Medicare Dental, Vision, and Hearing Benefit Act of 2021
Bill: H.R.4311 | Sponsor: Rep. Doggett, Lloyd (D-TX)
Policy area: Health

Summary:
Medicare Dental, Vision, and Hearing Benefit Act of 2021
This bill provides for Medicare coverage of dental, vision, and hearing care. Coverage includes (1) routine dental cleanings and exams, basic and major dental services, emergency dental care, and dentures; (2) routine eye exams, eyeglasses, and contact lenses; and (3) routine hearing exams, hearing aids, and exams for hearing aids. With respect to such care, the bill establishes special payment rules, limitations, and coinsurance requirements.

To amend title XVIII of the Social Security Act to provide for coverage 
    of dental, vision, and hearing care under the Medicare program.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Dental, Vision, and Hearing 
Benefit Act of 2021''.

SEC. 2. DENTAL AND ORAL HEALTH CARE.

    (a) Coverage.--Section 1861(s)(2) of the Social Security 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 adding ``and'' after the 
        semicolon at the end; and
            (3) by adding at the end the following new subparagraph:
            ``(II) dental and oral health services (as defined in 
        subsection (lll));''.
    (b) Dental and Oral Health Services Defined.--Section 1861 of the 
Social Security Act (42 U.S.C. 1395x) is amended by adding at the end 
the following new subsection:

                   ``Dental and Oral Health Services

    ``(lll) The term `dental and oral health services' means--
            ``(1) preventative and screening services, such as oral 
        exams, dental cleanings, dental x-rays, and fluoride 
        treatments;
            ``(2) basic dental services, such as tooth restorations, 
        basic periodontics services, tooth extractions, and oral 
        disease management services;
            ``(3) major dental services, such as major tooth 
        restorations, major periodontics services, bridges, crowns, 
        root canals, and extractions;
            ``(4) emergency dental care; and
            ``(5) other necessary services related to dental or oral 
        health (as defined by the Secretary).''.
    (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) 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(lll)), 
                the amount paid shall be the payment amount specified 
                under section 1834(y)''.
            (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:
    ``(y) 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.
            ``(2) Applicable percent.--
                    ``(A) In general.--For purposes of paragraph (1), 
                except as provided in subparagraph (B), the applicable 
                percent specified in this paragraph is--
                            ``(i) with respect to services described in 
                        section 1861(lll)(1) furnished during 2022 or a 
                        subsequent year, 100 percent; and
                            ``(ii) with respect to services not 
                        described in clause (i)--
                                    ``(I) for a year before 2023, 0 
                                percent;
                                    ``(II) for 2023, 30 percent;
                                    ``(III) for 2024, 60 percent; and
                                    ``(IV) for 2025 and each subsequent 
                                year, 80 percent.
                    ``(B) Special rule for certain low-income 
                individuals.--For purposes of paragraph (1), the 
                applicable percent specified in this paragraph is, with 
                respect to services furnished to an individual who is a 
                subsidy eligible individual (as defined in section 
                1860D-14(a)(3)), or who would be a subsidy eligible 
                individual if the individual were enrolled in a 
                prescription drug plan or MA-PD plan--
                            ``(i) with respect to services described in 
                        section 1861(lll)(1), for 2022 and each 
                        subsequent year, 100 percent; and
                            ``(ii) with respect to services not 
                        described in clause (i), for 2023 and each 
                        subsequent year, 80 percent.
            ``(3) Limitations and secretarial authority.--
                    ``(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 additional 
                        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 authorization requirement.
                            ``(ii) Authority to modify coverage.--
                        Notwithstanding any other provision of this 
                        title, if the Secretary determines appropriate, 
                        the Secretary may modify 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 
                        Preventive Services Task Force.
                            ``(iii) Authority to waive frequency 
                        limitations.--Notwithstanding subparagraph (A), 
                        the Secretary may waive any frequency 
                        limitation under such subparagraph for an 
                        individual (or category of individuals) if 
                        determined appropriate by the Secretary.''.
    (d) 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 
inserting ``(2)(II),'' before ``(3)''.
    (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 
                inserting ``(including dentures)''; 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 following new paragraph:
            ``(23) Payment and limits for dentures.--
                    ``(A) In general.--The payment amount under this 
                part for dentures shall be, subject to subparagraph 
                (C), the applicable percent (specified in subparagraph 
                (B)) of the amount otherwise payable for such dentures 
                under this section.
                    ``(B) Applicable percent.--For purposes of 
                subparagraph (A), the applicable percent specified in 
                this subparagraph is--
                            ``(i) for a year before 2023, 0 percent; 
                        and
                            ``(ii) for 2023 and each subsequent year, 
                        80 percent.
                    ``(C) Limitations and secretarial authority.--
                            ``(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 denture once every 
                                five years; and
                                    ``(II) not more than one partial 
                                upper denture and one partial lower 
                                denture once every five years.
                            ``(ii) Secretarial authority.--
                                    ``(I) Authority to apply additional 
                                limitations.--The Secretary may apply 
                                such other reasonable limitations on 
                                the extent to which dentures 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 
                                Secretary determines appropriate, the 
                                Secretary may modify the coverage under 
                                this part of dentures to the extent 
                                that such modification is consistent 
                                with the recommendations of the United 
                                States Preventive Services Task Force.
                                    ``(III) Authority to waive 
                                frequency limitations.--Notwithstanding 
                                clause (i), the Secretary may waive any 
                                frequency limitation under such clause 
                                for an individual (or category of 
                                individuals) if determined appropriate 
                                by the Secretary.''.
    (f) Repeal of Ground for Exclusion.--Section 1862(a) of the Social 
Security Act (42 U.S.C. 1395y) is amended by striking paragraph (12).
    (g) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after January 1, 2022.

