II 

117TH CONGRESS 

1ST SESSION S. 2618 

To amend titles XVIII and XIX of the Social Security Act to provide for 

coverage of dental and oral health services, vision services, and hearing 

services under the Medicare and Medicaid programs. 

IN THE SENATE OF THE UNITED STATES 

AUGUST 5, 2021 

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 and oral health services, 

vision services, and hearing services under the Medicare 

and Medicaid programs. 

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. 

4 This Act may be cited as the ‘‘Medicare and Medicaid 

5 Dental, Vision, and Hearing Benefit Act of 2021’’. 


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1 SEC. 2. DENTAL AND ORAL HEALTH SERVICES UNDER 

2 MEDICARE. 

3 (a) COVERAGE.—Section 1861(s)(2) of the Social Se4 curity Act (42 U.S.C. 1395x(s)(2)) is amended— 

5 (1) in subparagraph (GG), by striking ‘‘and’’ 

6 after the semicolon at the end; 

7 (2) in subparagraph (HH), by striking the pe8 riod at the end and inserting ‘‘; and’’; and 

9 (3) by adding at the end the following new sub10 paragraph: 

11 ‘‘(II) dental and oral health services (as defined 

12 in subsection (lll));’’. 

13 (b) DENTAL AND ORAL HEALTH SERVICES DE14 FINED.—Section 1861 of the Social Security Act (42 

15 U.S.C. 1395x) is amended by adding at the end the fol16 lowing new subsection: 

17 ‘‘Dental and Oral Health Services 

18 ‘‘(lll) The term ‘dental and oral health services’ 

19 means— 

20 ‘‘(1) routine dental cleanings and exams; 

21 ‘‘(2) basic dental services, such as fillings and 

22 crowns; 

23 ‘‘(3) major dental services, such as root canals, 

24 and extractions; 

25 ‘‘(4) emergency dental care; and 


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1 ‘‘(5) other necessary services related to dental 

2 or oral health (as defined by the Secretary).’’. 

3 (c) PAYMENT; COINSURANCE; AND LIMITATIONS.— 

4 (1) IN GENERAL.—Section 1833(a)(1) of the 

5 Social Security Act (42 U.S.C. 1395l(a)(1)) is 

6 amended— 

7 (A) by striking ‘‘and’’ before ‘‘(DD)’’; and 

8 (B) by inserting before the semicolon at 

9 the end the following: ‘‘, and (EE) with respect 

10 to dental and oral health services (as defined in 

11 section 1861(lll)), the amount paid shall be the 

12 payment amount specified under section 

13 1834(z)’’. 

14 (2) PAYMENT AND LIMITS SPECIFIED.—Section 

15 1834 of the Social Security Act (42 U.S.C. 1395m) 

16 is amended by adding at the end the following new 

17 subsection: 

18 ‘‘(z) PAYMENT AND LIMITS FOR DENTAL AND ORAL

19 HEALTH SERVICES.— 

20 ‘‘(1) IN GENERAL.—The payment amount 

21 under this part for dental and oral health services 

22 (as defined in section 1861(lll)) shall be, subject to 

23 paragraph (3), the applicable percent (specified in 

24 paragraph (2)) of the lesser of the actual charge for 


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1 the services or the amount determined under the 

2 payment basis determined under section 1848. 

3 ‘‘(2) APPLICABLE PERCENT.—For purposes of 

4 paragraph (1), the applicable percent specified in 

5 this paragraph is— 

6 ‘‘(A) for the first year beginning at least 6 

7 months after the date of the enactment of this 

8 subsection, 0 percent; 

9 ‘‘(B) for the year following the year speci10 fied in subparagraph (A) and each subsequent 

11 year through the seventh year following the 

12 year specified in subparagraph (A), the applica13 ble percent specified in this paragraph for the 

14 previous year increased by 10 percentage 

15 points; and 

16 ‘‘(C) for the eighth year following the year 

17 specified in subparagraph (A) and each subse18 quent year, 80 percent. 

