II 

116TH CONGRESS 

1ST SESSION S. 1423 

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

coverage of dental, vision, and hearing care under the Medicare and 

Medicaid programs. 

IN THE SENATE OF THE UNITED STATES 

MAY 13, 2019 

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, vision, and hearing 

care 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 2019’’. 

6 SEC. 2. DENTAL AND ORAL HEALTH CARE UNDER MEDI7 CARE. 

8 (a) COVERAGE.—Section 1861(s)(2) of the Social Se9 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 adding ‘‘and’’ 

4 after the semicolon at the end; 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 ‘‘Dental and Oral Health Services 

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

15 means— 

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

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

18 crowns; 

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

20 and extractions; 

21 ‘‘(4) emergency dental care; and 

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

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

24 (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)) is 

3 amended— 

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

5 (B) by inserting before the semicolon at 

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

7 to dental and oral health services (as defined in 

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

9 the payment amount specified under section 

10 1834(x)’’. 

11 (2) PAYMENT AND LIMITS SPECIFIED.—Section 

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

13 is amended by adding at the end the following new 

14 subsection: 

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

16 HEALTH SERVICES.— 

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

18 under this part for dental and oral health services 

19 (as defined in section 1861(kkk)) shall be, subject to 

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

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

22 the services or the amount determined under the 

23 payment 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) LIMITATIONS AND SECRETARIAL AUTHOR18 ITY.— 

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

20 and oral health services that are— 

21 ‘‘(i) routine dental cleanings, payment 

22 may be made under this part for only two 

23 such cleanings during a 12-month period; 

24 and 


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

2 made under this part for only two such 

3 exams during a 12-month period. 

4 ‘‘(B) SECRETARIAL AUTHORITY.— 

5 ‘‘(i) AUTHORITY TO APPLY ADDI6 TIONAL LIMITATIONS.—The Secretary may 

7 apply such other reasonable limitations on 

8 the extent to which dental and oral services 

9 are covered under this part, including 

10 through application of a prior authoriza11 tion requirement. 

12 ‘‘(ii) AUTHORITY TO MODIFY COV13 ERAGE.—Notwithstanding any other provi14 sion of this title, if the Secretary deter15 mines appropriate, the Secretary may mod16 ify the coverage under this part of dental 

17 and oral health services to the extent that 

18 such modification is consistent with the 

19 recommendations of the United States Pre20 ventive Services Task Force.’’. 

21 (d) PAYMENT UNDER PHYSICIAN FEE SCHEDULE.— 

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

23 1395w–4(j)(3)) is amended by inserting ‘‘(2)(II),’’ before 

24 ‘‘(3)’’. 

25 (e) DENTURES.— 


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

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

3 amended— 

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

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

6 (B) by striking ‘‘internal body’’. 

7 (2) SPECIAL PAYMENT RULES.—Section 

8 1834(a) of the Social Security Act (42 U.S.C. 

9 1395m(a)) is amended by adding at the end the fol10 lowing new paragraph: 

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

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

13 under this part for dentures shall be, subject to 

14 subparagraph (C), the applicable percent (speci15 fied in subparagraph (B)) of the amount other16 wise payable for such dentures under this sec17 tion. 

18 ‘‘(B) APPLICABLE PERCENT.—For pur19 poses of subparagraph (A), the applicable per20 cent specified in this subparagraph is— 

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

22 least 6 months after the date of the enact23 ment of this paragraph, 0 percent; 

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

25 specified in clause (i) and each subsequent 


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1 year through the seventh year following the 

2 year specified in clause (i), the applicable 

3 percent specified in this subparagraph for 

4 the previous year increased by 10 percent5 age points; and 

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

7 year specified in clause (i) and each subse8 quent year, 80 percent. 

9 ‘‘(C) LIMITATIONS AND SECRETARIAL AU10 THORITY.— 

11 ‘‘(i) IN GENERAL.—Payment may be 

12 made under this part for an individual 

13 for— 

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

15 and one full lower denture once every 

16 five years; and 

17 ‘‘(II) not more than one partial 

18 upper denture and one partial lower 

19 denture once every five years. 

