,i #aahth ,,congress #ast ,session ,h4 ,r4 #cc ,,in ,,the ,,house ,,of ,,representatives ,january #i1 #bjbc,mr4 ,doggett 7for himself1 ,mrs4 ,beatty1 ,mr4 ,beyer1 ,mr4 ,bishop of ,georgia1 ,mr4 ,blumenauer1 ,mr4 ,bowman1 ,ms4 ,bush1 ,mr4 ,carson1 ,mr4 ,carter of ,louisiana1 ,mr4 ,cartwright1 ,mr4 ,casar1 ,mr4 ,castro of ,texas1 ,ms4 ,chu1 ,mr4 ,cleaver1 ,mr4 ,cohen1 ,mr4 ,connolly1 ,mr4 ,courtney1 ,mr4 ,cuellar1 ,ms4 ,de,lauro1 ,mr4 ,de,saulnier1 ,mrs4 ,dingell1 ,ms4 ,escobar1 ,mr4 ,espaillat1 ,mr4 ,evans1 ,ms4 ,leger ,fernandez1 ,mr4 ,garamendi1 ,mr4 ,garca of ,illinois1 ,ms4 ,garcia of ,texas1 ,mr4 ,vicente ,gonzalez of ,texas1 ,mr4 ,gottheimer1 ,mr4 ,green of ,texas1 ,mr4 ,grijalva1 ,mrs4 ,hayes1 ,mr4 ,higgins of ,new ,york1 ,ms4 ,jackson ,lee1 ,ms4 ,jayapal1 ,mr4 ,johnson of ,georgia1 ,ms4 ,kaptur1 ,mr4 ,khanna1 ,mr4 ,kim of ,new ,jersey1 ,mr4 ,larson of ,connecticut1 ,ms4 ,lee of ,california1 ,mr4 ,lieu1 ,ms4 ,mc,collum1 ,mr4 ,mc,govern1 ,ms4 ,meng1 ,mr4 ,mfume1 ,ms4 ,moore of ,wisconsin1 ,mr4 ,nadler1 ,mr4 ,neguse1 ,mr4 ,norcross1 ,ms4 ,norton1 ,ms4 ,ocasio-,cortez1 ,ms4 ,omar1 ,mr4 ,pascrell1 ,mr4 ,payne1 ,ms4 ,pingree1 ,mr4 ,pocan1 ,ms4 ,porter1 ,ms4 ,pressley1 ,ms4 ,blunt ,rochester1 ,mr4 ,ruiz1 ,mr4 ,ruppersberger1 ,ms4 ,schakowsky1 ,mr4 ,schiff1 ,mr4 ,david ,scott of ,georgia1 ,mr4 ,sherman1 ,mr4 ,swalwell1 ,mr4 ,takano1 ,mr4 ,thompson of ,california1 ,ms4 ,titus1 ,ms4 ,tlaib1 ,mr4 ,tonko1 ,mr4 ,torres of ,new ,york1 ,mrs4 ,trahan1 ,mr4 ,trone1 ,mr4 ,veasey1 ,mrs4 ,watson ,coleman1 and ,ms4 ,williams of ,georgia7 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 for coverage of dental1 vision1 and hearing care under the ,medicare program4 #a4 ,short title ,this ,act may be cited as the ,medicare ,dental1 ,vision1 and ,hearing ,benefit ,act of #bjbc4 #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,,ii71 by striking and after the semicolon at the end2 7#b7 in subparagraph 7,,jj71 by adding and after the semicolon at the end2 and 7#c7 by adding at the end the following new subparagraph3 7,,kk7 dental and oral health services 7as defined in subsection 7nnn772 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 7nnn7 ,dental and oral health services ,the term dental and oral health services means-- 7#a7 preventative and screening services1 such as oral exams1 dental cleanings1 dental x-rays1 and fluoride treatments2 7#b7 basic dental services1 such as tooth restorations1 basic periodontics services1 tooth extractions1 and oral disease management services2 7#c7 major dental services1 such as major tooth restorations1 major periodontics services1 bridges1 crowns1 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,,gg72 and 7,b7 by inserting before the semicolon at the end the following3 1 and 7,,hh7 with respect to dental and oral health services 7as defined in section #ahfa7lll771 the amount paid shall be the payment amount specified under section #ahcd7;aa74 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 7aa7 ,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 #ahfa7nnn77 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 7,a7 ,in general ,for purposes of paragraph 7#a71 except as provided in subparagraph 7,b71 the applicable percent specified in this paragraph is-- 7i7 with respect to services described in section #ahfa7nnn77#a7 furnished during #bjbd or a subsequent year1 #ajj percent2 and 7ii7 with respect to services not described in clause 7i7-- 7,i7 for a year before #bjbe1 #j percent2 7,,ii7 for #bjbe1 #cj percent2 7,,iii7 for #bjbf1 #fj percent2 and 7,,iv7 for #bjbg and each subsequent year1 #hj percent4 7,b7 ,special rule for certain low-income individuals ,for purposes of paragraph 7#a71 the applicable percent specified in this paragraph is1 with respect to services 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 ,,ma-,,pd plan-- 7i7 with respect to services described in section #ahfa7nnn77#a71 for #bjbd and each subsequent year1 #ajj percent2 and 7ii7 with respect to services not described in clause 7i71 for #bjbe 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 7iii7 ,authority to waive frequency limitations ,notwithstanding subparagraph 7,a71 the ,secretary may waive any frequency limitation under such subparagraph for an individual 7or category of individuals7 if determined appropriate by the ,secretary4 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,,kk71 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 a year before #bjbe1 #j percent2 and 7ii7 for #bjbe 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 7,,iii7 ,authority to waive frequency limitations ,notwithstanding clause 7i71 the ,secretary may waive any frequency limitation under such clause for an individual 7or category of individuals7 if determined appropriate by the ,secretary4 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 #a1 #bjbd4 #c4 ,vision care 7a7 ,coverage ,section #ahfa7s77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#b771 as amended by section #b1 is further amended-- 7#a7 in subparagraph 7,,jj71 by striking and after the semicolon at the end2 7#b7 in subparagraph 7,,kk71 by adding and after the semicolon at the end2 and 7#c7 by adding at the end the following new subparagraph3 7,,ll7 vision services 7as defined in subsection 7ooo772 4 7b7 ,vision services defined ,section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex71 as amended by section #b1 is further amended by adding at the end the following new subsection3 7ooo7 ,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 #b1 is further amended-- 7,a7 by striking and before 7,,hh72 