 3 ‘‘(B) SECRETARIAL AUTHORITY.— 4 ‘‘(i) AUTHORITY TO APPLY ADDI- 5 TIONAL LIMITATIONS.—The Secretary may 6 apply such other reasonable limitations on 7 the extent to which dental and oral services 8 are covered under this part, including 9 through application of a prior authoriza- 10 tion requirement. 11 ‘‘(ii) AUTHORITY TO MODIFY COV- 12 ERAGE.—Notwithstanding any other provi- 13 sion of this title, if the Secretary deter- 14 mines appropriate, the Secretary may mod- 15 ify the coverage under this part of dental 16 and oral health services to the extent that 17 such modification is consistent with the 18 recommendations of the United States Pre- 19 ventive Services Task Force.’’. 20 (d) PAYMENT UNDER PHYSICIAN FEE SCHEDULE.— 21 Section 1848(j)(3) of the Social Security Act (42 U.S.C. 22 1395w–4(j)(3)) is amended by inserting ‘‘(2)(II),’’ before 23 ‘‘(3)’’. 24 (e) DENTURES.— 25 VerDate Sep 11 2014 19:06 May 21, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1423.IS S1423 pamtmann on DSKBFK8HB2PROD with BILLS 6 •S 1423 IS (1) IN GENERAL.—Section 1861(s)(8) of the 1 Social Security Act (42 U.S.C. 1395x(s)(8)) is 2 amended— 3 (A) by striking ‘‘(other than dental)’’ and 4 inserting ‘‘(including dentures)’’; and 5 (B) by striking ‘‘internal body’’. 6 (2) SPECIAL PAYMENT RULES.—Section 7 1834(a) of the Social Security Act (42 U.S.C. 8 1395m(a)) is amended by adding at the end the fol- 9 lowing new paragraph: 10 ‘‘(23) PAYMENT AND LIMITS FOR DENTURES.— 11 ‘‘(A) IN GENERAL.—The payment amount 12 under this part for dentures shall be, subject to 13 subparagraph (C), the applicable percent (speci- 14 fied in subparagraph (B)) of the amount other- 15 wise payable for such dentures under this sec- 16 tion. 17 ‘‘(B) APPLICABLE PERCENT.—For pur- 18 poses of subparagraph (A), the applicable per- 19 cent specified in this subparagraph is— 20 ‘‘(i) for the first year beginning at 21 least 6 months after the date of the enact- 22 ment of this paragraph, 0 percent; 23 ‘‘(ii) for the year following the year 24 specified in clause (i) and each subsequent 25 VerDate Sep 11 2014 19:06 May 21, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1423.IS S1423 pamtmann on DSKBFK8HB2PROD with BILLS 7 •S 1423 IS year through the seventh year following the 1 year specified in clause (i), the applicable 2 percent specified in this subparagraph for 3 the previous year increased by 10 percent- 4 age points; and 5 ‘‘(iii) for the eighth year following the 6 year specified in clause (i) and each subse- 7 quent year, 80 percent. 8 ‘‘(C) LIMITATIONS AND SECRETARIAL AU- 9 THORITY.— 10 ‘‘(i) IN GENERAL.—Payment may be 11 made under this part for an individual 12 for— 13 ‘‘(I) not more than one full upper 14 and one full lower denture once every 15 five years; and 16 ‘‘(II) not more than one partial 17 upper denture and one partial lower 18 denture once every five years. 19 ‘‘(ii) SECRETARIAL AUTHORITY.— 20 ‘‘(I) AUTHORITY TO APPLY ADDI- 21 TIONAL LIMITATIONS.—The Secretary 22 may apply such other reasonable limi- 23 tations on the extent to which den- 24 tures are covered under this part, in- 25 VerDate Sep 11 2014 19:06 May 21, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1423.IS S1423 pamtmann on DSKBFK8HB2PROD with BILLS 8 •S 1423 IS cluding through application of a prior 1 authorization requirement. 2 ‘‘(II) AUTHORITY TO MODIFY 3 COVERAGE.