I 
118TH CONGRESS 
1ST SESSION H. R. 4146 
To amend title XVIII of the Social Security Act to provide for coverage 
of dental services under the Medicare program. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 15, 2023 
Ms. BARRAGA´N (for herself and Ms. KELLY of Illinois) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
To amend title XVIII of the Social Security Act to provide 
for coverage of dental services under the Medicare program. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medicare Dental Ben-
efit Act of 2023’’. 
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SEC. 2. COVERAGE OF DENTAL SERVICES UNDER THE 
MEDICARE PROGRAM. 
(a) COVERAGE.—Section 1861(s)(2) of the Social Se-
curity Act (42 U.S.C. 1395x(s)(2)) is amended— 
(1) in subparagraph (II), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (JJ), by adding ‘‘and’’ at 
the end; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(KK) dental and oral health services (as de-
fined in subsection (nnn));’’. 
(b) DENTAL
AND ORAL HEALTH SERVICES DE-
FINED.—Section 1861 of the Social Security Act (42 
U.S.C. 1395x) is amended by adding at the end the fol-
lowing new subsection: 
‘‘Dental and Oral Health Services 
‘‘(nnn) The term ‘dental and oral health services’ 
means services (as defined by the Secretary) that are nec-
essary to prevent disease and promote oral health, restore 
oral structures to health and function, reduce oral pain, 
and treat emergency conditions, including— 
‘‘(1) routine diagnostic and preventive care 
such as dental cleanings, exams, and x-rays; 
‘‘(2) basic dental services such as fillings and 
extractions; 
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‘‘(3) major dental services such as root canals, 
crowns, and dentures; 
‘‘(4) emergency dental care; and 
‘‘(5) other necessary services related to dental 
and oral health (as defined by the Secretary).’’. 
(c) COVERAGE OF ROUTINE DIAGNOSTIC AND PRE-
VENTIVE CARE
AS
A PREVENTIVE SERVICE.—Section 
1861(ddd)(3) of the Social Security Act (42 U.S.C. 
1395x(ddd)(3)) is amended by adding at the end the fol-
lowing new subparagraph: 
‘‘(D) Dental and oral health services described 
in paragraph (1) of subsection (nnn), relating to 
routine diagnostic and preventive care.’’. 
(d) PAYMENT; COINSURANCE; AND LIMITATIONS.— 
(1) IN GENERAL.—Section 1833(a)(1) of the 
Social Security Act (42 U.S.C. 1395l(a)(1)) is 
amended— 
(A) by striking ‘‘and’’ before ‘‘(HH)’’; and 
(B) by inserting before the semicolon at 
the end the following: ‘‘and (II) with respect to 
dental and oral health services (as defined in 
section 1861(nnn), other than those services de-
scribed in paragraph (1) of such section), the 
amount paid shall be the payment amount spec-
ified under section 1834(aa).’’. 
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(2) PAYMENT AND LIMITS SPECIFIED.—Section 
1834 of the Social Security Act (42 U.S.C. 1395m) 
is amended by adding at the end the following new 
subsection: 
‘‘(aa) 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(nnn), other than those 
services described in paragraph (1) of such section) 
shall be, subject to paragraph (3), the applicable 
percentage (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 PERCENTAGE.— 
‘‘(A) IN GENERAL.—For purposes of para-
graph (1), subject to subparagraph (B), the ap-
plicable percentage specified in this paragraph 
is— 
‘‘(i) for the first year beginning at 
least 6 months after the date of the enact-
ment of this subsection, 0 percent; 
‘‘(ii) for the year following the year 
specified in subparagraph (A) and each 
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subsequent year through the seventh year 
following the year specified in subpara-
graph (A), the applicable percent specified 
in this paragraph for the previous year in-
creased by 10 percentage points; and 
‘‘(iii) for the eighth year following the 
year specified in subparagraph (A) and 
each subsequent year, 80 percent. 
‘‘(B) SPECIAL RULE FOR CERTAIN LOW-IN-
COME
INDIVIDUALS.—For purposes of para-
graph (1), with respect to dental and oral 
health services described in such paragraph that 
are 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 in-
dividual if the individual were enrolled in a pre-
scription drug plan or an MA–PD plan under 
part D, for the first year beginning at least 6 
months after the date of the enactment of this 
subsection and each subsequent year, the appli-
cable percent specified in this paragraph is 80 
percent. 
‘‘(3) LIMITATIONS AND SECRETARIAL AUTHOR-
ITY.— 
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‘‘(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
ADDI-
TIONAL 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 authoriza-
tion requirement. 
‘‘(ii) AUTHORITY
TO
MODIFY
COV-
ERAGE.—Notwithstanding any other provi-
sion of this title, if the Secretary deter-
mines appropriate, the Secretary may mod-
ify the coverage under this part of dental 
and oral health services to the extent that 
such modification is consistent with the 
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recommendations of the United States Pre-
ventive Services Task Force. 