and 7,b7 by inserting before the semicolon at the end the following3 1 and 7,,ii7 with respect to vision services 7as defined in section #ahfa7mmm771 the amount paid shall be the payment amount specified under section #ahcd7;bb74 7#b7 ,payment and limits specified ,section #ahcd of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem71 as amended by section #b1 is further amended by adding at the end the following new subsection3 7bb7 ,payment and limits for vision services 7#a7 ,in general ,the payment amount under this part for vision services 7as defined in section #ahfa7ooo77 shall be1 subject to paragraph 7#b71 #hj percent of the lesser of the actual charge for the services or the amount determined under the payment basis determined under section #ahdh4 7#b7 ,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 7iii7 ,authority to waive frequency limitations ,notwithstanding subparagraph 7,a71 the ,secretary may waive any frequency limitation under such subparagraph for an individual 7or category of individuals7 if determined appropriate by the ,secretary4 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,,ll71 after 7#b77,,kk71 7as added by section #b74 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 #b1 is further amended by adding at the end the following3 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,b71 #hj percent of the amount otherwise payable for such eyeglass lenses1 eyeglass frames1 and contact lenses1 respectively1 under this section4 7,b7 ,limitations and ,secretarial authority 7i7 ,in general ,subject to clause 7iii71 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 period in an amount not exceeding #ajj2 7,,ii7 not more than one set of eyeglass frames during any #bd-month period in an amount not exceeding #ajj2 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,,iii7 ,authority to waive frequency limitations ,notwithstanding clause 7i71 the ,secretary may waive any frequency limitation under such clause for an individual 7or category of individuals7 if determined appropriate by the ,secretary4 7iii7 ,update of payment limits to account for inflation ,with respect to eyeglass lenses and contact lenses furnished during #bjbe or a subsequent year1 the ,secretary shall increase the dollar amounts in effect under this subparagraph for such year by the percentage change in the consumer price index for all urban consumers 7,united ,states city average7 for the #ab-month period ending with ,june of the previous year4 7#be7 ,payment and limits for low vision devices 7,a7 ,in general ,the payment amount under this part for low vision devices shall be #hj percent of the amount otherwise payable for low vision devices under this section4 7,b7 ,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,c7 ,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 #a1 #bjbd4 #d4 ,hearing care 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 #b and #c1 is further amended-- 7,a7 in subparagraph 7,,kk71 by striking and at the end2 7,b7 in subparagraph 7,,ll71 by inserting and at the end2 and 7,c7 by adding at the end the following new subparagraph3 7,,mm7 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 #b and #c1 is further amended-- 7,a7 by striking and before 7,,ii72 and 7,b7 by inserting before the semicolon at the end the following3 1 and 7,,jj7 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 #ahcd7;cc74 7#b7 ,payment and limits specified ,section #ahcd of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem71 as amended by sections #b and #c1 is further amended by adding at the end the following new subsection3 7cc7 ,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#b71 #hj percent of the lesser of the actual charge for the services or the amount determined under the payment basis determined under section #ahdh4 7#b7 ,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 section #b7;d71 is further amended by inserting 7#b77,,mm71 before 7#c74 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 further 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 #c1 is further 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 #b and #c1 is further 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,b71 #hj percent of the amount otherwise payable for hearing aids under this section4 7,b7 ,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 7iii7 ,authority to waive frequency limitations ,notwithstanding clause 7i71 the ,secretary may waive any frequency limitation under such clause for an individual 7or category of individuals7 if determined appropriate by the ,secretary4 4 7e7 ,effective date ,the amendments made by this section shall apply to services furnished on or after ,january #a1 #bjbd4 #e4 ,nonapplication of competitive acquisition to certain items ,section #ahdg7;a77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#c7;a77#b77 is amended-- 7#a7 by striking and excluding and inserting excluding2 and 7#b7 by inserting 1 and excluding dentures1 eyeglass lenses1 contact lenses1 and hearing aids before the period at the end4 #f4 ,inclusion of an oral health professional on the ,united ,states ,preventive ,services ,task ,force 7a7 ,in general ,the first sentence of section #iae7;a77#a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bii;b-#d7;a77#a77 is amended by inserting 1 including at least #a oral health professional before the period at the end4 7b7 ,effective date ,the amendment made by subsection 7a7 shall apply beginning on ,january #a of the first year beginning at least #f months after the date of the enactment of this ,act4