19 ‘‘(3) LIMITATIONS AND SECRETARIAL AUTHOR20 ITY.— 

21 ‘‘(A) FREQUENCY.—With respect to dental 

22 and oral health services that are— 

23 ‘‘(i) routine dental cleanings, payment 

24 may be made under this part for only two 


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1 such cleanings during a 12-month period; 

2 and 

3 ‘‘(ii) routine exams, payment may be 

4 made under this part for only two such 

5 exams during a 12-month period. 

6 ‘‘(B) SECRETARIAL AUTHORITY.— 

7 ‘‘(i) AUTHORITY TO APPLY ADDI8 TIONAL LIMITATIONS.—The Secretary may 

9 apply such other reasonable limitations on 

10 the extent to which dental and oral services 

11 are covered under this part, including 

12 through application of a prior authoriza13 tion requirement. 

14 ‘‘(ii) AUTHORITY TO MODIFY COV15 ERAGE.—Notwithstanding any other provi16 sion of this title, if the Secretary deter17 mines appropriate, the Secretary may mod18 ify the coverage under this part of dental 

19 and oral health services to the extent that 

20 such modification is consistent with the 

21 recommendations of the United States Pre22 ventive Services Task Force.’’. 

23 (d) PAYMENT UNDER PHYSICIAN FEE SCHEDULE.— 

24 Section 1848(j)(3) of the Social Security Act (42 U.S.C. 


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1 1395w–4(j)(3)) is amended by inserting ‘‘(2)(II),’’ before 

2 ‘‘(3)’’. 

3 (e) DENTURES.— 

4 (1) IN GENERAL.—Section 1861(s)(8) of the 

5 Social Security Act (42 U.S.C. 1395x(s)(8)) is 

6 amended— 

7 (A) by striking ‘‘(other than dental)’’ and 

8 inserting ‘‘(including dentures)’’; and 

9 (B) by striking ‘‘internal body’’. 

10 (2) SPECIAL PAYMENT RULES.—Section 

11 1834(a) of the Social Security Act (42 U.S.C. 

12 1395m(a)) is amended by adding at the end the fol13 lowing new paragraph: 

14 ‘‘(23) PAYMENT AND LIMITS FOR DENTURES.— 

15 ‘‘(A) IN GENERAL.—The payment amount 

16 under this part for dentures shall be, subject to 

17 subparagraph (C), the applicable percent (speci18 fied in subparagraph (B)) of the amount other19 wise payable for such dentures under this sec20 tion. 

21 ‘‘(B) APPLICABLE PERCENT.—For pur22 poses of subparagraph (A), the applicable per23 cent specified in this subparagraph is— 


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1 ‘‘(i) for the first year beginning at 

2 least 6 months after the date of the enact3 ment of this paragraph, 0 percent; 

4 ‘‘(ii) for the year following the year 

5 specified in clause (i) and each subsequent 

6 year through the seventh year following the 

7 year specified in clause (i), the applicable 

8 percent specified in this subparagraph for 

9 the previous year increased by 10 percent10 age points; and 

11 ‘‘(iii) for the eighth year following the 

12 year specified in clause (i) and each subse13 quent year, 80 percent. 

14 ‘‘(C) LIMITATIONS AND SECRETARIAL AU15 THORITY.— 

16 ‘‘(i) IN GENERAL.—Payment may be 

17 made under this part for an individual 

18 for— 

19 ‘‘(I) not more than one full upper 

20 and one full lower denture once every 

21 five years; and 

22 ‘‘(II) not more than one partial 

23 upper denture and one partial lower 

24 denture once every five years. 

25 ‘‘(ii) SECRETARIAL AUTHORITY.— 


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1 ‘‘(I) AUTHORITY TO APPLY ADDI2 TIONAL LIMITATIONS.—The Secretary 

3 may apply such other reasonable limi4 tations on the extent to which den5 tures are covered under this part, in6 cluding through application of a prior 

7 authorization requirement. 

