I 118th CONGRESS 1st Session H. R. 1326 IN THE HOUSE OF REPRESENTATIVES March 1, 2023 Ms. Porter introduced the following bill; which was referred to the Committee on Ways and Means , and in addition to the Committee on Energy and Commerce , for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To modify the limitation on the deduction by individuals of certain State and local taxes and to provide coverage for hearing and vision care under the Medicare program.

1. Short title This Act may be cited as the Supporting Americans with Lower Taxes Act or as the SALT Act . 2. Modification of limitation on the deduction by individuals of certain State and local, etc., taxes (a) In general Section 164(b)(6) of the Internal Revenue Code of 1986 is amended to read as follows: (6) Limitation on deduction by certain high-income individuals (A) In general In the case of a taxpayer with adjusted gross income which equals or exceeds $400,000 for any taxable year— (i) foreign real property taxes shall not be taken into account under subsection (a)(1) (or section 216(a)) for such taxable year, and (ii) the aggregate amount of taxes taken into account under paragraphs (1), (2), and (3) of subsection (a) and paragraph (5) of this subsection (and any tax described in any such paragraph taken into account under section 216(a)(1)) for such taxable year shall not exceed $60,000. (B) Phasedown of limitation based on adjusted gross income The $60,000 amount in subparagraph (A)(ii) shall be reduced (but not below zero) by the dollar amount which bears the same ratio to $60,000 as— (i) the excess of the taxpayer’s adjusted gross income over $400,000, bears to (ii) $600,000. (C) Application restricted to certain taxpayers and taxes (i) Application to individuals Subparagraph (A) shall only apply to individuals, estates, and trusts. (ii) Exclusion of certain business taxes Subparagraph (A) shall not apply to any foreign taxes described in subsection (a)(3) or to any taxes described in paragraph (1) and (2) of subsection (a) which are paid or accrued in carrying on a trade or business or an activity described in section 212. (D) Married individuals filing a separate return In the case of a married individual filing a separate return, subparagraphs (A) and (B) shall be applied— (i) by substituting $200,000 for $400,000 each place it appears, (ii) by substituting $30,000 for $60,000 each place it appears, and (iii) by substituting $300,000 for $600,000 in subparagraph (B)(ii). (E) Estates and trusts In the case of an estate or trust, adjusted gross income shall be determined as provided in section 67(e). (F) Denial of deduction to billionaires Unless the taxpayer has less than $1,000,000,000 ($500,000,000 in the case of a married individual filing a separate return) in assets as of the close of the taxable year (and attests to such fact under penalty of perjury at such time and in such manner as the Secretary may provide)— (i) subparagraph (A) shall be applied— (I) by substituting zero for $400,000 , and (II) by substituting zero for $60,000 , and (ii) subparagraphs (B) and (D) shall not apply. For purposes of this subparagraph, the term assets means all property, real or personal, tangible or intangible, wherever situated (within the meaning of section 2031) and such property shall be valued in the same manner as for purposes of part III of subchapter A of chapter 11. . (b) Effective date The amendment made by subsection (a) shall apply to taxable years beginning after the date of the enactment of this Act. (c) Appropriations to Federal Supplementary Medical Insurance Trust Fund (1) In general There are hereby appropriated to the Federal Supplementary Medical Insurance Trust Fund amounts equivalent to the amounts received in the Treasury by reason of the amendment made by subsection (a). Rules similar to the rules of section 9601 of the Internal Revenue Code of 1986 shall apply with respect to transfers made by reason of the preceding sentence. (2) Conforming amendment Section 1841(a) of the Social Security Act ( 42 U.S.C. 1395t ) is amended by inserting , or section 2(b) of the SALT Act , after this part . 3. Providing coverage for hearing care under the Medicare program (a) Provision of audiology services by qualified audiologists and qualified hearing aid professionals (1) In general Section 1861(ll) of the Social Security Act ( 42 U.S.C. 1395x(ll) ) is amended— (A) in paragraph (3)— (i) by inserting (and, beginning January 1, 2025, such aural rehabilitation and treatment services) after assessment services ; (ii) by inserting , and, beginning on January 1, 2025, such hearing assessment services furnished by a qualified hearing aid professional, after by a qualified audiologist ; and (iii) by striking the audiologist and inserting the audiologist or qualified hearing aid professional ; and (B) in paragraph (4), by adding at the end the following new subparagraph: (C) The term qualified hearing aid professional means, with respect to hearing assessment services described in paragraph (3), an individual who— (i) is licensed or registered as a hearing aid dispenser, hearing aid specialist, hearing instrument dispenser, or related professional by the State in which the individual furnishes such services; and (ii) meets such other requirements as the Secretary determines