Medicare Dental Benefit Act of 2021
Bill: S.97 | Sponsor: Sen. Cardin, Benjamin L. (D-MD)
Policy area: Health

Summary:
Medicare Dental Benefit Act of 2021
This bill provides for Medicare coverage of dental and oral health services, including routine diagnostic and preventive services, basic and major dental services, and emergency care; dental prostheses are also covered. Currently, such services are excluded from Medicare coverage.

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 Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Dental Benefit Act of 
2021''.

SEC. 2. COVERAGE OF DENTAL SERVICES UNDER THE MEDICARE PROGRAM.

    (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'' at the end;
            (2) in subparagraph (HH), by striking the period at the end 
        and inserting ``; and''; 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 services 
(as defined by the Secretary) that are necessary to prevent disease and 
promote oral health, restore oral structures to health and function, 
and treat emergency 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;
            ``(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 Preventive 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 following 
new subparagraph:
            ``(D) Dental and oral health services described in 
        paragraph (1) of subsection (lll), 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 ``(DD)''; and
                    (B) 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), 
                other than those services described in paragraph (1) of 
                such section), 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) 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), 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.--
                    ``(A) In general.--For purposes of paragraph (1), 
                subject to subparagraph (B), the applicable percentage 
                specified in this paragraph is--
                            ``(i) for the first year beginning at least 
                        6 months after the date of the enactment of 
                        this subsection, 0 percent;
                            ``(ii) for the year following the year 
                        specified in subparagraph (A) and each 
                        subsequent year through the seventh year 
                        following the year specified in subparagraph 
                        (A), the applicable percent specified in this 
                        paragraph for the previous year increased by 10 
                        percentage points; and
                            ``(iii) for the eighth year following the 
                        year specified in subparagraph (A) and each 
                        subsequent year, 80 percent.
                    ``(B) Special rule for certain low-income 
                individuals.--For purposes of paragraph (1), with 
                respect to dental and oral health services described in 
                such paragraph that are 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 an MA-PD plan under part D, 
                for the first year beginning at least 6 months after 
                the date of the enactment of this subsection and each 
                subsequent year, the applicable percent specified in 
                this paragraph is 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.--The Secretary may waive any 
                        frequency limitation or other limitation as 
                        described in this paragraph for an individual 
                        (or category of individuals) as determined 
                        appropriate by the Secretary.''.
    (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 following new paragraph:
            ``(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 percent (specified in 
                subparagraph (B)) of the amount otherwise payable for 
                such dental prostheses under this section.
                    ``(B) Applicable percent.--
                            ``(i) In general.--For purposes of 
                        subparagraph (A), subject to clause (ii), the 
                        applicable percent specified in this 
                        subparagraph is--
                                    ``(I) for the first year beginning 
                                at least 6 months after the date of the 
                                enactment 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 
                                percentage points; and
                                    ``(III) for the eighth year 
                                following the year specified in clause 
                                (i) and each subsequent year, 80 
                                percent.
                            ``(ii) Special rule for certain low-income 
                        individuals.--For purposes of subparagraph (A), 
                        with respect to dental prostheses 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 an MA-PD plan under 
                        part D, for the first year beginning at least 6 
                        months after the date of the enactment of this 
                        paragraph and each subsequent year, the 
                        applicable percent specified in this 
                        subparagraph is 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 dental prostheses 
                                once every five years; and
                                    ``(II) not more than one partial 
                                upper dental prostheses and one partial 
                                lower dental prostheses 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 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 
                                Secretary determines appropriate, the 
                                Secretary may modify the coverage under 
                                this part of dental prostheses 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.--The Secretary 
                                may waive any frequency limitation or 
                                other limitation as described in this 
                                subparagraph for an individual (or 
                                category of individuals) as determined 
                                appropriate by the Secretary''.
    (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, 2022.

SEC. 3. INCREASED FMAP FOR ADDITIONAL EXPENDITURES FOR MEDICARE COST-
              SHARING FOR DENTAL AND ORAL HEALTH SERVICES.

    Section 1905 of the Social Security Act (42 U.S.C. 1396d) is 
amended--
            (1) in subsection (b), by striking ``and (ff)'' and 
        inserting ``(ff), and (ii)''; and
            (2) by adding at the end the following new subsection:
    ``(ii) Increased FMAP for Additional Expenditures for Medicare 
Cost-Sharing for Dental and Oral Health Services.--Notwithstanding 
subsection (b), with respect to the portion of the amounts expended by 
a State for medical assistance for medicare cost-sharing (as defined in 
subsection (p)(3)) for qualified medicare beneficiaries described in 
subsection (p)(1) that is attributable to the coverage under part B of 
title XVIII of dental and oral health services (as defined in section 
1861(lll)), as determined by the Secretary, the Federal medical 
assistance percentage for a State that is one of the 50 States or the 
District of Columbia shall be equal to 100 percent.''.

SEC. 4. PREVENTIVE SERVICES TASKFORCE.

    (a) In General.--Section 915(a)(1) of the Public Health Service Act 
(42 U.S.C. 299b-4(a)(1)) is amended, in the first sentence, by 
inserting ``, including at least 1 oral health professional'' after 
``expertise''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect January 1, 2022.
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