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SEC. 506. PROVIDING FOR CERTAIN RULES REGARDING 
THE TREATMENT OF ELIGIBLE RETIREMENT 
PLANS IN DETERMINING THE ELIGIBILITY OF 
INDIVIDUALS 
FOR 
PREMIUM 
AND 
COST- 
SHARING SUBSIDIES UNDER PART D OF THE 
MEDICARE PROGRAM. 
Section 1860D–14(a)(3)(C)(i) of the Social Security 
Act (42 U.S.C. 1395w–114(a)(3)(C)(i)) is amended, by 
striking ‘‘except that support and maintenance furnished 
in kind shall not be counted as income; and’’ and inserting 
‘‘except that— 
‘‘(I) support and maintenance 
furnished in kind shall not be counted 
as income; and 
‘‘(II) for plan years beginning on 
or after January 1, 2024, any dis-
tribution or withdrawal from an eligi-
ble retirement plan (as defined in sub-
paragraph (B) of section 402(c)(8) of 
the Internal Revenue Code of 1986, 
but excluding any defined benefit plan 
described in clause (iv) or (v) of such 
subparagraph and any qualified trust 
(as defined in subparagraph (A) of 
such section) which is part of such a 
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defined benefit plan) shall be counted 
as income; and’’. 
SEC. 507. REDUCING COST-SHARING AND OTHER PROGRAM 
IMPROVEMENTS 
FOR 
LOW-INCOME 
BENE-
FICIARIES. 
(a) INCREASE IN INCOME ELIGIBILITY TO 150 PER-
CENT
OF
FPL FOR
QUALIFIED
MEDICARE
BENE-
FICIARIES.— 
(1) IN GENERAL.—Section 1905(p)(2)(A) of the 
Social Security Act (42 U.S.C. 1396d(p)(2)(A)) is 
amended by striking ‘‘shall be at least the percent 
provided under subparagraph (B) (but not more 
than 100 percent) of the official poverty line’’ and 
all that follows through the period at the end and 
inserting the following: ‘‘shall be— 
‘‘(i) before January 1, 2022, at least 
the percent provided under subparagraph 
(B) (but not more than 100 percent) of 
the official poverty line (as defined by the 
Office of Management and Budget, and re-
vised annually in accordance with section 
673(2) of the Omnibus Budget Reconcili-
ation Act of 1981) applicable to a family 
of the size involved; and 
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‘‘(ii) on or after January 1, 2022, 
equal to 150 percent of the official poverty 
line (as so defined and revised) applicable 
to a family of the size involved.’’. 
(2) NOT
COUNTING
IN-KIND
SUPPORT
AND 
MAINTENANCE AS INCOME.—Section 1905(p)(2)(D) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396d(p)(2)(D)) is amended by adding at the end 
the following new clause: 
‘‘(iii) In determining income under 
this subsection, support and maintenance 
furnished in kind, as described in section 
1612(a)(2)(A), shall not be counted as in-
come.’’. 
(3) CONFORMING AMENDMENTS.— 
(A) Section 1902(a)(10)(E) of the Social 
Security Act (42 U.S.C. 1396a(a)(10)(E)) is 
amended— 
(i) in clause (iii), by striking ‘‘for 
making medical’’ and inserting ‘‘before 
January 1, 2022, for making medical’’; 
and 
(ii) in clause (iv), by striking ‘‘subject 
to sections’’ and inserting ‘‘before January 
1, 2022, subject to sections’’. 
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(B) Section 1933 of the Social Security 
Act (42 U.S.C. 1396u–3) is amended— 
(i) in subsection (a), by striking ‘‘A 
State plan’’ and inserting ‘‘Subject to sub-
section (h), a State plan’’; and 
(ii) by adding at the end the following 
new subsection: 
‘‘(h) SUNSET.—The provisions of this section shall 
have no force or effect after December 31, 2021.’’. 
(b) 100 PERCENT FMAP.—Section 1905 of the So-
cial Security Act (42 U.S.C. 1396d) is amended by adding 
at the end the following new subsection: 
‘‘(gg) INCREASED FMAP FOR EXPANDED MEDICARE 
COST-SHARING POPULATIONS.— 
‘‘(1) IN GENERAL.—Notwithstanding subsection 
(b), with respect to expenditures described in para-
graph (2) the Federal medical assistance percentage 
shall be equal to 100 percent. 
