II 

116TH CONGRESS 

1ST SESSION S. 22 

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 3, 2019 

Mr. CARDIN 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 2019’’. 

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— 


kjohnson on DSK79L0C42 with BILLS
2 

•S 22 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 (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 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 


kjohnson on DSK79L0C42 with BILLS
3 

•S 22 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 (kkk), relating to 

10 routine 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 ‘‘(CC)’’; and 

16 (B) by inserting before the semicolon at 

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

18 to dental and oral health services (as defined in 

19 section 1861(kkk), 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(v)’’. 

23 (2) PAYMENT AND LIMITS SPECIFIED.—Section 

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


kjohnson on DSK79L0C42 with BILLS
4 

•S 22 IS

1 is amended by adding at the end the following new 

2 subsection: 

3 ‘‘(v) 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), 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.—For purposes 

15 of paragraph (1), the applicable percentage specified 

16 in 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 


kjohnson on DSK79L0C42 with BILLS
5 

•S 22 IS

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) LIMITATIONS AND SECRETARIAL AUTHOR7 ITY.— 

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

9 and oral health services that are— 

10 ‘‘(i) routine dental cleanings, payment 

11 may be made under this part for only two 

12 such cleanings during a 12-month period; 

13 and 

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

15 made under this part for only two such 

16 exams during a 12-month period. 

17 ‘‘(B) SECRETARIAL AUTHORITY.— 

18 ‘‘(i) AUTHORITY TO APPLY ADDI19 TIONAL LIMITATIONS.—The Secretary may 

20 apply such other reasonable limitations on 

21 the extent to which dental and oral services 

22 are covered under this part, including 

23 through application of a prior authoriza24 tion requirement. 


kjohnson on DSK79L0C42 with BILLS
6 

•S 22 IS

1 ‘‘(ii) AUTHORITY TO MODIFY COV2 ERAGE.—Notwithstanding any other provi3 sion of this title, if the Secretary deter4 mines appropriate, the Secretary may mod5 ify the coverage under this part of dental 

6 and oral health services to the extent that 

7 such modification is consistent with the 

8 recommendations of the United States Pre9 ventive Services Task Force.’’. 

10 (e) PAYMENT UNDER PHYSICIAN FEE SCHEDULE.— 

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

12 1395w–4(j)(3)) is amended by striking ‘‘risk assessment) 

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

14 (f) DENTAL PROSTHESES.— 

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

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

17 amended— 

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

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

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

21 (2) SPECIAL PAYMENT RULES.—Section 

22 1834(a) of the Social Security Act (42 U.S.C. 

23 1395m(a)) is amended by adding at the end the fol24 lowing new paragraph: 


kjohnson on DSK79L0C42 with BILLS
7 

•S 22 IS

1 ‘‘(23) PAYMENT AND LIMITS FOR DENTAL

2 PROSTHESES.— 

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

4 under this part for dental prostheses shall be, 

5 subject to subparagraph (C), the applicable per6 cent (specified in subparagraph (B)) of the 

7 amount otherwise payable for such dental pros8 theses under 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. 


kjohnson on DSK79L0C42 with BILLS
8 

•S 22 IS

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

3 ‘‘(i) IN GENERAL.—Payment may be 

4 made under this part for an individual 

5 for— 

6 ‘‘(I) not more than one full upper 

7 and one full lower dental prostheses 

8 once every five years; and 

9 ‘‘(II) not more than one partial 

10 upper dental prostheses and one par11 tial lower dental prostheses once every 

12 five years. 

13 ‘‘(ii) SECRETARIAL AUTHORITY.— 

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

16 may apply such other reasonable limi17 tations on the extent to which dental 

18 prostheses are covered under this 

19 part, including through application of 

20 a prior authorization requirement. 

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 


kjohnson on DSK79L0C42 with BILLS
9 

•S 22 IS

1 under this part of dental prostheses to 

2 the extent that such modification is 

3 consistent with the recommendations 

4 of the United States Preventive Serv5 ices Task Force.’’. 

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

7 1862(a) of the Social Security Act (42 U.S.C. 1395y) is 

8 amended by striking paragraph (12). 

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

10 this section shall apply to services furnished on or after 

11 January 1, 2020. 

Æ 


kjohnson on DSK79L0C42 with BILLS