,,ii #aaith ,,congress #ast ,session ,s4 #ici ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,march #aa 7legislative day1 ,march #aj71 #bjbe,mr4 ,sanders 7for himself1 ,ms4 ,warren1 ,mr4 ,booker1 ,mr4 ,welch1 ,mr4 ,markey1 ,ms4 ,duckworth1 ,mr4 ,merkley1 and ,mr4 ,blumenthal7 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 coverage for dental and oral health care1 hearing care1 and vision care under the ,medicare program4 #a4 ,short title ,this ,act may be cited as the ,medicare ,dental1 ,hearing1 and ,vision ,expansion ,act of #bjbe4 #b4 ,coverage of 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,,jj71 by adding and at the end2 and 7#b7 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 7#a7 ,in general ,except as provided in paragraph 7#b71 the term dental and oral health services means the following items and services that are 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#c77 on or after ,january #a1 #bjbg 7or ,january #a1 #bjbf1 in the case of dentures73 7,a7 ,preventive and screening services ,preventive and screening services1 including oral exams1 dental cleanings1 dental x-rays1 and fluoride treatments4 7,b7 ,procedures and treatment services ,services to address oral disease1 including services such as restorative services1 prosthodontic and endodontic services1 including fillings bridges1 crowns1 and root canals1 periodontal maintenance1 periodontal scaling and root planing1 tooth extractions1 therapeutic pulpotomy1 and other related items and services4 7,c7 ,dentures and dental prosthetics ,complete dentures1 partial dentures1 and implants1 including related items and services4 7#b7 ,exclusions ,such term does not include items and services for which1 as of the date of the enactment of this subsection1 coverage was permissible under section #ahfb7;a77#ab7 and cosmetic services not otherwise covered under section #ahfb7;a77#aj74 7#c7 ,oral health professional ,the term oral health professional means1 with respect to dental and oral health services1 a health professional 7other than a doctor of dental surgery or of dental medicine 7as described in subsection 7r77#b777 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 in subparagraph 7,n71 by inserting and dental and oral health services 7as defined in section #ahfa7nnn77 after section #ahfa7;hhh77#a772 7,b7 by striking and before 7,,hh72 and 7,c7 by inserting before the semicolon at the end the following3 and 7,,ii7 with respect to dental and oral health services 7as defined in section #ahfa7nnn771 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 ,payment ,the payment amount under this part for dental and oral health services 7as defined in section #ahfa7nnn77 shall be1 subject to paragraphs 7#c7 and 7#d71 #hj percent 7or #ajj percent1 in the case of preventive and screening services described in section #ahfa7nnn77#a77;,a77 of the lesser of-- 7,a7 the actual charge for the service2 or 7,b7 7i7 in the case of such services furnished by a doctor of dental surgery or of dental medicine 7as described in section #ahfa7r77#b771 the amount determined under the fee schedule established under paragraph 7#b72 or 7ii7 in the case of such services furnished by an oral health professional 7as defined in section #ahfa7nnn77#c771 #he percent of the amount determined under the fee schedule established under paragraph 7#b74 7#b7 ,establishment of fee schedule for dental and oral health services 7,a7 ,establishment 7i7 ,in general ,the ,secretary shall establish a fee schedule for dental and oral health services furnished in #bjbg 7or #bjbf1 in the case of dentures7 and subsequent years4 ,the fee schedule amount for a dental or oral health service shall be equal to #gj percent of the national median fee 7as determined under subparagraph 7,b77 for the service or a similar service for the year 7or1 in the case of dentures1 at the bundled payment amount under clause 7iv7 of such subparagraph71 adjusted by the geographic adjustment factor established under section #ahdh7;e77#b7 for the area for the year4 7ii7 ,consultation ,in carrying out this paragraph1 the ,secretary shall consult annually with organizations representing dentists and other providers who furnish dental and oral health services and shall share with such providers the data and data analysis used to determine fee schedule amounts under this paragraph4 7,b7 ,determination of national median fee 7i7 ,in general ,for purposes of subparagraph 7,a71 the ,secretary shall apply the national median fee for a dental or oral health service for #bjbg 7or #bjbf1 in the case of dentures7 and subsequent years in accordance with this subparagraph4 7ii7 ,use of #bjbj dental fee survey 7,i7 ,in general ,except as provided in clause 7iii7 and clause 7iv71 the national median fee for a dental or oral health service shall be equal to-- 7aa7 for #bjbg 7or #bjbf1 in