,,ii #aafth ,,congress #ast ,session ,s4 #adbc ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,may #ac1 #bjai,mr4 ,casey 7for himself and ,mr4 ,cardin7 introduced the following bill2 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 dental1 vision1 and hearing care under the ,medicare and ,medicaid programs4 #a4 ,short title ,this ,act may be cited as the ,medicare and ,medicaid ,dental1 ,vision1 and ,hearing ,benefit ,act of #bjai4 #b4 ,dental and oral health care under ,medicare 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 adding and after the semicolon at the end2 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 ,the term dental and oral health services means-- 7#a7 routine dental cleanings and exams2 7#b7 basic dental services1 such as fillings and crowns2 7#c7 major dental services1 such as root canals1 and extractions2 7#d7 emergency dental care2 and 7#e7 other necessary services related to dental or oral health 7as defined by the ,secretary74 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 is-- 7,a7 for the first year beginning at least #f months after the date of the enactment of this subsection1 #j percent2 7,b7 for the year following the year specified in subparagraph 7,a7 and each subsequent year through the seventh year following the year specified in subparagraph 7,a71 the applicable percent specified in this paragraph for the previous year increased by #aj percentage points2 and 7,c7 for the eighth year following the year specified in subparagraph 7,a7 and each subsequent year1 #hj percent4 7#c7 ,limitations and ,secretarial authority 7,a7 ,frequency ,with respect to dental and oral health services that are-- 7i7 routine dental cleanings1 payment may be made under this part for only two such cleanings during a #ab-month period2 and 7ii7 routine exams1 payment may be made under this part for only two such exams during a #ab-month period4 7,b7 ,secretarial authority 7i7 ,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 part1 including through application of a prior authorization requirement4 7ii7 ,authority to modify coverage ,notwithstanding any other provision of this title1 if the ,secretary determines appropriate1 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 ,force4 4 7d7 ,payment under physician fee schedule ,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 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 dental7 and inserting 7including dentures72 and 7,b7 by striking internal body4 7#b7 ,special payment rules ,section #ahcd7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7a77 is amended by adding at the end the following new paragraph3 7#bc7 ,payment and limits for dentures 7,a7 ,in general ,the payment amount under this part for dentures shall be1 subject to subparagraph 7,c71 the applicable percent 7specified in subparagraph 7,b77 of the amount otherwise payable for such dentures under this section4 7,b7 ,applicable percent ,for purposes of subparagraph 7,a71 the applicable percent specified in this subparagraph is-- 7i7 for the first year beginning at least #f months after the date of the enactment of this paragraph1 #j percent2 7ii7 for the year following the year specified in clause 7i7 and each subsequent year through the seventh year following the year specified in clause 7i71 the applicable percent specified in this subparagraph for the previous year increased by #aj percentage points2 and 7iii7 for the eighth year following the year specified in clause 7i7 and each subsequent year1 #hj percent4 7,c7 ,limitations and ,secretarial authority 7i7 ,in general ,payment may be made under this part for an individual for-- 7,i7 not more than one full upper and one full lower denture once every five years2 and 7,,ii7 not more than one partial upper denture and one partial lower denture once every five years4 7ii7 ,secretarial authority 7,i7 ,authority to apply additional limitations ,the ,secretary may apply such other reasonable limitations on the extent to which dentures are covered under this part1 including through application of a prior authorization requirement4 7,,ii7 ,authority to modify coverage ,notwithstanding any other provision of this title1 if the ,secretary determines appropriate1 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 ,force4 4 7f7 ,repeal of ground for exclusion ,section #ahfb7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciey7 is amended by striking paragraph 7#ab74 7g7 ,effective date ,the amendments made by this section shall apply to services furnished on or after ,january #a of the first year beginning at least six months after the date of the enactment of this ,act4 #c4 ,vision care under ,medicare 7a7 ,coverage ,section #ahfa7s77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#b771 as amended by section #b7;a71 is amended-- 7#a7 in subparagraph 7,,hh71 by striking and after the semicolon at the end2 7#b7 in subparagraph 7,,ii71 by adding and after the semicolon at the end2 and 7#c7 by adding at the end the following new subparagraph3 7,,jj7 vision services 7as defined in subsection 7lll772 4 7b7 ,vision services defined ,section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex71 