Bill Summary
This bill aims to expand Medicare and Medicaid coverage to include dental, vision, and hearing care. It defines these services and sets payment and limitations for them. It also repeals certain exclusions and includes provisions for eyeglasses, contact lenses, and hearing aids. The effective date for these changes is set for January 1 of the first year beginning at least six months after the date of enactment. Additionally, this legislation proposes an increase in the FMAP for these services under Medicaid.
Possible Impacts
1. Under the proposed legislation, individuals who are covered by Medicare and Medicaid programs will now have access to dental, vision, and hearing care services, which were previously not covered under these programs. This will greatly benefit those who may have struggled to afford or access these critical healthcare services.
2. With the addition of dental and oral health services, individuals on Medicare and Medicaid will now have access to routine cleanings, basic and major dental procedures, and emergency care. This will greatly impact the oral health and overall well-being of individuals who may have previously not been able to afford or access these services.
3. The proposed changes to Medicare coverage of vision and hearing care will also have a significant impact on individuals. This will include expanded coverage for eyeglasses, contact lenses, and hearing aids, which were previously excluded. This will greatly benefit individuals who may have difficulty affording or accessing these necessary medical devices.
[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 1423 Introduced in Senate (IS)]
<DOC>
116th CONGRESS
1st Session
S. 1423
To amend titles XVIII and XIX of the Social Security Act to provide for
coverage of dental, vision, and hearing care under the Medicare and
Medicaid programs.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 13, 2019
Mr. Casey (for himself and Mr. Cardin) introduced the following bill;
which was read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend titles XVIII and XIX of the Social Security Act to provide for
coverage of dental, vision, and hearing care under the Medicare and
Medicaid programs.
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 and Medicaid Dental,
Vision, and Hearing Benefit Act of 2019''.
SEC. 2. DENTAL AND ORAL HEALTH CARE UNDER MEDICARE.
(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'' after the
semicolon at the end;
(2) in subparagraph (HH), by adding ``and'' after the
semicolon at the end; 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--
``(1) routine dental cleanings and exams;
``(2) basic dental services, such as fillings and crowns;
``(3) major dental services, such as root canals, and
extractions;
``(4) emergency dental care; and
``(5) other necessary services related to dental or oral
health (as defined by the Secretary).''.
(c) 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)),
the amount paid shall be the payment amount specified
under section 1834(x)''.
(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:
``(x) 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)) shall be, subject to paragraph (3), the applicable
percent (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 percent.--For purposes of paragraph (1),
the applicable percent 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.''.
(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)(II),'' before ``(3)''.
(e) Dentures.--
(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 dentures)''; 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 dentures.--
``(A) In general.--The payment amount under this
part for dentures shall be, subject to subparagraph
(C), the applicable percent (specified in subparagraph
(B)) of the amount otherwise payable for such dentures
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 denture once every
five years; and
``(II) not more than one partial
upper denture and one partial lower
denture 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 dentures 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 dentures to the extent
that such modification is consistent
with the recommendations of the United
States Preventive Services Task
Force.''.
(f) Repeal of Ground for Exclusion.--Section 1862(a) of the Social
Security Act (42 U.S.C. 1395y) is amended by striking paragraph (12).
(g) Effective Date.--The amendments made by this section shall
apply to services furnished on or after January 1 of the first year
beginning at least six months after the date of the enactment of this
Act.
SEC. 3. VISION CARE UNDER MEDICARE.
(a) Coverage.--Section 1861(s)(2) of the Social Security Act (42
U.S.C. 1395x(s)(2)), as amended by section 2(a), is amended--
(1) in subparagraph (HH), by striking ``and'' after the
semicolon at the end;
(2) in subparagraph (II), by adding ``and'' after the
semicolon at the end; and
(3) by adding at the end the following new subparagraph:
``(JJ) vision services (as defined in subsection (lll));''.
