,i #aai? ,,congress #a/ ,session ,h4 ,r4 #bjde ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,m>* #aa1 #bjbe,mr4 ,doggett 7= himself1 ,ms4 ,adams1 ,ms4 ,ans>i1 ,ms4 ,bal9t1 ,ms4 ,b>ragn1 ,mrs4 ,beatty1 ,mr4 ,bey]1 ,mr4 ,bi%op1 ,ms4 ,bonamici1 ,mr4 ,boyle ( ,p5nsylvania1 ,mr4 ,c>son1 ,mr4 ,c>t] ( ,l\isiana1 ,mr4 ,cas>1 ,mr4 ,ca/ro ( ,texas1 ,ms4 ,*u1 ,mr4 ,cleav]1 ,mr4 ,coh51 ,mr4 ,connolly1 ,ms4 ,crockett1 ,mr4 ,cuell>1 ,mr4 ,davis ( ,ill9ois1 ,ms4 ,dean ( ,p5nsylvania1 ,ms4 ,de,gette1 ,mrs4 ,mc,clain ,delaney1 ,ms4 ,de,lauro1 ,mr4 ,deluzio1 ,mr4 ,de,saulnier1 ,ms4 ,dext]1 ,mrs4 ,d+ell1 ,ms4 ,escob>1 ,mr4 ,espaillat1 ,mr4 ,evans ( ,p5nsylvania1 ,ms4 ,leg] ,f]n&ez1 ,mr4 ,fields1 ,ms4 ,fri$man1 ,mr4 ,fro/1 ,mr4 ,g>am5di1 ,mr4 ,g>ca ( ,ill9ois1 ,mr4 ,g>cia ( ,cali=nia1 ,ms4 ,g>cia ( ,texas1 ,mr4 ,goldman ( ,new ,york1 ,mr4 ,got!im]1 ,mr4 ,gre5 ( ,texas1 ,mr4 ,grijalva1 ,mrs4 ,hayes1 ,ms4 ,hoyle ( ,oregon1 ,mr4 ,huffman1 ,mr4 ,jackson ( ,ill9ois1 ,ms4 ,jacobs1 ,ms4 ,jayapal1 ,mr4 ,johnson ( ,georgia1 ,ms4 ,johnson ( ,texas1 ,ms4 ,kaptur1 ,mr4 ,khanna1 ,mr4 ,kri%namoor?i1 ,mr4 ,l&sman1 ,mr4 ,l>s5 ( ,wa%+ton1 ,mr4 ,l>son ( ,connecticut1 ,ms4 ,lee ( ,p5nsylvania1 ,ms4 ,lee ( ,nevada1 ,mr4 ,lieu1 ,ms4 ,mc,bride1 ,ms4 ,mc,clellan1 ,ms4 ,mc,collum1 ,mrs4 ,*]filus-,mc,cormick1 ,mr4 ,mc,govern1 ,mr4 ,meeks1 ,ms4 ,m5g1 ,mr4 ,mfume1 ,ms4 ,moore ( ,wiscons91 ,mr4 ,nadl]1 ,mr4 ,norcross1 ,ms4 ,norton1 ,ms4 ,ocasio-,cortez1 ,ms4 ,om>1 ,ms4 ,p+ree1 ,mr4 ,pocan1 ,ms4 ,p\1 ,ms4 ,pressley1 ,mrs4 ,ramirez1 ,mr4 ,rask91 ,ms4 ,ross1 ,mr4 ,ruiz1 ,ms4 ,sal9as1 ,ms4 ,sn*ez1 ,ms4 ,scanlon1 ,ms4 ,s*ak[sky1 ,mr4 ,david ,scott ( ,georgia1 ,ms4 ,sewell1 ,mr4 ,%]man1 ,ms4 ,%]rill1 ,mr4 ,smi? ( ,wa%+ton1 ,mr4 ,soto1 ,ms4 ,/ansbury1 ,mr4 ,swalwell1 ,mr4 ,takano1 ,mr4 ,?an$>1 ,mr4 ,?ompson ( ,mississippi1 ,mr4 ,?ompson ( ,cali=nia1 ,ms4 ,titus1 ,ms4 ,tlaib1 ,ms4 ,tokuda1 ,mr4 ,tonko1 ,mr4 ,torres ( ,new ,york1 ,mrs4 ,trahan1 ,mr4 ,v>gas1 ,mr4 ,veasey1 ,ms4 ,velzquez1 ,ms4 ,wass]man ,s*ultz1 ,ms4 ,wat]s1 ,mrs4 ,watson ,coleman1 ,ms4 ,williams ( ,georgia1 ,ms4 ,wilson ( ,florida1 ,mr4 ,mc,garvey1 ,mrs4 ,f\%ee1 ,mrs4 ,mc,iver1 ,ms4 ,lois ,frankel ( ,florida1 & ,mr4 ,gomez7 introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,en]gy & ,comm]ce1 & 9 addition to ! ,committee on ,ways & ,means1 = a p]iod to be subsequ5tly det]m9$ by ! ,speak]1 9 ea* case = consid]ation ( su* provisions z fall )9 ! jurisdiction ( ! committee conc]n$ ,a ,,bill ,to am5d title ,,xviii ( ! ,social ,security ,act to provide = cov]age ( d5tal1 vision1 & he>+ c>e "u ! ,m$ic>e program4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,m$ic>e ,d5tal1 ,vision1 & ,he>+ ,b5efit ,act ( #bjbe4 #b4 ,d5tal & oral heal? c>e 7a7 ,cov]age ,section #ahfa7s77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#b77 is am5d$-- 7#a7 9 subp>agraph 7,,ii71 by /rik+ & aft] ! semicolon at ! end2 7#b7 9 subp>agraph 7,,jj71 by add+ & aft] ! semicolon at ! end2 & 7#c7 by add+ at ! end ! foll[+ new subp>agraph3 7,,kk7 d5tal & oral heal? s]vices 