I 

112TH CONGRESS 

1ST SESSION H. R. 1290 

To amend title XVIII of the Social Security Act to provide for coverage 

under part B of the Medicare program for medically necessary dental 

procedures. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 31, 2011 

Mr. COHEN 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 

A BILL 

To amend title XVIII of the Social Security Act to provide 

for coverage under part B of the Medicare program 

for medically necessary dental procedures. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; FINDINGS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Medicare Medically Necessary Dental Care Act of 2011’’. 

6 (b) FINDINGS.—Congress finds the following: 


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1 (1) Oral and general healths are inseparable, 

2 and good dental care is critical to our overall phys3 ical health and well-being. 

4 (2) A 1999 Institute of Medicine study found 

5 that the prevention and management of oral infec6 tion have significant health implications when such 

7 infection has the potential to increase morbidity in 

8 Medicare patients who are at risk of adverse out9 comes from underlying health problems. 

10 (3) Improved oral health care may reduce mor11 tality and morbidity rates of Medicare patients suf12 fering from head and neck cancer, leukemia, 

13 lymphoma, organ transplantation, and heart valve 

14 disease. 

15 (4) The Medicare program, from its inception, 

16 has excluded coverage for services in connection with 

17 the care, treatment, filling, removal, or replacement 

18 of teeth or structures directly supporting the teeth. 

19 (5) The Centers for Medicare & Medicaid Serv20 ices has approved coverage exceptions for limited 

21 dental services and proposed additional exceptions 

22 based on the argument that oral health services 

23 would reduce the risk of infection and other com24 plications of medical care. 


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1 (6) The Institute of Medicine study concluded 

2 that it is reasonable for Congress to update the stat3 utory language relating to coverage of dental serv4 ices for Medicare beneficiaries so that it clearly cov5 ers dental care that is effective in preventing or re6 ducing oral and systemic complications associated 

7 with serious medical conditions and treatments. 

8 SEC. 2. MEDICARE COVERAGE OF MEDICALLY NECESSARY 

9 DENTAL PROCEDURES. 

10 (a) IN GENERAL.—Section 1862 of the Social Secu11 rity Act (42 U.S.C. 1395y) is amended— 

12 (1) in subsection (a)(12)— 

13 (A) by inserting ‘‘(A)’’ after ‘‘except that’’, 

14 and 

15 (B) by inserting before the semicolon at 

16 the end the following: ‘‘, and (B) payment may 

17 be made under part B for the provision of such 

18 dental services that are medically necessary as 

19 a direct result of, or will have a direct impact 

20 on, an underlying medical condition if the cov21 erage of such services is medically necessary, as 

22 determined under subsection (p)’’; and 

23 (2) by adding at the end the following new sub24 section: 


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1 ‘‘(p) For purposes of subsection (a)(12)(B), dental 

2 services shall be considered to be medically necessary if 

3 furnished— 

4 ‘‘(1) in conjunction with treatment of an indi5 vidual with any of the following diagnoses: prosthetic 

6 heart valve replacement, cancer of the head or neck, 

7 lymphoma, leukemia, and organ transplantation; and 

8 ‘‘(2) not later than one year after the later of— 

9 ‘‘(A) the date of such diagnosis; or 

10 ‘‘(B) the date of the related surgical or 

11 medical treatment for that diagnosis.’’. 

12 (b) EFFECTIVE DATE.—The amendments made by 

13 subsection (a) shall apply to procedures performed on or 

14 after January 1, 2012. 

Æ 


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