(b) Vision Services Defined.--Section 1861 of the Social Security
Act (42 U.S.C. 1395x), as amended by section 2(b), is amended by adding
at the end the following new subsection:
``Vision Services
``(lll) The term `vision services' means--
``(1) routine eye examinations and procedures performed
(during the course of any eye examination) to determine the
refractive state of the eyes; and
``(2) other necessary services related to eye and vision
health (as defined by the Secretary).''.
(c) Payment; Coinsurance; and Limitations.--
(1) In general.--Section 1833(a)(1) of the Social Security
Act (42 U.S.C. 1395l(a)(1)), as amended by section 2(c)(1), is
amended--
(A) by striking ``and'' before ``(DD)''; and
(B) by inserting before the semicolon at the end
the following: ``, and (EE) with respect to vision
services (as defined in section 1861(lll)), the amount
paid shall be the payment amount specified under
section 1834(w)''.
(2) Payment and limits specified.--Section 1834 of the
Social Security Act (42 U.S.C. 1395m), as amended by section
2(c)(2), is amended by adding at the end the following new
subsection:
``(y) Payment and Limits for Vision Services.--
``(1) In general.--The payment amount under this part for
vision services (as defined in section 1861(lll)) shall be,
subject to paragraph (3), the applicable percent (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 percent.--For purposes of paragraph (1),
the applicable percent 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 routine eye
exams, payment may be made under this part for only one
such exam during a 12-month period.
``(B) Secretarial authority.--
``(i) Authority to apply additional
limitations.--The Secretary may apply other
reasonable limitations on the extent to which
vision 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 vision services to the extent that
such modification is consistent with the
recommendations of the United States Preventive
Services Task Force.''.
(d) Payment Under Physician Fee Schedule.--Section 1848(j)(3) of
the Social Security Act (42 U.S.C. 1395w-4(j)(3)), as amended by
section 2(d), is amended by inserting ``(2)(JJ),'' after ``(2)(II),''.
(e) Special Payment Rules for Eyeglasses, Contact Lenses, and Low
Vision Devices.--Section 1834(a) of the Social Security Act (42 U.S.C.
1395m(a)), as amended by section 2(e)(2), is amended by adding at the
end the following new paragraphs:
``(24) Payment and limits for eyeglasses and contact
lenses.--
``(A) In general.--The payment amount under this
part for eyeglass lenses, eyeglass frames, and contact
lenses shall be, subject to subparagraph (C), the
applicable percent (specified in subparagraph (B)) of
the amount otherwise payable for such eyeglass lenses,
eyeglass frames, and contact lenses, respectively,
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 (other than for eyewear
described in section 1861(s)(8)) for an
individual for--
``(I) not more than one pair of
eyeglass lenses during any 12-month
period;
``(II) not more than one set of
eyeglass frames during any 24-month
period; and
``(III) contact lenses, only to the
extent that the sum of such payments
for contact lenses does not exceed a
limitation of $200 during any 24-month
period beginning during the first year
beginning at least six months after the
date of the enactment of this paragraph
(or, beginning during a subsequent
year, such limitation for a 24-month
period beginning in the previous year
increase by an appropriate inflation
adjustment specified by the Secretary).
``(ii) Secretarial authority.--
``(I) Authority to apply additional
limitations.--The Secretary may apply
such other reasonable limitations on
the extent to which eyeglass lenses,
eyeglass frames, and contact lenses 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 eyeglass lenses, eyeglass
frames, and contact lenses to the
extent that such modification is
consistent with the recommendations of
the United States Preventive Services
Task Force.
``(25) Payment and limits for low vision devices.--
``(A) In general.--The payment amount under this
part for low vision devices shall be, subject to
subparagraph (C), the applicable percent (specified in
subparagraph (B)) of the amount otherwise payable for
low vision devices 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) Secretarial authority.--
``(i) Authority to apply limitations.--The
Secretary may apply reasonable limitations on
the extent to which low vision devices 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 low vision devices to the extent
that such modification is consistent with the
recommendations of the United States Preventive
Services Task Force.
