II 

117TH CONGRESS 

1ST SESSION S. 97 

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

of dental services under the Medicare program. 

IN THE SENATE OF THE UNITED STATES 

JANUARY 28, 2021 

Mr. CARDIN (for himself, Mr. BROWN, Mr. MERKLEY, Mr. VAN HOLLEN, Mr. 

BLUMENTHAL, and Mr. CASEY) introduced the following bill; which was 

read twice and referred to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to provide 

for coverage of dental services under the Medicare program. 

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 Dental Ben5 efit Act of 2021’’. 

6 SEC. 2. COVERAGE OF DENTAL SERVICES UNDER THE 

7 MEDICARE PROGRAM. 

8 (a) COVERAGE.—Section 1861(s)(2) of the Social Se9 curity Act (42 U.S.C. 1395x(s)(2)) is amended— 


pamtmann on DSKBC07HB2PROD with BILLS
2 

•S 97 IS

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

2 the end; 

3 (2) in subparagraph (HH), by striking the pe4 riod at the end and inserting ‘‘; and’’; and 

5 (3) by adding at the end the following new sub6 paragraph: 

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

8 in subsection (lll));’’. 

9 (b) DENTAL AND ORAL HEALTH SERVICES DE10 FINED.—Section 1861 of the Social Security Act (42 

11 U.S.C. 1395x) is amended by adding at the end the fol12 lowing new subsection: 

13 ‘‘Dental and Oral Health Services 

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

15 means services (as defined by the Secretary) that are nec16 essary to prevent disease and promote oral health, restore 

17 oral structures to health and function, and treat emer18 gency conditions, including— 

19 ‘‘(1) routine diagnostic and preventive care 

20 such as dental cleanings, exams, and x-rays; 

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

22 extractions; 

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

24 crowns, and dentures; 

25 ‘‘(4) emergency dental care; and 


pamtmann on DSKBC07HB2PROD with BILLS
3 

•S 97 IS

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

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

3 (c) COVERAGE OF ROUTINE DIAGNOSTIC AND PRE4 VENTIVE CARE AS A PREVENTIVE SERVICE.—Section 

5 1861(ddd)(3) of the Social Security Act (42 U.S.C. 

6 1395x(ddd)(3)) is amended by adding at the end the fol7 lowing new subparagraph: 

8 ‘‘(D) Dental and oral health services described 

9 in paragraph (1) of subsection (lll), relating to rou10 tine diagnostic and preventive care.’’. 

11 (d) PAYMENT; COINSURANCE; AND LIMITATIONS.— 

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

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

14 amended— 

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

16 (B) by inserting before the semicolon at 

17 the end the following: ‘‘and (EE) with respect 

18 to dental and oral health services (as defined in 

19 section 1861(lll), other than those services de20 scribed in paragraph (1) of such section), the 

21 amount paid shall be the payment amount spec22 ified under section 1834(z).’’. 

23 (2) PAYMENT AND LIMITS SPECIFIED.—Section 

24 1834 of the Social Security Act (42 U.S.C. 1395m) 


pamtmann on DSKBC07HB2PROD with BILLS
4 

•S 97 IS

1 is amended by adding at the end the following new 

2 subsection: 

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

4 HEALTH SERVICES.— 

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

6 under this part for dental and oral health services 

7 (as defined in section 1861(lll), other than those 

8 services described in paragraph (1) of such section) 

9 shall be, subject to paragraph (3), the applicable 

10 percentage (specified in paragraph (2)) of the lesser 

11 of the actual charge for the services or the amount 

12 determined under the payment basis determined 

13 under section 1848. 

14 ‘‘(2) APPLICABLE PERCENTAGE.— 

15 ‘‘(A) IN GENERAL.—For purposes of para16 graph (1), subject to subparagraph (B), the ap17 plicable percentage specified in this paragraph 

18 is— 

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

20 least 6 months after the date of the enact21 ment of this subsection, 0 percent; 

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

23 specified in subparagraph (A) and each 

24 subsequent year through the seventh year 

25 following the year specified in subparaVerDate Sep 11 2014 22:42 Feb 14, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S97.IS S97

pamtmann on DSKBC07HB2PROD with BILLS
5 

•S 97 IS

1 graph (A), the applicable percent specified 

2 in this paragraph for the previous year in3 creased by 10 percentage points; and 

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

5 year specified in subparagraph (A) and 

6 each subsequent year, 80 percent. 

