,,ii #aagth ,,congress #ast ,session ,s4 #ig ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,january #bh1 #bjba,mr4 ,cardin 7for himself1 ,mr4 ,brown1 ,mr4 ,merkley1 ,mr4 ,van ,hollen1 ,mr4 ,blumenthal1 and ,mr4 ,casey7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to provide for coverage of dental services under the ,medicare program4 #a4 ,short title ,this ,act may be cited as the ,medicare ,dental ,benefit ,act of #bjba4 #b4 ,coverage of dental services under the ,medicare program 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 at the end2 7#b7 in subparagraph 7,,hh71 by striking the period at the end and inserting 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 7lll772 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 7lll7 ,dental and oral ,health ,services ,the term dental and oral health services means services 7as defined by the ,secretary7 that are necessary to prevent disease and promote oral health1 restore oral structures to health and function1 and treat emergency conditions1 including-- 7#a7 routine diagnostic and preventive care such as dental cleanings1 exams1 and x-rays2 7#b7 basic dental services such as fillings and extractions2 7#c7 major dental services such as root canals1 crowns1 and dentures2 7#d7 emergency dental care2 and 7#e7 other necessary services related to dental and oral health 7as defined by the ,secretary74 4 7c7 ,coverage of routine diagnostic and preventive care as a preventive service ,section #ahfa7;ddd77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7ddd77#c77 is amended by adding at the end the following new subparagraph3 7,d7 ,dental and oral health services described in paragraph 7#a7 of subsection 7lll71 relating to routine diagnostic and preventive care4 4 7d7 ,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 8and0 before 87,,dd702 and 7,b7 by inserting before the semicolon at the end the following3 8and 7,,ee7 with respect to dental and oral health services 7as defined in section #ahfa7lll71 other than those services described in paragraph 7#a7 of such section71 the amount paid shall be the payment amount specified under section #ahcd7z7404 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 7z7 ,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 #ahfa7lll71 other than those services described in paragraph 7#a7 of such section7 shall be1 subject to paragraph 7#c71 the applicable percentage 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 percentage 7,a7 ,in general ,for purposes of paragraph 7#a71 subject to subparagraph 7,b71 the applicable percentage specified in this paragraph is-- 7i7 for the first year beginning at least #f months after the date of the enactment of this subsection1 #j percent2 7ii7 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 7iii7 for the eighth year following the year specified in subparagraph 7,a7 and each subsequent year1 #hj percent4 7,b7 ,special rule for certain low-income individuals ,for purposes of paragraph 7#a71 with respect to dental and oral health services described in such paragraph that are furnished to an individual who is a subsidy eligible individual 7as defined in section #ahfj;,d-#ad7;a77#c771 or who would be a subsidy eligible individual if the individual were enrolled in a prescription drug plan or an ,,ma-,,pd plan under part ,d1 for the first year beginning at least #f months after the date of the enactment of this subsection and each subsequent year1 the applicable percent specified in this paragraph is #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 7iii7 ,authority to waive frequency limitations ,the ,secretary may waive any frequency limitation or other limitation as described in this paragraph for an individual 7or category of individuals7 as determined appropriate by the ,secretary4 4 7e7 ,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 striking risk assessment7 1 and inserting risk assessment71 7#b77;,,ii714 7f7 ,dental prostheses 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 dental72 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 dental prostheses 7,a7 ,in general ,the payment amount under this part for dental prostheses shall be1 subject to subparagraph 7,c71 the applicable percent 7specified in subparagraph 7,b77 of the amount otherwise payable for such dental prostheses under this section4 7,b7 ,applicable percent 7i7 ,in general ,for purposes of subparagraph 7,a71 subject to clause 7ii71 the applicable percent specified in this subparagraph is-- 7,i7 for the first year beginning at least #f months after the date of the enactment of this paragraph1 #j percent2 7,,ii7 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 7,,iii7 for the eighth year following the year specified in clause 7i7 and each subsequent year1 #hj percent4 7ii7 ,special rule for certain low-income individuals ,for purposes of subparagraph 7,a71 with respect to dental prostheses furnished to an individual who is a subsidy eligible individual 7as defined in section #ahfj;,d-#ad7;a77#c771 or who would be a subsidy eligible individual if the individual were enrolled in a prescription drug plan or an ,,ma-,,pd plan under part ,d1 for the first year beginning at least #f months after the date of the enactment of this paragraph and each subsequent year1 the applicable percent specified in this subparagraph is #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 dental prostheses once every five years2 and 7,,ii7 not more than one partial upper dental prostheses and one partial lower dental prostheses 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 dental prostheses 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 dental prostheses to the extent that such modification is consistent with the recommendations of the ,united ,states ,preventive ,services ,task ,force4 7,,iii7 ,authority to waive frequency limitations ,the ,secretary may waive any frequency limitation or other limitation as described in this subparagraph for an individual 7or category of individuals7 as determined appropriate by the ,secretary 4 7g7 ,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 7h7 ,effective date ,the amendments made by this section shall apply to services furnished on or after ,january #a1 #bjbb4 #c4 ,increased ,,fmap for additional expenditures for medicare cost-sharing for dental and oral health services ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is amended-- 7#a7 in subsection 7b71 by striking and 7ff7 and inserting 7ff71 and 7ii72 and 7#b7 by adding at the end the following new subsection3 7ii7 ,increased ,,fmap for additional expenditures for medicare cost-,sharing for dental and oral health services ,notwithstanding subsection 7b71 with respect to the portion of the amounts expended by a ,state for medical assistance for medicare cost-sharing 7as defined in subsection 7p77#c77 for qualified medicare beneficiaries described in subsection 7p77#a7 that is attributable to the coverage under part ,b of title ,,xviii of dental and oral health services 7as defined in section #ahfa7lll771 as determined by the ,secretary1 the ,federal medical assistance percentage for a ,state that is one of the #ej ,states or the ,district of ,columbia shall be equal to #ajj percent4 4 #d4 ,preventive ,services ,taskforce 7a7 ,in general ,section #iae7;a77#a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bii;b-#d7;a77#a77 is amended1 in the first sentence1 by inserting 1 including at least #a oral health professional after expertise4 7b7 ,effective date ,the amendment made by subsection 7a7 shall take effect ,january #a1 #bjbb4