SEC. 3. VISION CARE.

    (a) Coverage.--Section 1861(s)(2) of the Social Security Act (42 
U.S.C. 1395x(s)(2)), as amended by section 2, is further amended--
            (1) in subparagraph (HH), by striking ``and'' after the 
        semicolon at the end;
            (2) in subparagraph (II), by adding ``and'' after the 
        semicolon at the end; and
            (3) by adding at the end the following new subparagraph:
            ``(JJ) vision services (as defined in subsection (mmm));''.
    (b) Vision Services Defined.--Section 1861 of the Social Security 
Act (42 U.S.C. 1395x), as amended by section 2, is further amended by 
adding at the end the following new subsection:

                           ``Vision Services

    ``(mmm) The term `vision services' means--
            ``(1) routine eye examinations and procedures performed 
        (during the course of any eye examination) to determine the 
        refractive state of the eyes; and
            ``(2) other necessary services related to eye and vision 
        health (as defined by the Secretary).''.
    (c) Payment; Coinsurance; and Limitations.--
            (1) In general.--Section 1833(a)(1) of the Social Security 
        Act (42 U.S.C. 1395l(a)(1)), as amended by section 2, is 
        further amended--
                    (A) by striking ``and'' before ``(DD)''; and
                    (B) by inserting before the semicolon at the end 
                the following: ``, and (EE) with respect to vision 
                services (as defined in section 1861(mmm)), the amount 
                paid shall be the payment amount specified under 
                section 1834(z)''.
            (2) Payment and limits specified.--Section 1834 of the 
        Social Security Act (42 U.S.C. 1395m), as amended by section 2, 
        is further amended by adding at the end the following new 
        subsection:
    ``(z) Payment and Limits for Vision Services.--
            ``(1) In general.--The payment amount under this part for 
        vision services (as defined in section 1861(mmm)) shall be, 
        subject to paragraph (2), 80 percent of the lesser of the 
        actual charge for the services or the amount determined under 
        the payment basis determined under section 1848.
            ``(2) Limitations and secretarial authority.--
                    ``(A) Frequency.--With respect to routine eye 
                exams, payment may be made under this part for only one 
                such exam during a 12-month period.
                    ``(B) Secretarial authority.--
                            ``(i) Authority to apply additional 
                        limitations.--The Secretary may apply other 
                        reasonable limitations on the extent to which 
                        vision services 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 Secretary determines appropriate, 
                        the Secretary may modify the coverage under 
                        this part of vision services to the extent that 
                        such modification is consistent with the 
                        recommendations of the United States Preventive 
                        Services Task Force.
                            ``(iii) Authority to waive frequency 
                        limitations.--Notwithstanding subparagraph (A), 
                        the Secretary may waive any frequency 
                        limitation under such subparagraph for an 
                        individual (or category of individuals) if 
                        determined appropriate by the Secretary.''.
    (d) 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 
inserting ``(2)(JJ),'' after ``(2)(II),'' (as added by section 2).
    (e) Special Payment Rules for Eyeglasses, Contact Lenses, and Low 
Vision Devices.--Section 1834(a) of the Social Security Act (42 U.S.C. 
1395m(a)), as amended by section 2, is further amended by adding at the 
end the following:
            ``(24) Payment and limits for eyeglasses and contact 
        lenses.--
                    ``(A) In general.--The payment amount under this 
                part for eyeglass lenses, eyeglass frames, and contact 
                lenses shall be, subject to subparagraph (B), 80 
                percent of the amount otherwise payable for such 
                eyeglass lenses, eyeglass frames, and contact lenses, 
                respectively, under this section.
                    ``(B) Limitations and secretarial authority.--
                            ``(i) In general.--Subject to clause (iii), 
                        payment may be made under this part (other than 
                        for eyewear described in section 1861(s)(8)) 
                        for an individual for--
                                    ``(I) not more than one pair of 
                                eyeglass lenses during any 12-month 
                                period in an amount not exceeding $100;
                                    ``(II) not more than one set of 
                                eyeglass frames during any 24-month 
                                period in an amount not exceeding $100; 
                                and
                                    ``(III) contact lenses, only to the 
                                extent that the sum of such payments 
