Bill Summary
This bill, known as the "Medicare Medically Necessary Dental Care Act of 2021", aims to amend the existing Medicare program under title XVIII of the Social Security Act to provide coverage for medically necessary dental procedures. This means that certain dental services deemed necessary for the treatment or prevention of an underlying medical condition would be eligible for coverage under Medicare Part B. The bill was introduced in response to findings that show the important connection between oral and overall health, and the potential benefits of providing dental care for Medicare patients. The bill specifies that dental services related to certain medical conditions, such as cancer, organ transplantation, and heart valve replacement, would be considered medically necessary and therefore eligible for coverage. These changes would go into effect on January 1, 2022.
Possible Impacts
1. Access to dental care for Medicare beneficiaries: This legislation would expand Medicare coverage to include medically necessary dental procedures for individuals with certain conditions, such as those with prosthetic heart valve replacements or a diagnosis of cancer of the head or neck. This could greatly benefit these individuals by providing them with necessary dental care that can improve their overall health and well-being.
2. Improved health outcomes: By including coverage for dental services, this legislation aims to improve the overall health outcomes of Medicare patients. This could lead to a reduction in mortality and morbidity rates for individuals with certain conditions, such as head and neck cancer, leukemia, and heart valve disease.
3. Financial impact: The expanded coverage for dental services under Medicare could have a financial impact on both patients and the healthcare system. Patients may have to pay less out-of-pocket for necessary dental procedures, while the healthcare system may have to allocate more resources to cover these services. This could also potentially lead to increased healthcare costs for the government and taxpayers.
[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5110 Introduced in House (IH)]
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117th CONGRESS
1st Session
H. R. 5110
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.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
August 27, 2021
Mr. Cohen 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
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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