8 ‘‘(II) AUTHORITY TO MODIFY

9 COVERAGE.—Notwithstanding any 

10 other provision of this title, if the Sec11 retary determines appropriate, the 

12 Secretary may modify the coverage 

13 under this part of dentures to the ex14 tent that such modification is con15 sistent with the recommendations of 

16 the United States Preventive Services 

17 Task Force.’’. 

18 (f) REPEAL OF GROUND FOR EXCLUSION.—Section 

19 1862(a) of the Social Security Act (42 U.S.C. 1395y) is 

20 amended by striking paragraph (12). 

21 (g) EFFECTIVE DATE.—The amendments made by 

22 this section shall apply to services furnished on or after 

23 January 1 of the first year beginning at least six months 

24 after the date of the enactment of this Act. 


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1 SEC. 3. VISION SERVICES UNDER MEDICARE. 

2 (a) COVERAGE.—Section 1861(s)(2) of the Social Se3 curity Act (42 U.S.C. 1395x(s)(2)), as amended by section 

4 2(a), is amended— 

5 (1) in subparagraph (HH), by striking ‘‘and’’ 

6 after the semicolon at the end; 

7 (2) in subparagraph (II), by adding ‘‘and’’ after 

8 the semicolon at the end; and 

9 (3) by adding at the end the following new sub10 paragraph: 

11 ‘‘(JJ) vision services (as defined in subsection 

12 (mmm));’’. 

13 (b) VISION SERVICES DEFINED.—Section 1861 of 

14 the Social Security Act (42 U.S.C. 1395x), as amended 

15 by section 2(b), is amended by adding at the end the fol16 lowing new subsection: 

17 ‘‘Vision Services 

18 ‘‘(mmm) The term ‘vision services’ means— 

19 ‘‘(1) routine eye examinations and procedures 

20 performed (during the course of any eye examina21 tion) to determine the refractive state of the eyes; 

22 and 

23 ‘‘(2) other necessary services related to eye and 

24 vision health (as defined by the Secretary).’’. 

25 (c) PAYMENT; COINSURANCE; AND LIMITATIONS.— 


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1 (1) IN GENERAL.—Section 1833(a)(1) of the 

2 Social Security Act (42 U.S.C. 1395l(a)(1)), as 

3 amended by section 2(c)(1), is amended— 

4 (A) by striking ‘‘and’’ before ‘‘(EE)’’; and 

5 (B) by inserting before the semicolon at 

6 the end the following: ‘‘, and (FF) with respect 

7 to vision services (as defined in section 

8 1861(mmm)), the amount paid shall be the 

9 payment amount specified under section 

10 1834(aa)’’. 

11 (2) PAYMENT AND LIMITS SPECIFIED.—Section 

12 1834 of the Social Security Act (42 U.S.C. 1395m), 

13 as amended by section 2(c)(2), is amended by add14 ing at the end the following new subsection: 

15 ‘‘(aa) PAYMENT AND LIMITS FOR VISION SERV16 ICES.— 

17 ‘‘(1) IN GENERAL.—The payment amount 

18 under this part for vision services (as defined in sec19 tion 1861(mmm)) shall be, subject to paragraph (3), 

20 the applicable percent (specified in paragraph (2)) of 

21 the lesser of the actual charge for the services or the 

22 amount determined under the payment basis deter23 mined under section 1848. 


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1 ‘‘(2) APPLICABLE PERCENT.—For purposes of 

2 paragraph (1), the applicable percent specified in 

3 this paragraph is— 

4 ‘‘(A) for the first year beginning at least 6 

5 months after the date of the enactment of this 

6 subsection, 0 percent; 

7 ‘‘(B) for the year following the year speci8 fied in subparagraph (A) and each subsequent 

9 year through the seventh year following the 

10 year specified in subparagraph (A), the applica11 ble percent specified in this paragraph for the 

12 previous year increased by 10 percentage 

13 points; and 

14 ‘‘(C) for the eighth year following the year 

15 specified in subparagraph (A) and each subse16 quent year, 80 percent. 