‘‘(2) EXPENDITURES DESCRIBED.—The expend-
itures described in this paragraph are expenditures 
made on or after January 1, 2022, for medical as-
sistance for medicare cost-sharing provided to any 
individual under clause (i) or (ii) of section 
1902(a)(10)(E) who would not have been eligible for 
medicare cost-sharing under any such clause under 
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the income or resource eligibility standards in effect 
on October 1, 2018.’’. 
TITLE VI—PROVIDING FOR DEN-
TAL, VISION, AND HEARING 
COVERAGE UNDER THE MEDI-
CARE PROGRAM 
SEC. 601. DENTAL AND ORAL HEALTH CARE. 
(a) COVERAGE.—Section 1861(s)(2) of the Social Se-
curity Act (42 U.S.C. 1395x(s)(2)) is amended— 
(1) in subparagraph (GG), by striking ‘‘and’’ 
after the semicolon at the end; 
(2) in subparagraph (HH), by striking the pe-
riod at the end and adding ‘‘; and’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(II) dental and oral health services (as defined 
in subsection (kkk));’’. 
(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: 
‘‘(kkk) DENTAL AND ORAL HEALTH SERVICES.— 
‘‘(1) IN GENERAL.—The term ‘dental and oral 
health services’ means items and services (other 
than such items and services for which payment may 
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be made under part A as inpatient hospital services) 
that are furnished during 2025 or a subsequent 
year, for which coverage was not provided under 
part B as of the date of the enactment of this sub-
section, and that are— 
‘‘(A) the preventive and screening services 
described in paragraph (2) furnished by a doc-
tor of dental surgery or of dental medicine (as 
described in subsection (r)(2)) or an oral health 
professional (as defined in paragraph (4)); or 
‘‘(B) the basic treatments specified for 
such year by the Secretary pursuant to para-
graph (3)(A) and the major treatments speci-
fied for such year by the Secretary pursuant to 
paragraph (3)(B) furnished by such a doctor or 
such a professional. 
‘‘(2) PREVENTIVE
AND
SCREENING
SERV-
ICES.—The preventive and screening services de-
scribed in this paragraph are the following: 
‘‘(A) Oral exams. 
‘‘(B) Dental cleanings. 
‘‘(C) Dental x-rays performed in the office 
of a doctor or professional described in para-
graph (1)(A). 
‘‘(D) Fluoride treatments. 
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‘‘(3) BASIC
AND
MAJOR
TREATMENTS.—For 
2025 and each subsequent year, the Secretary shall 
specify— 
‘‘(A) basic treatments (which may include 
basic tooth restorations, basic periodontic serv-
ices, tooth extractions, and oral disease man-
agement services); and 
‘‘(B) major treatments (which may include 
major tooth restorations, major periodontic 
services, bridges, crowns, and root canals); 
that shall be included as dental and oral health serv-
ices for such year. 
‘‘(4) ORAL HEALTH PROFESSIONAL.—The term 
‘oral health professional’ means, with respect to den-
tal and oral health services, a health professional 
who is licensed to furnish such services, acting with-
in the scope of such license, by the State in which 
such services are furnished.’’. 
(c) 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) in subparagraph (N), by inserting 
‘‘and dental and oral health services (as defined 
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in 
section 
1861(kkk))’’ 
after 
‘‘section 
1861(hhh)(1))’’; 
(B) by striking ‘‘and’’ before ‘‘(CC)’’; and 
(C) 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(kkk)), the amount paid shall be 
the payment amount specified under section 
1834(x)’’. 
(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: 
‘‘(x) 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(kkk)) 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. In 
determining such amounts determined under such 
payment basis, the Secretary shall consider payment 
rates paid to dentists for comparable services under 
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State plans under title XIX, under the TRICARE 
program under chapter 55 of title 10 of the United 
States Code, and by other health care payers, such 
as Medicare Advantage plans under part C. 