20 ‘‘(ii) SECRETARIAL AUTHORITY.— 

21 ‘‘(I) AUTHORITY TO APPLY ADDI22 TIONAL LIMITATIONS.—The Secretary 

23 may apply such other reasonable limi24 tations on the extent to which den25 tures are covered under this part, inVerDate Sep 11 2014 19:06 May 21, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1423.IS S1423

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1 cluding through application of a prior 

2 authorization requirement. 

3 ‘‘(II) AUTHORITY TO MODIFY

4 COVERAGE.—Notwithstanding any 

5 other provision of this title, if the Sec6 retary determines appropriate, the 

7 Secretary may modify the coverage 

8 under this part of dentures to the ex9 tent that such modification is con10 sistent with the recommendations of 

11 the United States Preventive Services 

12 Task Force.’’. 

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

14 1862(a) of the Social Security Act (42 U.S.C. 1395y) is 

15 amended by striking paragraph (12). 

16 (g) 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. 3. VISION CARE UNDER MEDICARE. 

21 (a) COVERAGE.—Section 1861(s)(2) of the Social Se22 curity Act (42 U.S.C. 1395x(s)(2)), as amended by section 

23 2(a), is amended— 

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

25 after the semicolon at the end; 


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

2 the semicolon at the end; and 

3 (3) by adding at the end the following new sub4 paragraph: 

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

6 (lll));’’. 

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

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

9 by section 2(b), is amended by adding at the end the fol10 lowing new subsection: 

11 ‘‘Vision Services 

12 ‘‘(lll) The term ‘vision services’ means— 

13 ‘‘(1) routine eye examinations and procedures 

14 performed (during the course of any eye examina15 tion) to determine the refractive state of the eyes; 

16 and 

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

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

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

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

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

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

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

24 (B) by inserting before the semicolon at 

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


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1 to vision services (as defined in section 

2 1861(lll)), the amount paid shall be the pay3 ment amount specified under section 1834(w)’’. 

4 (2) PAYMENT AND LIMITS SPECIFIED.—Section 

5 1834 of the Social Security Act (42 U.S.C. 1395m), 

6 as amended by section 2(c)(2), is amended by add7 ing at the end the following new subsection: 

8 ‘‘(y) PAYMENT AND LIMITS FOR VISION SERVICES.— 

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

10 under this part for vision services (as defined in sec11 tion 1861(lll)) shall be, subject to paragraph (3), the 

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

13 lesser of the actual charge for the services or the 

14 amount determined under the payment basis deter15 mined under section 1848. 

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

17 paragraph (1), the applicable percent specified in 

18 this paragraph is— 

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

20 months after the date of the enactment of this 

21 subsection, 0 percent; 

22 ‘‘(B) for the year following the year speci23 fied in subparagraph (A) and each subsequent 

24 year through the seventh year following the 

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1 ble percent specified in this paragraph for the 

2 previous year increased by 10 percentage 

3 points; and 

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

5 specified in subparagraph (A) and each subse6 quent year, 80 percent. 

7 ‘‘(3) LIMITATIONS AND SECRETARIAL AUTHOR8 ITY.— 

9 ‘‘(A) FREQUENCY.—With respect to rou10 tine eye exams, payment may be made under 

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

12 month period. 

13 ‘‘(B) SECRETARIAL AUTHORITY.— 

14 ‘‘(i) AUTHORITY TO APPLY ADDI15 TIONAL LIMITATIONS.—The Secretary may 

16 apply other reasonable limitations on the 

17 extent to which vision services are covered 

18 under this part, including through applica19 tion of a prior authorization requirement. 

20 ‘‘(ii) AUTHORITY TO MODIFY COV21 ERAGE.—Notwithstanding any other provi22 sion of this title, if the Secretary deter23 mines appropriate, the Secretary may mod24 ify the coverage under this part of vision 

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1 tion is consistent with the recommenda2 tions of the United States Preventive Serv3 ices Task Force.’’. 