the case of dentures71 the median fee for the service in the table titled ,general ,practitioners-,national of the #bjbj ,survey of ,dental ,fees published by the ,american ,dental ,association1 increased by the applicable percent increase for the year determined under subclause 7,,ii71 as reduced by the productivity adjustment under subclause 7,,iii72 and 7bb7 for #bjbh 7or #bjbg1 in the case of dentures7 and subsequent years1 the amount determined under this subclause for the preceding year1 updated pursuant to subparagraph 7,c77i74 7,,ii7 ,applicable percent increase ,the applicable percent increase determined under this subclause for a year is an amount equal to the percentage increase between-- 7aa7 the consumer price index for all urban consumers 7,united ,states city average7 ending with ,june of the previous year2 and 7bb7 the consumer price index for all urban consumers 7,united ,states city average7 ending with ,june of #bjbf 7or #bjbe1 in the case of dentures74 7,,iii7 ,productivity adjustment ,after determining the applicable percentage increase under subclause 7,,ii7 for a year1 the ,secretary shall reduce such percentage increase by the productivity adjustment described in section #ahhf7;b77#c77;,b77xi77,,ii74 7iii7 ,determination if insufficient survey data ,if the ,secretary determines there is insufficient data under the ,survey described in clause 7ii7 with respect to a dental or oral health service1 the national median fee for the service for a year shall be equal to an amount established for the service using #a or more of the following methods1 as determined appropriate by the ,secretary3 7,i7 ,the payment basis determined under section #ahdh4 7,,ii7 ,fee schedules for dental and oral health services which shall include1 as practicable1 fee schedules-- 7aa7 under ,medicare ,advantage plans under part ,c2 7bb7 under ,state plans 7or waivers of such plans7 under title ,,xix2 and 7cc7 established by other health care payers4 7iv7 ,special rule for dentures 7,i7 ,in general ,the ,secretary shall make payment for dentures and associated professional services as a bundled payment as determined by the ,secretary4 7,,ii7 ,payment considerations ,in establishing such bundled payment1 the ,secretary shall consider the national median fee for the service for the year determined under clause 7ii7 or 7iii7 and the rate determined for such dentures under the ,federal ,supply ,schedule of the ,general ,services ,administration1 as published by such ,administration in #bjba1 updated to the year involved using the applicable percent increase for the year determined under clause 7ii77,,ii71 as reduced by the productivity adjustment under clause 7ii77,,iii71 and shall ensure that the payment component for dentures under such bundled payment does not exceed the maximum rate determined for such dentures under the ,federal ,supply ,schedule1 as so published and updated to the year involved4 7,c7 ,annual update and adjustments 7i7 ,annual update ,the ,secretary shall update payment amounts determined under the fee schedule from year to year beginning in #bjbh 7or #bjbg1 in the case of dentures7 by increasing such amounts from the prior year by the percentage increase in the consumer price index for all urban consumers 7,united ,states city average7 for the #ab-month period ending with ,june of the preceding year1 reduced by the productivity adjustment described in section #ahhf7;b77#c77;,b77xi77,,ii74 7ii7 ,adjustments 7,i7 ,in general ,the ,secretary shall1 to the extent the ,secretary determines to be necessary and subject to subclause 7,,ii71 adjust the amounts determined under the fee schedule established under this paragraph for #bjbh 7or #bjbg1 in the case of dentures7 and subsequent years to take into account changes in dental practice1 coding changes1 new data on work1 practice1 or malpractice expenses1 or the addition of new procedures4 7,,ii7 ,limitation on annual adjustments ,the adjustments under subclause 7,i7 for a year shall not cause the amount of expenditures under this part for the year to differ by more than #bj1jjj1jjj from the amount of expenditures under this part that would have been made if such adjustments had not been made4 7#c7 ,limitations ,with respect to dental and oral health services that are preventive and screening services described in paragraph 7#a77;,a7 of section #ahfa7nnn7-- 7,a7 payment shall be made under this part for-- 7i7 not more than #b oral exams in a year2 7ii7 not more than #b dental cleanings in a year2 7iii7 not more than #a fluoride treatment in a year2 and 7iv7 not more than #a full-mouth series of x-rays as part of a preventive and screening oral exam every #c years2 and 7,b7 in the case of preventive and screening services not described in subparagraph 7,a71 payment shall be made under this part only at such frequencies determined