‘‘(2) APPLICABLE PERCENT.—For purposes of 
paragraph (1), the applicable percent specified in 
this paragraph is, with respect to dental and oral 
health services (as defined in section 1861(kkk)) fur-
nished in a year— 
‘‘(A) that are preventive and screening 
services described in paragraph (2) or basic 
treatments specified for such year pursuant to 
paragraph (3)(A) of such section, 80 percent; 
and 
‘‘(B) that are major treatments specified 
for such year pursuant to paragraph (3)(B) of 
such section— 
‘‘(i) in the case such services are fur-
nished during 2025, 10 percent; 
‘‘(ii) in the case such services are fur-
nished during 2026 or a subsequent year 
before 2029, the applicable percent speci-
fied under this subparagraph for the pre-
vious year, increased by 10 percentage 
points; and 
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‘‘(iii) in the case such services are fur-
nished during 2029 or a subsequent year, 
50 percent. 
‘‘(3) LIMITATIONS.—With respect to dental and 
oral health services that are— 
‘‘(A) preventive and screening oral exams, 
payment may be made under this part for not 
more than two such exams during a 12-month 
period; 
‘‘(B) dental cleanings, payment may be 
made under this part for not more than two 
such cleanings during a 12-month period; and 
‘‘(C) not described in subparagraph (A) or 
(B), payment may be made under this part only 
at such frequencies and under such cir-
cumstances determined appropriate by the Sec-
retary.’’. 
(d) PAYMENT UNDER PHYSICIAN FEE SCHEDULE.— 
(1) IN
GENERAL.—Section 1848(j)(3) of the 
Social Security Act (42 U.S.C. 1395w–4(j)(3)) is 
amended by inserting ‘‘(2)(II),’’ before ‘‘(3)’’. 
(2) 
EXCLUSION
FROM
MIPS.—Section 
1848(q)(1)(C)(ii) of the Social Security Act (42 
U.S.C. 1395w–4(q)(1)(C)(ii)) is amended— 
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(A) in subclause (II), by striking ‘‘or’’ at 
the end; 
(B) in subclause (III), by striking the pe-
riod at the end and inserting ‘‘; or’’; and 
(C) by adding at the end the following new 
subclause: 
‘‘(IV) with respect to 2025 and 
each subsequent year, is a doctor of 
dental surgery or of dental medicine 
(as described in section 1861(r)(2)) or 
is an oral health professional (as de-
fined in section 1861(kkk)(4)).’’. 
(3) INCLUSION
OF
ORAL
HEALTH
PROFES-
SIONALS
AS
CERTAIN
PRACTITIONERS.—Section 
1842(b)(18)(C) of the Social Security Act (42 
U.S.C. 1395u(b)(18)(C)) is amended by adding at 
the end the following new clause: 
‘‘(vii) With respect to 2025 and each subse-
quent year, an oral health professional (as defined in 
section 1861(kkk)(4)).’’. 
(e) DENTURES.— 
(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 
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(B) by inserting ‘‘and excluding dental, ex-
cept for a full or partial set of dentures fur-
nished on or after January 1, 2025’’ after ‘‘co-
lostomy care’’. 
(2) SPECIAL PAYMENT RULES.— 
(A) LIMITATIONS.—Section 1834(h) of the 
Social Security Act (42 U.S.C. 1395m(h)) is 
amended by adding at the end the following 
new paragraph: 
‘‘(6) SPECIAL
PAYMENT
RULE
FOR
DEN-
TURES.—Payment may be made under this part 
with respect to an individual for dentures— 
‘‘(A) not more than once during any 5-year 
period (except in the case that a doctor or pro-
fessional described in section 1861(kkk)(1)(A) 
determines such dentures do not fit the indi-
vidual); and 
‘‘(B) only to the extent that such dentures 
are furnished pursuant to a written order of 
such a doctor or professional.’’. 
(B) APPLICATION OF COMPETITIVE ACQUI-
SITION.— 
(i) 
IN
GENERAL.—Section 
1834(h)(1)(H) of the Social Security Act 
(42 U.S.C. 1395m(h)(1)(H)) is amended— 
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(I) in the subparagraph heading, 
by inserting ‘‘, 
DENTURES’’ after 
‘‘ORTHOTICS’’; 
(II) by inserting ‘‘, of dentures 
described in paragraph (2)(D) of such 
section,’’ after ‘‘2011,’’; and 
(III) in clause (i), by inserting ‘‘, 
such dentures’’ after ‘‘orthotics’’. 
(ii) CONFORMING AMENDMENT.—Sec-
tion 1847(a)(2) of the Social Security Act 
(42 U.S.C. 1395w–3(a)(2)) is amended by 
adding at the end the following new sub-
paragraph: 
‘‘(D) DENTURES.—Dentures described in 
section 1861(s)(8) for which payment would 
otherwise be made under section 1834(h).’’. 