4 (d) PAYMENT UNDER PHYSICIAN FEE SCHEDULE.— 

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

6 1395w–4(j)(3)), as amended by section 2(d), is amended 

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

8 (e) SPECIAL PAYMENT RULES FOR EYEGLASSES, 

9 CONTACT LENSES, AND LOW VISION DEVICES.—Section 

10 1834(a) of the Social Security Act (42 U.S.C. 1395m(a)), 

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

12 the end the following new paragraphs: 

13 ‘‘(24) PAYMENT AND LIMITS FOR EYEGLASSES

14 AND CONTACT LENSES.— 

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

16 under this part for eyeglass lenses, eyeglass 

17 frames, and contact lenses shall be, subject to 

18 subparagraph (C), the applicable percent (speci19 fied in subparagraph (B)) of the amount other20 wise payable for such eyeglass lenses, eyeglass 

21 frames, and contact lenses, respectively, under 

22 this section. 

23 ‘‘(B) APPLICABLE PERCENT.—For pur24 poses of subparagraph (A), the applicable per25 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 (other than for 

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

19 for an individual for— 

20 ‘‘(I) not more than one pair of 

21 eyeglass lenses during any 12-month 

22 period; 

23 ‘‘(II) not more than one set of 

24 eyeglass frames during any 24-month 

25 period; and 


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

2 extent that the sum of such payments 

3 for contact lenses does not exceed a 

4 limitation of $200 during any 24- 

5 month period beginning during the 

6 first year beginning at least six 

7 months after the date of the enact8 ment of this paragraph (or, beginning 

9 during a subsequent year, such limita10 tion for a 24-month period beginning 

11 in the previous year increase by an 

12 appropriate inflation adjustment spec13 ified by the Secretary). 

14 ‘‘(ii) SECRETARIAL AUTHORITY.— 

15 ‘‘(I) AUTHORITY TO APPLY ADDI16 TIONAL LIMITATIONS.—The Secretary 

17 may apply such other reasonable limi18 tations on the extent to which eye19 glass lenses, eyeglass frames, and con20 tact lenses are covered under this 

21 part, including through application of 

22 a prior authorization requirement. 

23 ‘‘(II) AUTHORITY TO MODIFY

24 COVERAGE.—Notwithstanding any 

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1 retary determines appropriate, the 

2 Secretary may modify the coverage 

3 under this part of eyeglass lenses, eye4 glass frames, and contact lenses to 

5 the extent that such modification is 

6 consistent with the recommendations 

7 of the United States Preventive Serv8 ices Task Force. 

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

10 DEVICES.— 

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

12 under this part for low vision devices shall be, 

13 subject to subparagraph (C), the applicable per14 cent (specified in subparagraph (B)) of the 

15 amount otherwise payable for low vision devices 

16 under this section. 

17 ‘‘(B) APPLICABLE PERCENT.—For pur18 poses of subparagraph (A), the applicable per19 cent specified in this subparagraph is— 

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

21 least 6 months after the date of the enact22 ment of this paragraph, 0 percent; 

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

24 specified in clause (i) and each subsequent 

25 year through the seventh year following the 


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1 year specified in clause (i), the applicable 

2 percent specified in this subparagraph for 

3 the previous year increased by 10 percent4 age points; and 

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

6 year specified in clause (i) and each subse7 quent year, 80 percent. 

8 ‘‘(C) SECRETARIAL AUTHORITY.— 

9 ‘‘(i) AUTHORITY TO APPLY LIMITA10 TIONS.—The Secretary may apply reason11 able limitations on the extent to which low 

12 vision devices are covered under this part, 

13 including through application of a prior 

14 authorization requirement. 

15 ‘‘(ii) AUTHORITY TO MODIFY COV16 ERAGE.—Notwithstanding any other provi17 sion of this title, if the Secretary deter18 mines appropriate, the Secretary may mod19 ify the coverage under this part of low vi20 sion devices to the extent that such modi21 fication is consistent with the recommenda22 tions of the United States Preventive Serv23 ices Task Force. 

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

25 this paragraph, the term ‘low vision device’ 


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1 means a device, prescribed by a physician, that 

2 magnifies, enhances, or otherwise augments or 

3 interprets visual images irrespective of the size, 

4 form, or technological features of such device 

5 and does not include ordinary eyeglasses or con6 tact lenses. In the previous sentence, the term 

7 ‘ordinary eyeglasses or contact lenses’ means 

8 lenses that are intended to fully correct visual 

9 acuity or fully eliminate refractive error.’’. 