appropriate by the ,secretary4 7#d7 ,incentives for rural providers ,in the case of dental and oral health services furnished by a doctor of dental surgery or of dental medicine 7as described in section #ahfa7r77#b77 or an oral health professional 7as defined in section #ahfa7nnn77#c77 who predominantly furnishes such services under this part in an area that is designated by the ,secretary 7under section #ccb7;a77#a77;,a7 of the ,public ,health ,service ,act7 as a health professional shortage area1 in addition to the amount of payment that would otherwise be made for such services under this subsection1 there also shall be paid an amount equal to #aj percent of the payment amount for the service under this subsection for such doctor or professional4 7#e7 ,limitation on beneficiary liability ,the provisions of section #ahdh7;g7 shall apply to a nonparticipating doctor of dental surgery or of dental medicine 7as described in section #ahfa7r77#b77 who does not accept payment on an assignment-related basis for dental and oral health services furnished with respect to an individual enrolled under this part in the same manner as such provisions apply with respect to a physician's service4 7#f7 ,establishment of dental administrator ,the ,secretary shall designate #a or more 7not to exceed #d7 medicare administrative contractors under section #ahgd;,a to establish coverage policies and establish such policies and process claims for payment for dental and oral health services1 as determined appropriate by the ,secretary4 4 7d7 ,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 7ix7 ,with respect to #bjbh and each subsequent year1 an oral health professional 7as defined in section #ahfa7nnn77#c774 4 7e7 ,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 #ahfa7nnn77 for which a limitation is applicable under section #ahcd7;aa77#c71 which are furnished more frequently than is provided under such section2 2 and 7#b7 in paragraph 7#ab71 by inserting before the semicolon at the end the following3 and except that payment shall be made under part ,b for dental and oral health services that are covered under section #ahfa7s77#b77,,kk74 7f7 ,inclusion as excepted medical treatment ,section #ahba7;b77#e77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#e7;b77#e77;,a77 is amended-- 7#a7 in clause 7ii71 by striking or at the end2 7#b7 in clause 7iii71 by striking the period and inserting 1 or2 and 7#c7 by adding at the end the following new clause3 7iv7 consisting of dental and oral health services 7as defined in subsection 7mmm7 of section #ahfa7 that are payable under part ,b as a result of the amendments made by the ,medicare ,dental1 ,hearing1 and ,vision ,expansion ,act of #bjbe4 4 7g7 ,rural health clinics and federally qualified health centers 7#a7 ,coverage of dental and oral health services ,section #ahfa7;aa7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7aa771 is amended-- 7,a7 in paragraph 7#a7-- 7i7 in subparagraph 7,c71 by striking and at the end2 7ii7 in subparagraph 7,d71 by inserting and after the comma at the end2 and 7iii7 by inserting after subparagraph 7,d7 the following new subparagraph3 7,e7 dental and oral health services 7as defined in subsection 7nnn77 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 subsection 7nnn77#c77 who is employed by or working under contract with a rural health clinic if such rural health clinic furnishes such services1 2 and 7,b7 in paragraph 7#c77;,a71 by striking 7,d7 and inserting 7,e74 7#b7 ,temporary payment rates for certain services under the ,,rhc ,,air and ,,fqhc ,,pps 7,a7 ,,air ,section #ahcc of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7 is amended-- 7i7 in subsection 7a77#c77;,a71 by inserting 7which shall1 in the case of dental and oral health services 7as defined in section #ahfa7nnn771 in lieu of any limits on reasonable costs otherwise applicable1 be based on the rates payable for such services under the payment basis determined under section #ahdh until such time as the ,secretary determines sufficient data has been collected to otherwise apply such limits 7or ,january #a1 #bjca1 if no such determination has been made as of such date77 after may prescribe in regulations2 and 7ii7 by adding at the end the following new subsection3 7ee7 ,disregard of costs attributable to certain services from calculation of ,,rhc ,,air ,payments for rural health clinic services other than dental and oral health services 7as defined in section #ahfa7nnn77 under the methodology for all-inclusive rates 7established by the ,secretary7 under subsection 7a77#c7 shall not take into account the costs of such services while rates for such services are based on rates payable for such services under the payment basis established under section #ahdh4 4 7,b7 ,,pps ,section #ahcd7o7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7o77 