17 ‘‘(3) LIMITATIONS AND SECRETARIAL AUTHOR18 ITY.— 

19 ‘‘(A) FREQUENCY.—With respect to rou20 tine eye exams, payment may be made under 

21 this part for only one such exam during a 12- 

22 month period. 

23 ‘‘(B) SECRETARIAL AUTHORITY.— 

24 ‘‘(i) AUTHORITY TO APPLY ADDI25 TIONAL LIMITATIONS.—The Secretary may 


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1 apply other reasonable limitations on the 

2 extent to which vision services are covered 

3 under this part, including through applica4 tion of a prior authorization requirement. 

5 ‘‘(ii) AUTHORITY TO MODIFY COV6 ERAGE.—Notwithstanding any other provi7 sion of this title, if the Secretary deter8 mines appropriate, the Secretary may mod9 ify the coverage under this part of vision 

10 services to the extent that such modifica11 tion is consistent with the recommenda12 tions of the United States Preventive Serv13 ices Task Force.’’. 

14 (d) PAYMENT UNDER PHYSICIAN FEE SCHEDULE.— 

15 Section 1848(j)(3) of the Social Security Act (42 U.S.C. 

16 1395w–4(j)(3)), as amended by section 2(d), is amended 

17 by inserting ‘‘(2)(JJ),’’ after ‘‘(2)(II),’’. 

18 (e) SPECIAL PAYMENT RULES FOR EYEGLASSES, 

19 CONTACT LENSES, AND LOW VISION DEVICES.—Section 

20 1834(a) of the Social Security Act (42 U.S.C. 1395m(a)), 

21 as amended by section 2(e)(2), is amended by adding at 

22 the end the following new paragraphs: 

23 ‘‘(24) PAYMENT AND LIMITS FOR EYEGLASSES

24 AND CONTACT LENSES.— 


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1 ‘‘(A) IN GENERAL.—The payment amount 

2 under this part for eyeglass lenses, eyeglass 

3 frames, and contact lenses shall be, subject to 

4 subparagraph (C), the applicable percent (speci5 fied in subparagraph (B)) of the amount other6 wise payable for such eyeglass lenses, eyeglass 

7 frames, and contact lenses, respectively, under 

8 this section. 

9 ‘‘(B) APPLICABLE PERCENT.—For pur10 poses of subparagraph (A), the applicable per11 cent specified in this subparagraph is— 

12 ‘‘(i) for the first year beginning at 

13 least 6 months after the date of the enact14 ment of this paragraph, 0 percent; 

15 ‘‘(ii) for the year following the year 

16 specified in clause (i) and each subsequent 

17 year through the seventh year following the 

18 year specified in clause (i), the applicable 

19 percent specified in this subparagraph for 

20 the previous year increased by 10 percent21 age points; and 

22 ‘‘(iii) for the eighth year following the 

23 year specified in clause (i) and each subse24 quent year, 80 percent. 


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1 ‘‘(C) LIMITATIONS AND SECRETARIAL AU2 THORITY.— 

3 ‘‘(i) IN GENERAL.—Payment may be 

4 made under this part (other than for 

5 eyewear described in section 1861(s)(8)) 

6 for an individual for— 

7 ‘‘(I) not more than one pair of 

8 eyeglass lenses during any 12-month 

9 period; 

10 ‘‘(II) not more than one set of 

11 eyeglass frames during any 24-month 

12 period; and 

13 ‘‘(III) contact lenses, only to the 

14 extent that the sum of such payments 

15 for contact lenses does not exceed a 

16 limitation of $200 during any 24- 

17 month period beginning during the 

18 first year beginning at least six 

19 months after the date of the enact20 ment of this paragraph (or, beginning 

21 during a subsequent year, such limita22 tion for a 24-month period beginning 

23 in the previous year increase by an 

24 appropriate inflation adjustment spec25 ified by the Secretary). 


