I 
116TH CONGRESS 
1ST SESSION H. R. 2951 
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 
MAY 23, 2019 
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 2019’’. 
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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 (GG), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (HH), by striking the pe-
riod at the end and inserting ‘‘; 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: 
‘‘Dental and Oral Health Services 
‘‘(kkk) 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, and treat emer-
gency 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 (kkk), 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 ‘‘(CC)’’; and 
(B) 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), 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(v)’’. 
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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: 
‘‘(v) 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), 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.—For purposes 
of paragraph (1), the applicable percentage specified 
in this paragraph is— 
‘‘(A) for the first year beginning at least 6 
months after the date of the enactment of this 
subsection, 0 percent; 
‘‘(B) for the year following the year speci-
fied in subparagraph (A) and each subsequent 
year through the seventh year following the 
year specified in subparagraph (A), the applica-
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ble percent specified in this paragraph for the 
previous year increased by 10 percentage 
points; and 
‘‘(C) for the eighth year following the year 
specified in subparagraph (A) and each subse-
quent year, 80 percent. 
‘‘(3) LIMITATIONS AND SECRETARIAL AUTHOR-
ITY.— 
‘‘(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. 
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‘‘(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 
recommendations of the United States Pre-
ventive Services Task Force.’’. 
(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)(II),’’. 
(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.—For pur-
poses of subparagraph (A), the applicable per-
cent specified in this subparagraph is— 
‘‘(i) for the first year beginning at 
least 6 months after the date of the enact-
ment of this paragraph, 0 percent; 
‘‘(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 specified in this subparagraph for 
the previous year increased by 10 percent-
age points; and 
‘‘(iii) for the eighth year following the 
year specified in clause (i) and each subse-
quent year, 80 percent. 
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‘‘(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 
‘‘(II) not more than one partial 
upper dental prostheses and one par-
tial lower dental prostheses once every 
five years. 
‘‘(ii) SECRETARIAL AUTHORITY.— 
‘‘(I) AUTHORITY TO APPLY ADDI-
TIONAL LIMITATIONS.—The Secretary 
may apply such other reasonable limi-
tations on the extent to which dental 
prostheses are covered under this 
part, including through application of 
a prior authorization requirement. 
‘‘(II) AUTHORITY
TO
MODIFY 
COVERAGE.—Notwithstanding 
any 
other provision of this title, if the Sec-
retary determines appropriate, the 
Secretary may modify the coverage 
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under this part of dental prostheses to 
the extent that such modification is 
consistent with the recommendations 
of the United States Preventive Serv-
ices Task Force.’’. 
(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, 2020. 
Æ 
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