Medicare Dental, Vision, and Hearing Benefit Act of 2021

To amend title XVIII of the Social Security Act to provide for coverage of dental, vision, and hearing care under the Medicare program. 1. Short title This Act may be cited as the Medicare Dental, Vision, and Hearing Benefit Act of 2021 2. Dental and oral health care (a) Coverage Section 1861(s)(2) of the Social Security Act 42 U.S.C. 1395x(s)(2) (1) in subparagraph (GG), by striking and (2) in subparagraph (HH), by adding and (3) by adding at the end the following new subparagraph: (II) dental and oral health services (as defined in subsection (lll)); . (b) Dental and oral health services defined Section 1861 of the Social Security Act ( 42 U.S.C. 1395x (lll) Dental and oral health services The term dental and oral health services (1) preventative and screening services, such as oral exams, dental cleanings, dental x-rays, and fluoride treatments; (2) basic dental services, such as tooth restorations, basic periodontics services, tooth extractions, and oral disease management services; (3) major dental services, such as major tooth restorations, major periodontics services, bridges, crowns, root canals, and extractions; (4) emergency dental care; and (5) other necessary services related to dental or oral health (as defined by the Secretary). . (c) Payment; coinsurance; and limitations (1) In general Section 1833(a)(1) of the Social Security Act ( 42 U.S.C. 1395l(a)(1) (A) by striking and (CC) (B) by inserting before the semicolon at the end the following: , and (DD) with respect to dental and oral health services (as defined in section 1861(lll)), the amount paid shall be the payment amount specified under section 1834(y) (2) Payment and limits specified Section 1834 of the Social Security Act ( 42 U.S.C. 1395m (y) Payment and limits for dental and oral health services (1) In general The payment amount under this part for dental and oral health services (as defined in section 1861(lll)) shall be, subject to paragraph (3), the applicable percent (specified in paragraph (2)) of the lesser of the actual charge for the services or the amount determined under the payment basis determined under section 1848. (2) Applicable percent (A) In general For purposes of paragraph (1), except as provided in subparagraph (B), the applicable percent specified in this paragraph is— (i) with respect to services described in section 1861(lll)(1) furnished during 2022 or a subsequent year, 100 percent; and (ii) with respect to services not described in clause (i)— (I) for a year before 2023, 0 percent; (II) for 2023, 30 percent; (III) for 2024, 60 percent; and (IV) for 2025 and each subsequent year, 80 percent. (B) Special rule for certain low-income individuals For purposes of paragraph (1), the applicable percent specified in this paragraph is, with respect to services furnished to an individual who is a subsidy eligible individual (as defined in section 1860D–14(a)(3)), or who would be a subsidy eligible individual if the individual were enrolled in a prescription drug plan or MA–PD plan— (i) with respect to services described in section 1861(lll)(1), for 2022 and each subsequent year, 100 percent; and (ii) with respect to services not described in clause (i), for 2023 and each subsequent year, 80 percent. (3) Limitations and Secretarial authority (A) Frequency With respect to dental and oral health services that are— (i) routine dental cleanings, payment may be made under this part for only two such cleanings during a 12-month period; and (ii) routine exams, payment may be made under this part for only two such exams during a 12-month period. (B) Secretarial authority (i) Authority to apply additional limitations The Secretary may apply such other reasonable limitations on the extent to which dental and oral services are covered under this part, including through application of a prior authorization requirement. (ii) Authority to modify coverage Notwithstanding any other provision of this title, if the Secretary determines appropriate, the Secretary may modify the coverage under this part of dental and oral health services to the extent that such modification is consistent with the recommendations of the United States Preventive Services Task Force. (iii) Authority to waive frequency limitations Notwithstanding subparagraph (A), the Secretary may waive any frequency limitation under such subparagraph for an individual (or category of individuals) if determined appropriate by the Secretary. . (d) Payment under physician fee schedule Section 1848(j)(3) of the Social Security Act ( 42 U.S.C. 1395w–4(j)(3) (2)(II), (3) (e) Dentures (1) In general Section 1861(s)(8) of the Social Security Act 42 U.S.C. 1395x(s)(8) (A) by striking (other than dental) (including dentures) (B) by striking internal body (2) Special payment rules Section 1834(a) of the Social Security Act ( 42 U.S.C. 1395m(a) (23) Payment and limits for dentures (A) In general The payment amount under this part for dentures shall be, subject to subparagraph (C), the applicable percent (specified in subparagraph (B)) of the amount otherwise payable for such dentures under this section. (B) Applicable percent For purposes of subparagraph (A), the applicable percent specified in this subparagraph is— (i) for a year before 2023, 0 percent; and (ii) for 2023 and each subsequent year, 80 percent. (C) Limitations and Secretarial authority (i) In general Payment may be made under this part for an individual for— (I) not more than one full upper and one full lower denture once every five years; and (II) not more than one partial upper denture and one partial lower denture once every five years. (ii) Secretarial authority (I) Authority to apply additional limitations The Secretary may apply such other reasonable limitations on the extent to which dentures are covered under this part, including through application of a prior authorization requirement. (II) Authority to modify coverage Notwithstanding any other provision of this title, if the Secretary determines appropriate, the Secretary may modify the coverage under this part of dentures to the extent that such modification is consistent with the recommendations of the United States Preventive Services Task Force. (III) Authority to waive frequency limitations Notwithstanding clause (i), the Secretary may waive any frequency limitation under such clause for an individual (or category of individuals) if determined appropriate by the Secretary. . (f) Repeal of ground for exclusion Section 1862(a) of the Social Security Act ( 42 U.S.C. 1395y (g) Effective date The amendments made by this section shall apply to services furnished on or after January 1, 2022. 3. Vision care (a) Coverage Section 1861(s)(2) of the Social Security Act ( 42 U.S.C. 1395x(s)(2) (1) in subparagraph (HH), by striking and (2) in subparagraph (II), by adding and (3) by adding at the end the following new subparagraph: (JJ) vision services (as defined in subsection (mmm)); . (b) Vision services defined Section 1861 of the Social Security Act ( 42 U.S.C. 1395x (mmm) Vision services The term vision services (1) routine eye examinations and procedures performed (during the course of any eye examination) to determine the refractive state of the eyes; and (2) other necessary services related to eye and vision health (as defined by the Secretary). . (c) Payment; coinsurance; and limitations (1) In general Section 1833(a)(1) of the Social Security Act ( 42 U.S.C. 1395l(a)(1) (A) by striking and (DD) (B) by inserting before the semicolon at the end the following: , and (EE) with respect to vision services (as defined in section 1861(mmm)), the amount paid shall be the payment amount specified under section 1834(z) (2) Payment and limits specified Section 1834 of the Social Security Act ( 42 U.S.C. 1395m (z) Payment and limits for vision services (1) In general The payment amount under this part for vision services (as defined in section 1861(mmm)) shall be, subject to paragraph (2), 80 percent of the lesser of the actual charge for the services or the amount determined under the payment basis determined under section 1848. (2) Limitations and Secretarial authority (A) Frequency With respect to routine eye exams, payment may be made under this part for only one such exam during a 12-month period. (B) Secretarial authority (i) Authority to apply additional limitations The Secretary may apply other reasonable limitations on the extent to which vision services are covered under this part, including through application of a prior authorization requirement. (ii) Authority to modify coverage Notwithstanding any other provision of this title, if the Secretary determines appropriate, the Secretary may modify the coverage under this part of vision services to the extent that such modification is consistent with the recommendations of the United States Preventive Services Task Force. (iii) Authority to waive frequency limitations Notwithstanding subparagraph (A), the Secretary may waive any frequency limitation under such subparagraph for an individual (or category of individuals) if determined appropriate by the Secretary. . (d) Payment under physician fee schedule Section 1848(j)(3) of the Social Security Act ( 42 U.S.C. 1395w–4(j)(3) (2)(JJ), (2)(II), (e) Special payment rules for eyeglasses, contact lenses, and low vision devices Section 1834(a) of the Social Security Act ( 42 U.S.C. 1395m(a) (24) Payment and limits for eyeglasses and contact lenses (A) In general The payment amount under this part for eyeglass lenses, eyeglass frames, and contact lenses shall be, subject