Union Calendar No. 303
116th CONGRESS 2d Session |
[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.
October 11, 2019
Ms. Kelly of Illinois (for herself and Mr. Horsford) introduced 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
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. Barragán, Mr. Butterfield, Mr. Cuellar, Ms. Norton, Mr. Malinowski, Mr. Payne, Mr. Welch, and Mr. Cartwright
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]
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.
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
SEC. 2. Dental and oral health care.
(a) Coverage.—Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)) is amended—
(b) Dental and oral health services defined.—Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended by adding at the end the following new subsection:
“(kkk) Dental and oral health services.—
“(1) IN GENERAL.—The term ‘dental and oral health services’ means items and services (other than such items and services for which payment may be made under part A as inpatient hospital services) that are furnished during 2022 or a subsequent year, for which coverage was not provided under part B as of the date of the enactment of this subsection, and that are—
“(2) PREVENTIVE AND SCREENING SERVICES.—The preventive and screening services described in this paragraph are the following:
“(3) BASIC AND MAJOR TREATMENTS.—For 2022 and each subsequent year, the Secretary shall specify—
“(A) basic treatments (which may include basic tooth restorations, basic periodontic services, tooth extractions, and oral disease management services); and
“(B) major treatments (which may include major tooth restorations, major periodontic services, bridges, crowns, dental implants, and root canals);
that shall be included as dental and oral health services for such year.
(c) Payment; coinsurance; and limitations.—
(1) IN GENERAL.—Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) is amended—
(2) PAYMENT AND LIMITS SPECIFIED.—Section 1834 of the Social Security Act (42 U.S.C. 1395m) is amended by adding at the end the following new subsection:
“(x) Payment and limits for dental and oral health services.—
“(1) IN GENERAL.—The payment amount under this part for dental and oral health services (as defined in section 1861(kkk)) shall be, subject to paragraph (3), the applicable percent (specified in paragraph (2)) of the lesser of the actual charge for the services or the amount determined under the payment basis determined under section 1848.
“(2) APPLICABLE PERCENT.—For purposes of paragraph (1), the applicable percent specified in this paragraph is, with respect to dental and oral health services (as defined in section 1861(kkk)) furnished in a year—
“(A) that are preventive and screening services described in paragraph (2) or basic treatments specified for such year pursuant to paragraph (3)(A) of such section, 80 percent; and
“(B) that are major treatments specified for such year pursuant to paragraph (3)(B) of such section—
“(3) LIMITATIONS.—With respect to dental and oral health services that are—
“(A) oral exams, payment may be made under this part for not more than two such exams during a 12-month period;
(d) Payment under physician fee schedule.—
(1) IN GENERAL.—Section 1848(j)(3) of the Social Security Act (42 U.S.C. 1395w–4(j)(3)) is amended by inserting “(2)(II),” before “(3)”.
(2) BUDGET NEUTRALITY.—Section 1848(c)(2)(B)(iv) of the Social Security Act (42 U.S.C. 1395–w(c)(2)(B)(iv)) is amended—
(3) EXCLUSION FROM MIPS.—Section 1848(q)(1)(C)(ii) of the Social Security Act (42 U.S.C. 1395w–4(q)(1)(C)(ii)) is amended—
(4) INCLUSION OF ORAL HEALTH PROFESSIONALS AS CERTAIN PRACTITIONERS.—Section 1842(b)(18)(C) of the Social Security Act (42 U.S.C. 1395u(b)(18)(C)) is amended by adding at the end the following new clause:
(e) Dentures.—
(1) IN GENERAL.—Section 1861(s)(8) of the Social Security Act (42 U.S.C. 1395x(s)(8)) is amended—
(2) SPECIAL PAYMENT RULES.—
(A) LIMITATIONS.—Section 1834(h) of the Social Security Act (42 U.S.C. 1395m(h)) is amended by adding at the end the following new paragraph:
“(6) SPECIAL PAYMENT RULE FOR DENTURES.—Payment may be made under this part with respect to an individual for dentures—
(B) APPLICATION OF COMPETITIVE ACQUISITION.—
(i) IN GENERAL.—Section 1834(h)(1)(H) of the Social Security Act (42 U.S.C. 1395m(h)(1)(H)) is amended—
(ii) CONFORMING AMENDMENT.—Section 1847(a)(2) of the Social Security Act (42 U.S.C. 1395w–3(a)(2)) is amended by adding at the end the following new subparagraph:
(iii) EXEMPTION OF CERTAIN ITEMS FROM COMPETITIVE ACQUISITION.—Section 1847(a)(7) of the Social Security Act (42 U.S.C. 1395w–3(a)(7)) is amended by adding at the end the following new subparagraph:
(f) Exclusion modifications.—Section 1862(a) of the Social Security Act (42 U.S.C. 1395y(a)) is amended—
SEC. 3. Implementation funding.
The Secretary of Health and Human Services shall provide for the transfer from the Federal Supplementary Medical Insurance Trust Fund under section 1841 of the Social Security Act (42 U.S.C. 1395t) to the Centers for Medicare & Medicaid Services Program Management Account for the period of 2020 through 2024 of such sums as may be necessary for purposes of implementing the amendments made by section 2.
Union Calendar No. 303 | |||||
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[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 |