``(D) Low vision device defined.--In this
paragraph, the term `low vision device' means a device,
prescribed by a physician, that magnifies, enhances, or
otherwise augments or interprets visual images
irrespective of the size, form, or technological
features of such device and does not include ordinary
eyeglasses or contact lenses. In the previous sentence,
the term `ordinary eyeglasses or contact lenses' means
lenses that are intended to fully correct visual acuity
or fully eliminate refractive error.''.
(f) Definition of Durable Medical Equipment To Include Eyeglasses,
Contact Lenses, and Low Vision Devices.--Section 1861(n) of the Social
Security Act (42 U.S.C. 1395x(n)) is amended--
(1) by striking ``and'' before ``eye tracking'' and
inserting a comma; and
(2) by inserting ``, and eyeglass lenses, low vision
devices (as defined in section 1834(a)(25)), eyeglass frames,
and contact lenses'' before ``; except''.
(g) Repeal of Ground for Exclusion.--Section 1862(a)(7) of the
Social Security Act (42 U.S.C. 1395y(a)(7)) is amended by striking ``,
eyeglasses (other than eyewear described in section 1861(s)(8)) or eye
examinations for the purpose of prescribing, fitting, or changing
eyeglasses, procedures performed (during the course of any eye
examination) to determine the refractive state of the eyes''.
(h) Effective Date.--The amendments made by this section shall
apply to services furnished on or after January 1 of the first year
beginning at least six months after the date of the enactment of this
Act.
SEC. 4. HEARING CARE UNDER MEDICARE.
(a) Coverage.--
(1) In general.--Section 1861(s)(2) of the Social Security
Act (42 U.S.C. 1395x(s)(2)), as amended by sections 2(a) and
3(a), is amended--
(A) in subparagraph (II), by striking ``and'' at
the end;
(B) in subparagraph (JJ), by inserting ``and'' at
the end; and
(C) by adding at the end the following new
subparagraph:
``(KK) audiology services (as defined in subsection
(ll)(3)) and hearing services (as defined in subsection
(ll)(5));''.
(2) Hearing services defined.--Section 1861(ll) of the
Social Security Act (42 U.S.C. 1395x(ll)) is amended--
(A) in the subsection heading, by inserting ``;
Hearing Services'' after ``Audiology Services''; and
(B) by adding at the end the following new
paragraph:
``(5) The term `hearing services' means--
``(A) routine hearing exams and exams for hearing aids; and
``(B) other necessary services related to hearing health
(as defined by the Secretary).''.
(b) Payment; Coinsurance; and Limitations.--
(1) In general.--Section 1833(a)(1) of the Social Security
Act (42 U.S.C. 1395l(a)(1)), as amended by sections 2(c)(1) and
3(c)91), is amended--
(A) by striking ``and'' before ``(EE)''; and
(B) by inserting before the semicolon at the end
the following: ``, and (FF) with respect to audiology
services (as defined in section 1861(ll)(3)) and
hearing services (as defined in section 1861(ll)(5)),
the amount paid shall be the payment amount specified
under section 1834(x)''.
(2) Payment and limits specified.--Section 1834 of the
Social Security Act (42 U.S.C. 1395m), as amended by sections
2(c)(2) and 3(c)(2), is amended by adding at the end the
following new subsection:
``(z) Payment and Limits for Hearing Services.--
``(1) In general.--The payment amount under this part for
audiology services (as defined in section 1861(ll)(3)) and
hearing services (as defined in section 1861(ll)(5)), shall be,
subject to paragraph (3), the applicable percent (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 percent.--For purposes of paragraph (1),
the applicable percent 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) Secretarial authority.--
``(A) Authority to apply limitations.--The
Secretary may apply reasonable limitations on the
extent to which audiology services and hearing services
are covered under this part, including through
application of a prior authorization requirement.
