I 

116TH CONGRESS 

1ST SESSION H. R. 4650 

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 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 

coverage for certain dental items and services under part 

B of 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 Act 

5 of 2019’’. 

6 SEC. 2. DENTAL AND ORAL HEALTH CARE. 

7 (a) COVERAGE.—Section 1861(s)(2) of the Social Se8 curity Act (42 U.S.C. 1395x(s)(2)) is amended— 


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

2 after the semicolon at the end; 

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

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 ‘‘(kkk) DENTAL AND ORAL HEALTH SERVICES.— 

14 ‘‘(1) IN GENERAL.—The term ‘dental and oral 

15 health services’ means items and services (other 

16 than such items and services for which payment may 

17 be made under part A as inpatient hospital services) 

18 that are furnished during 2022 or a subsequent 

19 year, for which coverage was not provided under 

20 part B as of the date of the enactment of this sub21 section, and that are— 

22 ‘‘(A) the preventive and screening services 

23 described in paragraph (2) furnished by a doc24 tor of dental surgery or of dental medicine (as 


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1 described in subsection (r)(2)) or an oral health 

2 professional (as defined in paragraph (4)); or 

3 ‘‘(B) the basic treatments specified for 

4 such year by the Secretary pursuant to para5 graph (3)(A) and the major treatments speci6 fied for such year by the Secretary pursuant to 

7 paragraph (3)(B) furnished by such a doctor or 

8 such a professional. 

9 ‘‘(2) PREVENTIVE AND SCREENING SERV10 ICES.—The preventive and screening services de11 scribed in this paragraph are the following: 

12 ‘‘(A) Oral exams. 

13 ‘‘(B) Dental cleanings. 

14 ‘‘(C) Dental x-rays performed in the office 

15 of a doctor or professional described in para16 graph (1)(A). 

17 ‘‘(D) Fluoride treatments. 

18 ‘‘(3) BASIC AND MAJOR TREATMENTS.—For 

19 2022 and each subsequent year, the Secretary shall 

20 specify— 

21 ‘‘(A) basic treatments (which may include 

22 basic tooth restorations, basic periodontic serv23 ices, tooth extractions, and oral disease man24 agement services); and 


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1 ‘‘(B) major treatments (which may include 

2 major tooth restorations, major periodontic 

3 services, bridges, crowns, dental implants, and 

4 root canals); 

5 that shall be included as dental and oral health serv6 ices for such year. 

7 ‘‘(4) ORAL HEALTH PROFESSIONAL.—The term 

8 ‘oral health professional’ means, with respect to den9 tal and oral health services, a health professional 

10 who is licensed to furnish such services, acting with11 in the scope of such license, by the State in which 

12 such services are furnished.’’. 

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

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

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

16 amended— 

17 (A) by striking ‘‘and’’ before ‘‘(CC)’’; and 

18 (B) by inserting before the semicolon at 

19 the end the following: ‘‘, and (DD) with respect 

20 to dental and oral health services (as defined in 

21 section 1861(kkk)), the amount paid shall be 

22 the payment amount specified under section 

23 1834(x)’’. 

24 (2) PAYMENT AND LIMITS SPECIFIED.—Section 

25 1834 of the Social Security Act (42 U.S.C. 1395m) 


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1 is amended by adding at the end the following new 

2 subsection: 

3 ‘‘(x) 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(kkk)) shall be, subject to 

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

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

10 the services or the amount determined under the 

11 payment basis determined under section 1848. 

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

13 paragraph (1), the applicable percent specified in 

14 this paragraph is, with respect to dental and oral 

15 health services (as defined in section 1861(kkk)) fur16 nished in a year— 

17 ‘‘(A) that are preventive and screening 

18 services described in paragraph (2) or basic 

19 treatments specified for such year pursuant to 

20 paragraph (3)(A) of such section, 80 percent; 

21 and 

22 ‘‘(B) that are major treatments specified 

23 for such year pursuant to paragraph (3)(B) of 

24 such section— 


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1 ‘‘(i) in the case such services are fur2 nished during 2022, 10 percent; 

3 ‘‘(ii) in the case such services are fur4 nished during 2023 or a subsequent year 

5 before 2026, the applicable percent speci6 fied under this subparagraph for the pre7 vious year, increased by 10 percentage 

8 points; and 

9 ‘‘(iii) in the case such services are fur10 nished during 2026 or a subsequent year, 

11 50 percent. 

12 ‘‘(3) LIMITATIONS.—With respect to dental and 

13 oral health services that are— 

14 ‘‘(A) oral exams, payment may be made 

15 under this part for not more than two such 

16 exams during a 12-month period; 

17 ‘‘(B) dental cleanings, payment may be 

18 made under this part for not more than two 

19 such cleanings during a 12-month period; and 

20 ‘‘(C) not described in subparagraph (A) or 

21 (B), payment may be made under this part only 

22 at such frequencies and under such cir23 cumstances determined appropriate by the Sec24 retary.’’. 

25 (d) PAYMENT UNDER PHYSICIAN FEE SCHEDULE.— 


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1 (1) IN GENERAL.—Section 1848(j)(3) of the 

2 Social Security Act (42 U.S.C. 1395w–4(j)(3)) is 

3 amended by inserting ‘‘(2)(II),’’ before ‘‘(3)’’. 

4 (2) BUDGET NEUTRALITY.—Section 

5 1848(c)(2)(B)(iv) of the Social Security Act (42 

6 U.S.C. 1395–w(c)(2)(B)(iv)) is amended— 

7 (A) in subclause (III), by striking ‘‘and’’ at 

8 the end; 

9 (B) in subclause (IV), by striking the pe10 riod at the end and inserting ‘‘; and’’; and 

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

12 subclause: 

13 ‘‘(V) the amendment made by 

14 section 2(d)(1) of the Medicare Dental 

15 Act of 2019 shall not be taken into 

16 account in applying clause (ii)(II) for 

17 2022 and 2023.’’. 

