Dental and oral health services under Medicare

(a) Coverage Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)) is amended— (1) in subparagraph (JJ), by inserting and after the semicolon at the end; and (2) by adding at the end the following new subparagraph: (KK) dental and oral health services (as defined in subsection (nnn));. (b) Dental and oral health services defined Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended by adding at the end the following new subsection: (nnn) Dental and Oral Health Services The term dental and oral health services means— (1) routine dental cleanings and exams; (2) basic dental services, such as fillings and crowns; (3) major dental services, such as root canals, and extractions; (4) emergency dental care; and (5) other necessary services related to dental or oral health (as defined by the Secretary).. (c) Payment; coinsurance; and limitations (1) In general Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) is amended— (A) by striking and before (HH); and (B) by inserting before the semicolon at the end the following:, and (II) with respect to dental and oral health services (as defined in section 1861(nnn)), the amount paid shall be the payment amount specified under section 1834(aa). (2) Payment and limits specified Section 1834 of the Social Security Act (42 U.S.C. 1395m) is amended by adding at the end the following new subsection: (aa) Payment and limits for dental and oral health services (1) In general The payment amount under this part for dental and oral health services (as defined in section 1861(nnn)) shall be, subject to paragraph (3), the applicable percent (specified in paragraph (2)) of the lesser of the actual charge for the services or the amount determined under the payment basis determined under section 1848. (2) Applicable percent For purposes of paragraph (1), the applicable percent specified in this paragraph is— (A) for the first year beginning at least 6 months after the date of the enactment of this subsection, 0 percent; (B) for the year following the year specified in subparagraph (A) and each subsequent year through the seventh year following the year specified in subparagraph (A), the applicable percent specified in this paragraph for the previous year increased by 10 percentage points; and (C) for the eighth year following the year specified in subparagraph (A) and each subsequent year, 80 percent. (3) Limitations and Secretarial authority (A) Frequency With respect to dental and oral health services that are— (i) routine dental cleanings, payment may be made under this part for only two such cleanings during a 12-month period; and (ii) routine exams, payment may be made under this part for only two such exams during a 12-month period. (B) Secretarial authority (i) 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 part, including through application of a prior authorization requirement. (ii) Authority to modify coverage Notwithstanding any other provision of this title, if the Secretary determines appropriate, 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 Force.. (d) Payment under physician fee schedule Section 1848(j)(3) of the Social Security Act (42 U.S.C. 1395w–4(j)(3)) is amended by inserting (2)(KK), before (3). (e) Dentures (1) In general Section 1861(s)(8) of the Social Security Act (42 U.S.C. 1395x(s)(8)) is amended— (A) by striking (other than dental) and inserting (including dentures); and (B) by striking internal body. (2) Special payment rules Section 1834(a) of the Social Security Act (42 U.S.C. 1395m(a)) is amended by adding at the end the following new paragraph: (23) Payment and limits for dentures (A) In general The payment amount under this part for dentures shall be, subject to subparagraph (C), the applicable percent (specified in subparagraph (B)) of the amount otherwise payable for such dentures under this section. (B) Applicable percent For purposes of subparagraph (A), the applicable percent specified in this subparagraph is— (i) for the first year beginning at least 6 months after the date of the enactment of this paragraph, 0 percent; (ii) for the year following the year specified in clause (i) and each subsequent year through the seventh year following the year specified in clause (i), the applicable percent specified in this subparagraph for the previous year increased by 10 percentage points; and (iii) for the eighth year following the year specified in clause (i) and each subsequent year, 80 percent. (C) Limitations and Secretarial authority (i) In general Payment may be made under this part for an individual for— (I) not more than one full upper and one full lower denture once every five years; and (II) not more than one partial upper denture and one partial lower denture once every five years. (ii) Secretarial authority (I) Authority to apply additional limitations The Secretary may apply such other reasonable limitations on the extent to which dentures are covered under this part, including through application of a prior authorization requirement. (II) Authority to modify coverage Notwithstanding any other provision of this title, if the Secretary determines appropriate, 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 Force.. (f) Repeal of ground for exclusion Section 1862(a) of the Social Security Act (42 U.S.C. 1395y) is amended by striking paragraph (12). (g) Effective date The amendments made by this section shall apply to services furnished on or after January 1 of the first year beginning at least six months after the date of the enactment of this Act.