I 
112TH CONGRESS 
1ST SESSION H. R. 1290 
To amend title XVIII of the Social Security Act to provide for coverage 
under part B of the Medicare program for medically necessary dental 
procedures. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 31, 2011 
Mr. COHEN introduced the following bill; which was referred to the Committee 
on Energy and Commerce, and in addition to the Committee on Ways 
and Means, for a period to be subsequently determined by the Speaker, 
in each case for consideration of such provisions as fall within the juris-
diction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to provide 
for coverage under part B of the Medicare program 
for medically necessary dental procedures. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; FINDINGS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Medicare Medically Necessary Dental Care Act of 2011’’. 
(b) FINDINGS.—Congress finds the following: 
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(1) Oral and general healths are inseparable, 
and good dental care is critical to our overall phys-
ical health and well-being. 
(2) A 1999 Institute of Medicine study found 
that the prevention and management of oral infec-
tion have significant health implications when such 
infection has the potential to increase morbidity in 
Medicare patients who are at risk of adverse out-
comes from underlying health problems. 
(3) Improved oral health care may reduce mor-
tality and morbidity rates of Medicare patients suf-
fering from head and neck cancer, leukemia, 
lymphoma, organ transplantation, and heart valve 
disease. 
(4) The Medicare program, from its inception, 
has excluded coverage for services in connection with 
the care, treatment, filling, removal, or replacement 
of teeth or structures directly supporting the teeth. 
(5) The Centers for Medicare & Medicaid Serv-
ices has approved coverage exceptions for limited 
dental services and proposed additional exceptions 
based on the argument that oral health services 
would reduce the risk of infection and other com-
plications of medical care. 
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(6) The Institute of Medicine study concluded 
that it is reasonable for Congress to update the stat-
utory language relating to coverage of dental serv-
ices for Medicare beneficiaries so that it clearly cov-
ers dental care that is effective in preventing or re-
ducing oral and systemic complications associated 
with serious medical conditions and treatments. 
SEC. 2. MEDICARE COVERAGE OF MEDICALLY NECESSARY 
DENTAL PROCEDURES. 
(a) IN GENERAL.—Section 1862 of the Social Secu-
rity Act (42 U.S.C. 1395y) is amended— 
(1) in subsection (a)(12)— 
(A) by inserting ‘‘(A)’’ after ‘‘except that’’, 
and 
(B) by inserting before the semicolon at 
the end the following: ‘‘, and (B) payment may 
be made under part B for the provision of such 
dental services that are medically necessary as 
a direct result of, or will have a direct impact 
on, an underlying medical condition if the cov-
erage of such services is medically necessary, as 
determined under subsection (p)’’; and 
(2) by adding at the end the following new sub-
section: 
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‘‘(p) For purposes of subsection (a)(12)(B), dental 
services shall be considered to be medically necessary if 
furnished— 
‘‘(1) in conjunction with treatment of an indi-
vidual with any of the following diagnoses: prosthetic 
heart valve replacement, cancer of the head or neck, 
lymphoma, leukemia, and organ transplantation; and 
‘‘(2) not later than one year after the later of— 
‘‘(A) the date of such diagnosis; or 
‘‘(B) the date of the related surgical or 
medical treatment for that diagnosis.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to procedures performed on or 
after January 1, 2012. 
Æ 
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