appropriate (including requirements relating to educational certifications or accreditations), taking into account any additional requirements for hearing aid specialists, hearing aid dispensers, and hearing instrument dispensers established by Medicare Advantage organizations under part C, State plans (or waivers of such plans) under title XIX, and the group health plans and health insurance issuers (as such terms are defined in section 2791 of the Public Health Service Act). . (2) Payment for qualified hearing aid professionals Section 1833(a)(1) of the Social Security Act ( 42 U.S.C. 1395l(a)(1) ) is amended— (A) by striking and before (HH) ; and (B) by inserting before the semicolon at the end the following: and (II) with respect to hearing assessment services (as described in paragraph (3) of section 1861(ll)) furnished by a qualified hearing aid professional (as defined in paragraph (4)(C) of such section), the amounts paid shall be equal to 80 percent of the lesser of the actual charge for such services or 85 percent of the amount for such services determined under the payment basis determined under section 1848 . (b) Coverage of hearing aids (1) Inclusion of hearing aids as prosthetic devices Section 1861(s)(8) of the Social Security Act ( 42 U.S.C. 1395x(s)(8) ) is amended by inserting , and including hearing aids (as described in section 1834(h)(7)) furnished on or after January 1, 2025, to individuals diagnosed with moderately severe, severe, or profound hearing loss before the semicolon at the end. (2) Payment limitations for hearing aids Section 1834(h) of the Social Security Act ( 42 U.S.C. 1395m(h) ) is amended by adding at the end the following new paragraphs: (6) Payment only on an assignment-related basis Payment for hearing aids for which payment may be made under this part may be made only on an assignment-related basis. The provisions of section 1842(b)(18)(B) shall apply to hearing aids in the same manner as they apply to services furnished by a practitioner described in subsection (b)(18)(C). (7) Limitations for hearing aids Payment may be made under this part with respect to an individual, with respect to hearing aids furnished on or after January 1, 2025— (A) not more than once per ear during a 5-year period; (B) only for types of such hearing aids that are determined appropriate by the Secretary; and (C) only if furnished pursuant to a written order of a physician, qualified audiologist (as defined in section 1861(ll)(4)), qualified hearing aid professional (as so defined), physician assistant, nurse practitioner, or clinical nurse specialist. . (3) Application of competitive acquisition (A) 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 header, by inserting and hearing aids after orthotics ; (ii) by inserting , or of hearing aids described in paragraph (2)(D) of such section, after 2011, ; and (iii) in clause (i), by inserting or such hearing aids after such orthotics . (B) Conforming amendment (i) In general 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) Hearing aids Hearing aids described in section 1861(s)(8) for which payment would otherwise be made under section 1834(h). . (ii) 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 hearing aids 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. . (4) Inclusion of qualified audiologists and qualified hearing aid professionals as certain practitioners to receive payment on an assignment-related basis 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 clauses: (ix) Beginning on January 1, 2025, a qualified audiologist (as defined in section 1861(ll)(4)(B)). (x) A qualified hearing aid professional (as defined in section 1861(ll)(4)(C)). . (c) Exclusion modification Section 1862(a)(7) of the Social Security Act ( 42 U.S.C. 1395y(a)(7) ) is amended by inserting (except such hearing aids or examinations therefor as described in and otherwise allowed under section 1861(s)(8)) after hearing aids or examinations therefor . (d) Inclusion as excepted medical treatment Section 1821(b)(5)(A) of the Social Security Act ( 42 U.S.C. 1395i–5(b)(5)(A) ) is amended— (1) in clause (i), by striking or ; (2) in clause (ii), by striking the period and inserting , or ; and (3) by adding at the end the following new clause: (iii) consisting of audiology services described in subsection (ll)(3) of section 1861, or hearing aids described in subsection (s)(8) of such section, that are payable under part B as a result of the amendments made by the SALT Act. . (e) Rural health clinics and Federally qualified health centers (1) Clarifying coverage of audiology services as physicians’ services Section 1861(aa)(1)(A) of the Social Security Act ( 42 U.S.C. 1395x(aa)(1)(A) ) is amended by inserting (including audiology services (as defined in subsection (ll)(3))) after physicians’ services . (2) Inclusion of qualified audiologists and qualified hearing aid professionals as RHC and FQHC practitioners Section 1861(aa)(1)(B) of the Social Security Act ( 42 U.S.C. 1395x(aa)(1)(B) ) is amended by inserting or by a qualified audiologist or a qualified hearing aid professional (as such terms are defined in subsection (ll)), after (as defined in subsection (hh)(1)), . (3) Temporary payment rates for certain services under the RHC AIR and FQHC PPS (A) AIR Section 1833 of the Social