to subparagraph (B), 80 percent of the amount otherwise payable for such eyeglass lenses, eyeglass frames, and contact lenses, respectively, under this section. (B) Limitations and Secretarial authority (i) In general Subject to clause (iii), payment may be made under this part (other than for eyewear described in section 1861(s)(8)) for an individual for— (I) not more than one pair of eyeglass lenses during any 12-month period in an amount not exceeding $100; (II) not more than one set of eyeglass frames during any 24-month period in an amount not exceeding $100; and (III) contact lenses, only to the extent that the sum of such payments for contact lenses does not exceed a limitation of $200 during any 24-month period beginning during the first year beginning at least six months after the date of the enactment of this paragraph (or, beginning during a subsequent year, such limitation for a 24-month period beginning in the previous year increase by an appropriate inflation adjustment specified by the Secretary). (ii) Secretarial authority (I) Authority to apply additional limitations The Secretary may apply such other reasonable limitations on the extent to which eyeglass lenses, eyeglass frames, and contact lenses are covered under this part, including through application of a prior authorization requirement. (II) Authority to modify coverage Notwithstanding any other provision of this title, if the Secretary determines appropriate, the Secretary may modify the coverage under this part of eyeglass lenses, eyeglass frames, and contact lenses to the extent that such modification is consistent with the recommendations of the United States Preventive Services Task Force. (III) Authority to waive frequency limitations Notwithstanding clause (i), the Secretary may waive any frequency limitation under such clause for an individual (or category of individuals) if determined appropriate by the Secretary. (iii) Update of payment limits to account for inflation With respect to eyeglass lenses and contact lenses furnished during 2023 or a subsequent year, the Secretary shall increase the dollar amounts in effect under this subparagraph for such year by the percentage change in the consumer price index for all urban consumers (United States city average) for the 12-month period ending with June of the previous year. (25) Payment and limits for low vision devices (A) In general The payment amount under this part for low vision devices shall be 80 percent of the amount otherwise payable for low vision devices under this section. (B) Secretarial authority (i) Authority to apply limitations The Secretary may apply reasonable limitations on the extent to which low vision devices are covered under this part, including through application of a prior authorization requirement. (ii) Authority to modify coverage Notwithstanding any other provision of this title, if the Secretary determines appropriate, the Secretary may modify the coverage under this part of low vision devices to the extent that such modification is consistent with the recommendations of the United States Preventive Services Task Force. (C) Low vision device defined In this paragraph, the term low vision device ordinary eyeglasses or contact lenses . (f) Definition of durable medical equipment To include eyeglasses, contact lenses, and low vision devices Section 1861(n) of the Social Security Act ( 42 U.S.C. 1395x(n) (1) by striking and eye tracking (2) by inserting , and eyeglass lenses, low vision devices (as defined in section 1834(a)(25)), eyeglass frames, and contact lenses ; except (g) Repeal of ground for exclusion Section 1862(a)(7) of the Social Security Act ( 42 U.S.C. 1395y(a)(7) , eyeglasses (other than eyewear described in section 1861(s)(8)) or eye examinations for the purpose of prescribing, fitting, or changing eyeglasses, procedures performed (during the course of any eye examination) to determine the refractive state of the eyes (h) Effective date The amendments made by this section shall apply to services furnished on or after January 1, 2022. 4. Hearing care (a) Coverage (1) In general Section 1861(s)(2) of the Social Security Act ( 42 U.S.C. 1395x(s)(2) (A) in subparagraph (II), by striking and (B) in subparagraph (JJ), by inserting and (C) by adding at the end the following new subparagraph: (KK) audiology services (as defined in subsection (ll)(3)) and hearing services (as defined in subsection (ll)(5)); . (2) Hearing services defined Section 1861(ll) of the Social Security Act ( 42 U.S.C. 1395x(ll) (A) in the subsection heading, by inserting ; Hearing Services Audiology Services (B) by adding at the end the following new paragraph: (5) The term hearing services (A) routine hearing exams and exams for hearing aids; and (B) other necessary services related to hearing