—Notwithstanding any 4 other provision of this title, if the Sec- 5 retary determines appropriate, the 6 Secretary may modify the coverage 7 under this part of dentures to the ex- 8 tent that such modification is con- 9 sistent with the recommendations of 10 the United States Preventive Services 11 Task Force.’’. 12 (f) REPEAL OF GROUND FOR EXCLUSION.—Section 13 1862(a) of the Social Security Act (42 U.S.C. 1395y) is 14 amended by striking paragraph (12). 15 (g) EFFECTIVE DATE.—The amendments made by 16 this section shall apply to services furnished on or after 17 January 1 of the first year beginning at least six months 18 after the date of the enactment of this Act. 19 SEC. 3. VISION CARE UNDER MEDICARE. 20 (a) COVERAGE.—Section 1861(s)(2) of the Social Se- 21 curity Act (42 U.S.C. 1395x(s)(2)), as amended by section 22 2(a), is amended— 23 (1) in subparagraph (HH), by striking ‘‘and’’ 24 after the semicolon at the end; 25 VerDate Sep 11 2014 19:06 May 21, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1423.IS S1423 pamtmann on DSKBFK8HB2PROD with BILLS 9 •S 1423 IS (2) in subparagraph (II), by adding ‘‘and’’ after 1 the semicolon at the end; and 2 (3) by adding at the end the following new sub- 3 paragraph: 4 ‘‘(JJ) vision services (as defined in subsection 5 (lll));’’. 6 (b) VISION SERVICES DEFINED.—Section 1861 of 7 the Social Security Act (42 U.S.C. 1395x), as amended 8 by section 2(b), is amended by adding at the end the fol- 9 lowing new subsection: 10 ‘‘Vision Services 11 ‘‘(lll) The term ‘vision services’ means— 12 ‘‘(1) routine eye examinations and procedures 13 performed (during the course of any eye examina- 14 tion) to determine the refractive state of the eyes; 15 and 16 ‘‘(2) other necessary services related to eye and 17 vision health (as defined by the Secretary).’’. 18 (c) PAYMENT; COINSURANCE; AND LIMITATIONS.— 19 (1) IN GENERAL.—Section 1833(a)(1) of the 20 Social Security Act (42 U.S.C. 1395l(a)(1)), as 21 amended by section 2(c)(1), is amended— 22 (A) by striking ‘‘and’’ before ‘‘(DD)’’; and 23 (B) by inserting before the semicolon at 24 the end the following: ‘‘, and (EE) with respect 25 VerDate Sep 11 2014 19:06 May 21, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1423.IS S1423 pamtmann on DSKBFK8HB2PROD with BILLS 10 •S 1423 IS to vision services (as defined in section 1 1861(lll)), the amount paid shall be the pay- 2 ment amount specified under section 1834(w)’’. 3 (2) PAYMENT AND LIMITS SPECIFIED.—Section 4 1834 of the Social Security Act (42 U.S.C. 1395m), 5 as amended by section 2(c)(2), is amended by add- 6 ing at the end the following new subsection: 7 ‘‘(y) PAYMENT AND LIMITS FOR VISION SERVICES.— 8 ‘‘(1) IN GENERAL.—The payment amount 9 under this part for vision services (as defined in sec- 10 tion 1861(lll)) shall be, subject to paragraph (3), the 11 applicable percent (specified in paragraph (2)) of the 12 lesser of the actual charge for the services or the 13 amount determined under the payment basis deter- 14 mined under section 1848. 15 ‘‘(2) APPLICABLE PERCENT.