is amended by adding at the end the following new paragraph3 7#f7 ,temporary payment rates based on pfs for certain services ,the ,secretary shall1 in establishing payment rates for dental and oral health services 7as defined in section #ahfa7nnn77 that are ,federally qualified health center services under the prospective payment system established under this subsection1 in lieu of the rates otherwise applicable under such system1 base such rates on rates payable for such services under the payment basis established under section #ahdh until such time as the ,secretary determines sufficient data has been collected to otherwise establish rates for such services under such system 7or ,january #a1 #bjca1 if no such determination has been made as of such date74 ,payments for ,federally qualified health center services other than such dental and oral health services under such system shall not take into account the costs of such services while rates for such services are based on rates payable for such services under the payment basis established under section #ahdh4 4 7h7 ,implementation ,in addition to amounts otherwise available1 there is appropriated to the ,secretary of ,health and ,human ,services for fiscal year #bjbe1 out of any money in the ,treasury not otherwise appropriated1 #ijj1jjj1jjj1 to remain available until expended1 for purposes of implementing the amendments made by this section during the period beginning on ,january #a1 #bjbe1 and ending on ,september #cj1 #bjcd4 #c4 ,providing coverage for hearing care under the ,medicare program 7a7 ,provision of audiology services by qualified audiologists and hearing aid examination services by qualified hearing aid professionals 7#a7 ,in general ,section #ahfa7ll7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7ll77 is amended-- 7,a7 in paragraph 7#c7-- 7i7 by inserting 7,a7 after 7#c72 7ii7 in subparagraph 7,a71 as added by clause 7i7 of this subparagraph-- 7,i7 by striking means such hearing and balance assessment services and inserting 8means-- 7i7 such hearing and balance assessment services and1 beginning ,january #a1 #bjbg1 such hearing aid examination services and treatment services 7including aural rehabilitation1 vestibular rehabilitation1 and cerumen management7 2 7,,ii7 in clause 7i71 as added by subclause 7,i7 of this clause1 by striking the period at the end and inserting 2 and2 and 7,,iii7 by adding at the end the following new clause3 7ii7 beginning ,january #a1 #bjbg1 such hearing aid examination services furnished by a qualified hearing aid professional 7as defined in paragraph 7#d77;,c77 as the professional is legally authorized to perform under ,state law 7or the ,state regulatory mechanism provided by ,state law71 as would otherwise be covered if furnished by a physician4 2 and 7iii7 by adding at the end the following new subparagraph3 7,b7 ,beginning ,january #a1 #bjbg1 audiology services described in subparagraph 7,a77i7 shall be furnished without a requirement for an order from a physician or practitioner4 2 and 7,b7 in paragraph 7#d71 by adding at the end the following new subparagraph3 7,c7 ,the term qualified hearing aid professional means an individual who-- 7i7 is licensed or registered as a hearing aid dispenser1 hearing aid specialist1 hearing instrument dispenser1 or related professional by the ,state in which the individual furnishes such services2 and 7ii7 is accredited by the ,national ,board for ,certification in ,hearing ,instrument ,sciences or meets such other requirements as the ,secretary determines appropriate 7including requirements relating to educational certifications or accreditations7 taking into account any additional relevant requirements for hearing aid specialists1 hearing aid dispensers1 and hearing instrument dispensers established by ,medicare ,advantage organizations under part ,c1 ,state plans 7or waivers of such plans7 under title ,,xix1 and group health plans and health insurance issuers 7as such terms are defined in section #bgia of the ,public ,health ,service ,act74 4 7#b7 ,payment for qualified hearing aid professionals ,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,,ii72 and 7,b7 by inserting before the semicolon at the end the following3 and 7,,jj7 with respect to hearing aid examination services 7as described in paragraph 7#c77;,a77ii7 of section #ahfa7ll77 furnished by a qualified hearing aid professional 7as defined in paragraph 7#d77;,c7 of such section71 the amounts paid shall be equal to #hj percent of the lesser of the actual charge for such services or #he percent of the amount for such services determined under the payment basis determined under section #ahdh4 7#c7 ,inclusion of qualified audiologists and qualified hearing aid professionals as certain practitioners to receive payment on an assignment-related basis 7,a7 ,qualified audiologists ,section #ahdb7;b77#ah77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieu7b77#ah77;,c771 as amended by section #b7;d71 is amended by adding at the end the following new clause3 7x7 ,beginning on ,january #a1 #bjbg1 a qualified audiologist 7as defined in section #ahfa7ll77#d77;,b774 4 7,b7 ,qualified hearing aid professionals ,section #ahdb7;b77#ah7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieu7b77#ah77 is amended-- 7i7 in each of subparagraphs 7,a7 and 7,b71 by striking subparagraph 7,c7 and inserting subparagraph 7,c7 or1 beginning on ,january #a1 #bjbg1 subparagraph 7,e72 and 7ii7 by adding at the end the following new subparagraph3 7,e7 ,a practitioner described in this subparagraph is a qualified hearing aid professional 7as defined in section #ahfa7ll77#d77;,c774 4 7b7 ,coverage of hearing aids 7#a7 ,inclusion of hearing aids as prosthetic devices ,section #ahfa7s77#h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#h77 is amended by inserting 1 and including hearing aids 7as described in section #ahcd7;h77#g77 furnished on or after ,january #a1 #bjbg1 to individuals with moderately severe1 severe1 or profound hearing loss before the semicolon at the end4 7#b7 ,payment limitations for hearing aids ,section #ahcd7;h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7h77 is amended by adding at the end the following new paragraphs3 7#f7 ,payment only on an assignment-related basis ,payment for hearing aids for which payment may be made under this part may be made only on an assignment-related basis4 ,the provisions of subparagraphs 7,a7 and 7,b7 of section #ahdb7;b77#ah7 shall apply to hearing aids in the same manner as they apply to services furnished by a practitioner described in subparagraph 7,c7 of such section4 7#g7 ,limitations for hearing aids 7,a7 ,in general ,payment may be made under this part with respect to an individual1 with respect to hearing aids furnished by a qualified hearing aid supplier 7as defined in subparagraph 7,c77 on or after ,january #a1 #bjbg-- 7i7 not more than once per ear during a #e-year period2 7ii7 only for types of such hearing aids that are determined appropriate by the ,secretary2 and 7iii7 only if furnished pursuant to a written order of a physician1 qualified audiologist 7as defined in section #ahfa7ll77#d771 qualified hearing aid professional 7as defined in subparagraph 7,c7 of such section71 physician assistant1 nurse practitioner1 or clinical nurse specialist4 7,b7 ,special rule ,the payment basis determined under this subsection 7including after application of paragraph 7#a77;,h71 relating to application of competitive acquisition7 for hearing aids furnished by a qualified hearing aid supplier on or after ,january #a1 #bjbg1 shall not exceed the rate determined for such hearing aids under the ,federal ,supply ,schedule of the ,general ,services ,administration1 as published by such ,administration in #bjba1 updated to the year involved using the applicable percent increase for the year4 7,c7 ,definitions ,in this subsection3 7i7 ,hearing aid ,the term hearing aid means the item and related services including selection1 fitting1 adjustment1 and patient education and training4 7ii7 ,qualified hearing aid supplier ,the term qualified hearing aid supplier means-- 7,i7 a qualified audiologist2 7,,ii7 a physician 7as defined in section #ahfa7r77#a772 7,,iii7 a physician assistant1 nurse practitioner1 or clinical nurse specialist2 7,,iv7 a qualified hearing aid professional 7as defined in section #ahfa7ll77#d77;,c772 and 7,v7 other suppliers as determined by the ,secretary4 4 7#c7 ,application of competitive acquisition 7,a7 ,in general ,section #ahcd7;h77#a77;,h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7h77#a77;,h77 is amended-- 7i7 in the header1 by inserting and hearing aids after orthotics2 7ii7 in the matter preceding clause 7i71 by inserting or of hearing aids described in paragraph 7#b77;,d7 of such section1 after #bjaa12 and 7iii7 in clause 7i71 by inserting or such hearing aids after such orthotics4 7,b7 ,conforming amendments 7i7 ,in general ,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,e7 ,hearing aids ,hearing aids described in section #ahfa7s77#h7 for which payment would otherwise be made under section #ahcd7;h74 4 7ii7 ,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 hearing aids ,those items and services described in paragraph 7#b77;,e7 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 7iii7 ,implementation ,section #ahdg7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#c7;a77 is amended by adding at the end the following new paragraph3 7#h7 ,competition with respect to hearing aids ,not later than ,january #a1 #bjca1 the ,secretary shall begin the competition with respect to the items and services described in paragraph 7#b77;,e74 4 7#d7 ,physician self-referral law ,section #ahgg7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acienn7b77 is amended by adding at the end the following new paragraph3 7#f7 ,hearing aids and services ,in the case of hearing aid examination services and hearing aids-- 7,a7 furnished on or after ,january #a1 #bjbg1 and before ,january #a1 #bjbi2 and 7,b7 furnished on or after ,january #a1 #bjbi1 if the financial relationship specified in subsection 7a77#b7 meets such requirements the ,secretary imposes by regulation to protect against program or patient abuse4 4 7c7 ,exclusion modification ,section #ahfb7;a77#g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciey7a77#g77 is amended by inserting 7except such hearing aids or examinations therefor as described in and otherwise allowed under section #ahfa7s77#h77 after hearing aids or examinations therefor4 7d7 ,inclusion as excepted medical treatment ,section #ahba7;b77#e77;,a77iv7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#e7;b77#e77;,a77iv771 as added by section #b7;f71 is amended by inserting 1 audiology services described in subsection 7ll77#c7 of such section1 or hearing aids described in subsection 7s77#h7 of such section after section #ahfa74 7e7 ,rural health clinics and federally qualified health centers 7#a7 ,clarifying coverage of audiology services as physicians' services ,section #ahfa7;aa77#a77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7aa77#a77;,a77 is amended by inserting 7including audiology services 7as defined in subsection 7ll77#c777 after physicians' services4 7#b7 ,inclusion of qualified audiologists and qualified hearing aid professionals as ,,rhc and ,,fqhc practitioners ,section #ahfa7;aa77#a77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7aa77#a77;,b77 is amended by inserting or by a qualified audiologist or a qualified hearing aid professional 7as such terms are defined in subsection 7ll771 after 7as defined in subsection 7hh77#a7714 7#c7 ,temporary payment rates for certain services under the ,,rhc ,,air and ,,fqhc ,,pps 7,a7 ,,air ,section #ahcc of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel71 as amended by section #b7;g77#b77;,a71 is amended-- 7i7 in subsection 7a77#c77;,a71 by inserting or audiology services 7as defined in section #ahfa7ll77#c77 after 7as defined in section #ahfa7nnn72 and 7ii7 in subsection 7ee71 by inserting or audiology services 7as defined in section #ahfa7ll77#c77 after 7as defined in section #ahfa7nnn74 7,b7 ,,pps ,section #ahcd7o77#f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7o77#f771 as added by section #b7;g77#b77;,b71 is amended-- 7i7 in the first sentence1 by inserting or audiology services 7as defined in section #ahfa7ll77#c77 after 7as defined in section #ahfa7nnn772 and 7ii7 in the second sentence1 by inserting or such audiology services after such dental and oral health services4 7f7 ,expediting implementation ,the ,secretary of ,health and ,human ,services shall implement this section for #bjbg and #bjbh through program instruction or other forms of program guidance4 7g7 ,funding ,in addition to amounts otherwise available1 there is appropriated to the ,secretary of ,health and ,human ,services for fiscal year #bjbe1 out of any money in the ,treasury not otherwise appropriated1 #cgj1jjj1jjj1 to remain available until expended1 for purposes of implementing the amendments made by this section during the period beginning on ,january #a1 #bjbf1 and ending on ,september #cj1 #bjce4 #d4 ,providing coverage for vision care under the ,medicare program 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,,jj71 by striking and after the semicolon at the end2 7#b7 in subparagraph 7,,kk71 by striking the period at the end and adding 2 and2 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 #b7;b71 is amended by adding at the end the following new subsection3 7ooo7 ,vision services ,the term vision services means routine eye examinations to determine the refractive state of the eyes1 including procedures performed during the course of such examination1 furnished on or after ,january #a1 #bjbg1 by or under the direct supervision of an ophthalmologist or optometrist who is legally authorized to furnish such examinations or procedures 7as applicable7 under ,state law 7or the ,state regulatory mechanism provided by ,state law7 of the ,state in which the examinations or procedures are furnished4 4 7c7 ,payment limitations ,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 7bb7 ,limitation for vision services ,with respect to vision services 7as defined in section #ahfa7ooo77 and an individual1 payment shall be made under this part for only #a routine eye examination described in such subsection during a #b-year period4 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 before 7#c74 7e7 ,coverage of conventional eyeglasses ,section #ahfa7s77#h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#h771 