Medicare Dental Coverage Act of 2021
Bill: H.R.4650 | Sponsor: Rep. Kelly, Robin L. (D-IL)
Policy area: Health

Summary:
Medicare Dental Coverage Act of 2021
This bill expands Medicare coverage to include dentures and dental and oral health services, in accordance with specified limitations. Covered services include basic and major treatments (as determined by the Centers for Medicare & Medicaid Services) as well as specified preventive and screening services.

To amend title XVIII of the Social Security Act to provide for dental 
       and oral health care benefits 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 Coverage 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 striking the period at the end 
        and adding ``; 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:
    ``(lll) Dental and Oral Health Services.--
            ``(1) In general.--The term `dental and oral health 
        services' means items and services (other than such items and 
        services for which payment may be made under part A as 
        inpatient hospital services) that are furnished during 2025 or 
        a subsequent year, for which coverage was not provided under 
        part B as of the date of the enactment of this subsection, and 
        that are--
                    ``(A) the preventive and screening services 
                described in paragraph (2) furnished by a doctor of 
                dental surgery or of dental medicine (as described in 
                subsection (r)(2)) or an oral health professional (as 
                defined in paragraph (4)); or
                    ``(B) the basic treatments specified for such year 
                by the Secretary pursuant to paragraph (3)(A) and the 
                major treatments specified for such year by the 
                Secretary pursuant to paragraph (3)(B) furnished by 
                such a doctor or such a professional.
            ``(2) Preventive and screening services.--The preventive 
        and screening services described in this paragraph are the 
        following:
                    ``(A) Oral exams.
                    ``(B) Dental cleanings.
                    ``(C) Dental x-rays performed in the office of a 
                doctor or professional described in paragraph (1)(A).
                    ``(D) Fluoride treatments.
            ``(3) Basic and major treatments.--For 2025 and each 
        subsequent year, the Secretary shall specify--
                    ``(A) basic treatments (which may include basic 
                tooth restorations, basic periodontic services, tooth 
                extractions, and oral disease management services); and
                    ``(B) major treatments (which may include major 
                tooth restorations, major periodontic services, 
                bridges, crowns, and root canals);
        that shall be included as dental and oral health services for 
        such year.
            ``(4) Oral health professional.--The term `oral health 
        professional' means, with respect to dental and oral health 
        services, a health professional who is licensed to furnish such 
        services, acting within the scope of such license, by the State 
        in which such services are furnished.''.
    (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) in subparagraph (N), by inserting ``and dental 
                and oral health services (as defined in section 
                1861(lll))'' after ``section 1861(hhh)(1))'';
                    (B) by striking ``and'' before ``(DD)''; and
                    (C) 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)), 
                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)) 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. In determining 
        such amounts determined under such payment basis, the Secretary 
        shall consider payment rates paid to dentists for comparable 
        services under State plans under title XIX, under the TRICARE 
        program under chapter 55 of title 10 of the United States Code, 
        and by other health care payers, such as Medicare Advantage 
        plans under part C.
            ``(2) Applicable percent.--For purposes of paragraph (1), 
        the applicable percent specified in this paragraph is, with 
        respect to dental and oral health services (as defined in 
        section 1861(lll)) furnished in a year--
                    ``(A) that are preventive and screening services 
                described in paragraph (2) or basic treatments 
                specified for such year pursuant to paragraph (3)(A) of 
                such section, 80 percent; and
                    ``(B) that are major treatments specified for such 
                year pursuant to paragraph (3)(B) of such section--
                            ``(i) in the case such services are 
                        furnished during 2025, 10 percent;
                            ``(ii) in the case such services are 
                        furnished during 2026 or a subsequent year 
                        before 2029, the applicable percent specified 
                        under this subparagraph for the previous year, 
                        increased by 10 percentage points; and
                            ``(iii) in the case such services are 
                        furnished during 2029 or a subsequent year, 50 
                        percent.
            ``(3) Limitations.--With respect to dental and oral health 
        services that are--
                    ``(A) preventive and screening oral exams, payment 
                may be made under this part for not more than two such 
                exams during a 12-month period;
                    ``(B) dental cleanings, payment may be made under 
                this part for not more than two such cleanings during a 
                12-month period; and
                    ``(C) not described in subparagraph (A) or (B), 
                payment may be made under this part only at such 
                frequencies and under such circumstances determined 
                appropriate by the Secretary.''.
    (d) Payment Under Physician Fee Schedule.--
            (1) In general.--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)''.
            (2) Exclusion from mips.--Section 1848(q)(1)(C)(ii) of the 
        Social Security Act (42 U.S.C. 1395w-4(q)(1)(C)(ii)) is 
        amended--
                    (A) in subclause (II), by striking ``or'' at the 
                end;
                    (B) in subclause (III), by striking the period at 
                the end and inserting ``; or''; and
                    (C) by adding at the end the following new 
                subclause:
                                    ``(IV) with respect to 2025 and 
                                each subsequent year, is a doctor of 
                                dental surgery or of dental medicine 
                                (as described in section 1861(r)(2)) or 
                                is an oral health professional (as 
                                defined in section 1861(lll)(4)).''.