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1 ‘‘(ii) SECRETARIAL AUTHORITY.— 

2 ‘‘(I) AUTHORITY TO APPLY ADDI3 TIONAL LIMITATIONS.—The Secretary 

4 may apply such other reasonable limi5 tations on the extent to which eye6 glass lenses, eyeglass frames, and con7 tact lenses are covered under this 

8 part, including through application of 

9 a prior authorization requirement. 

10 ‘‘(II) AUTHORITY TO MODIFY

11 COVERAGE.—Notwithstanding any 

12 other provision of this title, if the Sec13 retary determines appropriate, the 

14 Secretary may modify the coverage 

15 under this part of eyeglass lenses, eye16 glass frames, and contact lenses to 

17 the extent that such modification is 

18 consistent with the recommendations 

19 of the United States Preventive Serv20 ices Task Force. 

21 ‘‘(25) PAYMENT AND LIMITS FOR LOW VISION

22 DEVICES.— 

23 ‘‘(A) IN GENERAL.—The payment amount 

24 under this part for low vision devices shall be, 

25 subject to subparagraph (C), the applicable perVerDate Sep 11 2014 15:54 Aug 06, 2021 Jkt 019200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\S2618.IS S2618

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1 cent (specified in subparagraph (B)) of the 

2 amount otherwise payable for low vision devices 

3 under this section. 

4 ‘‘(B) APPLICABLE PERCENT.—For pur5 poses of subparagraph (A), the applicable per6 cent specified in this subparagraph is— 

7 ‘‘(i) for the first year beginning at 

8 least 6 months after the date of the enact9 ment of this paragraph, 0 percent; 

10 ‘‘(ii) for the year following the year 

11 specified in clause (i) and each subsequent 

12 year through the seventh year following the 

13 year specified in clause (i), the applicable 

14 percent specified in this subparagraph for 

15 the previous year increased by 10 percent16 age points; and 

17 ‘‘(iii) for the eighth year following the 

18 year specified in clause (i) and each subse19 quent year, 80 percent. 

20 ‘‘(C) SECRETARIAL AUTHORITY.— 

21 ‘‘(i) AUTHORITY TO APPLY LIMITA22 TIONS.—The Secretary may apply reason23 able limitations on the extent to which low 

24 vision devices are covered under this part, 


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1 including through application of a prior 

2 authorization requirement. 

3 ‘‘(ii) AUTHORITY TO MODIFY COV4 ERAGE.—Notwithstanding any other provi5 sion of this title, if the Secretary deter6 mines appropriate, the Secretary may mod7 ify the coverage under this part of low vi8 sion devices to the extent that such modi9 fication is consistent with the recommenda10 tions of the United States Preventive Serv11 ices Task Force. 

12 ‘‘(D) LOW VISION DEVICE DEFINED.—In 

13 this paragraph, the term ‘low vision device’ 

14 means a device, prescribed by a physician, that 

15 magnifies, enhances, or otherwise augments or 

16 interprets visual images irrespective of the size, 

17 form, or technological features of such device 

18 and does not include ordinary eyeglasses or con19 tact lenses. In the previous sentence, the term 

20 ‘ordinary eyeglasses or contact lenses’ means 

21 lenses that are intended to fully correct visual 

22 acuity or fully eliminate refractive error.’’. 

23 (f) DEFINITION OF DURABLE MEDICAL EQUIPMENT

24 TO INCLUDE EYEGLASSES, CONTACT LENSES, AND LOW


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1 VISION DEVICES.—Section 1861(n) of the Social Security 

2 Act (42 U.S.C. 1395x(n)) is amended— 

3 (1) by striking ‘‘and’’ before ‘‘eye tracking’’ and 

4 inserting a comma; and 

5 (2) by inserting ‘‘, and eyeglass lenses, low vi6 sion devices (as defined in section 1834(a)(25)), eye7 glass frames, and contact lenses’’ before ‘‘; except’’. 