as amended by section #b7;b71 is amended by adding at the end the following new subsection3 7lll7 ,vision ,services ,the term vision services means-- 7#a7 routine eye examinations and procedures performed 7during the course of any eye examination7 to determine the refractive state of the eyes2 and 7#b7 other necessary services related to eye and vision health 7as defined by the ,secretary74 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#a771 as amended by section #b7;c77#a71 is amended-- 7,a7 by striking and before 7,,dd72 and 7,b7 by inserting before the semicolon at the end the following3 1 and 7,,ee7 with respect to vision services 7as defined in section #ahfa7lll771 the amount paid shall be the payment amount specified under section #ahcd7w74 7#b7 ,payment and limits specified ,section #ahcd of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem71 as amended by section #b7;c77#b71 is amended by adding at the end the following new subsection3 7y7 ,payment and limits for vision services 7#a7 ,in general ,the payment amount under this part for vision services 7as defined in section #ahfa7lll77 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 is-- 7,a7 for the first year beginning at least #f months after the date of the enactment of this subsection1 #j percent2 7,b7 for the year following the year specified in subparagraph 7,a7 and each subsequent year through the seventh year following the year specified in subparagraph 7,a71 the applicable percent specified in this paragraph for the previous year increased by #aj percentage points2 and 7,c7 for the eighth year following the year specified in subparagraph 7,a7 and each subsequent year1 #hj percent4 7#c7 ,limitations and ,secretarial authority 7,a7 ,frequency ,with respect to routine eye exams1 payment may be made under this part for only one such exam during a #ab-month period4 7,b7 ,secretarial authority 7i7 ,authority to apply additional limitations ,the ,secretary may apply other reasonable limitations on the extent to which vision services are covered under this part1 including through application of a prior authorization requirement4 7ii7 ,authority to modify coverage ,notwithstanding any other provision of this title1 if the ,secretary determines appropriate1 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 ,force4 4 7d7 ,payment under physician fee schedule ,section #ahdh7;j77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;j77#c771 as amended by section #b7;d71 is amended by inserting 7#b77;,,jj71 after 7#b77;,,ii714 7e7 ,special payment rules for eyeglasses1 contact lenses1 and low vision devices ,section #ahcd7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7a771 as amended by section #b7;e77#b71 is amended by adding at the end the following new paragraphs3 7#bd7 ,payment and limits for eyeglasses and contact lenses 7,a7 ,in general ,the payment amount under this part for eyeglass lenses1 eyeglass frames1 and contact lenses shall be1 subject to subparagraph 7,c71 the applicable percent 7specified in subparagraph 7,b77 of the amount otherwise payable for such eyeglass lenses1 eyeglass frames1 and contact lenses1 respectively1 under this section4 7,b7 ,applicable percent ,for purposes of subparagraph 7,a71 the applicable percent specified in this subparagraph is-- 7i7 for the first year beginning at least #f months after the date of the enactment of this paragraph1 #j percent2 7ii7 for the year following the year specified in clause 7i7 and each subsequent year through the seventh year following the year specified in clause 7i71 the applicable percent specified in this subparagraph for the previous year increased by #aj percentage points2 and 7iii7 for the eighth year following the year specified in clause 7i7 and each subsequent year1 #hj percent4 7,c7 ,limitations and ,secretarial authority 7i7 ,in general ,payment may be made under this part 7other than for eyewear described in section #ahfa7s77#h77 for an individual for-- 7,i7 not more than one pair of eyeglass lenses during any #ab-month period2 7,,ii7 not more than one set of eyeglass frames during any #bd-month period2 and 7,,iii7 contact lenses1 only to the extent that the sum of such payments for contact lenses does not exceed a limitation of #bjj during any #bd-month period beginning during the first year beginning at least six months after the date of the enactment of this paragraph 7or1 beginning during a subsequent year1 such limitation for a #bd-month period beginning in the previous year increase by an appropriate inflation adjustment specified by the ,secretary74 7ii7 ,secretarial authority 7,i7 ,authority to apply additional limitations ,the ,secretary may apply such other reasonable limitations on the extent to which eyeglass lenses1 eyeglass frames1 and contact lenses are covered under this part1 including through application of a prior authorization requirement4 7,,ii7 ,authority to modify coverage ,notwithstanding any other provision of this title1 if the ,secretary determines appropriate1 the ,secretary may modify the coverage under this part of eyeglass lenses1 eyeglass frames1 and contact lenses to the extent that