                                for contact lenses does not exceed a 
                                limitation of $200 during any 24-month 
                                period beginning during the first year 
                                beginning at least six months after the 
                                date of the enactment of this paragraph 
                                (or, beginning during a subsequent 
                                year, such limitation for a 24-month 
                                period beginning in the previous year 
                                increase by an appropriate inflation 
                                adjustment specified by the Secretary).
                            ``(ii) Secretarial authority.--
                                    ``(I) Authority to apply additional 
                                limitations.--The Secretary may apply 
                                such other reasonable limitations on 
                                the extent to which eyeglass lenses, 
                                eyeglass frames, and contact lenses 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 
                                Secretary determines appropriate, the 
                                Secretary may modify the coverage under 
                                this part of eyeglass lenses, eyeglass 
                                frames, and contact lenses to the 
                                extent that such modification is 
                                consistent with the recommendations of 
                                the United States Preventive Services 
                                Task Force.
                                    ``(III) Authority to waive 
                                frequency limitations.--Notwithstanding 
                                clause (i), the Secretary may waive any 
                                frequency limitation under such clause 
                                for an individual (or category of 
                                individuals) if determined appropriate 
                                by the Secretary.
                            ``(iii) Update of payment limits to account 
                        for inflation.--With respect to eyeglass lenses 
                        and contact lenses furnished during 2023 or a 
                        subsequent year, the Secretary shall increase 
                        the dollar amounts in effect under this 
                        subparagraph for such year by the percentage 
                        change in the consumer price index for all 
                        urban consumers (United States city average) 
                        for the 12-month period ending with June of the 
                        previous year.
            ``(25) Payment and limits for low vision devices.--
                    ``(A) In general.--The payment amount under this 
                part for low vision devices shall be 80 percent of the 
                amount otherwise payable for low vision devices under 
                this section.
                    ``(B) Secretarial authority.--
                            ``(i) Authority to apply limitations.--The 
                        Secretary may apply reasonable limitations on 
                        the extent to which low vision devices 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 Secretary determines appropriate, 
                        the Secretary may modify the coverage under 
                        this part of low vision devices to the extent 
                        that such modification is consistent with the 
                        recommendations of the United States Preventive 
                        Services Task Force.
                    ``(C) Low vision device defined.--In this 
                paragraph, the term `low vision device' means a device, 
                prescribed by a physician, that magnifies, enhances, or 
                otherwise augments or interprets visual images 
                irrespective of the size, form, or technological 
                features of such device and does not include ordinary 
                eyeglasses or contact lenses. In the previous sentence, 
                the term `ordinary eyeglasses or contact lenses' means 
                lenses that are intended to fully correct visual acuity 
                or fully eliminate refractive error.''.
    (f) Definition of Durable Medical Equipment To Include Eyeglasses, 
Contact Lenses, and Low Vision Devices.--Section 1861(n) of the Social 
Security Act (42 U.S.C. 1395x(n)) is amended--
            (1) by striking ``and'' before ``eye tracking'' and 
        inserting a comma; and
            (2) by inserting ``, and eyeglass lenses, low vision 
        devices (as defined in section 1834(a)(25)), eyeglass frames, 
        and contact lenses'' before ``; except''.
    (g) Repeal of Ground for Exclusion.--Section 1862(a)(7) of the 
Social Security Act (42 U.S.C. 1395y(a)(7)) is amended by striking ``, 
eyeglasses (other than eyewear described in section 1861(s)(8)) or eye 
examinations for the purpose of prescribing, fitting, or changing 
eyeglasses, procedures performed (during the course of any eye 
examination) to determine the refractive state of the eyes''.
    (h) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after January 1, 2022.

