Title: Medicare Dental Benefit Act of 2019
Policy area: Health

Summary:
Medicare Dental Benefit Act of 2019
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.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 22 Introduced in Senate (IS)]

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116th CONGRESS
  1st Session
                                 S. 22

To amend title XVIII of the Social Security Act to provide for coverage 
             of dental services under the Medicare program.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            January 3, 2019

  Mr. Cardin introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 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 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 
2019''.

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 (kkk));''.
    (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

    ``(kkk) 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 (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 described in paragraph (1) of 
                such section), the amount paid shall be the payment 
                amount specified under section 1834(v)''.
            (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 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
                    ``(C) for the eighth year following the year 
                specified in subparagraph (A) 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.''.
    (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.--For purposes of 
                subparagraph (A), 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.
                    ``(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.''.
    (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.
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