such modification is consistent with the recommendations of the ,united ,states ,preventive ,services ,task ,force4 7#be7 ,payment and limits for low vision devices 7,a7 ,in general ,the payment amount under this part for low vision devices shall be1 subject to subparagraph 7,c71 the applicable percent 7specified in subparagraph 7,b77 of the amount otherwise payable for low vision devices under this section4 7,b7 ,applicable percent ,for purposes of subparagraph 7,a71 the applicable percent specified in this subparagraph is-- 7i7 for the first year beginning at least #f months after the date of the enactment of this paragraph1 #j percent2 7ii7 for the year following the year specified in clause 7i7 and each subsequent year through the seventh year following the year specified in clause 7i71 the applicable percent specified in this subparagraph for the previous year increased by #aj percentage points2 and 7iii7 for the eighth year following the year specified in clause 7i7 and each subsequent year1 #hj percent4 7,c7 ,secretarial authority 7i7 ,authority to apply limitations ,the ,secretary may apply reasonable limitations on the extent to which low vision devices are covered under this part1 including through application of a prior authorization requirement4 7ii7 ,authority to modify coverage ,notwithstanding any other provision of this title1 if the ,secretary determines appropriate1 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 ,force4 7,d7 ,low vision device defined ,in this paragraph1 the term low vision device means a device1 prescribed by a physician1 that magnifies1 enhances1 or otherwise augments or interprets visual images irrespective of the size1 form1 or technological features of such device and does not include ordinary eyeglasses or contact lenses4 ,in the previous sentence1 the term ordinary eyeglasses or contact lenses means lenses that are intended to fully correct visual acuity or fully eliminate refractive error4 4 7f7 ,definition of durable medical equipment ,to include eyeglasses1 contact lenses1 and low vision devices ,section #ahfa7n7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7n77 is amended-- 7#a7 by striking and before eye tracking and inserting a comma2 and 7#b7 by inserting 1 and eyeglass lenses1 low vision devices 7as defined in section #ahcd7;a77#be771 eyeglass frames1 and contact lenses before 2 except4 7g7 ,repeal of ground for exclusion ,section #ahfb7;a77#g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciey7a77#g77 is amended by striking 1 eyeglasses 7other than eyewear described in section #ahfa7s77#h77 or eye examinations for the purpose of prescribing1 fitting1 or changing eyeglasses1 procedures performed 7during the course of any eye examination7 to determine the refractive state of the eyes4 7h7 ,effective date ,the amendments made by this section shall apply to services furnished on or after ,january #a of the first year beginning at least six months after the date of the enactment of this ,act4 #d4 ,hearing care under ,medicare 7a7 ,coverage 7#a7 ,in general ,section #ahfa7s77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#b771 as amended by sections #b7;a7 and #c7;a71 is amended-- 7,a7 in subparagraph 7,,ii71 by striking and at the end2 7,b7 in subparagraph 7,,jj71 by inserting and at the end2 and 7,c7 by adding at the end the following new subparagraph3 7,,kk7 audiology services 7as defined in subsection 7ll77#c77 and hearing services 7as defined in subsection 7ll77#e772 4 7#b7 ,hearing services defined ,section #ahfa7ll7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7ll77 is amended-- 7,a7 in the subsection heading1 by inserting 2 ,hearing ,services after ,audiology ,services2 and 7,b7 by adding at the end the following new paragraph3 7#e7 ,the term hearing services means-- 7,a7 routine hearing exams and exams for hearing aids2 and 7,b7 other necessary services related to hearing health 7as defined by the ,secretary74 4 7b7 ,payment2 coinsurance2 and limitations 7#a7 ,in general ,section #ahcc7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77#a771 as amended by sections #b7;c77#a7 and #c7;c7#ia71 is amended-- 7,a7 by striking and before 7,,ee72 and 7,b7 by inserting before the semicolon at the end the following3 1 and 7,,ff7 with respect to audiology services 7as defined in section #ahfa7ll77#c77 and hearing services 7as defined in section #ahfa7ll77#e771 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 #aciem71 as amended by sections #b7;c77#b7 and #c7;c77#b71 is amended by adding at the end the following new subsection3 7z7 ,payment and limits for hearing services 7#a7 ,in general ,the payment amount under this part for audiology services 7as defined in section #ahfa7ll77#c77 and hearing services 7as defined in section #ahfa7ll77#e771 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 is-- 7,a7 for the first year beginning at least #f months after the date of the enactment of this subsection1 #j percent2 7,b7 for the year following the year specified in subparagraph 7,a7 and each subsequent year through the seventh year following the year specified in subparagraph 7,a71 the applicable percent specified in