7z def9$ 9 subsection 7nnn772 4 7b7 ,d5tal & oral heal? s]vices def9$ ,section #ahfa ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7nnn7 ,d5tal & oral heal? s]vices ,! t]m d5tal & oral heal? s]vices means-- 7#a7 prev5tative & scre5+ s]vices1 su* z oral exams1 d5tal clean+s1 d5tal x-rays1 & fluoride treatm5ts2 7#b7 basic d5tal s]vices1 su* z too? re/orations1 basic p]iodontics s]vices1 too? extractions1 & oral disease managem5t s]vices2 7#c7 major d5tal s]vices1 su* z major too? re/orations1 major p]iodontics s]vices1 bridges1 cr[ns1 root canals1 & extractions2 7#d7 em]g5cy d5tal c>e2 & 7#e7 o!r necess>y s]vices relat$ to d5tal or oral heal? 7z def9$ by ! ,secret>y74 4 7c7 ,paym5t2 co9surance2 & limitations 7#a7 ,9 g5]al ,section #ahcc7;a77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77#a77 is am5d$-- 7,a7 by /rik+ & be=e 7,,gg72 & 7,b7 by ins]t+ be=e ! semicolon at ! end ! foll[+3 1 & 7,,hh7 ) respect to d5tal & oral heal? s]vices 7z def9$ 9 section #ahfa7lll771 ! am\nt paid %all be ! paym5t am\nt specifi$ "u section #ahcd7;aa74 7#b7 ,paym5t & limits specifi$ ,section #ahcd ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7aa7 ,paym5t & limits = d5tal & oral heal? s]vices 7#a7 ,9 g5]al ,! paym5t am\nt "u ?is "p = d5tal & oral heal? s]vices 7z def9$ 9 section #ahfa7nnn77 %all be1 subject to p>agraph 7#c71 ! applicable p]c5t 7specifi$ 9 p>agraph 7#b77 ( ! less] ( ! actual *>ge = ! s]vices or ! am\nt det]m9$ "u ! paym5t basis det]m9$ "u section #ahdh4 7#b7 ,applicable p]c5t 7,a7 ,9 g5]al ,= purposes ( p>agraph 7#a71 except z provid$ 9 subp>agraph 7,b71 ! applicable p]c5t specifi$ 9 ?is p>agraph is-- 7i7 ) respect to s]vices describ$ 9 section #ahfa7nnn77#a7 furni%$ dur+ #bjbf or a subsequ5t ye>1 #ajj p]c5t2 & 7ii7 ) respect to s]vices n describ$ 9 clause 7i7-- 7,i7 = a ye> be=e #bjbg1 #j p]c5t2 7,,ii7 = #bjbg1 #cj p]c5t2 7,,iii7 = #bjbh1 #fj p]c5t2 & 7,,iv7 = #bjbi & ea* subsequ5t ye>1 #hj p]c5t4 7,b7 ,special rule = c]ta9 l[-income individuals ,= purposes ( p>agraph 7#a71 ! applicable p]c5t specifi$ 9 ?is p>agraph is1 ) respect to s]vices furni%$ to an individual :o is a subsidy eligible individual 7z def9$ 9 section #ahfj;,d-#ad7;a77#c771 or :o w\ld be a subsidy eligible individual if ! individual 7 enroll$ 9 a prescription drug plan or ,,ma-,,pd plan-- 7i7 ) respect to s]vices describ$ 9 section #ahfa7nnn77#a71 = #bjbf & ea* subsequ5t ye>1 #ajj p]c5t2 & 7ii7 ) respect to s]vices n describ$ 9 clause 7i71 = #bjbg & ea* subsequ5t ye>1 #hj p]c5t4 7#c7 ,limitations & ,secret>ial au?ority 7,a7 ,frequ5cy ,) respect to d5tal & oral heal? s]vices t are-- 7i7 r\t9e d5tal clean+s1 paym5t may be made "u ?is "p = only two su* clean+s dur+ a #ab-mon? p]iod2 & 7ii7 r\t9e exams1 paym5t may be made "u ?is "p = only two su* exams dur+ a #ab-mon? p]iod4 7,b7 ,secret>ial au?ority 7i7 ,au?ority to apply additional limitations ,! ,secret>y may apply su* o!r reasonable limitations on ! ext5t to :i* d5tal & oral s]vices are cov]$ "u ?is "p1 includ+ ?r\gh application ( a prior au?orization requirem5t4 7ii7 ,au?ority to modify cov]age ,not)/&+ any o!r provision ( ?is title1 if ! ,secret>y det]m9es appropriate1 ! ,secret>y may modify ! cov]age "u ?is "p ( d5tal & oral heal? s]vices to ! ext5t t su* modification is consi/5t ) ! recomm5dations ( ! ,unit$ ,/ates ,prev5tive ,s]vices ,task ,=ce4 7iii7 ,au?ority to waive frequ5cy limitations ,not)/&+ subp>agraph 7,a71 ! ,secret>y may waive any frequ5cy limitation "u su* subp>agraph = an individual 7or category ( individuals7 if det]m9$ appropriate by ! ,secret>y4 4 7d7 ,paym5t "u physician fee s*$ule ,section #ahdh7;j77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;j77#c77 is am5d$ by ins]t+ 7#b77,,kk71 be=e 7#c74 7e7 ,d5tures 7#a7 ,9 g5]al ,section #ahfa7s77#h7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#h77 is am5d$-- 7,a7 by /rik+ 7o!r ?an d5tal7 & ins]t+ 7includ+ d5tures72 & 7,b7 by /rik+ int]nal body4 7#b7 ,special paym5t rules ,section #ahcd7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7a77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#bc7 ,paym5t & limits = d5tures 7,a7 ,9 g5]al ,! paym5t am\nt "u ?is "p = d5tures %all be1 subject to subp>agraph 7,c71 ! applicable p]c5t 7specifi$ 9 subp>agraph 7,b77 ( ! am\nt o!rwise payable = su* d5tures "u ?is section4 7,b7 ,applicable p]c5t ,= purposes ( subp>agraph 7,a71 ! applicable p]c5t specifi$ 9 ?is subp>agraph is-- 7i7 = a ye> be=e #bjbg1 #j p]c5t2 & 7ii7 = #bjbg & ea* subsequ5t ye>1 #hj p]c5t4 7,c7 ,limitations & ,secret>ial au?ority 7i7 ,9 g5]al ,paym5t may be made "u ?is "p = an individual =-- 7,i7 n m ?an "o full upp] & "o full l[] d5ture once e five ye>s2 & 7,,ii7 n m ?an "o p>tial upp] d5ture & "o p>tial l[] d5ture once e five ye>s4 7ii7 ,secret>ial au?ority 7,i7 ,au?ority to apply additional limitations ,! ,secret>y may apply su* o!r reasonable limitations on ! ext5t to :i* d5tures are cov]$ "u ?is "p1 includ+ ?r\gh application ( a prior au?orization requirem5t4 7,,ii7 ,au?ority to modify cov]age ,not)/&+ any o!r provision ( ?is title1 if ! ,secret>y det]m9es appropriate1 ! ,secret>y may modify ! cov]age "u ?is "p ( d5tures to ! ext5t t su* modification is consi/5t ) ! recomm5dations ( ! ,unit$ ,/ates ,prev5tive ,s]vices ,task ,=ce4 7,,iii7 ,au?ority to waive frequ5cy limitations ,not)/&+ clause 7i71 ! ,secret>y may waive any frequ5cy limitation "u su* clause = an individual 7or category ( individuals7 if det]m9$ appropriate by ! ,secret>y4 4 7f7 ,repeal ( gr\nd = exclusion ,section #ahfb7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciey7 is am5d$ by /rik+ p>agraph 7#ab74 7g7 ,effective date ,! am5dm5ts made by ?is section %all apply to s]vices furni%$ on or aft] ,janu>y #a1 #bjbf4 #c4 ,vision c>e 7a7 ,cov]age ,section #ahfa7s77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#b771 z am5d$ by section #b1 is fur!r am5d$-- 7#a7 9 subp>agraph 7,,jj71 by /rik+ & aft] ! semicolon at ! end2 7#b7 9 subp>agraph 7,,kk71 by add+ & aft] ! semicolon at ! end2 & 7#c7 by add+ at ! end ! foll[+ new subp>agraph3 7,,ll7 vision s]vices 7z def9$ 9 subsection 7ooo772 4 7b7 ,vision s]vices def9$ ,section #ahfa ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex71 z am5d$ by section #b1 is fur!r am5d$ by add+ at ! end ! foll[+ new subsection3 7ooo7 ,vision s]vices ,! t]m vision s]vices means-- 7#a7 r\t9e eye exam9ations & proc$ures p]=m$ 7dur+ ! c\rse ( any eye exam9ation7 to det]m9e ! refractive /ate ( ! eyes2 & 7#b7 o!r necess>y s]vices relat$ to eye & vision heal? 7z def9$ by ! ,secret>y74 4 7c7 ,paym5t2 co9surance2 & limitations 7#a7 ,9 g5]al ,section #ahcc7;a77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77#a771 z am5d$ by section #b1 is fur!r am5d$-- 7,a7 by /rik+ & be=e 7,,hh72 & 7,b7 by ins]t+ be=e ! semicolon at ! end ! foll[+3 1 & 7,,ii7 ) respect to vision s]vices 7z def9$ 9 section #ahfa7mmm771 ! am\nt paid %all be ! paym5t am\nt specifi$ "u section #ahcd7;bb74 7#b7 ,paym5t & limits specifi$ ,section #ahcd ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem71 z am5d$ by section #b1 is fur!r am5d$ by add+ at ! end ! foll[+ new subsection3 7bb7 ,paym5t & limits = vision s]vices 7#a7 ,9 g5]al ,! paym5t am\nt "u ?is "p = vision s]vices 7z def9$ 9 section #ahfa7ooo77 %all be1 subject to p>agraph 7#b71 #hj p]c5t ( ! less] ( ! actual *>ge = ! s]vices or ! am\nt det]m9$ "u ! paym5t basis det]m9$ "u section #ahdh4 7#b7 ,limitations & ,secret>ial au?ority 7,a7 ,frequ5cy ,) respect to r\t9e eye exams1 paym5t may be made "u ?is "p = only "o su* exam dur+ a #ab-mon? p]iod4 7,b7 ,secret>ial au?ority 7i7 ,au?ority to apply additional limitations ,! ,secret>y may apply o!r reasonable limitations on ! ext5t to :i* vision s]vices are cov]$ "u ?is "p1 includ+ ?r\gh application ( a prior au?orization requirem5t4 7ii7 ,au?ority to modify cov]age ,not)/&+ any o!r provision ( ?is title1 if ! ,secret>y det]m9es appropriate1 ! ,secret>y may modify ! cov]age "u ?is "p ( vision s]vices to ! ext5t t su* modification is consi/5t ) ! recomm5dations ( ! ,unit$ ,/ates ,prev5tive ,s]vices ,task ,=ce4 7iii7 ,au?ority to waive frequ5cy limitations ,not)/&+ subp>agraph 7,a71 ! ,secret>y may waive any frequ5cy limitation "u su* subp>agraph = an individual 7or category ( individuals7 if det]m9$ appropriate by ! ,secret>y4 4 7d7 ,paym5t "u physician fee s*$ule ,section #ahdh7;j77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;j77#c77 is am5d$ by ins]t+ 7#b77,,ll71 aft] 7#b77,,kk71 7z add$ by section #b74 7e7 ,special paym5t rules = eyeglasses1 contact l5ses1 & l[ vision devices ,section #ahcd7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7a771 z am5d$ by section #b1 is fur!r am5d$ by add+ at ! end ! foll[+3 7#bd7 ,paym5t & limits = eyeglasses & contact l5ses 7,a7 ,9 g5]al ,! paym5t am\nt "u ?is "p = eyeglass l5ses1 eyeglass frames1 & contact l5ses %all be1 subject to subp>agraph 7,b71 #hj p]c5t ( ! am\nt o!rwise payable = su* eyeglass l5ses1 eyeglass frames1 & contact l5ses1 respectively1 "u ?is section4 7,b7 ,limitations & ,secret>ial au?ority 7i7 ,9 g5]al ,subject to clause 7iii71 paym5t may be made "u ?is "p 7o!r ?an = eyewe> describ$ 9 section #ahfa7s77#h77 = an individual =-- 7,i7 n m ?an "o pair ( eyeglass l5ses dur+ any #ab-mon? p]iod 9 an am\nt n exce$+ #ajj2 7,,ii7 n m ?an "o set ( eyeglass frames dur+ any #bd-mon? p]iod 9 an am\nt n exce$+ #ajj2 & 7,,iii7 contact l5ses1 only to ! ext5t t ! sum ( su* paym5ts = contact l5ses does n exce$ a limitation ( #bjj dur+ any #bd-mon? p]iod beg9n+ dur+ ! fir/ ye> beg9n+ at lea/ six mon?s aft] ! date ( ! enactm5t ( ?is p>agraph 7or1 beg9n+ dur+ a subsequ5t ye>1 su* limitation = a #bd-mon? p]iod beg9n+ 9 ! previ\s ye> increase by an appropriate inflation adju/m5t specifi$ by ! ,secret>y74 7ii7 ,secret>ial au?ority 7,i7 ,au?ority to apply additional limitations ,! ,secret>y may apply su* o!r reasonable limitations on ! ext5t to :i* eyeglass l5ses1 eyeglass frames1 & contact l5ses are cov]$ "u ?is "p1 includ+ ?r\gh application ( a prior au?orization requirem5t4 7,,ii7 ,au?ority to modify cov]age ,not)/&+ any o!r provision ( ?is title1 if ! ,secret>y det]m9es appropriate1 ! ,secret>y may modify ! cov]age "u ?is "p ( eyeglass l5ses1 eyeglass frames1 & contact l5ses to ! ext5t t su* modification is consi/5t ) ! recomm5dations ( ! ,unit$ ,/ates ,prev5tive ,s]vices ,task ,=ce4 7,,iii7 ,au?ority to waive frequ5cy limitations ,not)/&+ clause 7i71 ! ,secret>y may waive any frequ5cy limitation "u su* clause = an individual 7or category ( individuals7 if det]m9$ appropriate by ! ,secret>y4 7iii7 ,update ( paym5t limits to acc\nt = inflation ,) respect to eyeglass l5ses & contact l5ses furni%$ dur+ #bjbg or a subsequ5t ye>1 ! ,secret>y %all increase ! doll> am\nts 9 effect "u ?is subp>agraph = su* ye> by ! p]c5tage *ange 9 ! consum] price index = all urban consum]s 7,unit$ ,/ates city av]age7 = ! #ab-mon? p]iod end+ ) ,june ( ! previ\s ye>4 7#be7 ,paym5t & limits = l[ vision devices 7,a7 ,9 g5]al ,! paym5t am\nt "u ?is "p = l[ vision devices %all be #hj p]c5t ( ! am\nt o!rwise payable = l[ vision devices "u ?is section4 7,b7 ,secret>ial au?ority 7i7 ,au?ority to apply limitations ,! ,secret>y may apply reasonable limitations on ! ext5t to :i* l[ vision devices are cov]$ "u ?is "p1 includ+ ?r\gh application ( a prior au?orization requirem5t4 7ii7 ,au?ority to modify cov]age ,not)/&+ any o!r provision ( ?is title1 if ! ,secret>y det]m9es appropriate1 ! ,secret>y may modify ! cov]age "u ?is "p ( l[ vision devices to ! ext5t t su* modification is consi/5t ) ! recomm5dations ( ! ,unit$ ,/ates ,prev5tive ,s]vices ,task ,=ce4 7,c7 ,l[ vision device def9$ ,9 ?is p>agraph1 ! t]m l[ vision device means a device1 prescrib$ by a physician1 t magnifies1 enhances1 or o!rwise augm5ts or int]prets visual images irrespective ( ! size1 =m1 or te*nological features ( su* device & does n include ord9>y eyeglasses or contact l5ses4 ,9 ! previ\s s5t5ce1 ! t]m ord9>y eyeglasses or contact l5ses means l5ses t are int5d$ to fully correct visual acuity or fully elim9ate refractive error4 4 7f7 ,def9ition ( durable m$ical equipm5t ,to include eyeglasses1 contact l5ses1 & l[ vision devices ,section #ahfa7n7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7n77 is am5d$-- 7#a7 by /rik+ & be=e eye track+ & ins]t+ a comma2 & 7#b7 by ins]t+ 1 & eyeglass l5ses1 l[ vision devices 7z def9$ 9 section #ahcd7;a77#be771 eyeglass frames1 & contact l5ses be=e 2 except4 7g7 ,repeal ( gr\nd = exclusion ,section #ahfb7;a77#g7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciey7a77#g77 is am5d$ by /rik+ 1 eyeglasses 7o!r ?an eyewe> describ$ 9 section #ahfa7s77#h77 or eye exam9ations = ! purpose ( prescrib+1 fitt+1 or *ang+ eyeglasses1 proc$ures p]=m$ 7dur+ ! c\rse ( any eye exam9ation7 to det]m9e ! refractive /ate ( ! eyes4 7h7 ,effective date ,! am5dm5ts made by ?is section %all apply to s]vices furni%$ on or aft] ,janu>y #a1 #bjbf4 #d4 ,he>+ c>e 7a7 ,cov]age 7#a7 ,9 g5]al ,section #ahfa7s77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#b771 z am5d$ by sections #b & #c1 is fur!r am5d$-- 7,a7 9 subp>agraph 7,,kk71 by /rik+ & at ! end2 7,b7 9 subp>agraph 7,,ll71 by ins]t+ & at ! end2 & 7,c7 by add+ at ! end ! foll[+ new subp>agraph3 7,,mm7 audiology s]vices 7z def9$ 9 subsection 7ll77#c77 & he>+ s]vices 7z def9$ 9 subsection 7ll77#e772 4 7#b7 ,he>+ s]vices def9$ ,section #ahfa7ll7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7ll77 is am5d$-- 7,a7 9 ! subsection head+1 by ins]t+ 2 ,he>+ ,s]vices aft] ,audiology ,s]vices2 & 7,b7 by add+ at ! end ! foll[+ new p>agraph3 7#e7 ,! t]m he>+ s]vices means-- 7,a7 r\t9e he>+ exams & exams = he>+ aids2 & 7,b7 o!r necess>y s]vices relat$ to he>+ heal? 7z def9$ by ! ,secret>y74 4 7b7 ,paym5t2 co9surance2 & limitations 7#a7 ,9 g5]al ,section #ahcc7;a77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77#a771 z am5d$ by sections #b & #c1 is fur!r am5d$-- 7,a7 by /rik+ & be=e 7,,ii72 & 7,b7 by ins]t+ be=e ! semicolon at ! end ! foll[+3 1 & 7,,jj7 ) respect to audiology s]vices 7z def9$ 9 section #ahfa7ll77#c77 & he>+ s]vices 7z def9$ 9 section #ahfa7ll77#e771 ! am\nt paid %all be ! paym5t am\nt specifi$ "u section #ahcd7;cc74 7#b7 ,paym5t & limits specifi$ ,section #ahcd ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem71 z am5d$ by sections #b & #c1 is fur!r am5d$ by add+ at ! end ! foll[+ new subsection3 7cc7 ,paym5t & limits = he>+ s]vices 7#a7 ,9 g5]al ,! paym5t am\nt "u ?is "p = audiology s]vices 7z def9$ 9 section #ahfa7ll77#c77 & he>+ s]vices 7z def9$ 9 section #ahfa7ll77#e771 %all be1 subject to p>agraph 7#b71 #hj p]c5t ( ! less] ( ! actual *>ge = ! s]vices or ! am\nt det]m9$ "u ! paym5t basis det]m9$ "u section #ahdh4 7#b7 ,secret>ial au?ority 7,a7 ,au?ority to apply limitations ,! ,secret>y may apply reasonable limitations on ! ext5t to :i* audiology s]vices & he>+ s]vices are cov]$ "u ?is "p1 includ+ ?r\gh application ( a prior au?orization requirem5t4 7,b7 ,au?ority to modify cov]age ,not)/&+ any o!r provision ( ?is title1 if ! ,secret>y det]m9es appropriate1 ! ,secret>y may modify ! cov]age "u ?is "p ( audiology