IB 

Union Calendar No. 303 

116TH CONGRESS 

2D SESSION H. R. 4650 

[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. 

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 

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. BARRAGA ́N, Mr. 

BUTTERFIELD, Mr. CUELLAR, Ms. NORTON, Mr. MALINOWSKI, Mr. 

PAYNE, Mr. WELCH, and Mr. CARTWRIGHT


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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] 

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. 


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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 Cov5 erage Act of 2019’’. 

6 SEC. 2. DENTAL AND ORAL HEALTH CARE. 

7 (a) COVERAGE.—Section 1861(s)(2) of the Social Secu8 rity Act (42 U.S.C. 1395x(s)(2)) is amended— 

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

10 after the semicolon at the end; 

11 (2) in subparagraph (HH), by striking the pe12 riod at the end and adding ‘‘; and’’; and 

13 (3) by adding at the end the following new sub14 paragraph: 

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

16 in subsection (kkk));’’. 

17 (b) DENTAL AND ORAL HEALTH SERVICES DE18 FINED.—Section 1861 of the Social Security Act (42 U.S.C. 

19 1395x) is amended by adding at the end the following new 

20 subsection: 

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

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

23 health services’ means items and services (other than 

24 such items and services for which payment may be 

25 made under part A as inpatient hospital services) 


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1 that are furnished during 2022 or a subsequent year, 

2 for which coverage was not provided under part B as 

3 of the date of the enactment of this subsection, and 

4 that are— 

5 ‘‘(A) the preventive and screening services 

6 described in paragraph (2) furnished by a doctor 

7 of dental surgery or of dental medicine (as de8 scribed in subsection (r)(2)) or an oral health 

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

10 ‘‘(B) the basic treatments specified for such 

11 year by the Secretary pursuant to paragraph 

12 (3)(A) and the major treatments specified for 

13 such year by the Secretary pursuant to para14 graph (3)(B) furnished by such a doctor or such 

15 a professional. 

16 ‘‘(2) PREVENTIVE AND SCREENING SERVICES.— 

17 The preventive and screening services described in 

18 this paragraph are the following: 

19 ‘‘(A) Oral exams. 

20 ‘‘(B) Dental cleanings. 

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

22 of a doctor or professional described in para23 graph (1)(A). 

24 ‘‘(D) Fluoride treatments. 


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1 ‘‘(3) BASIC AND MAJOR TREATMENTS.—For 2022 

2 and each subsequent year, the Secretary shall speci3 fy— 

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

5 basic tooth restorations, basic periodontic serv6 ices, tooth extractions, and oral disease manage7 ment services); and 

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

9 major tooth restorations, major periodontic serv10 ices, bridges, crowns, dental implants, and root 

11 canals); 

12 that shall be included as dental and oral health serv13 ices for such year. 

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

15 ‘oral health professional’ means, with respect to den16 tal and oral health services, a health professional who 

17 is licensed to furnish such services, acting within the 

18 scope of such license, by the State in which such serv19 ices are furnished.’’. 

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

21 (1) IN GENERAL.—Section 1833(a)(1) of the So22 cial Security Act (42 U.S.C. 1395l(a)(1)) is amend23 ed— 

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


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1 (B) by inserting before the semicolon at the 

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

3 dental and oral health services (as defined in sec4 tion 1861(kkk)), the amount paid shall be the 

5 payment amount specified under section 

6 1834(x)’’. 

7 (2) PAYMENT AND LIMITS SPECIFIED.—Section 

8 1834 of the Social Security Act (42 U.S.C. 1395m) is 

9 amended by adding at the end the following new sub10 section: 

11 ‘‘(x) PAYMENT AND LIMITS FOR DENTAL AND ORAL

12 HEALTH SERVICES.— 

13 ‘‘(1) IN GENERAL.—The payment amount under 

14 this part for dental and oral health services (as de15 fined in section 1861(kkk)) shall be, subject to para16 graph (3), the applicable percent (specified in para17 graph (2)) of the lesser of the actual charge for the 

18 services or the amount determined under the payment 

19 basis determined under section 1848. 

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

21 paragraph (1), the applicable percent specified in this 

22 paragraph is, with respect to dental and oral health 

23 services (as defined in section 1861(kkk)) furnished in 

24 a year— 


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1 ‘‘(A) that are preventive and screening serv2 ices described in paragraph (2) or basic treat3 ments specified for such year pursuant to para4 graph (3)(A) of such section, 80 percent; and 

5 ‘‘(B) that are major treatments specified for 

6 such year pursuant to paragraph (3)(B) of such 

7 section— 

8 ‘‘(i) in the case such services are fur9 nished during 2022, 10 percent; 

10 ‘‘(ii) in the case such services are fur11 nished during 2023 or a subsequent year be12 fore 2026, the applicable percent specified 

13 under this subparagraph for the previous 

14 year, increased by 10 percentage points; 

15 and 

16 ‘‘(iii) in the case such services are fur17 nished during 2026 or a subsequent year, 

18 50 percent. 

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

20 oral health services that are— 

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

22 under this part for not more than two such 

23 exams during a 12-month period; 


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

2 made under this part for not more than two such 

3 cleanings during a 12-month period; and 

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

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

6 at such frequencies and under such cir7 cumstances determined appropriate by the Sec8 retary.’’. 