SEC. 4. HEARING CARE.

    (a) Coverage.--
            (1) In general.--Section 1861(s)(2) of the Social Security 
        Act (42 U.S.C. 1395x(s)(2)), as amended by sections 2 and 3, is 
        further amended--
                    (A) in subparagraph (II), by striking ``and'' at 
                the end;
                    (B) in subparagraph (JJ), by inserting ``and'' at 
                the end; and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(KK) audiology services (as defined in subsection 
        (ll)(3)) and hearing services (as defined in subsection 
        (ll)(5));''.
            (2) Hearing services defined.--Section 1861(ll) of the 
        Social Security Act (42 U.S.C. 1395x(ll)) is amended--
                    (A) in the subsection heading, by inserting ``; 
                Hearing Services'' after ``Audiology Services''; and
                    (B) by adding at the end the following new 
                paragraph:
    ``(5) The term `hearing services' means--
            ``(A) routine hearing exams and exams for hearing aids; and
            ``(B) other necessary services related to hearing health 
        (as defined by the Secretary).''.
    (b) Payment; Coinsurance; and Limitations.--
            (1) In general.--Section 1833(a)(1) of the Social Security 
        Act (42 U.S.C. 1395l(a)(1)), as amended by sections 2 and 3, is 
        further amended--
                    (A) by striking ``and'' before ``(EE)''; and
                    (B) by inserting before the semicolon at the end 
                the following: ``, and (FF) with respect to audiology 
                services (as defined in section 1861(ll)(3)) and 
                hearing services (as defined in section 1861(ll)(5)), 
                the amount paid shall be the payment amount specified 
                under section 1834(aa)''.
            (2) Payment and limits specified.--Section 1834 of the 
        Social Security Act (42 U.S.C. 1395m), as amended by sections 2 
        and 3, is further amended by adding at the end the following 
        new subsection:
    ``(aa) Payment and Limits for Hearing Services.--
            ``(1) In general.--The payment amount under this part for 
        audiology services (as defined in section 1861(ll)(3)) and 
        hearing services (as defined in section 1861(ll)(5)), shall be, 
        subject to paragraph (2), 80 percent of the lesser of the 
        actual charge for the services or the amount determined under 
        the payment basis determined under section 1848.
            ``(2) Secretarial authority.--
                    ``(A) Authority to apply limitations.--The 
                Secretary may apply reasonable limitations on the 
                extent to which audiology services and hearing services 
                are covered under this part, including through 
                application of a prior authorization requirement.
                    ``(B) Authority to modify coverage.--
                Notwithstanding any other provision of this title, if 
                the Secretary determines appropriate, the Secretary may 
                modify the coverage under this part of audiology 
                services and hearing services to the extent that such 
                modification is consistent with the recommendations of 
                the United States Preventive Services Task Force.''.
    (c) Payment Under the Physician Fee Schedule.--Section 1848(j)(3) 
of the Social Security Act (42 U.S.C. 1395w-4(j)(3)), as amended by 
section 2(d), is further amended by inserting ``(2)(KK),'' before 
``(3)''.
    (d) Hearing Aids.--
            (1) Repeal of ground for exclusion.--Section 1862(a)(7) of 
        the Social Security Act (42 U.S.C. 1395y(a)(7)), as amended by 
        section 3(g), is further amended by striking ``, hearing aids 
        or examinations therefor,''.
            (2) Definition of durable medical equipment to include 