(iii) EXEMPTION OF CERTAIN ITEMS 
FROM
COMPETITIVE
ACQUISITION.—Sec-
tion 1847(a)(7) of the Social Security Act 
(42 U.S.C. 1395w–3(a)(7)) is amended by 
adding at the end the following new sub-
paragraph: 
‘‘(C) CERTAIN
DENTURES.—Those items 
and services described in paragraph (2)(D) if 
furnished by a physician or other practitioner 
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(as defined by the Secretary) to the physician’s 
or practitioner’s own patients as part of the 
physician’s or practitioner’s professional serv-
ice.’’. 
(f) EXCLUSION MODIFICATIONS.—Section 1862(a) of 
the Social Security Act (42 U.S.C. 1395y(a)) is amend-
ed— 
(1) in paragraph (1)— 
(A) in subparagraph (O), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (P), by striking the 
semicolon at the end and inserting ‘‘, and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(Q) in the case of dental and oral health serv-
ices (as defined in section 1861(kkk)) that are pre-
ventive and screening services described in para-
graph (2) of such section, which are furnished more 
frequently than provided under section 1834(x)(3) 
and under circumstances other than circumstances 
determined appropriate under such section;’’; and 
(2) in paragraph (12), by inserting before the 
semicolon at the end the following: ‘‘and except that 
payment may be made under part B for dental and 
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oral health services that are covered under section 
1861(s)(2)(II)’’. 
(g) CERTAIN NON-APPLICATION.— 
(1) IN GENERAL.—Paragraphs (1) and (4) of 
section 1839(a) of the Social Security Act (42 
U.S.C. 1395r(a)) are amended by adding at the end 
of each such paragraphs the following: ‘‘In applying 
this paragraph there shall not be taken into account 
benefits and administrative costs attributable to the 
amendments made by section 601 (other than sub-
section (g)) of the Elijah E. Cummings Lower Drug 
Costs Now Act and the Government contribution 
under section 1844(a)(4)’’. 
(2) PAYMENT.—Section 1844(a) of such Act 
(42 U.S.C. 1395w(a)) is amended— 
(A) in paragraph (3), by striking the pe-
riod at the end and inserting ‘‘; plus’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(4) a Government contribution equal to the 
amount that is estimated to be payable for benefits 
and related administrative costs incurred that are 
attributable to the amendments made by section 601 
(other than subsection (g)) of the Elijah E. Cum-
mings Lower Drug Costs Now Act.’’. 
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(h) IMPLEMENTATION FUNDING.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services (in this subsection referred to as 
the ‘‘Secretary’’) shall provide for the transfer from 
the Federal Supplementary Medical Insurance Trust 
Fund under section 1841 of the Social Security Act 
(42 U.S.C. 1395t) to the Centers for Medicare & 
Medicaid Services Program Management Account 
of— 
(A) $20,000,000 for each of fiscal years 
2020 through 2025 for purposes of imple-
menting the amendments made by this section; 
and 
(B) such sums as determined appropriate 
by the Secretary for each subsequent fiscal year 
for purposes of administering the provisions of 
such amendments. 
(2) AVAILABILITY
AND
ADDITIONAL
USE
OF 
FUNDS.—Funds transferred pursuant to paragraph 
(1) shall remain available until expended and may be 
used, in addition to the purpose specified in para-
graph (1)(A), to implement the amendments made 
by sections 602 and 603. 
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SEC. 602. PROVIDING COVERAGE FOR HEARING CARE 
UNDER THE MEDICARE PROGRAM. 
(a) PROVISION
OF AURAL REHABILITATION
AND 
TREATMENT SERVICES BY QUALIFIED AUDIOLOGISTS.— 
Section 1861(ll)(3) of the Social Security Act (42 U.S.C. 
1395x(ll)(3)) is amended by inserting ‘‘(and, beginning 
January 1, 2023, such aural rehabilitation and treatment 
services)’’ after ‘‘assessment services’’. 