as amended by section #c7;b77#a71 is amended by striking 1 and including one pair of conventional eyeglasses or contact lenses furnished subsequent to each cataract surgery with insertion of an intraocular lens and inserting 1 including #a pair of conventional eyeglasses or contact lenses furnished subsequent to each cataract surgery with insertion of an intraocular lens1 if furnished before ,january #a1 #bjbg1 and including conventional eyeglasses 7as described in section #ahcd7;h77#h771 whether or not furnished subsequent to such a surgery1 if furnished on or after ,january #a1 #bjbg4 7f7 ,special payment rules for eyeglasses 7#a7 ,limitations ,section #ahcd7;h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7h771 as amended by section #c7;b77#b71 is amended by adding at the end the following new paragraph3 7#h7 ,payment limitations for eyeglasses 7,a7 ,in general ,with respect to conventional eyeglasses furnished to an individual on or after ,january #a1 #bjbg1 subject to subparagraph 7,b71 payment shall be made under this part only during a #b-year period1 for #a pair of eyeglasses 7including lenses and the frame74 7,b7 ,exception ,with respect to a #b-year period described in subparagraph 7,a71 in the case of an individual who receives cataract surgery with insertion of an intraocular lens1 payment shall be made under this part for #a pair of conventional eyeglasses furnished subsequent to such cataract surgery during such period4 7,c7 ,special rule ,the payment basis determined under this subsection 7including after application of paragraph 7#a77;,h71 relating to application of competitive acquisition7 for conventional eyeglasses furnished to an individual on or after ,january #a1 #bjbg1 shall not exceed the rate determined for such eyeglasses under the ,federal ,supply ,schedule of the ,general ,services ,administration1 as published by such ,administration in #bjba1 updated to the year involved using the applicable percent increase for the year4 7,d7 ,no coverage of certain items ,payment shall not be made under this part for deluxe eyeglasses or conventional reading glasses4 4 7#b7 ,application of competitive acquisition 7,a7 ,in general ,section #ahcd7;h77#a77;,h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7h77#a77;,h771 as amended by section #c7;b77#c77;,a71 is amended-- 7i7 in the heading1 by striking and hearing aids and inserting hearing aids1 and eyeglasses2 7ii7 in the matter preceding clause 7i7-- 7,i7 by striking or of hearing aids and inserting of hearing aids2 and 7,,ii7 by inserting or of eyeglasses described in paragraph 7#b77;,e7 of such section1 after paragraph 7#b77;,d7 of such section12 and 7iii7 in clause 7i71 by striking or such hearing aids and inserting 1 such hearing aids1 or such eyeglasses4 7,b7 ,conforming amendment ,section #ahdg7;a77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#c7;a77#b771 as amended by section #c7;b77#c77;,b77i71 is amended by adding at the end the following new subparagraph3 7,f7 ,eyeglasses ,eyeglasses described in section #ahfa7s77#h7 for which payment would otherwise be made under section #ahcd7;h74 4 7,c7 ,implementation ,section #ahdg7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#c7;a771 as amended by section #c7;b77#c77;,b77iii71 is amended by adding at the end the following new paragraph3 7#i7 ,competition with respect to eyeglasses ,not later than ,january #a1 #bjcj1 the ,secretary shall begin the competition with respect to the items and services described in paragraph 7#b77;,f74 4 7g7 ,exclusion modifications ,section #ahfb7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciey7a771 as amended by section #b7;e71 is amended-- 7#a7 in paragraph 7#a7-- 7,a7 in subparagraph 7,p71 by striking and at the end2 7,b7 in subparagraph 7,q71 by striking the semicolon at the end and inserting 1 and2 and 7,c7 by adding at the end the following new subparagraph3 7,r7 in the case of vision services 7as defined in section #ahfa7ooo77 that are routine eye examinations as described in such section1 which are furnished more frequently than once during a #b-year period2 2 and 7#b7 in paragraph 7#g7-- 7,a7 by inserting 7other than such an examination that is a vision service that is covered under section #ahfa7s77#b77,,ll77 after eye examinations2 and 7,b7 by inserting 7other than such a procedure that is a vision service that is covered under section #ahfa7s77#b77,,ll77 after refractive state of the eyes4 7h7 ,inclusion as excepted medical treatment ,section #ahba7;b77#e77;,a77iv7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#e7;b77#e77;,a77iv771 as added by section #b7;f7 and amended by section #c7;d71 is amended-- 7#a7 by striking or hearing aids and inserting hearing aids2 and 7#b7 by inserting 1 or vision services 7as defined in subsection 7ooo7 of such section7 after