,i #aafth ,,congress #ast ,session ,h4 ,r4 #dfej ,,in ,,the ,,house ,,of ,,representatives ,october #aa1 #bjai,ms4 ,kelly of ,illinois 7for herself and ,mr4 ,horsford7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,ways and ,means1 for a period to be subsequently determined by the ,speaker1 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 coverage for certain dental items and services under part ,b of the ,medicare program4 #a4 ,short title ,this ,act may be cited as the ,medicare ,dental ,act of #bjai4 #b4 ,dental and oral health care 7a7 ,coverage ,section #ahfa7s77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#b77 is amended-- 7#a7 in subparagraph 7,,gg71 by striking and after the semicolon at the end2 7#b7 in subparagraph 7,,hh71 by striking the period at the end and adding 2 and2 and 7#c7 by adding at the end the following new subparagraph3 7,,ii7 dental and oral health services 7as defined in subsection 7kkk772 4 7b7 ,dental and oral health services defined ,section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 is amended by adding at the end the following new subsection3 7kkk7 ,dental and oral health services 7#a7 ,in general ,the term dental and oral health services means items and services 7other than such items and services for which payment may be made under part ,a as inpatient hospital services7 that are furnished during #bjbb or a subsequent year1 for which coverage was not provided under part ,b as of the date of the enactment of this subsection1 and that are-- 7,a7 the preventive and screening services described in paragraph 7#b7 furnished by a doctor of dental surgery or of dental medicine 7as described in subsection 7r77#b77 or an oral health professional 7as defined in paragraph 7#d772 or 7,b7 the basic treatments specified for such year by the ,secretary pursuant to paragraph 7#c77;,a7 and the major treatments specified for such year by the ,secretary pursuant to paragraph 7#c77;,b7 furnished by such a doctor or such a professional4 7#b7 ,preventive and screening services ,the preventive and screening services described in this paragraph are the following3 7,a7 ,oral exams4 7,b7 ,dental cleanings4 7,c7 ,dental x-rays performed in the office of a doctor or professional described in paragraph 7#a77;,a74 7,d7 ,fluoride treatments4 7#c7 ,basic and major treatments ,for #bjbb and each subsequent year1 the ,secretary shall specify-- 7,a7 basic treatments 7which may include basic tooth restorations1 basic periodontic services1 tooth extractions1 and oral disease management services72 and 7,b7 major treatments 7which may include major tooth restorations1 major periodontic services1 bridges1 crowns1 dental implants1 and root canals72 that shall be included as dental and oral health services for such year4 7#d7 ,oral health professional ,the term oral health professional means1 with respect to dental and oral health services1 a health professional who is licensed to furnish such services1 acting within the scope of such license1 by the ,state in which such services are furnished4 4 7c7 ,payment2 coinsurance2 and limitations 7#a7 ,in general ,section #ahcc7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77#a77 is amended-- 7,a7 by striking and before 7,,cc72 and 7,b7 by inserting before the semicolon at the end the following3 1 and 7,,dd7 with respect to dental and oral health services 7as defined in section #ahfa7kkk771 the amount paid shall be the payment amount specified under section #ahcd7x74 7#b7 ,payment and limits specified ,section #ahcd of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7 is amended by adding at the end the following new subsection3 7x7 ,payment and limits for dental and oral health services 7#a7 ,in general ,the payment amount under this part for dental and oral health services 7as defined in section #ahfa7kkk77 shall be1 subject to paragraph 7#c71 the applicable percent 7specified in paragraph 7#b77 of the lesser of the actual charge for the services or the amount determined under the payment basis determined under section #ahdh4 7#b7 ,applicable percent ,for purposes of paragraph 7#a71 the applicable percent specified in this paragraph is1 with respect to dental and oral health services 7as defined in section #ahfa7kkk77 furnished in a year-- 7,a7 that are preventive and screening services described in paragraph 7#b7 or basic treatments specified for such year pursuant to paragraph 7#c77;,a7 of such section1 #hj percent2 and 7,b7 that are major treatments specified for such year pursuant to paragraph 7#c77;,b7 of such section-- 7i7 in the case such services are furnished during #bjbb1 #aj percent2 7ii7 in the case such services are furnished during #bjbc or a subsequent year before #bjbf1 the applicable percent specified under this subparagraph for the previous year1 increased by #aj percentage points2 and 7iii7 in the case such services are furnished during #bjbf or a subsequent year1 #ej percent4 7#c7 ,limitations ,with respect to dental and oral health services that are-- 7,a7 oral exams1 payment may be made under this part for not more than two such exams during a #ab-month period2 7,b7 dental cleanings1 payment may be made under this part for not more