(b) COVERAGE OF HEARING AIDS.— 
(1) INCLUSION
OF
HEARING
AIDS
AS
PROS-
THETIC DEVICES.—Section 1861(s)(8) of the Social 
Security Act (42 U.S.C. 1395x(s)(8)) is amended by 
inserting ‘‘, and including hearing aids furnished on 
or after January 1, 2023, to individuals diagnosed 
with profound or severe hearing loss’’ before the 
semicolon at the end. 
(2) PAYMENT
LIMITATIONS
FOR
HEARING 
AIDS.—Section 1834(h) of the Social Security Act 
(42 U.S.C. 1395m(h)), as amended by section 
601(e)(2)(A), is further amended by adding at the 
end the following new paragraph: 
‘‘(7) LIMITATIONS FOR HEARING AIDS.—Pay-
ment may be made under this part with respect to 
an individual, with respect to hearing aids furnished 
on or after January 1, 2023— 
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‘‘(A) not more than once during a 5-year 
period; 
‘‘(B) only for types of such hearing aids 
that are not over-the-counter hearing aids (as 
defined in section 520(q)(1) of the Federal 
Food, Drug, and Cosmetic Act) and that are 
determined appropriate by the Secretary; and 
‘‘(C) only if furnished pursuant to a writ-
ten order of a physician or qualified audiologist 
(as defined in section 1861(ll)(4)(B)).’’. 
(3) APPLICATION
OF
COMPETITIVE
ACQUISI-
TION.— 
(A) IN GENERAL.—Section 1834(h)(1)(H) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395m(h)(1)(H)), 
as 
amended 
by 
section 
601(e)(2)(B)(i), is further amended— 
(i) in the header, by inserting ‘‘, 
HEARING AIDS’’ after ‘‘DENTURES’’; 
(ii) by inserting ‘‘, of hearing aids de-
scribed in paragraph (2)(E) of such sec-
tion,’’ after ‘‘paragraph (2)(D) of such sec-
tion’’; and 
(iii) in clause (i), by inserting ‘‘, such 
hearing aids’’ after ‘‘such dentures’’. 
(B) CONFORMING AMENDMENT.— 
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(i) IN GENERAL.—Section 1847(a)(2) 
of the Social Security Act (42 U.S.C. 
1395w–3(a)(2)), as amended by section 
601(e)(2)(B)(ii), is further amended by 
adding at the end the following new sub-
paragraph: 
‘‘(E) HEARING
AIDS.—Hearing aids de-
scribed in section 1861(s)(8) for which payment 
would 
otherwise 
be 
made 
under 
section 
1834(h).’’. 
(ii) EXEMPTION
OF
CERTAIN
ITEMS 
FROM
COMPETITIVE
ACQUISITION.—Sec-
tion 1847(a)(7) of the Social Security Act 
(42 U.S.C. 1395w–3(a)(7)), as amended 
by section 601(e)(2)(B)(iii), is further 
amended by adding at the end the fol-
lowing new subparagraph: 
‘‘(D) CERTAIN
HEARING
AIDS.—Those 
items and services described in paragraph 
(2)(E) if furnished by a physician or other 
practitioner (as defined by the Secretary) to the 
physician’s or practitioner’s own patients as 
part of the physician’s or practitioner’s profes-
sional service.’’. 
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(4) INCLUSION OF AUDIOLOGISTS AS CERTAIN 
PRACTITIONERS TO RECEIVE PAYMENT ON AN AS-
SIGNMENT-RELATED
BASIS.—Section 
1842(b)(18)(C) of the Social Security Act (42 
U.S.C. 1395u(b)(18)(C)), as amended by section 
601(d)(4), is further amended by adding at the end 
the following new clause: 
‘‘(viii) With respect to 2023 and each 
subsequent year, a qualified audiologist (as 
defined in section 1861(ll)(4)(B)).’’. 
(c) EXCLUSION MODIFICATION.—Section 1862(a)(7) 
of the Social Security Act (42 U.S.C. 1395y(a)(7)) is 
amended by inserting ‘‘(except such hearing aids or exami-
nations therefor as described in and otherwise allowed 
under section 1861(s)(8))’’ after ‘‘hearing aids or exami-
nations therefor’’. 
(d) CERTAIN NON-APPLICATION.— 
(1) IN GENERAL.—The last sentence of section 
1839(a)(1) of the Social Security Act (42 U.S.C. 