subsection 7s77#h7 of such section4 7i7 ,rural ,health ,clinics and ,federally ,qualified ,health ,centers 7#a7 ,clarifying coverage of vision services as physicians' services ,section #ahfa7;aa77#a77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7aa77#a77;,a771 as amended by section #c7;e77#a71 is amended by inserting and vision services 7as defined in subsection 7ooo77 after 7as defined in subsection 7ll77#c774 7#b7 ,temporary payment rates for certain services under the ,,rhc ,,air and ,,fqhc ,,pps 7,a7 ,,air ,section #ahcc of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel71 as amended by sections #b7;g77#b77;,a7 and #c7;e77#c77;,a71 is amended-- 7i7 in subsection 7a77#c77;,a7-- 7,i7 by striking or audiology and inserting 1 audiology2 and 7,,ii7 by inserting 1 or vision services 7as defined in section #ahfa7ooo77 after 7as defined in section #ahfa7ll77#c772 and 7ii7 in subsection 7ee7-- 7,i7 by striking or audiology and inserting 1 audiology2 and 7,,ii7 by inserting 1 or vision services 7as defined in section #ahfa7ooo77 after 7as defined in section #ahfa7ll77#c774 7,b7 ,,pps ,section #ahcd7o77#f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7o77#f771 as added by section #b7;g77#b77;,b7 and amended by section #c7;e77#c77;,b71 is amended-- 7i7 in the first sentence-- 7,i7 by striking or audiology and inserting 1 audiology2 and 7,,ii7 by inserting 1 or vision services 7as defined in section #ahfa7ooo77 after 7as defined in section #ahfa7ll77#c772 and 7ii7 in the second sentence1 by striking or such audiology services and inserting 1 such audiology services1 or such vision services4 7j7 ,expediting implementation ,the ,secretary of ,health and ,human ,services shall implement this section for #bjbg and #bjbh through program instruction or other forms of program guidance4 7k7 ,funding ,in addition to amounts otherwise available1 there is appropriated to the ,secretary of ,health and ,human ,services for fiscal year #bjbe1 out of any money in the ,treasury not otherwise appropriated1 #ejj1jjj1jjj1 to remain available until expended1 for purposes of implementing the amendments made by this section during the period beginning on ,january #a1 #bjbf1 and ending on ,september #cj1 #bjcd4 #e4 ,phase-in of impact of dental and oral health coverage on part ,b premiums ,section #ahci7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acier7a77 is amended-- 7#a7 in the second sentence of paragraph 7#a71 by striking and 7#g7 and inserting 7#g71 and 7#h72 7#b7 in paragraph 7#c71 by striking ,the ,secretary and inserting ,subject to paragraph 7#h77;,c71 the ,secretary2 and 7#c7 by adding at the end the following3 7#h7 ,special rule for #bjbf through #bjcj 7,a7 ,determination of alternative monthly actuarial rate for each of #bjbf through #bjcj ,for each of #bjbf through #bjcj1 the ,secretary shall1 at the same time as and in addition to the determination of the monthly actuarial rate for enrollees age #fe and over determined in each of #bjbe through #bjbi for the succeeding calendar year according to paragraph 7#a71 determine an alternative monthly actuarial rate for enrollees age #fe and over for the year as described in subparagraph 7,b74 7,b7 ,alternative monthly actuarial rate described 7i7 ,in general ,the alternative monthly actuarial rate described in this subparagraph is-- 7,i7 for #bjbf and #bjbg1 the monthly actuarial rate for enrollees age #fe and over for the year1 determined as if the amendments made by section #b of the ,medicare ,dental1 ,hearing1 and ,vision ,expansion ,act of #bjbe did not apply2 and 7,,ii7 for #bjbh1 #bjbi1 and #bjcj1 the monthly actuarial rate for enrollees age #fe and over for the year1 determined as if the amendments made by such section #b did not apply1 plus the applicable percent of the amount by which-- 7aa7 the monthly actuarial rate for enrollees age #fe and over for the year determined according to paragraph 7#a72 exceeds 7bb7 the monthly actuarial rate for enrollees age #fe and over for the year1 determined as if the amendments made by such section #b did not apply4 7ii7 ,definition of applicable percent ,for purposes of this subparagraph1 the term applicable percent means-- 7,i7 for #bjbh1 #be percent2 7,,ii7 for #bjbi1 #ej percent2 and 7,,iii7 for #bjcj1 #ge percent4 7,c7 ,application to part b premium and other provisions of this part ,for each of #bjbf through #bjcj1 the ,secretary shall use the alternative monthly actuarial rate for enrollees age #fe and over for the year determined under subparagraph 7,a71 in lieu of the monthly actuarial rate for such enrollees for the year determined according to paragraph 7#a71 when determining the monthly premium rate for the year under paragraph 7#c7 and subsection 7j71 the part ,b deductible under section #ahcc7;b71 and the premium subsidy and monthly adjustment amount under subsection 7i74 4