Security Act ( 42 U.S.C. 1395l ) is amended— (i) in subsection (a)(3)(A), by inserting (which shall, in the case of audiology services (as defined in section 1861(ll)(3)), in lieu of any limits on reasonable charges otherwise applicable, be based on the rates payable for such services under the payment basis determined under section 1848 until such time as the Secretary determines sufficient data has been collected to otherwise apply such limits (or January 1, 2031, if no such determination has been made as of such date)) after may prescribe in regulations ; and (ii) by adding at the end the following new subsection: (ee) Disregard of costs attributable to certain services from calculation of RHC AIR Payments for rural health clinic services other than audiology services (as defined in section 1861(ll)(3)) under the methodology for all-inclusive rates (established by the Secretary) under subsection (a)(3) shall not take into account the costs of such services while rates for such services are based on rates payable for such services under the payment basis established under section 1848. . (B) PPS Section 1834(o) of the Social Security Act ( 42 U.S.C. 1395m(o) ) is amended by adding at the end the following new paragraph: (5) Temporary payment rates based on PFS for certain services The Secretary shall, in establishing payment rates for audiology services (as defined in section 1861(ll)(3)) that are Federally qualified health center services under the prospective payment system established under this subsection, in lieu of the rates otherwise applicable under such system, base such rates on rates payable for such services under the payment basis established under section 1848 until such time as the Secretary determines sufficient data has been collected to otherwise establish rates for such services under such system (or January 1, 2031, if no such determination has been made as of such date). Payments for Federally qualified health center services other than such audiology services under such system shall not take into account the costs of such services while rates for such services are based on rates payable for such services under the payment basis established under section 1848. . (f) Implementation (1) In general In addition to amounts otherwise available, the Secretary of Health and Human Services shall provide for the transfer from the Federal Supplementary Medical Insurance Trust Fund established 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 2024 and 2025 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 and additional use of funds Funds transferred pursuant to paragraph (1) shall remain available until expended and may be used, in addition to the purposes specified in paragraph (1), to implement the amendments made by section 4. (3) Administration The Secretary may implement, by program instruction or otherwise, any of the provisions of, or amendments made by, this section. 4. Providing coverage for vision care 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 (II), by striking and after the semicolon at the end; (2) in subparagraph (JJ), by striking the period at the end and adding ; and ; and (3) by adding at the end the following new subparagraph: (KK) vision services (as defined in subsection (nnn)); . (b) Vision 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: (nnn) Vision services The term vision services means— (1) routine eye examinations to determine the refractive state of the eyes, including procedures performed during the course of such examination; and (2) contact lens fitting services, furnished on or after January 1, 2025, by or under the direct supervision of an ophthalmologist or optometrist who is legally authorized to furnish such examinations, procedures, or fitting services (as applicable) under State law (or the State regulatory mechanism provided by State law) of the State in which the examinations, procedures, or fitting services are furnished. . (c) Payment limitations Section 1834 of the Social Security Act ( 42 U.S.C. 1395m ) is amended by adding at the end the following new subsection: (aa) Limitation for vision services With respect to vision services (as defined in section 1861(nnn)) and an individual, payment may be made under this part for only 1 routine eye examination described in paragraph (1) of such section and 1 contact lens fitting service described in paragraph (2) of such section during a 2-year period. . (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)(KK), before (3) . (e) Coverage of conventional eyeglasses and contact lenses (1) In general Section 1861(s)(8) of the Social Security Act ( 42 U.S.C. 1395x(s)(8) ) is amended by striking , and including one pair of conventional eyeglasses or contact lenses furnished subsequent to each cataract surgery with insertion of an intraocular lens and inserting , including one pair of conventional eyeglasses or contact lenses furnished subsequent to each cataract surgery with insertion of an intraocular lens, if furnished before January 1, 2025, and including conventional eyeglasses or contact lenses (as described in section 1834(h)(8)), whether or not furnished subsequent to such a surgery, if furnished on or after January 1, 2025 . (2) Conforming amendment Section 1842(b)(11)(A) of the Social Security Act ( 42 U.S.C. 