9 (d) PAYMENT UNDER PHYSICIAN FEE SCHEDULE.— 

10 (1) IN GENERAL.—Section 1848(j)(3) of the So11 cial Security Act (42 U.S.C. 1395w–4(j)(3)) is 

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

13 (2) BUDGET NEUTRALITY.—Section 

14 1848(c)(2)(B)(iv) of the Social Security Act (42 

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

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

17 the end; 

18 (B) in subclause (IV), by striking the period 

19 at the end and inserting ‘‘; and’’; and 

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

21 subclause: 

22 ‘‘(V) the amendment made by sec23 tion 2(d)(1) of the Medicare Dental Act 

24 of 2019 shall not be taken into account 


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1 in applying clause (ii)(II) for 2022 

2 and 2023.’’. 

3 (3) EXCLUSION FROM MIPS.—Section 

4 1848(q)(1)(C)(ii) of the Social Security Act (42 

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

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

7 the end; 

8 (B) in subclause (III), by striking the pe9 riod at the end and inserting ‘‘; or’’; and 

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

11 subclause: 

12 ‘‘(IV) with respect to 2022 and 

13 each subsequent year, is a doctor of 

14 dental surgery or of dental medicine 

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

16 is an oral health professional (as de17 fined in section 1861(kkk)(4)).’’. 

18 (4) INCLUSION OF ORAL HEALTH PROFES19 SIONALS AS CERTAIN PRACTITIONERS.—Section 

20 1842(b)(18)(C) of the Social Security Act (42 U.S.C. 

21 1395u(b)(18)(C)) is amended by adding at the end the 

22 following new clause: 

23 ‘‘(vii) With respect to 2022 and each subsequent 

24 year, an oral health professional (as defined in sec25 tion 1861(kkk)(4)).’’. 


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1 (e) DENTURES.— 

2 (1) IN GENERAL.—Section 1861(s)(8) of the So3 cial Security Act (42 U.S.C. 1395x(s)(8)) is amend4 ed— 

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

6 (B) by inserting ‘‘and excluding dental, ex7 cept for a full or partial set of dentures furnished 

8 on or after January 1, 2022’’ after ‘‘colostomy 

9 care’’. 

10 (2) SPECIAL PAYMENT RULES.— 

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

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

13 amended by adding at the end the following new 

14 paragraph: 

15 ‘‘(6) SPECIAL PAYMENT RULE FOR DENTURES.— 

16 Payment may be made under this part with respect 

17 to an individual for dentures— 

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

19 period (except in the case that a doctor or profes20 sional described in section 1861(kkk)(1)(A) deter21 mines such dentures do not fit the individual); 

22 and 

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

24 are furnished pursuant to a written order of 

25 such a doctor or professional.’’. 


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1 (B) APPLICATION OF COMPETITIVE ACQUISI2 TION.— 

3 (i) IN GENERAL.—Section 

4 1834(h)(1)(H) of the Social Security Act 

5 (42 U.S.C. 1395m(h)(1)(H)) is amended— 

6 (I) in the subparagraph heading, 

7 by inserting ‘‘, DENTURES’’ after 

8 ‘‘ORTHOTICS’’; 

9 (II) by inserting ‘‘and of dentures 

10 described in paragraph (2)(D) of such 

11 section,’’ after ‘‘2009,’’; and 

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

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

14 (ii) CONFORMING AMENDMENT.—Sec15 tion 1847(a)(2) of the Social Security Act 

16 (42 U.S.C. 1395w–3(a)(2)) is amended by 

17 adding at the end the following new sub18 paragraph: 

19 ‘‘(D) DENTURES.—Dentures for which pay20 ment would otherwise be made under section 

21 1834(h).’’. 

22 (iii) EXEMPTION OF CERTAIN ITEMS

23 FROM COMPETITIVE ACQUISITION.—Section 

24 1847(a)(7) of the Social Security Act (42 

25 U.S.C. 1395w–3(a)(7)) is amended by addVerDate Sep 11 2014 23:12 Jan 24, 2020 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6203 E:\BILLS\H4650.RH H4650

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1 ing at the end the following new subpara2 graph: 

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

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

5 furnished by a physician or other practitioner 

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

7 or practitioner’s own patients as part of the phy8 sician’s or practitioner’s professional service.’’. 

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

10 the Social Security Act (42 U.S.C. 1395y(a)) is amended— 

11 (1) in paragraph (1)— 

12 (A) in subparagraph (O), by striking ‘‘and’’ 

13 at the end; 

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

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

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

17 subparagraph: 

18 ‘‘(Q) in the case of dental and oral health serv19 ices (as defined in section 1861(kkk)) that are preven20 tive and screening services described in paragraph (2) 

21 of such section, which are furnished more frequently 

22 than provided under section 1834(x)(3);’’; and 

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

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

25 payment may be made under part B for dental and 


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1 oral health services that are covered under section 

2 1861(s)(2)(II)’’. 

3 SEC. 3. IMPLEMENTATION FUNDING. 

4 The Secretary of Health and Human Services shall 

5 provide for the transfer from the Federal Supplementary 

6 Medical Insurance Trust Fund under section 1841 of the 

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

8 Medicare & Medicaid Services Program Management Ac9 count for the period of 2020 through 2024 of such sums as 

10 may be necessary for purposes of implementing the amend11 ments made by section 2. 


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Union Calendar No. 303 

116TH CONGRESS 

2D SESSION H. R. 4650 

[Report No. 116–325, Parts I and II] 

A BILL 

To amend title XVIII of the Social Security Act to 

services under part B of the Medicare program. provide coverage for certain dental items and 

JANUARY 24, 2020 

Reported from the Committee on Energy and Commerce, 

the State of the Union, and ordered to be printed committed to the Committee of the Whole House on 


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