Medicare Dental Coverage Act of 2019

IB Union Calendar No. 303 116TH CONGRESS 2D SESSION H. R. 4650 [Report No. 116–325, Parts I and II] To amend title XVIII of the Social Security Act to provide coverage for certain dental items and services under part B of the Medicare program. IN THE HOUSE OF REPRESENTATIVES OCTOBER 11, 2019 Ms. KELLY of Illinois (for herself and Mr. HORSFORD) introduced the fol- lowing bill; which was referred to the Committee on Energy and Com- merce, and in addition to the Committee on Ways and Means, for a pe- riod to be subsequently determined by the Speaker, in each case for con- sideration of such provisions as fall within the jurisdiction of the com- mittee concerned DECEMBER 6, 2019 Reported from the Committee on Ways and Means with an amendment [Strike out all after the enacting clause and insert the part printed in italic] JANUARY 24, 2020 Additional sponsors: Ms. CASTOR of Florida, Ms. BARRAGA´N, Mr. BUTTERFIELD, Mr. CUELLAR, Ms. NORTON, Mr. MALINOWSKI, Mr. PAYNE, Mr. WELCH, and Mr. CARTWRIGHT VerDate Sep 11 2014 23:12 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\H4650.RH H4650 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 4650 RH JANUARY 24, 2020 Reported from the Committee on Energy and Commerce, committed to the Committee of the Whole House on the State of the Union, and ordered to be printed [For text of introduced bill, see copy of bill as introduced on October 11, 2019] A BILL To amend title XVIII of the Social Security Act to provide coverage for certain dental items and services under part B of the Medicare program. VerDate Sep 11 2014 23:12 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6652 E:\BILLS\H4650.RH H4650 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 4650 RH 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 Cov- 4 erage Act of 2019’’. 5 SEC. 2. DENTAL AND ORAL HEALTH CARE. 6 (a) COVERAGE.—Section 1861(s)(2) of the Social Secu- 7 rity Act (42 U.S.C. 1395x(s)(2)) is amended— 8 (1) in subparagraph (GG), by striking ‘‘and’’ 9 after the semicolon at the end; 10 (2) in subparagraph (HH), by striking the pe- 11 riod at the end and adding ‘‘; and’’; and 12 (3) by adding at the end the following new sub- 13 paragraph: 14 ‘‘(II) dental and oral health services (as defined 15 in subsection (kkk));’’. 16 (b) DENTAL AND ORAL HEALTH SERVICES DE- 17 FINED.—Section 1861 of the Social Security Act (42 U.S.C. 18 1395x) is amended by adding at the end the following new 19 subsection: 20 ‘‘(kkk) DENTAL AND ORAL HEALTH SERVICES.— 21 ‘‘(1) IN GENERAL.—The term ‘dental and oral 22 health services’ means items and services (other than 23 such items and services for which payment may be 24 made under part A as inpatient hospital services) 25 VerDate Sep 11 2014 23:12 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6203 E:\BILLS\H4650.RH H4650 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 4650 RH that are furnished during 2022 or a subsequent year, 1 for which coverage was not provided under part B as 2 of the date of the enactment of this subsection, and 3 that are— 4 ‘‘(A) the preventive and screening services 5 described in paragraph (2) furnished by a doctor 6 of dental surgery or of dental medicine (as de- 7 scribed in subsection (r)(2)) or an oral health 8 professional (as defined in paragraph (4)); or 9 ‘‘(B) the basic treatments specified for such 10 year by the Secretary pursuant to paragraph 11 (3)(A) and the major treatments specified for 12 such year by the Secretary pursuant to para- 13 graph (3)(B) furnished by such a doctor or such 14 a professional. 15 ‘‘(2) PREVENTIVE AND SCREENING SERVICES.