1395u(b)(11)(A) ) is amended by inserting furnished prior to January 1, 2025, after relating to them, . (f) Special payment rules for eyeglasses and contact lenses (1) Limitations Section 1834(h) of the Social Security Act ( 42 U.S.C. 1395m(h) ), as amended by section 3, is further amended by adding at the end the following new paragraph: (8) Payment limitations for eyeglasses and contact lenses (A) In general With respect to eyeglasses and contact lenses furnished to an individual on or after January 1, 2025, subject to subparagraph (B), payment may be made under this part only— (i) during a 2-year period, for either 1 pair of eyeglasses (including lenses and frames) or not more than a 2-year supply of contact lenses; (ii) with respect to amounts attributable to the lenses and frames of such a pair of eyeglasses or amounts attributable to such a 2-year supply of contact lenses, in an amount not greater than— (I) for a pair of eyeglasses furnished in, or a 2-year supply of contact lenses beginning in, 2025— (aa) $85 for the lenses of such pair of eyeglasses and $85 for the frames of such pair of eyeglasses; or (bb) $85 for such 2-year supply of contact lenses; and (II) for the lenses and frames of a pair of eyeglasses furnished in, or a 2-year supply of contact lenses beginning in, a subsequent year, the dollar amounts specified under this subparagraph for the previous year, increased 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; (iii) if furnished pursuant to a written order of an ophthalmologist or optometrist described in subsection (nnn); and (iv) if during the 2-year period described in clause (i), the individual did not already receive (as described in subparagraph (B)) one pair of conventional eyeglasses or contact lenses subsequent to a cataract surgery with insertion of an intraocular lens furnished during such period. (B) Exception With respect to a 2-year period described in subparagraph (A)(i), in the case of an individual who receives cataract surgery with insertion of an intraocular lens, notwithstanding subparagraph (A), payment may be made under this part for one pair of conventional eyeglasses or contact lenses furnished subsequent to such cataract surgery during such period. (C) Limitation on judicial review There shall be no administrative or judicial review under section 1869 or otherwise of— (i) the determination of the types of eyeglasses and contact lenses covered under this paragraph; or (ii) the determination of fee schedule rates under this subsection for eyeglasses and contact lenses. . (2) Application of competitive acquisition (A) In general Section 1834(h)(1)(H) of the Social Security Act ( 42 U.S.C. 1395m(h)(1)(H) ), as amended by section 3, is further amended— (i) in the header, by striking and hearing aids and inserting hearing aids, eyeglasses, and contact lenses ; (ii) by inserting and of eyeglasses and contact lenses described in paragraph (2)(E) of such section, after paragraph (2)(D) of such section, ; and (iii) in clause (i), by inserting , or such eyeglasses and contact lenses after such hearing aids . (B) Conforming amendment (i) In general Section 1847(a)(2) of the Social Security Act ( 42 U.S.C. 1395w–3(a)(2) ), as amended by section 3, is further amended by adding at the end the following new subparagraph: (E) Eyeglasses and contact lenses Eyeglasses and contact lenses described in section 1861(s)(8) for which payment would otherwise be made under section 1834(h). . (ii) Exemption of certain items from competitive acquisition Section 1847(a)(7) of the Social Security Act ( 42 U.S.C. 1395w–3(a)(7) ), as amended by section 3, is further amended by adding at the end the following new subparagraph: (D) Certain eyeglasses and contact lenses Those items and services described in paragraph (2)(E) 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. . (g) 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 vision services (as defined in section 1861(nnn)) that are routine eye examinations and contact lens fitting services (as described in paragraph (1) or (2), respectively, of such section), which are furnished more frequently than once during a 2-year period; ; and (2) in paragraph (7)— (A) by inserting (other than such an examination that is a vision service that is covered under section 1861(s)(2)(KK)) after eye examinations ; and (B) by inserting (other than such a procedure that is a vision service that is covered under section 1861(s)(2)(KK)) after refractive state of the eyes . (h) Implementation (1) Funding (A) In general In addition to amounts otherwise available, 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— (i) $20,000,000 for each of fiscal years 2024 and 2025 for purposes of implementing the amendments made by this section; and (ii) such sums as determined appropriate by the Secretary for each subsequent fiscal year for purposes of administering the provisions of such amendments. (B) Availability and additional use of funds Funds transferred pursuant to subparagraph (A) shall remain available until expended and may be used, in addition to the purpose specified in subparagraph (A)(i), to implement the amendments made by section 3. (2) Administration The Secretary may implement, by program instruction or otherwise, any of the provisions of, or amendments made by, this section.