Medicare Medically Necessary Dental Care Act of 2021
Bill: H.R.5110 | Sponsor: Rep. Cohen, Steve (D-TN)
Policy area: Health

Summary:
Medicare Medically Necessary Dental Care Act of 2021
This bill allows for coverage of certain medically necessary dental services under Medicare.
Specifically, the bill allows for coverage of dental services that are furnished (1) in conjunction with treatment relating to a prosthetic heart valve replacement, cancer of the head or neck, lymphoma, leukemia, or organ transplantation; and (2) within one year after the date of diagnosis or the date of the related surgical or medical treatment for the diagnosis, whichever is later.

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 Representatives 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 2021''.
    (b) Findings.--Congress finds the following:
            (1) Oral and general healths are inseparable, and good 
        dental care is critical to our overall physical health and 
        well-being.
            (2) A 1999 Institute of Medicine study found that the 
        prevention and management of oral infection have significant 
        health implications when such infection has the potential to 
        increase morbidity in Medicare patients who are at risk of 
        adverse outcomes from underlying health problems.
            (3) Improved oral health care may reduce mortality and 
        morbidity rates of Medicare patients suffering 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 Services 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 
        complications of medical care.
            (6) The Institute of Medicine study concluded that it is 
        reasonable for Congress to update the statutory language 
        relating to coverage of dental services for Medicare 
        beneficiaries so that it clearly covers dental care that is 
        effective in preventing or reducing 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 Security 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 coverage of such services is medically 
                necessary, as determined under subsection (p)''; and
            (2) by adding at the end the following new subsection:
    ``(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 individual with a 
        prosthetic heart valve replacement or a diagnosis of 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, 2022.
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