— 16 The preventive and screening services described in 17 this paragraph are the following: 18 ‘‘(A) Oral exams. 19 ‘‘(B) Dental cleanings. 20 ‘‘(C) Dental x-rays performed in the office 21 of a doctor or professional described in para- 22 graph (1)(A). 23 ‘‘(D) Fluoride treatments. 24 VerDate Sep 11 2014 23:12 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6203 E:\BILLS\H4650.RH H4650 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 4650 RH ‘‘(3) BASIC AND MAJOR TREATMENTS.—For 2022 1 and each subsequent year, the Secretary shall speci- 2 fy— 3 ‘‘(A) basic treatments (which may include 4 basic tooth restorations, basic periodontic serv- 5 ices, tooth extractions, and oral disease manage- 6 ment services); and 7 ‘‘(B) major treatments (which may include 8 major tooth restorations, major periodontic serv- 9 ices, bridges, crowns, dental implants, and root 10 canals); 11 that shall be included as dental and oral health serv- 12 ices for such year. 13 ‘‘(4) ORAL HEALTH PROFESSIONAL.—The term 14 ‘oral health professional’ means, with respect to den- 15 tal and oral health services, a health professional who 16 is licensed to furnish such services, acting within the 17 scope of such license, by the State in which such serv- 18 ices are furnished.’’. 19 (c) PAYMENT; COINSURANCE; AND LIMITATIONS.— 20 (1) IN GENERAL.—Section 1833(a)(1) of the So- 21 cial Security Act (42 U.S.C. 1395l(a)(1)) is amend- 22 ed— 23 (A) by striking ‘‘and’’ before ‘‘(CC)’’; and 24 VerDate Sep 11 2014 23:12 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6203 E:\BILLS\H4650.RH H4650 kjohnson on DSK79L0C42PROD with BILLS 6 •HR 4650 RH (B) by inserting before the semicolon at the 1 end the following: ‘‘, and (DD) with respect to 2 dental and oral health services (as defined in sec- 3 tion 1861(kkk)), the amount paid shall be the 4 payment amount specified under section 5 1834(x)’’. 6 (2) PAYMENT AND LIMITS SPECIFIED.—Section 7 1834 of the Social Security Act (42 U.S.C. 1395m) is 8 amended by adding at the end the following new sub- 9 section: 10 ‘‘(x) PAYMENT AND LIMITS FOR DENTAL AND ORAL 11 HEALTH SERVICES.— 12 ‘‘(1) IN GENERAL.—The payment amount under 13 this part for dental and oral health services (as de- 14 fined in section 1861(kkk)) shall be, subject to para- 15 graph (3), the applicable percent (specified in para- 16 graph (2)) of the lesser of the actual charge for the 17 services or the amount determined under the payment 18 basis determined under section 1848. 19 ‘‘(2) APPLICABLE PERCENT.—For purposes of 20 paragraph (1), the applicable percent specified in this 21 paragraph is, with respect to dental and oral health 22 services (as defined in section 1861(kkk)) furnished in 23 a year— 24 VerDate Sep 11 2014 23:12 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6203 E:\BILLS\H4650.RH H4650 kjohnson on DSK79L0C42PROD with BILLS 7 •HR 4650 RH ‘‘(A) that are preventive and screening serv- 1 ices described in paragraph (2) or basic treat- 2 ments specified for such year pursuant to para- 3 graph (3)(A) of such section, 80 percent; and 4 ‘‘(B) that are major treatments specified for 5 such year pursuant to paragraph (3)(B) of such 6 section— 7 ‘‘(i) in the case such services are fur- 8 nished during 2022, 10 percent; 9 ‘‘(ii) in the case such services are fur- 10 nished during 2023 or a subsequent year be- 11 fore 2026, the applicable percent specified 12 under this subparagraph for the previous 13 year, increased by 10 percentage points; 14 and 15 ‘‘(iii) in the case such services are fur- 16 nished during 2026 or a subsequent year, 17 50 percent. 18 ‘‘(3) LIMITATIONS.