10 (f) DEFINITION OF DURABLE MEDICAL EQUIPMENT

11 TO INCLUDE EYEGLASSES, CONTACT LENSES, AND LOW

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

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

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

15 inserting a comma; and 

16 (2) by inserting ‘‘, and eyeglass lenses, low vi17 sion devices (as defined in section 1834(a)(25)), eye18 glass frames, and contact lenses’’ before ‘‘; except’’. 

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

20 1862(a)(7) of the Social Security Act (42 U.S.C. 

21 1395y(a)(7)) is amended by striking ‘‘, eyeglasses (other 

22 than eyewear described in section 1861(s)(8)) or eye ex23 aminations for the purpose of prescribing, fitting, or 

24 changing eyeglasses, procedures performed (during the 


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1 course of any eye examination) to determine the refractive 

2 state of the eyes’’. 

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

4 this section shall apply to services furnished on or after 

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

6 after the date of the enactment of this Act. 

7 SEC. 4. HEARING CARE UNDER MEDICARE. 

8 (a) COVERAGE.— 

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

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

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

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

13 ‘‘and’’ at the end; 

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

15 ‘‘and’’ at the end; and 

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

17 subparagraph: 

18 ‘‘(KK) audiology services (as defined in sub19 section (ll)(3)) and hearing services (as defined in 

20 subsection (ll)(5));’’. 

21 (2) HEARING SERVICES DEFINED.—Section 

22 1861(ll) of the Social Security Act (42 U.S.C. 

23 1395x(ll)) is amended— 


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1 (A) in the subsection heading, by inserting 

2 ‘‘; HEARING SERVICES’’ after ‘‘AUDIOLOGY

3 SERVICES’’; and 

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

5 paragraph: 

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

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

8 hearing aids; and 

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

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

11 (b) 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)), as 

14 amended by sections 2(c)(1) and 3(c)91), is amend15 ed— 

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

17 (B) by inserting before the semicolon at 

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

19 to audiology services (as defined in section 

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

21 section 1861(ll)(5)), 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 as amended by sections 2(c)(2) and 3(c)(2), is 

2 amended by adding at the end the following new 

3 subsection: 

4 ‘‘(z) PAYMENT AND LIMITS FOR HEARING SERV5 ICES.— 

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

7 under this part for audiology services (as defined in 

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

9 in section 1861(ll)(5)), shall be, subject to para10 graph (3), the applicable percent (specified in para11 graph (2)) of the lesser of the actual charge for the 

12 services or the amount determined under the pay13 ment basis determined under section 1848. 

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

15 paragraph (1), the applicable percent specified in 

16 this paragraph is— 

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

18 months after the date of the enactment of this 

19 subsection, 0 percent; 

20 ‘‘(B) for the year following the year speci21 fied in subparagraph (A) and each subsequent 

22 year through the seventh year following the 

23 year specified in subparagraph (A), the applica24 ble percent specified in this paragraph for the 


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1 previous year increased by 10 percentage 

2 points; and 

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

4 specified in subparagraph (A) and each subse5 quent year, 80 percent. 

6 ‘‘(3) SECRETARIAL AUTHORITY.— 

7 ‘‘(A) AUTHORITY TO APPLY LIMITA8 TIONS.—The Secretary may apply reasonable 

9 limitations on the extent to which audiology 

10 services and hearing services are covered under 

11 this part, including through application of a 

12 prior authorization requirement. 

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

14 Notwithstanding any other provision of this 

15 title, if the Secretary determines appropriate, 

16 the Secretary may modify the coverage under 

17 this part of audiology services and hearing serv18 ices to the extent that such modification is con19 sistent with the recommendations of the United 

20 States Preventive Services Task Force.’’. 

21 (c) PAYMENT UNDER THE PHYSICIAN FEE SCHED22 ULE.—Section 1848(j)(3) of the Social Security Act (42 

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

24 3(d), is amended by inserting ‘‘(2)(KK),’’ after 

25 ‘‘(2)(JJ),’’. 


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1 (d) HEARING AIDS.— 

2 (1) REPEAL OF GROUND FOR EXCLUSION.— 

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

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

5 amended by striking ‘‘, hearing aids or examinations 

6 therefor,’’. 