1395r(a)(1)), as added by section 601(g)(1), is 
amended by striking ‘‘section 601 (other than sub-
section (g))’’ and inserting ‘‘sections 601 (other than 
subsection (g)), 602 (other than subsection (d))’’. 
(2) 
PAYMENT.—Paragraph 
(4) 
of 
section 
1844(a) of such Act (42 U.S.C. 1395w(a)), as added 
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by section 601(g)(2), is amended by striking ‘‘sec-
tion 601 (other than subsection (g))’’ and inserting 
‘‘sections 601 (other than subsection (g)), 602 
(other than subsection (d))’’. 
(e) REPORT; REGULATIONS.— 
(1) REPORT.—Not later than the date that is 
3 years after the date of the enactment of this Act, 
the Inspector General of the Department of Health 
and Human Services shall conduct a study to assess 
(and submit to the Secretary of Health and Human 
Services a report on) any program integrity or over-
utilization risks with respect to allowing qualified 
audiologists (as defined in paragraph (4)(B) of 
1861(ll) of the Social Security Act (42 U.S.C. 
1395x(ll))) to furnish audiology services (as defined 
in paragraph (3) of such section) to individuals enti-
tled to benefits under part A of title XVIII of such 
Act (42 U.S.C. 1395c et seq.) and enrolled for bene-
fits under part B of such title (42 U.S.C.1395j et 
seq.) without such individuals being referred by a 
physician (as defined in section 1861(r) of such Act 
(42 U.S.C. 1395x(r))) or practitioner (as described 
in section 602.32 of title 42, Code of Federal Regu-
lations) to such qualified audiologists. In conducting 
such study, the Inspector General may take into ac-
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count experiences with audiologists furnishing audi-
ology services to enrollees in other Federal pro-
grams, including in a health benefit plan under 
chapter 89 of title 5, United States Code or in 
health care benefits under the TRICARE program 
under chapter 55 of title 10 of the United States 
Code or under chapter 17 of title 38 of such Code. 
(2) REGULATIONS.—The Secretary of Health 
and Human Services may promulgate regulations to 
allow qualified audiologists (as so defined) to furnish 
audiology services (as so defined) without a referral 
from a physician or practitioner, consistent with the 
findings submitted to the Secretary pursuant to 
paragraph (1)(B). 
(f) IMPLEMENTATION FUNDING.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services (in this subsection referred to as 
the ‘‘Secretary’’) shall provide for the transfer from 
the Federal Supplementary Medical Insurance Trust 
Fund under section 1841 of the Social Security Act 
(42 U.S.C. 1395t) to the Centers for Medicare & 
Medicaid Services Program Management Account 
of— 
(A) $20,000,000 for each of fiscal years 
2020 through 2024 for purposes of imple-
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menting the amendments made by this section; 
and 
(B) such sums as determined appropriate 
by the Secretary for each subsequent fiscal year 
for purposes of administering the provisions of 
such amendments. 
(2) AVAILABILITY
AND
ADDITIONAL
USE
OF 
FUNDS.—Funds transferred pursuant to paragraph 
(1) shall remain available until expended and may be 
used, in addition to the purpose specified in para-
graph (1)(A), to implement the amendments made 
by sections 601 and 603. 
SEC. 603. PROVIDING COVERAGE FOR VISION CARE UNDER 
THE MEDICARE PROGRAM. 
(a) COVERAGE.—Section 1861(s)(2) of the Social Se-
curity Act (42 U.S.C. 1395x(s)(2)), as amended by section 
601(a), is further amended— 
(1) in subparagraph (HH), by striking ‘‘and’’ 
after the semicolon at the end; 
(2) in subparagraph (II), by striking the period 
at the end and adding ‘‘; and’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(JJ) vision services (as defined in subsection 
(lll));’’. 
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(b) VISION SERVICES DEFINED.—Section 1861 of 
the Social Security Act (42 U.S.C. 1395x), as amended 
by section 601(b), is further amended by adding at the 
end the following new subsection: 
‘‘(lll) VISION SERVICES.—The term ‘vision services’ 
means— 
‘‘(1) routine eye examinations to determine the 
refractive state of the eyes, including procedures per-
formed during the course of such examination; and 
‘‘(2) contact lens fitting services; 
furnished on or after January 1, 2023, by or under the 
direct supervision of an optometrist or ophthalmologist 
who is legally authorized to furnish such examinations, 
procedures, or fitting services (as applicable) under State 
law (or the State regulatory mechanism provided by State 
law) of the State in which the examinations, procedures, 
or fitting services are furnished.’’. 