—With respect to dental and 19 oral health services that are— 20 ‘‘(A) oral exams, payment may be made 21 under this part for not more than two such 22 exams during a 12-month period; 23 VerDate Sep 11 2014 23:12 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6203 E:\BILLS\H4650.RH H4650 kjohnson on DSK79L0C42PROD with BILLS 8 •HR 4650 RH ‘‘(B) dental cleanings, payment may be 1 made under this part for not more than two such 2 cleanings during a 12-month period; and 3 ‘‘(C) not described in subparagraph (A) or 4 (B), payment may be made under this part only 5 at such frequencies and under such cir- 6 cumstances determined appropriate by the Sec- 7 retary.’’. 8 (d) PAYMENT UNDER PHYSICIAN FEE SCHEDULE.— 9 (1) IN GENERAL.—Section 1848(j)(3) of the So- 10 cial Security Act (42 U.S.C. 1395w–4(j)(3)) is 11 amended by inserting ‘‘(2)(II),’’ before ‘‘(3)’’. 12 (2) BUDGET NEUTRALITY.—Section 13 1848(c)(2)(B)(iv) of the Social Security Act (42 14 U.S.C. 1395–w(c)(2)(B)(iv)) is amended— 15 (A) in subclause (III), by striking ‘‘and’’ at 16 the end; 17 (B) in subclause (IV), by striking the period 18 at the end and inserting ‘‘; and’’; and 19 (C) by adding at the end the following new 20 subclause: 21 ‘‘(V) the amendment made by sec- 22 tion 2(d)(1) of the Medicare Dental Act 23 of 2019 shall not be taken into account 24 VerDate Sep 11 2014 23:12 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6203 E:\BILLS\H4650.RH H4650 kjohnson on DSK79L0C42PROD with BILLS 9 •HR 4650 RH in applying clause (ii)(II) for 2022 1 and 2023.’’. 2 (3) EXCLUSION FROM MIPS.—Section 3 1848(q)(1)(C)(ii) of the Social Security Act (42 4 U.S.C. 1395w–4(q)(1)(C)(ii)) is amended— 5 (A) in subclause (II), by striking ‘‘or’’ at 6 the end; 7 (B) in subclause (III), by striking the pe- 8 riod at the end and inserting ‘‘; or’’; and 9 (C) by adding at the end the following new 10 subclause: 11 ‘‘(IV) with respect to 2022 and 12 each subsequent year, is a doctor of 13 dental surgery or of dental medicine 14 (as described in section 1861(r)(2)) or 15 is an oral health professional (as de- 16 fined in section 1861(kkk)(4)).’’. 17 (4) INCLUSION OF ORAL HEALTH PROFES- 18 SIONALS AS CERTAIN PRACTITIONERS.—Section 19 1842(b)(18)(C) of the Social Security Act (42 U.S.C. 20 1395u(b)(18)(C)) is amended by adding at the end the 21 following new clause: 22 ‘‘(vii) With respect to 2022 and each subsequent 23 year, an oral health professional (as defined in sec- 24 tion 1861(kkk)(4)).’’. 25 VerDate Sep 11 2014 23:12 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6203 E:\BILLS\H4650.RH H4650 kjohnson on DSK79L0C42PROD with BILLS 10 •HR 4650 RH (e) DENTURES.— 1 (1) IN GENERAL.—Section 1861(s)(8) of the So- 2 cial Security Act (42 U.S.C. 1395x(s)(8)) is amend- 3 ed— 4 (A) by striking ‘‘(other than dental)’’; and 5 (B) by inserting ‘‘and excluding dental, ex- 6 cept for a full or partial set of dentures furnished 7 on or after January 1, 2022’’ after ‘‘colostomy 8 care’’. 9 (2) SPECIAL PAYMENT RULES.— 10 (A) LIMITATIONS.—Section 1834(h) of the 11 Social Security Act (42 U.S.C. 1395m(h)) is 12 amended by adding at the end the following new 13 paragraph: 14 ‘‘(6) SPECIAL PAYMENT RULE FOR DENTURES.— 15 Payment may be made under this part with respect 16 to an individual for dentures— 17 ‘‘(A) not more than once during any 5-year 18 period (except in the case that a doctor or profes- 19 sional described in section 1861(kkk)(1)(A) deter- 20 mines such dentures do not fit the individual); 21 and 22 ‘‘(B) only to the extent that such dentures 23 are furnished pursuant to a written order of 24 such a doctor or professional.’’. 