this paragraph for the previous year increased by #aj percentage points2 and 7,c7 for the eighth year following the year specified in subparagraph 7,a7 and each subsequent year1 #hj percent4 7#c7 ,secretarial authority 7,a7 ,authority to apply limitations ,the ,secretary may apply reasonable limitations on the extent to which audiology services and hearing services are covered under this part1 including through application of a prior authorization requirement4 7,b7 ,authority to modify coverage ,notwithstanding any other provision of this title1 if the ,secretary determines appropriate1 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 ,force4 4 7c7 ,payment under the physician fee schedule ,section #ahdh7;j77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;j77#c771 as amended by sections #b7;d7 and #c7;d71 is amended by inserting 7#b77,,kk71 after 7#b77;,,jj714 7d7 ,hearing aids 7#a7 ,repeal of ground for exclusion ,section #ahfb7;a77#g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciey7a77#g771 as amended by section #c7;g71 is amended by striking 1 hearing aids or examinations therefor14 7#b7 ,definition of durable medical equipment to include hearing aids ,section #ahfa7n7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7n771 as amended by section #c7;f71 is amended by inserting hearing aids1 before and eyeglass lenses4 7#c7 ,special payment rules for hearing aids ,section #ahcd7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7a771 as amended by sections #b7;e77#b7 and #c7;e71 is amended by adding at the end the following new paragraph3 7#bf7 ,payment and limits for hearing aids 7,a7 ,in general ,the payment amount under this part for hearing aids shall be1 subject to subparagraph 7,c71 the applicable percent 7specified in subparagraph 7,b77 of the amount otherwise payable for hearing aids under this section4 7,b7 ,applicable percent ,for purposes of subparagraph 7,a71 the applicable percent specified in this subparagraph is-- 7i7 for the first year beginning at least #f months after the date of the enactment of this paragraph1 #j percent2 7ii7 for the year following the year specified in clause 7i7 and each subsequent year through the seventh year following the year specified in clause 7i71 the applicable percent specified in this subparagraph for the previous year increased by #aj percentage points2 and 7iii7 for the eighth year following the year specified in clause 7i7 and each subsequent year1 #hj percent4 7,c7 ,limitations and ,secretarial authority 7i7 ,in general ,payment may be made under this part for an individual for not more than one hearing aid per ear during a #dh-month period4 7ii7 ,secretarial authority 7,i7 ,authority to apply additional limitations ,the ,secretary may apply additional limitations on the extent to which hearing aids are covered under this part1 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 aid4 7,,ii7 ,authority to modify coverage ,notwithstanding any other provision of this title1 if the ,secretary determines appropriate1 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 ,force4 4 7e7 ,effective date ,the amendments made by this section shall apply to services furnished on or after ,january #a of the first year beginning at least six months after the date of the enactment of this ,act4 #e4 ,increased ,,fmap for coverage of dental and oral health care1 vision1 care1 and hearing care under ,medicaid ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is amended-- 7#a7 in subsection 7a7-- 7,a7 in paragraph 7#aj71 by inserting 1 which may include any dental and oral health service 7as defined in section #ahfa7kkk77 after dental services2 7,b7 in paragraph 7#ac7-- 7i7 in subparagraph 7,b71 by striking 2 and and inserting a semicolon2 7ii7 in subparagraph 7,c71 by striking the semicolon and inserting 2 and2 and 7iii7 by adding at the end the following new subparagraph3 7,d7 any service that is a vision service 7as defined in section #ahfa7lll77 or a hearing service 7as defined in section #ahfa7ll77#e72 2 and 7,c7 in paragraph 7#bi71 by realigning the left margin so as to align with the left margin of paragraph 7#bh72 and 7#b7 by adding at the end the following new subsection3 7ff7 ,increased ,,fmap for expenditures for dental and oral health services1 vision services1 and hearing services 7#a7 ,in general ,notwithstanding subsection 7b71 the ,federal medical assistance percentage with respect to amounts expended by a ,state for medical assistance for services described in paragraph 7#b7 shall be equal to #ij percent4 7#b7 ,services described ,a service described in this paragraph is any service that-- 7,a7 is furnished on or after ,january #a of the first calendar year that begins at least #f months after the date of the enactment of this subsection2 7,b7 is not furnished to an individual who is-- 7i7 under the age of #ba2 and 7ii7 eligible for medical assistance for the services described in subsection 7a77#d77;,b72 and 7,c7 is-- 7i7 a dental and oral health service 7as defined in section #ahfa7kkk772 7ii7 a vision service 7as defined in section #ahfa7lll772 or 7iii7 a hearing service 7as defined in section #ahfa7ll77#e774 4