health (as defined by the Secretary). . (b) Payment; coinsurance; and limitations (1) In general Section 1833(a)(1) of the Social Security Act ( 42 U.S.C. 1395l(a)(1) (A) by striking and (EE) (B) by inserting before the semicolon at the end the following: , and (FF) with respect to audiology services (as defined in section 1861(ll)(3)) and hearing services (as defined in section 1861(ll)(5)), the amount paid shall be the payment amount specified under section 1834(aa) (2) Payment and limits specified Section 1834 of the Social Security Act ( 42 U.S.C. 1395m (aa) Payment and limits for hearing services (1) In general The payment amount under this part for audiology services (as defined in section 1861(ll)(3)) and hearing services (as defined in section 1861(ll)(5)), shall be, subject to paragraph (2), 80 percent of the lesser of the actual charge for the services or the amount determined under the payment basis determined under section 1848. (2) Secretarial authority (A) Authority to apply limitations The Secretary may apply reasonable limitations on the extent to which audiology services and hearing services are covered under this part, including through application of a prior authorization requirement. (B) Authority to modify coverage Notwithstanding any other provision of this title, if the Secretary determines appropriate, the Secretary may modify the coverage under this part of audiology services and hearing services to the extent that such modification is consistent with the recommendations of the United States Preventive Services Task Force. . (c) Payment under the physician fee schedule Section 1848(j)(3) of the Social Security Act ( 42 U.S.C. 1395w–4(j)(3) (2)(KK), (3) (d) Hearing aids (1) Repeal of ground for exclusion Section 1862(a)(7) of the Social Security Act ( 42 U.S.C. 1395y(a)(7) , hearing aids or examinations therefor, (2) Definition of durable medical equipment to include hearing aids Section 1861(n) of the Social Security Act ( 42 U.S.C. 1395x(n) hearing aids, and eyeglass lenses (3) Special payment rules for hearing aids Section 1834(a) of the Social Security Act ( 42 U.S.C. 1395m(a) (26) Payment and limits for hearing aids (A) In general The payment amount under this part for hearing aids shall be, subject to subparagraph (B), 80 percent of the amount otherwise payable for hearing aids under this section. (B) Limitations and Secretarial authority (i) In general Payment may be made under this part for an individual for not more than one hearing aid per ear during a 48-month period. (ii) Secretarial authority (I) Authority to apply additional limitations The Secretary may apply additional limitations on the extent to which hearing aids are covered under this part, including through application of a prior authorization requirement and through application of criteria for a minimum level of hearing loss for coverage of an initial or replacement hearing aid. (II) Authority to modify coverage Notwithstanding any other provision of this title, if the Secretary determines appropriate, the Secretary may modify the coverage under this part of hearing aids to the extent that such modification is consistent with the recommendations of the United States Preventive Services Task Force. (iii) Authority to waive frequency limitations Notwithstanding clause (i), the Secretary may waive any frequency limitation under such clause for an individual (or category of individuals) if determined appropriate by the Secretary. . (e) Effective date The amendments made by this section shall apply to services furnished on or after January 1, 2022. 5. Nonapplication of competitive acquisition to certain items Section 1847(a)(2) of the Social Security Act ( 42 U.S.C. 1395w–3(a)(2) (1) by striking and excluding excluding (2) by inserting , and excluding dentures, eyeglass lenses, contact lenses, and hearing aids 6. Inclusion of an oral health professional on the United States Preventive Services Task Force (a) In general The first sentence of section 915(a)(1) of the Public Health Service Act ( 42 U.S.C. 299b–4(a)(1) , including at least 1 oral health professional (b) Effective date The amendment made by subsection (a) shall apply beginning on January 1 of the first year beginning at least 6 months after the date of the enactment of this Act.

Summary: Medicare Dental, Vision, and Hearing Benefit Act of 2021 This bill provides for Medicare coverage of dental, vision, and hearing care. Coverage includes (1) routine dental cleanings and exams, basic and major dental services, emergency dental care, and dentures; (2) routine eye exams, eyeglasses, and contact lenses; and (3) routine hearing exams, hearing aids, and exams for hearing aids. With respect to such care, the bill establishes special payment rules, limitations, and coinsurance requirements.