25 VerDate Sep 11 2014 23:12 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6203 E:\BILLS\H4650.RH H4650 kjohnson on DSK79L0C42PROD with BILLS 11 •HR 4650 RH (B) APPLICATION OF COMPETITIVE ACQUISI- 1 TION.— 2 (i) IN GENERAL.—Section 3 1834(h)(1)(H) of the Social Security Act 4 (42 U.S.C. 1395m(h)(1)(H)) is amended— 5 (I) in the subparagraph heading, 6 by inserting ‘‘, DENTURES’’ after 7 ‘‘ORTHOTICS’’; 8 (II) by inserting ‘‘and of dentures 9 described in paragraph (2)(D) of such 10 section,’’ after ‘‘2009,’’; and 11 (III) in clause (i), by inserting 12 ‘‘or such dentures’’ after ‘‘orthotics’’. 13 (ii) CONFORMING AMENDMENT.—Sec- 14 tion 1847(a)(2) of the Social Security Act 15 (42 U.S.C. 1395w–3(a)(2)) is amended by 16 adding at the end the following new sub- 17 paragraph: 18 ‘‘(D) DENTURES.—Dentures for which pay- 19 ment would otherwise be made under section 20 1834(h).’’. 21 (iii) EXEMPTION OF CERTAIN ITEMS 22 FROM COMPETITIVE ACQUISITION.—Section 23 1847(a)(7) of the Social Security Act (42 24 U.S.C. 1395w–3(a)(7)) is amended by add- 25 VerDate Sep 11 2014 23:12 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6203 E:\BILLS\H4650.RH H4650 kjohnson on DSK79L0C42PROD with BILLS 12 •HR 4650 RH ing at the end the following new subpara- 1 graph: 2 ‘‘(C) CERTAIN DENTURES.—Those items 3 and services described in paragraph (2)(D) if 4 furnished by a physician or other practitioner 5 (as defined by the Secretary) to the physician’s 6 or practitioner’s own patients as part of the phy- 7 sician’s or practitioner’s professional service.’’. 8 (f) EXCLUSION MODIFICATIONS.—Section 1862(a) of 9 the Social Security Act (42 U.S.C. 1395y(a)) is amended— 10 (1) in paragraph (1)— 11 (A) in subparagraph (O), by striking ‘‘and’’ 12 at the end; 13 (B) in subparagraph (P), by striking the 14 semicolon at the end and inserting ‘‘, and’’; and 15 (C) by adding at the end the following new 16 subparagraph: 17 ‘‘(Q) in the case of dental and oral health serv- 18 ices (as defined in section 1861(kkk)) that are preven- 19 tive and screening services described in paragraph (2) 20 of such section, which are furnished more frequently 21 than provided under section 1834(x)(3);’’; and 22 (2) in paragraph (12), by inserting before the 23 semicolon at the end the following: ‘‘and except that 24 payment may be made under part B for dental and 25 VerDate Sep 11 2014 23:12 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6203 E:\BILLS\H4650.RH H4650 kjohnson on DSK79L0C42PROD with BILLS 13 •HR 4650 RH oral health services that are covered under section 1 1861(s)(2)(II)’’. 2 SEC. 3. IMPLEMENTATION FUNDING. 3 The Secretary of Health and Human Services shall 4 provide for the transfer from the Federal Supplementary 5 Medical Insurance Trust Fund under section 1841 of the 6 Social Security Act (42 U.S.C. 1395t) to the Centers for 7 Medicare & Medicaid Services Program Management Ac- 8 count for the period of 2020 through 2024 of such sums as 9 may be necessary for purposes of implementing the amend- 10 ments made by section 2. 11 VerDate Sep 11 2014 23:12 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6203 E:\BILLS\H4650.RH H4650 kjohnson on DSK79L0C42PROD with BILLS Union Calendar No. 303 116TH CONGRESS 2D SESSION H. R. 4650 [Report No. 116–325, Parts I and II] A BILL To amend title XVIII of the Social Security Act to provide coverage for certain dental items and services under part B of the Medicare program. JANUARY 24, 2020 Reported from the Committee on Energy and Commerce, committed to the Committee of the Whole House on the State of the Union, and ordered to be printed VerDate Sep 11 2014 23:12 Jan 24, 2020 Jkt 099200 PO 00000 Frm 000 [Text truncated for display. Full text available on Congress.gov.]