than two such cleanings during a #ab-month period2 and 7,c7 not described in subparagraph 7,a7 or 7,b71 payment may be made under this part only at such frequencies and under such circumstances determined appropriate by the ,secretary4 4 7d7 ,payment under physician fee schedule 7#a7 ,in general ,section #ahdh7;j77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;j77#c77 is amended by inserting 7#b77;,,ii71 before 7#c74 7#b7 ,budget neutrality ,section #ahdh7;c77#b77;,b77iv7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie-w7c77#b77;,b77iv77 is amended-- 7,a7 in subclause 7,,iii71 by striking and at the end2 7,b7 in subclause 7,,iv71 by striking the period at the end and inserting 2 and2 and 7,c7 by adding at the end the following new subclause3 7,v7 the amendment made by section #b7;d77#a7 of the ,medicare ,dental ,act of #bjai shall not be taken into account in applying clause 7ii77,,ii7 for #bjbb and #bjbc4 4 7#c7 ,exclusion from ,,mips ,section #ahdh7q77#a77;,c77ii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7q77#a77;,c77ii77 is amended-- 7,a7 in subclause 7,,ii71 by striking or at the end2 7,b7 in subclause 7,,iii71 by striking the period at the end and inserting 2 or2 and 7,c7 by adding at the end the following new subclause3 7,,iv7 with respect to #bjbb and each subsequent year1 is a doctor of dental surgery or of dental medicine 7as described in section #ahfa7r77#b77 or is an oral health professional 7as defined in section #ahfa7kkk77#d774 4 7#d7 ,inclusion of oral health professionals as certain practitioners ,section #ahdb7;b77#ah77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieu7b77#ah77;,c77 is amended by adding at the end the following new clause3 7vii7 ,with respect to #bjbb and each subsequent year1 an oral health professional 7as defined in section #ahfa7kkk77#d774 4 7e7 ,dentures 7#a7 ,in general ,section #ahfa7s77#h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#h77 is amended-- 7,a7 by striking 7other than dental72 and 7,b7 by inserting and excluding dental1 except for a full or partial set of dentures furnished on or after ,january #a1 #bjbb after colostomy care4 7#b7 ,special payment rules 7,a7 ,limitations ,section #ahcd7;h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7h77 is amended by adding at the end the following new paragraph3 7#f7 ,special payment rule for dentures ,payment may be made under this part with respect to an individual for dentures-- 7,a7 not more than once during any #e-year period 7except in the case that a doctor or professional described in section #ahfa7kkk77#a77;,a7 determines such dentures do not fit the individual72 and 7,b7 only to the extent that such dentures are furnished pursuant to a written order of such a doctor or professional4 4 7,b7 ,application of competitive acquisition 7i7 ,in general ,section #ahcd7;h77#a77;,h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7h77#a77;,h77 is amended-- 7,i7 in the subparagraph heading1 by inserting 1 dentures after orthotics2 7,,ii7 by inserting and of dentures described in paragraph 7#b77;,d7 of such section1 after #bjji12 and 7,,iii7 in clause 7i71 by inserting or such dentures after orthotics4 7ii7 ,conforming amendment ,section #ahdg7;a77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#c7;a77#b77 is amended by adding at the end the following new subparagraph3 7,d7 ,dentures ,dentures for which payment would otherwise be made under section #ahcd7;h74 4 7iii7 ,exemption of certain items from competitive acquisition ,section #ahdg7;a77#g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#c7;a77#g77 is amended by adding at the end the following new subparagraph3 7,c7 ,certain dentures ,those items and services described in paragraph 7#b77;,d7 if furnished by a physician or other practitioner 7as defined by the ,secretary7 to the physician's or practitioner's own patients as part of the physician's or practitioner's professional service4 4 7f7 ,exclusion modifications ,section #ahfb7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciey7a77 is amended-- 7#a7 in paragraph 7#a7-- 7,a7 in subparagraph 7,o71 by striking and at the end2 7,b7 in subparagraph 7,p71 by striking the semicolon at the end and inserting 1 and2 and 7,c7 by adding at the end the following new subparagraph3 7,q7 in the case of dental and oral health services 7as defined in section #ahfa7kkk77 that are preventive and screening services described in paragraph 7#b7 of such section1 which are furnished more frequently than provided under section #ahcd7x77#c72 2 and 7#b7 in paragraph 7#ab71 by inserting before the semicolon at the end the following3 and except that payment may be made under part ,b for dental and oral health services that are covered under section #ahfa7s77#b77;,,ii74 #c4 ,implementation funding ,the ,secretary of ,health and ,human ,services shall provide for the transfer from the ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda of the ,social ,security ,act 7#db ,u4,s4,c4 #aciet7 to the ,centers for ,medicare ,medicaid ,services ,program ,management ,account for the period of #bjbj through #bjbd of such sums as may be necessary for purposes of implementing the amendments made by section #b4