18 (3) EXCLUSION FROM MIPS.—Section 

19 1848(q)(1)(C)(ii) of the Social Security Act (42 

20 U.S.C. 1395w–4(q)(1)(C)(ii)) is amended— 

21 (A) in subclause (II), by striking ‘‘or’’ at 

22 the end; 

23 (B) in subclause (III), by striking the pe24 riod at the end and inserting ‘‘; or’’; and 


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

2 subclause: 

3 ‘‘(IV) with respect to 2022 and 

4 each subsequent year, is a doctor of 

5 dental surgery or of dental medicine 

6 (as described in section 1861(r)(2)) or 

7 is an oral health professional (as de8 fined in section 1861(kkk)(4)).’’. 

9 (4) INCLUSION OF ORAL HEALTH PROFES10 SIONALS AS CERTAIN PRACTITIONERS.—Section 

11 1842(b)(18)(C) of the Social Security Act (42 

12 U.S.C. 1395u(b)(18)(C)) is amended by adding at 

13 the end the following new clause: 

14 ‘‘(vii) With respect to 2022 and each 

15 subsequent year, an oral health profes16 sional (as defined in section 

17 1861(kkk)(4)).’’. 

18 (e) DENTURES.— 

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

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

21 amended— 

22 (A) by striking ‘‘(other than dental)’’; and 

23 (B) by inserting ‘‘and excluding dental, ex24 cept for a full or partial set of dentures furVerDate Sep 11 2014 23:57 Oct 11, 2019 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H4650.IH H4650

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1 nished on or after January 1, 2022’’ after ‘‘co2 lostomy care’’. 

3 (2) SPECIAL PAYMENT RULES.— 

4 (A) LIMITATIONS.—Section 1834(h) of the 

5 Social Security Act (42 U.S.C. 1395m(h)) is 

6 amended by adding at the end the following 

7 new paragraph: 

8 ‘‘(6) SPECIAL PAYMENT RULE FOR DEN9 TURES.—Payment may be made under this part 

10 with respect to an individual for dentures— 

11 ‘‘(A) not more than once during any 5-year 

12 period (except in the case that a doctor or pro13 fessional described in section 1861(kkk)(1)(A) 

14 determines such dentures do not fit the indi15 vidual); and 

16 ‘‘(B) only to the extent that such dentures 

17 are furnished pursuant to a written order of 

18 such a doctor or professional.’’. 

19 (B) APPLICATION OF COMPETITIVE ACQUI20 SITION.— 

21 (i) IN GENERAL.—Section 

22 1834(h)(1)(H) of the Social Security Act 

23 (42 U.S.C. 1395m(h)(1)(H)) is amended— 


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1 (I) in the subparagraph heading, 

2 by inserting ‘‘, DENTURES’’ after 

3 ‘‘ORTHOTICS’’; 

4 (II) by inserting ‘‘and of den5 tures described in paragraph (2)(D) 

6 of such section,’’ after ‘‘2009,’’; and 

7 (III) in clause (i), by inserting 

8 ‘‘or such dentures’’ after ‘‘orthotics’’. 

9 (ii) CONFORMING AMENDMENT.—Sec10 tion 1847(a)(2) of the Social Security Act 

11 (42 U.S.C. 1395w–3(a)(2)) is amended by 

12 adding at the end the following new sub13 paragraph: 

14 ‘‘(D) DENTURES.—Dentures for which 

15 payment would otherwise be made under section 

16 1834(h).’’. 

17 (iii) EXEMPTION OF CERTAIN ITEMS

18 FROM COMPETITIVE ACQUISITION.—Sec19 tion 1847(a)(7) of the Social Security Act 

20 (42 U.S.C. 1395w–3(a)(7)) is amended by 

21 adding at the end the following new sub22 paragraph: 

23 ‘‘(C) CERTAIN DENTURES.—Those items 

24 and services described in paragraph (2)(D) if 

25 furnished by a physician or other practitioner 


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1 (as defined by the Secretary) to the physician’s 

2 or practitioner’s own patients as part of the 

3 physician’s or practitioner’s professional serv4 ice.’’. 

5 (f) EXCLUSION MODIFICATIONS.—Section 1862(a) of 

6 the Social Security Act (42 U.S.C. 1395y(a)) is amend7 ed— 

8 (1) in paragraph (1)— 

9 (A) in subparagraph (O), by striking 

10 ‘‘and’’ at the end; 

11 (B) in subparagraph (P), by striking the 

12 semicolon at the end and inserting ‘‘, and’’; and 

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

14 subparagraph: 

15 ‘‘(Q) in the case of dental and oral health serv16 ices (as defined in section 1861(kkk)) that are pre17 ventive and screening services described in para18 graph (2) of such section, which are furnished more 

19 frequently than provided under section 1834(x)(3);’’; 

20 and 

21 (2) in paragraph (12), by inserting before the 

22 semicolon at the end the following: ‘‘and except that 

23 payment may be made under part B for dental and 

24 oral health services that are covered under section 

25 1861(s)(2)(II)’’. 


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1 SEC. 3. IMPLEMENTATION FUNDING. 

2 The Secretary of Health and Human Services shall 

3 provide for the transfer from the Federal Supplementary 

4 Medical Insurance Trust Fund under section 1841 of the 

5 Social Security Act (42 U.S.C. 1395t) to the Centers for 

6 Medicare & Medicaid Services Program Management Ac7 count for the period of 2020 through 2024 of such sums 

8 as may be necessary for purposes of implementing the 

9 amendments made by section 2. 

Æ 


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