``(B) 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 audiology
services and hearing services to the extent that such
modification is consistent with the recommendations of
the United States Preventive Services Task Force.''.
(c) Payment Under the Physician Fee Schedule.--Section 1848(j)(3)
of the Social Security Act (42 U.S.C. 1395w-4(j)(3)), as amended by
sections 2(d) and 3(d), is amended by inserting ``(2)(KK),'' after
``(2)(JJ),''.
(d) Hearing Aids.--
(1) Repeal of ground for exclusion.--Section 1862(a)(7) of
the Social Security Act (42 U.S.C. 1395y(a)(7)), as amended by
section 3(g), is amended by striking ``, hearing aids or
examinations therefor,''.
(2) Definition of durable medical equipment to include
hearing aids.--Section 1861(n) of the Social Security Act (42
U.S.C. 1395x(n)), as amended by section 3(f), is amended by
inserting ``hearing aids,'' before ``and eyeglass lenses''.
(3) Special payment rules for hearing aids.--Section
1834(a) of the Social Security Act (42 U.S.C. 1395m(a)), as
amended by sections 2(e)(2) and 3(e), is amended by adding at
the end the following new paragraph:
``(26) Payment and limits for hearing aids.--
``(A) In general.--The payment amount under this
part for hearing aids shall be, subject to subparagraph
(C), the applicable percent (specified in subparagraph
(B)) of the amount otherwise payable for hearing aids
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 not more
than one hearing aid per ear during a 48-month
period.
``(ii) Secretarial authority.--
``(I) Authority to apply additional
limitations.--The Secretary may apply
additional limitations on the extent to
which hearing aids are covered under
this part, including through
application of a prior authorization
requirement and through application of
criteria for a minimum level of hearing
loss for coverage of an initial or
replacement hearing aid.
``(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 hearing aids to the extent
that such modification is consistent
with the recommendations of the United
States Preventive Services Task
Force.''.
(e) Effective Date.--The amendments made by this section shall
apply to services furnished on or after January 1 of the first year
beginning at least six months after the date of the enactment of this
Act.
SEC. 5. INCREASED FMAP FOR COVERAGE OF DENTAL AND ORAL HEALTH CARE,
VISION, CARE, AND HEARING CARE UNDER MEDICAID.
Section 1905 of the Social Security Act (42 U.S.C. 1396d) is
amended--
(1) in subsection (a)--
(A) in paragraph (10), by inserting ``, which may
include any dental and oral health service (as defined
in section 1861(kkk))'' after ``dental services'';
(B) in paragraph (13)--
(i) in subparagraph (B), by striking ``;
and'' and inserting a semicolon;
(ii) in subparagraph (C), by striking the
semicolon and inserting ``; and''; and
(iii) by adding at the end the following
new subparagraph:
``(D) any service that is a vision service (as
defined in section 1861(lll)) or a hearing service (as
defined in section 1861(ll)(5);''; and
(C) in paragraph (29), by realigning the left
margin so as to align with the left margin of paragraph
(28); and
(2) by adding at the end the following new subsection:
``(ff) Increased FMAP for Expenditures for Dental and Oral Health
Services, Vision Services, and Hearing Services.--
``(1) In general.--Notwithstanding subsection (b), the
Federal medical assistance percentage with respect to amounts
expended by a State for medical assistance for services
described in paragraph (2) shall be equal to 90 percent.
``(2) Services described.--A service described in this
paragraph is any service that--
``(A) is furnished on or after January 1 of the
first calendar year that begins at least 6 months after
the date of the enactment of this subsection;
``(B) is not furnished to an individual who is--
``(i) under the age of 21; and
``(ii) eligible for medical assistance for
the services described in subsection (a)(4)(B);
and
``(C) is--
``(i) a dental and oral health service (as
defined in section 1861(kkk));
``(ii) a vision service (as defined in
section 1861(lll)); or
``(iii) a hearing service (as defined in
section 1861(ll)(5)).''.
<all>