(c) PAYMENT LIMITATIONS.—Section 1834 of the 
Social Security Act (42 U.S.C. 1395m), as amended by 
section 601(c)(2), is further amended by adding at the end 
the following new subsection: 
‘‘(y) LIMITATION FOR VISION SERVICES.—With re-
spect to vision services (as defined in section 1861(lll)) 
and an individual, payment may be made under this part 
for only 1 routine eye examination described in paragraph 
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(1) of such section and 1 contact lens fitting service de-
scribed in paragraph (2) of such section during a 2-year 
period.’’. 
(d) PAYMENT UNDER PHYSICIAN FEE SCHEDULE.— 
Section 1848(j)(3) of the Social Security Act (42 U.S.C. 
1395w–4(j)(3)), as amended by section 601(d)(1), is fur-
ther amended by inserting ‘‘(2)(JJ),’’ before ‘‘(3)’’. 
(e) COVERAGE OF CONVENTIONAL EYEGLASSES AND 
CONTACT LENSES.—Section 1861(s)(8) of the Social Se-
curity Act (42 U.S.C. 1395x(s)(8)), as amended by section 
602(b)(1), is further amended by striking ‘‘, and including 
one pair of conventional eyeglasses or contact lenses fur-
nished subsequent to each cataract surgery with insertion 
of an intraocular lens’’ and inserting ‘‘, including one pair 
of conventional eyeglasses or contact lenses furnished sub-
sequent to each cataract surgery with insertion of an 
intraocular lens, if furnished before January 1, 2023, in-
cluding conventional eyeglasses or contact lenses, whether 
or not furnished subsequent to such a surgery, if furnished 
on or after January 1, 2024’’. 
(f) SPECIAL PAYMENT RULES FOR EYEGLASSES AND 
CONTACT LENSES.— 
(1) LIMITATIONS.—Section 1834(h) of the So-
cial Security Act (42 U.S.C. 1395m(h)), as amended 
by section 601(e)(2)(A) and section 602(b)(2), is 
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further amended by adding at the end the following 
new paragraph: 
‘‘(8) PAYMENT LIMITATIONS FOR EYEGLASSES 
AND CONTACT LENSES.— 
‘‘(A) IN GENERAL.—With respect to eye-
glasses and contact lenses furnished to an indi-
vidual on or after January 1, 2023, subject to 
subparagraph (B), payment may be made under 
this part only— 
‘‘(i) during a 2-year period, for either 
1 pair of eyeglasses (including lenses and 
frames) or not more than a 2-year supply 
of contact lenses that is provided in not 
more than 180-day increments; 
‘‘(ii) with respect to amounts attrib-
utable to the lenses and frames of such a 
pair of eyeglasses or amounts attributable 
to such a 2-year supply of contact lenses, 
in an amount not greater than— 
‘‘(I) for a pair of eyeglasses fur-
nished in, or a 2-year supply of con-
tact lenses beginning in, 2023— 
‘‘(aa) $85 for the lenses of 
such pair of eyeglasses and $85 
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for the frames of such pair of 
eyeglasses; or 
‘‘(bb) $85 for such 2-year 
supply of contact lenses; and 
‘‘(II) for the lenses and frames of 
a pair of eyeglasses furnished in, or a 
2-year supply of contact lenses begin-
ning in, a subsequent year, the dollar 
amounts specified under this subpara-
graph for the previous year, increased 
by the percentage change in the con-
sumer price index for all urban con-
sumers (United States city average) 
for the 12-month period ending with 
June of the previous year; 
‘‘(iii) for types of eyeglass lenses, and 
for types of contact lenses, as determined 
appropriate by the Secretary; 
‘‘(iv) if furnished pursuant to a writ-
ten order of a physician described in sec-
tion 1861(lll); and 
‘‘(v) if during the 2-year period de-
scribed in clause (i), the individual did not 
already receive (as described in subpara-
graph (B)) one pair of conventional eye-
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glasses or contact lenses subsequent to a 
cataract surgery with insertion of an intra-
ocular lens furnished during such period. 