‘‘(iii) AUTHORITY
TO
WAIVE
FRE-
QUENCY
LIMITATIONS.—The 
Secretary 
may waive any frequency limitation or 
other limitation as described in this para-
graph for an individual (or category of in-
dividuals) as determined appropriate by 
the Secretary.’’. 
(e) PAYMENT UNDER PHYSICIAN FEE SCHEDULE.— 
Section 1848(j)(3) of the Social Security Act (42 U.S.C. 
1395w–4(j)(3)) is amended by striking ‘‘risk assessment) 
,’’ and inserting ‘‘risk assessment), (2)(KK),’’. 
(f) DENTAL PROSTHESES.— 
(1) IN
GENERAL.—Section 1861(s)(8) of the 
Social Security Act (42 U.S.C. 1395x(s)(8)) is 
amended— 
(A) by striking ‘‘(other than dental)’’ and 
inserting ‘‘(including dental)’’; and 
(B) by striking ‘‘internal body’’. 
(2) 
SPECIAL
PAYMENT
RULES.—Section 
1834(a) of the Social Security Act (42 U.S.C. 
1395m(a)) is amended by adding at the end the fol-
lowing new paragraph: 
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‘‘(23) PAYMENT
AND
LIMITS
FOR
DENTAL 
PROSTHESES.— 
‘‘(A) IN GENERAL.—The payment amount 
under this part for dental prostheses shall be, 
subject to subparagraph (C), the applicable per-
cent (specified in subparagraph (B)) of the 
amount otherwise payable for such dental pros-
theses under this section. 
‘‘(B) APPLICABLE PERCENT.— 
‘‘(i) IN
GENERAL.—For purposes of 
subparagraph (A), subject to clause (ii), 
the applicable percent specified in this sub-
paragraph is— 
‘‘(I) for the first year beginning 
at least 6 months after the date of the 
enactment of this paragraph, 0 per-
cent; 
‘‘(II) for the year following the 
year specified in clause (i) and each 
subsequent year through the seventh 
year following the year specified in 
clause (i), the applicable percent spec-
ified in this subparagraph for the pre-
vious year increased by 10 percentage 
points; and 
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‘‘(III) for the eighth year fol-
lowing the year specified in clause (i) 
and each subsequent year, 80 percent. 
‘‘(ii) SPECIAL
RULE
FOR
CERTAIN 
LOW-INCOME INDIVIDUALS.—For purposes 
of subparagraph (A), with respect to den-
tal prostheses furnished to an individual 
who is a subsidy eligible individual (as de-
fined 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 an MA–PD plan under part 
D, for the first year beginning at least 6 
months after the date of the enactment of 
this paragraph and each subsequent year, 
the applicable percent specified in this sub-
paragraph is 80 percent. 
‘‘(C) LIMITATIONS AND SECRETARIAL AU-
THORITY.— 
‘‘(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 dental prostheses 
once every five years; and 
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tation or other limitation as described 
in this subparagraph for an individual 
(or category of individuals) as deter-
mined appropriate by the Secretary’’. 
(g) REPEAL OF GROUND FOR EXCLUSION.—Section 
1862(a) of the Social Security Act (42 U.S.C. 1395y) is 
amended by striking paragraph (12). 
(h) EFFECTIVE DATE.—The amendments made by 
this section shall apply to services furnished on or after 
January 1, 2025. 
SEC. 3. INCREASED FMAP FOR ADDITIONAL EXPENDI-
TURES FOR MEDICARE COST-SHARING FOR 
DENTAL AND ORAL HEALTH SERVICES. 
Section 1905 of the Social Security Act (42 U.S.C. 
1396d) is amended— 
(1) in subsection (b), by striking ‘‘and (ii)’’ and 
inserting ‘‘(ii), and (jj)’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(jj) INCREASED FMAP FOR ADDITIONAL EXPENDI-
TURES FOR MEDICARE COST-SHARING FOR DENTAL AND 
ORAL HEALTH SERVICES.—Notwithstanding subsection 
(b), with respect to the portion of the amounts expended 
by a State for medical assistance for medicare cost-sharing 
(as defined in subsection (p)(3)) for qualified medicare 
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beneficiaries described in subsection (p)(1) that is attrib-
utable to the coverage under part B of title XVIII of den-
tal and oral health services (as defined in section 
1861(nnn)), as determined by the Secretary, the Federal 
medical assistance percentage for a State that is one of 
the 50 States or the District of Columbia shall be equal 
to 100 percent.’’. 
SEC. 4. PREVENTIVE SERVICES TASKFORCE. 
(a) IN GENERAL.—Section 915(a)(1) of the Public 
Health Service Act (42 U.S.C. 299b–4(a)(1)) is amended, 
in the first sentence, by inserting ‘‘, including at least 1 
oral health professional’’ after ‘‘expertise’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall take effect January 1, 2025. 
Æ 
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