8 (g) REPEAL OF GROUND FOR EXCLUSION.—Section 

9 1862(a)(7) of the Social Security Act (42 U.S.C. 

10 1395y(a)(7)) is amended by striking ‘‘, eyeglasses (other 

11 than eyewear described in section 1861(s)(8)) or eye ex12 aminations for the purpose of prescribing, fitting, or 

13 changing eyeglasses, procedures performed (during the 

14 course of any eye examination) to determine the refractive 

15 state of the eyes’’. 

16 (h) EFFECTIVE DATE.—The amendments made by 

17 this section shall apply to services furnished on or after 

18 January 1 of the first year beginning at least six months 

19 after the date of the enactment of this Act. 

20 SEC. 4. HEARING SERVICES UNDER MEDICARE. 

21 (a) COVERAGE.— 

22 (1) IN GENERAL.—Section 1861(s)(2) of the 

23 Social Security Act (42 U.S.C. 1395x(s)(2)), as 

24 amended by sections 2(a) and 3(a), is amended— 


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1 (A) in subparagraph (II), by striking 

2 ‘‘and’’ at the end; 

3 (B) in subparagraph (JJ), by inserting 

4 ‘‘and’’ at the end; and 

5 (C) by adding at the end the following new 

6 subparagraph: 

7 ‘‘(KK) audiology services (as defined in sub8 section (ll)(3)) and hearing services (as defined in 

9 subsection (ll)(5));’’. 

10 (2) HEARING SERVICES DEFINED.—Section 

11 1861(ll) of the Social Security Act (42 U.S.C. 

12 1395x(ll)) is amended— 

13 (A) in the subsection heading, by inserting 

14 ‘‘; HEARING SERVICES’’ after ‘‘AUDIOLOGY

15 SERVICES’’; and 

16 (B) by adding at the end the following new 

17 paragraph: 

18 ‘‘(5) The term ‘hearing services’ means— 

19 ‘‘(A) routine hearing exams and exams for 

20 hearing aids; and 

21 ‘‘(B) other necessary services related to hearing 

22 health (as defined by the Secretary).’’. 

23 (b) PAYMENT; COINSURANCE; AND LIMITATIONS.— 

24 (1) IN GENERAL.—Section 1833(a)(1) of the 

25 Social Security Act (42 U.S.C. 1395l(a)(1)), as 


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1 amended by sections 2(c)(1) and 3(c)91), is amend2 ed— 

3 (A) by striking ‘‘and’’ before ‘‘(FF)’’; and 

4 (B) by inserting before the semicolon at 

5 the end the following: ‘‘, and (GG) with respect 

6 to audiology services (as defined in section 

7 1861(ll)(3)) and hearing services (as defined in 

8 section 1861(ll)(5)), the amount paid shall be 

9 the payment amount specified under section 

10 1834(bb)’’. 

11 (2) PAYMENT AND LIMITS SPECIFIED.—Section 

12 1834 of the Social Security Act (42 U.S.C. 1395m), 

13 as amended by sections 2(c)(2) and 3(c)(2), is 

14 amended by adding at the end the following new 

15 subsection: 

16 ‘‘(bb) PAYMENT AND LIMITS FOR HEARING SERV17 ICES.— 

18 ‘‘(1) IN GENERAL.—The payment amount 

19 under this part for audiology services (as defined in 

20 section 1861(ll)(3)) and hearing services (as defined 

21 in section 1861(ll)(5)), shall be, subject to para22 graph (3), the applicable percent (specified in para23 graph (2)) of the lesser of the actual charge for the 

24 services or the amount determined under the pay25 ment basis determined under section 1848. 