7 ‘‘(B) SPECIAL RULE FOR CERTAIN LOW-IN8 COME INDIVIDUALS.—For purposes of para9 graph (1), with respect to dental and oral 

10 health services described in such paragraph that 

11 are furnished to an individual who is a subsidy 

12 eligible individual (as defined in section 1860D– 

13 14(a)(3)), or who would be a subsidy eligible in14 dividual if the individual were enrolled in a pre15 scription drug plan or an MA–PD plan under 

16 part D, for the first year beginning at least 6 

17 months after the date of the enactment of this 

18 subsection and each subsequent year, the appli19 cable percent specified in this paragraph is 80 

20 percent. 

21 ‘‘(3) LIMITATIONS AND SECRETARIAL AUTHOR22 ITY.— 

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

24 and oral health services that are— 


pamtmann on DSKBC07HB2PROD with BILLS
6 

•S 97 IS

1 ‘‘(i) routine dental cleanings, payment 

2 may be made under this part for only two 

3 such cleanings during a 12-month period; 

4 and 

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

6 made under this part for only two such 

7 exams during a 12-month period. 

8 ‘‘(B) SECRETARIAL AUTHORITY.— 

9 ‘‘(i) AUTHORITY TO APPLY ADDI10 TIONAL LIMITATIONS.—The Secretary may 

11 apply such other reasonable limitations on 

12 the extent to which dental and oral services 

13 are covered under this part, including 

14 through application of a prior authoriza15 tion requirement. 

16 ‘‘(ii) AUTHORITY TO MODIFY COV17 ERAGE.—Notwithstanding any other provi18 sion of this title, if the Secretary deter19 mines appropriate, the Secretary may mod20 ify the coverage under this part of dental 

21 and oral health services to the extent that 

22 such modification is consistent with the 

23 recommendations of the United States Pre24 ventive Services Task Force. 


pamtmann on DSKBC07HB2PROD with BILLS
7 

•S 97 IS

1 ‘‘(iii) AUTHORITY TO WAIVE FRE2 QUENCY LIMITATIONS.—The Secretary 

3 may waive any frequency limitation or 

4 other limitation as described in this para5 graph for an individual (or category of in6 dividuals) as determined appropriate by 

7 the Secretary.’’. 

8 (e) PAYMENT UNDER PHYSICIAN FEE SCHEDULE.— 

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

10 1395w–4(j)(3)) is amended by striking ‘‘risk assessment) 

11 ,’’ and inserting ‘‘risk assessment), (2)(II),’’. 

12 (f) DENTAL PROSTHESES.— 

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

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

15 amended— 

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

17 inserting ‘‘(including dental)’’; and 

18 (B) by striking ‘‘internal body’’. 

19 (2) SPECIAL PAYMENT RULES.—Section 

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

21 1395m(a)) is amended by adding at the end the fol22 lowing new paragraph: 

23 ‘‘(23) PAYMENT AND LIMITS FOR DENTAL

24 PROSTHESES.— 


pamtmann on DSKBC07HB2PROD with BILLS
8 

•S 97 IS

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

2 under this part for dental prostheses shall be, 

3 subject to subparagraph (C), the applicable per4 cent (specified in subparagraph (B)) of the 

5 amount otherwise payable for such dental pros6 theses under this section. 

7 ‘‘(B) APPLICABLE PERCENT.— 

8 ‘‘(i) IN GENERAL.—For purposes of 

9 subparagraph (A), subject to clause (ii), 

10 the applicable percent specified in this sub11 paragraph is— 

12 ‘‘(I) for the first year beginning 

13 at least 6 months after the date of the 

14 enactment of this paragraph, 0 per15 cent; 

16 ‘‘(II) for the year following the 

17 year specified in clause (i) and each 

18 subsequent year through the seventh 

19 year following the year specified in 

20 clause (i), the applicable percent spec21 ified in this subparagraph for the pre22 vious year increased by 10 percentage 

23 points; and 


pamtmann on DSKBC07HB2PROD with BILLS
9 

•S 97 IS

1 ‘‘(III) for the eighth year fol2 lowing the year specified in clause (i) 

3 and each subsequent year, 80 percent. 

