Bill Summary
The Medicare Medically Necessary Dental Care Act of 2023 is a bill that aims to amend title XVIII of the Social Security Act to provide coverage for medically necessary dental procedures under the Medicare program. This bill was introduced in the United States Congress and includes a short title and findings section. The findings section acknowledges the importance of dental care for overall physical health and the potential health implications of not providing coverage for dental services under Medicare. The bill proposes to update the current exclusion of dental services under Medicare and cover services that are deemed medically necessary for the prevention or reduction of complications related to serious medical conditions and treatments. It also outlines specific conditions and timeframes in which these services would be covered. The effective date for these amendments is proposed to be January 1, 2024.
Possible Impacts
1. The Medicare Medically Necessary Dental Care Act of 2023 could potentially affect people who are beneficiaries of the Medicare program. This legislation would allow for coverage of medically necessary dental procedures for individuals with specific medical conditions, such as cancer or organ transplantation.
2. The amendment to Section 1862 of the Social Security Act could impact dentists and dental care providers, as they would need to determine if the dental services they are providing are considered medically necessary under the new criteria set forth in the legislation.
3. The effective date of January 1, 2024 could impact individuals who are currently receiving or may need dental procedures in the near future, as they may need to wait until after this date to have their procedures covered under Medicare.
[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 831 Introduced in House (IH)]
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118th CONGRESS
1st Session
H. R. 831
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
February 6, 2023
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 2023''.
(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, 2024.
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