s]vices & he>+ s]vices to ! ext5t t su* modification is consi/5t ) ! recomm5dations ( ! ,unit$ ,/ates ,prev5tive ,s]vices ,task ,=ce4 4 7c7 ,paym5t "u ! physician fee s*$ule ,section #ahdh7;j77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;j77#c771 z am5d$ by section #b7;d71 is fur!r am5d$ by ins]t+ 7#b77,,mm71 be=e 7#c74 7d7 ,he>+ aids 7#a7 ,repeal ( gr\nd = exclusion ,section #ahfb7;a77#g7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciey7a77#g771 z am5d$ by section #c7;g71 is fur!r am5d$ by /rik+ 1 he>+ aids or exam9ations !re=14 7#b7 ,def9ition ( durable m$ical equipm5t to include he>+ aids ,section #ahfa7n7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7n771 z am5d$ by section #c1 is fur!r am5d$ by ins]t+ he>+ aids1 be=e & eyeglass l5ses4 7#c7 ,special paym5t rules = he>+ aids ,section #ahcd7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7a771 z am5d$ by sections #b & #c1 is fur!r am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#bf7 ,paym5t & limits = he>+ aids 7,a7 ,9 g5]al ,! paym5t am\nt "u ?is "p = he>+ aids %all be1 subject to subp>agraph 7,b71 #hj p]c5t ( ! am\nt o!rwise payable = he>+ aids "u ?is section4 7,b7 ,limitations & ,secret>ial au?ority 7i7 ,9 g5]al ,paym5t may be made "u ?is "p = an individual = n m ?an "o he>+ aid p] e> dur+ a #dh-mon? p]iod4 7ii7 ,secret>ial au?ority 7,i7 ,au?ority to apply additional limitations ,! ,secret>y may apply additional limitations on ! ext5t to :i* he>+ aids are cov]$ "u ?is "p1 includ+ ?r\gh application ( a prior au?orization requirem5t & ?r\gh application ( crit]ia = a m9imum level ( he>+ loss = cov]age ( an initial or replacem5t he>+ aid4 7,,ii7 ,au?ority to modify cov]age ,not)/&+ any o!r provision ( ?is title1 if ! ,secret>y det]m9es appropriate1 ! ,secret>y may modify ! cov]age "u ?is "p ( he>+ aids to ! ext5t t su* modification is consi/5t ) ! recomm5dations ( ! ,unit$ ,/ates ,prev5tive ,s]vices ,task ,=ce4 7iii7 ,au?ority to waive frequ5cy limitations ,not)/&+ clause 7i71 ! ,secret>y may waive any frequ5cy limitation "u su* clause = an individual 7or category ( individuals7 if det]m9$ appropriate by ! ,secret>y4 4 7e7 ,effective date ,! am5dm5ts made by ?is section %all apply to s]vices furni%$ on or aft] ,janu>y #a1 #bjbf4 #e4 ,nonapplication ( competitive acquisition to c]ta9 items ,section #ahdg7;a77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#c7;a77#b77 is am5d$-- 7#a7 by /rik+ & exclud+ & ins]t+ exclud+2 & 7#b7 by ins]t+ 1 & exclud+ d5tures1 eyeglass l5ses1 contact l5ses1 & he>+ aids be=e ! p]iod at ! end4 #f4 ,inclusion ( an oral heal? pr(essional on ! ,unit$ ,/ates ,prev5tive ,s]vices ,task ,=ce 7a7 ,9 g5]al ,! fir/ s5t5ce ( section #iae7;a77#a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bii;b-#d7;a77#a77 is am5d$ by ins]t+ 1 includ+ at lea/ #a oral heal? pr(essional be=e ! p]iod at ! end4 7b7 ,effective date ,! am5dm5t made by subsection 7a7 %all apply beg9n+ on ,janu>y #a ( ! fir/ ye> beg9n+ at lea/ #f mon?s aft] ! date ( ! enactm5t ( ?is ,act4