4 ‘‘(ii) SPECIAL RULE FOR CERTAIN

5 LOW-INCOME INDIVIDUALS.—For purposes 

6 of subparagraph (A), with respect to den7 tal prostheses furnished to an individual 

8 who is a subsidy eligible individual (as de9 fined in section 1860D–14(a)(3)), or who 

10 would be a subsidy eligible individual if the 

11 individual were enrolled in a prescription 

12 drug plan or an MA–PD plan under part 

13 D, for the first year beginning at least 6 

14 months after the date of the enactment of 

15 this paragraph and each subsequent year, 

16 the applicable percent specified in this sub17 paragraph is 80 percent. 

18 ‘‘(C) LIMITATIONS AND SECRETARIAL AU19 THORITY.— 

20 ‘‘(i) IN GENERAL.—Payment may be 

21 made under this part for an individual 

22 for— 

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

24 and one full lower dental prostheses 

25 once every five years; and 


pamtmann on DSKBC07HB2PROD with BILLS
10 

•S 97 IS

1 ‘‘(II) not more than one partial 

2 upper dental prostheses and one par3 tial lower dental prostheses once every 

4 five years. 

5 ‘‘(ii) SECRETARIAL AUTHORITY.— 

6 ‘‘(I) AUTHORITY TO APPLY ADDI7 TIONAL LIMITATIONS.—The Secretary 

8 may apply such other reasonable limi9 tations on the extent to which dental 

10 prostheses are covered under this 

11 part, including through application of 

12 a prior authorization requirement. 

13 ‘‘(II) AUTHORITY TO MODIFY

14 COVERAGE.—Notwithstanding any 

15 other provision of this title, if the Sec16 retary determines appropriate, the 

17 Secretary may modify the coverage 

18 under this part of dental prostheses to 

19 the extent that such modification is 

20 consistent with the recommendations 

21 of the United States Preventive Serv22 ices Task Force. 

23 ‘‘(III) AUTHORITY TO WAIVE

24 FREQUENCY LIMITATIONS.—The Sec25 retary may waive any frequency limiVerDate Sep 11 2014 22:42 Feb 14, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S97.IS S97

pamtmann on DSKBC07HB2PROD with BILLS
11 

•S 97 IS

1 tation or other limitation as described 

2 in this subparagraph for an individual 

3 (or category of individuals) as deter4 mined appropriate by the Secretary’’. 

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

6 1862(a) of the Social Security Act (42 U.S.C. 1395y) is 

7 amended by striking paragraph (12). 

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

9 this section shall apply to services furnished on or after 

10 January 1, 2022. 

11 SEC. 3. INCREASED FMAP FOR ADDITIONAL EXPENDI12 TURES FOR MEDICARE COST-SHARING FOR 

13 DENTAL AND ORAL HEALTH SERVICES. 

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

15 1396d) is amended— 

16 (1) in subsection (b), by striking ‘‘and (ff)’’ and 

17 inserting ‘‘(ff), and (ii)’’; and 

18 (2) by adding at the end the following new sub19 section: 

20 ‘‘(ii) INCREASED FMAP FOR ADDITIONAL EXPENDI21 TURES FOR MEDICARE COST-SHARING FOR DENTAL AND

22 ORAL HEALTH SERVICES.—Notwithstanding subsection 

23 (b), with respect to the portion of the amounts expended 

24 by a State for medical assistance for medicare cost-sharing 

25 (as defined in subsection (p)(3)) for qualified medicare 


pamtmann on DSKBC07HB2PROD with BILLS
12 

•S 97 IS

1 beneficiaries described in subsection (p)(1) that is attrib2 utable to the coverage under part B of title XVIII of den3 tal and oral health services (as defined in section 

4 1861(lll)), as determined by the Secretary, the Federal 

5 medical assistance percentage for a State that is one of 

6 the 50 States or the District of Columbia shall be equal 

7 to 100 percent.’’. 

8 SEC. 4. PREVENTIVE SERVICES TASKFORCE. 

9 (a) IN GENERAL.—Section 915(a)(1) of the Public 

10 Health Service Act (42 U.S.C. 299b–4(a)(1)) is amended, 

11 in the first sentence, by inserting ‘‘, including at least 1 

12 oral health professional’’ after ‘‘expertise’’. 

13 (b) EFFECTIVE DATE.—The amendment made by 

14 subsection (a) shall take effect January 1, 2022. 

Æ 


pamtmann on DSKBC07HB2PROD with BILLS