        hearing aids.--Section 1861(n) of the Social Security Act (42 
        U.S.C. 1395x(n)), as amended by section 3, is further amended 
        by inserting ``hearing aids,'' before ``and eyeglass lenses''.
            (3) Special payment rules for hearing aids.--Section 
        1834(a) of the Social Security Act (42 U.S.C. 1395m(a)), as 
        amended by sections 2 and 3, is further amended by adding at 
        the end the following new paragraph:
            ``(26) Payment and limits for hearing aids.--
                    ``(A) In general.--The payment amount under this 
                part for hearing aids shall be, subject to subparagraph 
                (B), 80 percent of the amount otherwise payable for 
                hearing aids under this section.
                    ``(B) Limitations and secretarial authority.--
                            ``(i) In general.--Payment may be made 
                        under this part for an individual for not more 
                        than one hearing aid per ear during a 48-month 
                        period.
                            ``(ii) Secretarial authority.--
                                    ``(I) Authority to apply additional 
                                limitations.--The Secretary may apply 
                                additional limitations on the extent to 
                                which hearing aids are covered under 
                                this part, including through 
                                application of a prior authorization 
                                requirement and through application of 
                                criteria for a minimum level of hearing 
                                loss for coverage of an initial or 
                                replacement hearing aid.
                                    ``(II) Authority to modify 
                                coverage.--Notwithstanding any other 
                                provision of this title, if the 
                                Secretary determines appropriate, the 
                                Secretary may modify the coverage under 
                                this part of hearing aids to the extent 
                                that such modification is consistent 
                                with the recommendations of the United 
                                States Preventive Services Task Force.
                            ``(iii) Authority to waive frequency 
                        limitations.--Notwithstanding clause (i), the 
                        Secretary may waive any frequency limitation 
                        under such clause for an individual (or 
                        category of individuals) if determined 
                        appropriate by the Secretary.''.
    (e) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after January 1, 2022.

SEC. 5. NONAPPLICATION OF COMPETITIVE ACQUISITION TO CERTAIN ITEMS.

    Section 1847(a)(2) of the Social Security Act (42 U.S.C. 1395w-
3(a)(2)) is amended--
            (1) by striking ``and excluding'' and inserting 
        ``excluding''; and
            (2) by inserting ``, and excluding dentures, eyeglass 
        lenses, contact lenses, and hearing aids'' before the period at 
        the end.

SEC. 6. INCLUSION OF AN ORAL HEALTH PROFESSIONAL ON THE UNITED STATES 
              PREVENTIVE SERVICES TASK FORCE.

    (a) In General.--The first sentence of section 915(a)(1) of the 
Public Health Service Act (42 U.S.C. 299b-4(a)(1)) is amended by 
inserting ``, including at least 1 oral health professional'' before 
the period at the end.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply beginning on January 1 of the first year beginning at least 6 
months after the date of the enactment of this Act.
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