‘‘(B) EXCEPTION.—With respect to a 2- 
year period described in subparagraph (A)(i), in 
the case of an individual who receives cataract 
surgery with insertion of an intraocular lens, 
notwithstanding subparagraph (A), payment 
may be made under this part for one pair of 
conventional eyeglasses or contact lenses fur-
nished subsequent to such cataract surgery dur-
ing such period.’’. 
(2) APPLICATION
OF
COMPETITIVE
ACQUISI-
TION.— 
(A) IN GENERAL.—Section 1834(h)(1)(H) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395m(h)(1)(H)), 
as 
amended 
by 
section 
601(e)(2)(B)(i) and section 602(b)(3)(A), is 
further amended— 
(i) in the header by inserting ‘‘, EYE-
GLASSES, AND
CONTACT
LENSES’’ after 
‘‘HEARING AIDS’’; 
(ii) by inserting ‘‘and of eyeglasses 
and contact lenses described in paragraph 
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(2)(F) of such section,’’ after ‘‘paragraph 
(2)(E) of such section,’’; and 
(iii) in clause (i), by inserting ‘‘, or 
such eyeglasses and contact lenses’’ after 
‘‘such hearing aids’’. 
(B) CONFORMING AMENDMENT.— 
(i) IN GENERAL.—Section 1847(a)(2) 
of the Social Security Act (42 U.S.C. 
1395w–3(a)(2)), as amended by section 
601(e)(2)(B)(ii) 
and 
section 
602(b)(3)(B)(i), is further amended by 
adding at the end the following new sub-
paragraph: 
‘‘(F) 
EYEGLASSES
AND
CONTACT 
LENSES.—Eyeglasses and contact lenses de-
scribed in section 1861(s)(8) for which payment 
would 
otherwise 
be 
made 
under 
section 
1834(h).’’. 
(ii) EXEMPTION
OF
CERTAIN
ITEMS 
FROM
COMPETITIVE
ACQUISITION.—Sec-
tion 1847(a)(7) of the Social Security Act 
(42 U.S.C. 1395w–3(a)(7)), as amended 
by section 601(e)(2)(B)(iii) and section 
602(b)(3)(B)(ii), is further amended by 
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adding at the end the following new sub-
paragraph: 
‘‘(E) CERTAIN EYEGLASSES AND CONTACT 
LENSES.—Those items and services described in 
paragraph (2)(F) if furnished by a physician or 
other practitioner (as defined by the Secretary) 
to the physician’s or practitioner’s own patients 
as part of the physician’s or practitioner’s pro-
fessional service.’’. 
(g) EXCLUSION MODIFICATIONS.—Section 1862(a) 
of the Social Security Act (42 U.S.C. 1395y(a)), as 
amended by section 601(f), is further amended— 
(1) in paragraph (1)— 
(A) in subparagraph (P), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (Q), by striking the 
semicolon at the end and inserting ‘‘, and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(R) in the case of vision services (as defined 
in section 1861(lll)) that are routine eye examina-
tions and contact lens fitting services (as described 
in paragraph (1) or (2), respectively, of such sec-
tion), which are furnished more frequently than once 
during a 2-year period;’’; and 
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(2) in paragraph (7)— 
(A) by inserting ‘‘(other than such an ex-
amination that is a vision service that is cov-
ered under section 1861(s)(2)(JJ))’’ after ‘‘eye 
examinations’’; and 
(B) by inserting ‘‘(other than such a proce-
dure that is a vision service that is covered 
under section 1861(s)(2)(JJ))’’ after ‘‘refractive 
state of the eyes’’. 
(h) CERTAIN NON-APPLICATION.— 
(1) IN GENERAL.—The last sentence of section 
1839(a)(1) of the Social Security Act (42 U.S.C. 
1395r(a)(1)), as added by section 601(g)(1) and 
amended by section 602(d)(1), is further amended 
by inserting ‘‘, and 603 (other than subsection (h))’’ 
after ‘‘602 (other than subsection (d))’’. 
(2) 
PAYMENT.—Paragraph 
(4) 
of 
section 
1844(a) of such Act (42 U.S.C. 1395w(a)), as added 
by section 601(g)(2) and amended by section 
602(d)(2), is further amended by inserting ‘‘, and 
603 (other than subsection (h))’’ after ‘‘602 (other 
than subsection (d))’’. 
(i) IMPLEMENTATION FUNDING.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services (in this subsection referred to as 
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