            (3) Inclusion of oral health professionals as certain 
        practitioners.--Section 1842(b)(18)(C) of the Social Security 
        Act (42 U.S.C. 1395u(b)(18)(C)) is amended by adding at the end 
        the following new clause:
            ``(vii) With respect to 2025 and each subsequent year, an 
        oral health professional (as defined in section 
        1861(lll)(4)).''.
    (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
                    (B) by inserting ``and excluding dental, except for 
                a full or partial set of dentures furnished on or after 
                January 1, 2025'' after ``colostomy care''.
            (2) Special payment rules.--
                    (A) Limitations.--Section 1834(h) of the Social 
                Security Act (42 U.S.C. 1395m(h)) is amended by adding 
                at the end the following new paragraph:
            ``(6) Special payment rule for dentures.--Payment may be 
        made under this part with respect to an individual for 
        dentures--
                    ``(A) not more than once during any 5-year period 
                (except in the case that a doctor or professional 
                described in section 1861(lll)(1)(A) determines such 
                dentures do not fit the individual); and
                    ``(B) only to the extent that such dentures are 
                furnished pursuant to a written order of such a doctor 
                or professional.''.
                    (B) Application of competitive acquisition.--
                            (i) In general.--Section 1834(h)(1)(H) of 
                        the Social Security Act (42 U.S.C. 
                        1395m(h)(1)(H)) is amended--
                                    (I) in the subparagraph heading, by 
                                inserting ``, dentures'' after 
                                ``orthotics'';
                                    (II) by inserting ``, of dentures 
                                described in paragraph (2)(D) of such 
                                section,'' after ``2011,''; and
                                    (III) in clause (i), by inserting 
                                ``, such dentures'' after 
                                ``orthotics''.
                            (ii) Conforming amendment.--Section 
                        1847(a)(2) of the Social Security Act (42 
                        U.S.C. 1395w-3(a)(2)) is amended by adding at 
                        the end the following new subparagraph:
                    ``(D) Dentures.--Dentures described in section 
                1861(s)(8) for which payment would otherwise be made 
                under section 1834(h).''.
                            (iii) Exemption of certain items from 
                        competitive acquisition.--Section 1847(a)(7) of 
                        the Social Security Act (42 U.S.C. 1395w-
                        3(a)(7)) is amended by adding at the end the 
                        following new subparagraph:
                    ``(C) Certain dentures.--Those items and services 
                described in paragraph (2)(D) if furnished by a 
                physician or other practitioner (as defined by the 
                Secretary) to the physician's or practitioner's own 
                patients as part of the physician's or practitioner's 
                professional service.''.
    (f) Exclusion Modifications.--Section 1862(a) of the Social 
Security Act (42 U.S.C. 1395y(a)) is amended--
            (1) in paragraph (1)--
                    (A) in subparagraph (O), by striking ``and'' at the 
                end;
                    (B) in subparagraph (P), by striking the semicolon 
                at the end and inserting ``, and''; and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(Q) in the case of dental and oral health services (as 
        defined in section 1861(lll)) that are preventive and screening 
        services described in paragraph (2) of such section, which are 
        furnished more frequently than provided under section 
        1834(z)(3) and under circumstances other than circumstances 
        determined appropriate under such section;''; and
            (2) in paragraph (12), by inserting before the semicolon at 
        the end the following: ``and except that payment may be made 
        under part B for dental and oral health services that are 
        covered under section 1861(s)(2)(II)''.
    (g) Certain Non-Application.--
            (1) In general.--Paragraphs (1) and (4) of section 1839(a) 
        of the Social Security Act (42 U.S.C. 1395r(a)) are amended by 
        adding at the end of each such paragraphs the following: ``In 
        applying this paragraph there shall not be taken into account 
        benefits and administrative costs attributable to the 
        amendments made by section 2 (other than subsection (g)) of the 
        Medicare Dental Coverage Act of 2021 and the Government 
        contribution under section 1844(a)(5).''.
            (2) Payment.--Section 1844(a) of such Act (42 U.S.C. 
        1395w(a)) is amended--
                    (A) in paragraph (4), by striking the period at the 
                end and inserting ``; plus''; and
                    (B) by adding at the end the following new 
                paragraph:
            ``(5) a Government contribution equal to the amount that is 
        estimated to be payable for benefits and related administrative 
        costs incurred that are attributable to the amendments made by 
        section 2 (other than subsection (g)) of the Medicare Dental 
        Coverage Act of 2021.''.
    (h) Implementation Funding.--
            (1) In general.--The Secretary of Health and Human Services 
        (in this subsection referred to as the ``Secretary'') shall 
        provide for the transfer from the Federal Supplementary Medical 
        Insurance Trust Fund under section 1841 of the Social Security 
        Act (42 U.S.C. 1395t) to the Centers for Medicare & Medicaid 
        Services Program Management Account of--
                    (A) $20,000,000 for each of fiscal years 2022 
                through 2027 for purposes of implementing the 
                amendments made by this section; and
                    (B) such sums as determined appropriate by the 
                Secretary for each subsequent fiscal year for purposes 
                of administering the provisions of such amendments.
            (2) Availability.--Funds transferred pursuant to paragraph 
        (1) shall remain available until expended.
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