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1 ‘‘(2) APPLICABLE PERCENT.—For purposes of 

2 paragraph (1), the applicable percent specified in 

3 this paragraph is— 

4 ‘‘(A) for the first year beginning at least 6 

5 months after the date of the enactment of this 

6 subsection, 0 percent; 

7 ‘‘(B) for the year following the year speci8 fied in subparagraph (A) and each subsequent 

9 year through the seventh year following the 

10 year specified in subparagraph (A), the applica11 ble percent specified in this paragraph for the 

12 previous year increased by 10 percentage 

13 points; and 

14 ‘‘(C) for the eighth year following the year 

15 specified in subparagraph (A) and each subse16 quent year, 80 percent. 

17 ‘‘(3) SECRETARIAL AUTHORITY.— 

18 ‘‘(A) AUTHORITY TO APPLY LIMITA19 TIONS.—The Secretary may apply reasonable 

20 limitations on the extent to which audiology 

21 services and hearing services are covered under 

22 this part, including through application of a 

23 prior authorization requirement. 

24 ‘‘(B) AUTHORITY TO MODIFY COVERAGE.— 

25 Notwithstanding any other provision of this 


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1 title, if the Secretary determines appropriate, 

2 the Secretary may modify the coverage under 

3 this part of audiology services and hearing serv4 ices to the extent that such modification is con5 sistent with the recommendations of the United 

6 States Preventive Services Task Force.’’. 

7 (c) PAYMENT UNDER THE PHYSICIAN FEE SCHED8 ULE.—Section 1848(j)(3) of the Social Security Act (42 

9 U.S.C. 1395w–4(j)(3)), as amended by sections 2(d) and 

10 3(d), is amended by inserting ‘‘(2)(KK),’’ after 

11 ‘‘(2)(JJ),’’. 

12 (d) HEARING AIDS.— 

13 (1) REPEAL OF GROUND FOR EXCLUSION.— 

14 Section 1862(a)(7) of the Social Security Act (42 

15 U.S.C. 1395y(a)(7)), as amended by section 3(g), is 

16 amended by striking ‘‘, hearing aids or examinations 

17 therefor,’’. 

18 (2) DEFINITION OF DURABLE MEDICAL EQUIP19 MENT TO INCLUDE HEARING AIDS.—Section 1861(n) 

20 of the Social Security Act (42 U.S.C. 1395x(n)), as 

21 amended by section 3(f), is amended by inserting 

22 ‘‘hearing aids,’’ before ‘‘and eyeglass lenses’’. 

23 (3) SPECIAL PAYMENT RULES FOR HEARING

24 AIDS.—Section 1834(a) of the Social Security Act 

25 (42 U.S.C. 1395m(a)), as amended by sections 


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1 2(e)(2) and 3(e), is amended by adding at the end 

2 the following new paragraph: 

3 ‘‘(26) PAYMENT AND LIMITS FOR HEARING

4 AIDS.— 

5 ‘‘(A) IN GENERAL.—The payment amount 

6 under this part for hearing aids shall be, sub7 ject to subparagraph (C), the applicable percent 

8 (specified in subparagraph (B)) of the amount 

9 otherwise payable for hearing aids under this 

10 section. 

11 ‘‘(B) APPLICABLE PERCENT.—For pur12 poses of subparagraph (A), the applicable per13 cent specified in this subparagraph is— 

14 ‘‘(i) for the first year beginning at 

15 least 6 months after the date of the enact16 ment of this paragraph, 0 percent; 

17 ‘‘(ii) for the year following the year 

18 specified in clause (i) and each subsequent 

19 year through the seventh year following the 

20 year specified in clause (i), the applicable 

21 percent specified in this subparagraph for 

22 the previous year increased by 10 percent23 age points; and 


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1 ‘‘(iii) for the eighth year following the 

2 year specified in clause (i) and each subse3 quent year, 80 percent. 

