IB 
Union Calendar No. 303 
116TH CONGRESS 
2D SESSION 
H. R. 4650 
[Report No. 116–325, Parts I and II] 
To amend title XVIII of the Social Security Act to provide coverage for 
certain dental items and services under part B of the Medicare program. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 11, 2019 
Ms. KELLY of Illinois (for herself and Mr. HORSFORD) 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 
DECEMBER 6, 2019 
Reported from the Committee on Ways and Means with an amendment 
[Strike out all after the enacting clause and insert the part printed in italic] 
JANUARY 24, 2020 
Additional sponsors: Ms. CASTOR
of Florida, Ms. BARRAGA´N, Mr. 
BUTTERFIELD, Mr. CUELLAR, Ms. NORTON, Mr. MALINOWSKI, Mr. 
PAYNE, Mr. WELCH, and Mr. CARTWRIGHT 
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JANUARY 24, 2020 
Reported from the Committee on Energy and Commerce, committed to the 
Committee of the Whole House on the State of the Union, and ordered 
to be printed 
[For text of introduced bill, see copy of bill as introduced on October 11, 2019] 
A BILL 
To amend title XVIII of the Social Security Act to provide 
coverage for certain dental items and services under part 
B of the Medicare program. 
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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 Cov-
erage Act of 2019’’. 
SEC. 2. DENTAL AND ORAL HEALTH CARE. 
(a) COVERAGE.—Section 1861(s)(2) of the Social Secu-
rity 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 following 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 be 
made under part A as inpatient hospital services) 
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that are furnished during 2022 or a subsequent year, 
for which coverage was not provided under part B as 
of the date of the enactment of this subsection, and 
that are— 
‘‘(A) the preventive and screening services 
described in paragraph (2) furnished by a doctor 
of dental surgery or of dental medicine (as de-
scribed 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 paragraph 
(3)(A) and the major treatments specified for 
such year by the Secretary pursuant to para-
graph (3)(B) furnished by such a doctor or such 
a professional. 
‘‘(2) PREVENTIVE AND SCREENING SERVICES.— 
The preventive and screening services described 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 2022 
and each subsequent year, the Secretary shall speci-
fy— 
‘‘(A) basic treatments (which may include 
basic tooth restorations, basic periodontic serv-
ices, tooth extractions, and oral disease manage-
ment services); and 
‘‘(B) major treatments (which may include 
major tooth restorations, major periodontic serv-
ices, bridges, crowns, dental implants, 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 within the 
scope of such license, by the State in which such serv-
ices are furnished.’’. 
(c) PAYMENT; COINSURANCE; AND LIMITATIONS.— 
(1) IN GENERAL.—Section 1833(a)(1) of the So-
cial Security Act (42 U.S.C. 1395l(a)(1)) is amend-
ed— 
(A) by striking ‘‘and’’ before ‘‘(CC)’’; and 
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(B) by inserting before the semicolon at the 
end the following: ‘‘, and (DD) with respect to 
dental and oral health services (as defined in sec-
tion 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 sub-
section: 
‘‘(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 de-
fined in section 1861(kkk)) shall be, subject to para-
graph (3), the applicable percent (specified in para-
graph (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.—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)) furnished in 
a year— 
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‘‘(A) that are preventive and screening serv-
ices described in paragraph (2) or basic treat-
ments specified for such year pursuant to para-
graph (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 2022, 10 percent; 
‘‘(ii) in the case such services are fur-
nished during 2023 or a subsequent year be-
fore 2026, the applicable percent specified 
under this subparagraph for the previous 
year, increased by 10 percentage points; 
and 
‘‘(iii) in the case such services are fur-
nished during 2026 or a subsequent year, 
50 percent. 
‘‘(3) LIMITATIONS.—With respect to dental and 
oral health services that are— 
‘‘(A) oral exams, payment may be made 
under this part for not more than two such 
exams during a 12-month period; 
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‘‘(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 So-
cial Security Act (42 U.S.C. 1395w–4(j)(3)) is 
amended by inserting ‘‘(2)(II),’’ before ‘‘(3)’’. 
(2) 
BUDGET
NEUTRALITY.—Section 
1848(c)(2)(B)(iv) of the Social Security Act (42 
U.S.C. 1395–w(c)(2)(B)(iv)) is amended— 
(A) in subclause (III), by striking ‘‘and’’ at 
the end; 
(B) in subclause (IV), by striking the period 
at the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
subclause: 
‘‘(V) the amendment made by sec-
tion 2(d)(1) of the Medicare Dental Act 
of 2019 shall not be taken into account 
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in applying clause (ii)(II) for 2022 
and 2023.’’. 
(3) 
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— 
(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 2022 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)).’’. 
(4) 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 2022 and each subsequent 
year, an oral health professional (as defined in sec-
tion 1861(kkk)(4)).’’. 
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(e) DENTURES.— 
(1) IN GENERAL.—Section 1861(s)(8) of the So-
cial Security Act (42 U.S.C. 1395x(s)(8)) is amend-
ed— 
(A) by striking ‘‘(other than dental)’’; and 
(B) by inserting ‘‘and excluding dental, ex-
cept for a full or partial set of dentures furnished 
on or after January 1, 2022’’ after ‘‘colostomy 
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 DENTURES.— 
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 profes-
sional described in section 1861(kkk)(1)(A) deter-
mines such dentures do not fit the individual); 
and 
‘‘(B) only to the extent that such dentures 
are furnished pursuant to a written order of 
such a doctor or professional.’’. 
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(B) APPLICATION OF COMPETITIVE ACQUISI-
TION.— 
(i) 
IN
GENERAL.—Section 
1834(h)(1)(H) of the Social Security Act 
(42 U.S.C. 1395m(h)(1)(H)) is amended— 
(I) in the subparagraph heading, 
by inserting ‘‘, 
DENTURES’’ after 
‘‘ORTHOTICS’’; 
(II) by inserting ‘‘and of dentures 
described in paragraph (2)(D) of such 
section,’’ after ‘‘2009,’’; and 
(III) in clause (i), by inserting 
‘‘or 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 for which pay-
ment would otherwise be made under section 
1834(h).’’. 
(iii) EXEMPTION
OF
CERTAIN
ITEMS 
FROM COMPETITIVE ACQUISITION.—Section 
1847(a)(7) of the Social Security Act (42 
U.S.C. 1395w–3(a)(7)) is amended by add-
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ing at the end the following new subpara-
graph: 
‘‘(C) CERTAIN
DENTURES.—Those items 
and services described in paragraph (2)(D) 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 phy-
sician’s or practitioner’s professional service.’’. 
(f) EXCLUSION MODIFICATIONS.—Section 1862(a) of 
the Social Security Act (42 U.S.C. 1395y(a)) is amended— 
(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 preven-
tive and screening services described in paragraph (2) 
of such section, which are furnished more frequently 
than provided under section 1834(x)(3);’’; 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)’’. 
SEC. 3. IMPLEMENTATION FUNDING. 
The Secretary of Health and Human Services 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 Ac-
count for the period of 2020 through 2024 of such sums as 
may be necessary for purposes of implementing the amend-
ments made by section 2. 
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Union Calendar No. 303 
116TH CONGRESS 
2D SESSION 
H. R. 4650 
[Report No. 116–325, Parts I and II] 
A BILL 
To amend title XVIII of the Social Security Act to 
provide coverage for certain dental items and 
services under part B of the Medicare program. 
JANUARY 24, 2020 
Reported from the Committee on Energy and Commerce, 
committed to the Committee of the Whole House on 
the State of the Union, and ordered to be printed 
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