Bill Summary
The Medicare Dental Benefit Act of 2019 is a bill that aims to amend the existing Medicare program to include coverage for dental services. It would add a new category called "dental and oral health services" to the list of covered services under the Social Security Act. This includes routine diagnostic and preventive care, basic dental services, major dental services, emergency dental care, and other necessary services related to dental and oral health. The bill also specifies limitations on the frequency and type of services covered, as well as giving the Secretary of Health and Human Services the authority to modify coverage if deemed necessary. Additionally, it would repeal the current exclusion for dental services and provide payment and coinsurance rules for dental prostheses. The effective date of this bill would be January 1, 2020.
Possible Impacts
1. Improved access to dental services for Medicare beneficiaries: The Medicare Dental Benefit Act of 2019 would expand Medicare coverage to include dental services, which were previously not covered under the program. This could greatly benefit individuals who rely on Medicare for their healthcare needs and may have difficulty accessing dental care due to financial constraints.
2. Increased preventive care for oral health: With the inclusion of routine diagnostic and preventive care as a preventive service under Medicare, individuals may be more incentivized to prioritize their oral health and seek regular dental check-ups. This could lead to better overall oral health and potentially reduce the need for more costly dental procedures in the future.
3. Limitations on coverage and potential barriers to care: While the legislation aims to expand coverage for dental services, it also includes limitations on the frequency and types of services covered. This could potentially limit some individuals' access to necessary dental care, especially those who require more frequent or extensive procedures. Additionally, the Secretary's authority to modify coverage and apply prior authorization requirements could create additional barriers to care for some individuals.
[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2951 Introduced in House (IH)]
<DOC>
116th CONGRESS
1st Session
H. R. 2951
To amend title XVIII of the Social Security Act to provide for coverage
of dental services under the Medicare program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 23, 2019
Ms. Barragan (for herself and Ms. Kelly of Illinois) introduced the
following bill; which was referred to the Committee on Energy and
Commerce, and in addition to the Committee on Ways and Means, 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 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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