4 ‘‘(C) LIMITATIONS AND SECRETARIAL AU5 THORITY.— 

6 ‘‘(i) IN GENERAL.—Payment may be 

7 made under this part for an individual for 

8 not more than one hearing aid per ear dur9 ing a 48-month period. 

10 ‘‘(ii) SECRETARIAL AUTHORITY.— 

11 ‘‘(I) AUTHORITY TO APPLY ADDI12 TIONAL LIMITATIONS.—The Secretary 

13 may apply additional limitations on 

14 the extent to which hearing aids are 

15 covered under this part, including 

16 through application of a prior author17 ization requirement and through ap18 plication of criteria for a minimum 

19 level of hearing loss for coverage of an 

20 initial or replacement hearing aid. 

21 ‘‘(II) AUTHORITY TO MODIFY

22 COVERAGE.—Notwithstanding any 

23 other provision of this title, if the Sec24 retary determines appropriate, the 

25 Secretary may modify the coverage 


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1 under this part of hearing aids to the 

2 extent that such modification is con3 sistent with the recommendations of 

4 the United States Preventive Services 

5 Task Force.’’. 

6 (e) EFFECTIVE DATE.—The amendments made by 

7 this section shall apply to services furnished on or after 

8 January 1 of the first year beginning at least six months 

9 after the date of the enactment of this Act. 

10 SEC. 5. INCREASED FMAP FOR COVERAGE OF DENTAL AND 

11 ORAL HEALTH SERVICES, VISION SERVICES, 

12 AND HEARING SERVICES UNDER MEDICAID. 

13 Section 1905 of the Social Security Act (42 U.S.C. 

14 1396d) is amended— 

15 (1) in subsection (a)— 

16 (A) in paragraph (10), by inserting ‘‘, 

17 which may include any dental and oral health 

18 service (as defined in section 1861(lll))’’ after 

19 ‘‘dental services’’; 

20 (B) in paragraph (13)— 

21 (i) in subparagraph (B), by striking ‘‘; 

22 and’’ and inserting a semicolon; 

23 (ii) in subparagraph (C), by striking 

24 the semicolon and inserting ‘‘; and’’; and 


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•S 2618 IS

1 (iii) by adding at the end the fol2 lowing new subparagraph: 

3 ‘‘(D) any service that is a vision service (as 

4 defined in section 1861(mmm)) or a hearing 

5 service (as defined in section 1861(ll)(5);’’; 

6 (2) in subsection (b), by striking ‘‘and (ii)’’ and 

7 inserting ‘‘(ii), and (jj)’’; and 

8 (3) by adding at the end the following new sub9 section: 

10 ‘‘(jj) INCREASED FMAP FOR EXPENDITURES FOR

11 DENTAL AND ORAL HEALTH SERVICES, VISION SERV12 ICES, AND HEARING SERVICES.— 

13 ‘‘(1) IN GENERAL.—Notwithstanding subsection 

14 (b), the Federal medical assistance percentage with 

15 respect to amounts expended by a State for medical 

16 assistance for services described in paragraph (2) 

17 shall be equal to 90 percent. 

18 ‘‘(2) SERVICES DESCRIBED.—A service de19 scribed in this paragraph is any service that— 

20 ‘‘(A) is furnished on or after January 1 of 

21 the first calendar year that begins at least 6 

22 months after the date of the enactment of this 

23 subsection; 

24 ‘‘(B) is not furnished to an individual who 

25 is— 


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1 ‘‘(i) under the age of 21; and 

2 ‘‘(ii) eligible for medical assistance for 

3 the services described in subsection 

4 (a)(4)(B); and 

5 ‘‘(C) is— 

6 ‘‘(i) a dental and oral health service 

7 (as defined in section 1861(lll)); 

8 ‘‘(ii) a vision service (as defined in 

9 section 1861(mmm)); or 

10 ‘‘(iii) a hearing service (as defined in 

11 section 1861(ll)(5)).’’. 

Æ 


pamtmann on DSKBC07HB2PROD with BILLS