7 (2) DEFINITION OF DURABLE MEDICAL EQUIP8 MENT TO INCLUDE HEARING AIDS.—Section 1861(n) 

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

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

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

12 (3) SPECIAL PAYMENT RULES FOR HEARING

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

14 (42 U.S.C. 1395m(a)), as amended by sections 

15 2(e)(2) and 3(e), is amended by adding at the end 

16 the following new paragraph: 

17 ‘‘(26) PAYMENT AND LIMITS FOR HEARING

18 AIDS.— 

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

20 under this part for hearing aids shall be, sub21 ject to subparagraph (C), the applicable percent 

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

23 otherwise payable for hearing aids under this 

24 section. 


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1 ‘‘(B) APPLICABLE PERCENT.—For pur2 poses of subparagraph (A), the applicable per3 cent specified in this subparagraph is— 

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

5 least 6 months after the date of the enact6 ment of this paragraph, 0 percent; 

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

8 specified in clause (i) and each subsequent 

9 year through the seventh year following the 

10 year specified in clause (i), the applicable 

11 percent specified in this subparagraph for 

12 the previous year increased by 10 percent13 age points; and 

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

15 year specified in clause (i) and each subse16 quent year, 80 percent. 

17 ‘‘(C) LIMITATIONS AND SECRETARIAL AU18 THORITY.— 

19 ‘‘(i) IN GENERAL.—Payment may be 

20 made under this part for an individual for 

21 not more than one hearing aid per ear dur22 ing a 48-month period. 

23 ‘‘(ii) SECRETARIAL AUTHORITY.— 

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


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1 may apply additional limitations on 

2 the extent to which hearing aids are 

3 covered under this part, including 

4 through application of a prior author5 ization requirement and through ap6 plication of criteria for a minimum 

7 level of hearing loss for coverage of an 

8 initial or replacement hearing aid. 

9 ‘‘(II) AUTHORITY TO MODIFY

10 COVERAGE.—Notwithstanding any 

11 other provision of this title, if the Sec12 retary determines appropriate, the 

13 Secretary may modify the coverage 

14 under this part of hearing aids to the 

15 extent that such modification is con16 sistent with the recommendations of 

17 the United States Preventive Services 

18 Task Force.’’. 

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

20 this section shall apply to services furnished on or after 

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

22 after the date of the enactment of this Act. 


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25 

•S 1423 IS

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

2 ORAL HEALTH CARE, VISION, CARE, AND 

3 HEARING CARE UNDER MEDICAID. 

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

5 1396d) is amended— 

6 (1) in subsection (a)— 

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

8 which may include any dental and oral health 

9 service (as defined in section 1861(kkk))’’ after 

10 ‘‘dental services’’; 

11 (B) in paragraph (13)— 

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

13 and’’ and inserting a semicolon; 

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

15 the semicolon and inserting ‘‘; and’’; and 

16 (iii) by adding at the end the fol17 lowing new subparagraph: 

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

19 defined in section 1861(lll)) or a hearing service 

20 (as defined in section 1861(ll)(5);’’; and 

21 (C) in paragraph (29), by realigning the 

22 left margin so as to align with the left margin 

23 of paragraph (28); and 

24 (2) by adding at the end the following new sub25 section: 


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26 

•S 1423 IS

1 ‘‘(ff) INCREASED FMAP FOR EXPENDITURES FOR

2 DENTAL AND ORAL HEALTH SERVICES, VISION SERV3 ICES, AND HEARING SERVICES.— 

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

5 (b), the Federal medical assistance percentage with 

6 respect to amounts expended by a State for medical 

7 assistance for services described in paragraph (2) 

8 shall be equal to 90 percent. 

9 ‘‘(2) SERVICES DESCRIBED.—A service de10 scribed in this paragraph is any service that— 

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

12 the first calendar year that begins at least 6 

13 months after the date of the enactment of this 

14 subsection; 

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

16 is— 

17 ‘‘(i) under the age of 21; and 

18 ‘‘(ii) eligible for medical assistance for 

19 the services described in subsection 

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

21 ‘‘(C) is— 

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

23 (as defined in section 1861(kkk)); 

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

25 section 1861(lll)); or 


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27 

•S 1423 IS

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

2 section 1861(ll)(5)).’’. 

Æ 


pamtmann on DSKBFK8HB2PROD with BILLS