I 
117TH CONGRESS 
1ST SESSION H. R. 4650 
To amend title XVIII of the Social Security Act to provide for dental and 
oral health care benefits under the Medicare program. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 22, 2021 
Ms. KELLY of Illinois (for herself, Mr. HORSFORD, Mr. BUTTERFIELD, Mr. 
PAYNE, and Mr. WELCH) introduced the following bill; which was re-
ferred to the Committee on Energy and Commerce, and in addition to 
the Committee on Ways and Means, for a period to be subsequently de-
termined by the Speaker, in each case for consideration of such provisions 
as fall within the jurisdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to provide 
for dental and oral health care benefits under the Medi-
care 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 Cov-
erage Act of 2021’’. 
SEC. 2. 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— 
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(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 (lll));’’. 
(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: 
‘‘(lll) 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) 
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 
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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. 
‘‘(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 
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‘‘(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 
in 
section 
1861(lll))’’ 
after 
‘‘section 
1861(hhh)(1))’’; 
(B) by striking ‘‘and’’ before ‘‘(DD)’’; and 
(C) by inserting before the semicolon at 
the end the following: ‘‘, and (EE) with respect 
to dental and oral health services (as defined in 
section 1861(lll)), the amount paid shall be the 
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payment 
amount 
specified 
under 
section 
1834(z)’’. 
(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: 
‘‘(z) 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. In 
determining such amounts determined under such 
payment basis, the Secretary shall consider payment 
rates paid to dentists for comparable services under 
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 
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health services (as defined in section 1861(lll)) 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 
‘‘(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 
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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— 
(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 
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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(lll)(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(lll)(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 
(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 
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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(lll)(1)(A) de-
termines 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— 
(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 
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(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 
(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.’’. 
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(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(lll)) that are preven-
tive and screening services described in paragraph 
(2) of such section, which are furnished more fre-
quently than provided under section 1834(z)(3) and 
under circumstances other than circumstances deter-
mined 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 
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 
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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 2 (other than sub-
section (g)) of the Medicare Dental Coverage Act of 
2021 and the Government contribution under sec-
tion 1844(a)(5).’’. 
(2) PAYMENT.—Section 1844(a) of such Act 
(42 U.S.C. 1395w(a)) is amended— 
(A) in paragraph (4), by striking the pe-
riod at the end and inserting ‘‘; plus’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(5) 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 2 
(other than subsection (g)) of the Medicare Dental 
Coverage Act of 2021.’’. 
(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 
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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 
2022 through 2027 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.—Funds transferred pursu-
ant to paragraph (1) shall remain available until ex-
pended. 
Æ 
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