—For purposes of 16 paragraph (1), the applicable percent specified in 17 this paragraph is— 18 ‘‘(A) for the first year beginning at least 6 19 months after the date of the enactment of this 20 subsection, 0 percent; 21 ‘‘(B) for the year following the year speci- 22 fied in subparagraph (A) and each subsequent 23 year through the seventh year following the 24 year specified in subparagraph (A), the applica- 25 VerDate Sep 11 2014 19:06 May 21, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1423.IS S1423 pamtmann on DSKBFK8HB2PROD with BILLS 11 •S 1423 IS ble percent specified in this paragraph for the 1 previous year increased by 10 percentage 2 points; and 3 ‘‘(C) for the eighth year following the year 4 specified in subparagraph (A) and each subse- 5 quent year, 80 percent. 6 ‘‘(3) LIMITATIONS AND SECRETARIAL AUTHOR- 7 ITY.— 8 ‘‘(A) FREQUENCY.—With respect to rou- 9 tine eye exams, payment may be made under 10 this part for only one such exam during a 12- 11 month period. 12 ‘‘(B) SECRETARIAL AUTHORITY.— 13 ‘‘(i) AUTHORITY TO APPLY ADDI- 14 TIONAL LIMITATIONS.—The Secretary may 15 apply other reasonable limitations on the 16 extent to which vision services are covered 17 under this part, including through applica- 18 tion of a prior authorization requirement. 19 ‘‘(ii) AUTHORITY TO MODIFY COV- 20 ERAGE.—Notwithstanding any other provi- 21 sion of this title, if the Secretary deter- 22 mines appropriate, the Secretary may mod- 23 ify the coverage under this part of vision 24 services to the extent that such modifica- 25 VerDate Sep 11 2014 19:06 May 21, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S1423.IS S1423 pamtmann on DSKBFK8HB2PROD with BILLS 12 •S 1423 IS tion is consistent with the recommenda- 1 tions of the United States Preventive Serv- 2 ices Task Force.’’. 3 (d) PAYMENT UNDER PHYSICIAN FEE SCHEDULE.— 4 Section 1848(j)(3) of the Social Security Act (42 U.S.C. 5 1395w–4(j)(3)), as amended by section 2(d), is amended 6 by inserting ‘‘(2)(JJ),’’ after ‘‘(2)(II),’’. 7 (e) SPECIAL PAYMENT RULES FOR EYEGLASSES, 8 CONTACT LENSES, AND LOW VISION DEVICES.—Section 9 1834(a) of the Social Security Act (42 U.S.C. 1395m(a)), 10 as amended by section 2(e)(2), is amended by adding at 11 the end the following new paragraphs: 12 ‘‘(24) PAYMENT AND LIMITS FOR EYEGLASSES 13 AND CONTACT LENSES.— 14 ‘‘(A) IN GENERAL.—The payment amount 15 under this part for eyeglass lenses, eyeglass 16 frames, and contact lenses shall be, subject to 17 subparagraph (C), the applicable percent (speci- 18 fied in subparagraph (B)) of the amount other- 19 wise payable for such eyeglass lenses, eyeglass 20 frames, and contact lenses, respectively, under 21 this section. 22 ‘‘(B) APPLICABLE PERCENT.—For pur- 23 poses of subparagraph (A), the applicable per- 24 cent specified in this subparagraph is— 25 VerDate Sep 11 2014 19:06 May 21, 2019 Jkt 089200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S1423.IS S1423 pamtmann on DSKBFK8HB2PROD with BILLS 13 •S 1423 IS ‘‘(i) for the first year beginning at 1 least 6 months after the date of the enact- 2 ment of this paragraph, 0 percent; 3 ‘‘(ii) for the year following the year 4 specified in clause (i) and each subsequent 5 year through the seventh year following the 6 year specified in clause (i), the applicable 7 percent specified in this subparagraph for 8 the previous year increased by 10 percent- 9 age points; and 10 ‘‘(iii) for the eighth year following the 11 year specified in clause (i) and each subse- 12 quent year, 80 percent. 13 ‘‘(C) LIMITATIONS AND SECRETARIAL AU- 14 THOR [Text truncated for display. 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