Medicare Dental, Vision, and Hearing Benefit Act of 2016
This bill amends title XVIII (Medicare) of the Social Security Act to provide for Medicare coverage of dental, vision, and hearing care. With respect to such care, the bill establishes special payment rules, limitations, and coinsurance requirements.
[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5396 Introduced in House (IH)]
<DOC>
114th CONGRESS
2d Session
H. R. 5396
To amend title XVIII of the Social Security Act to provide for coverage
of dental, vision, and hearing care under the Medicare program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 7, 2016
Mr. McDermott (for himself, Mr. Conyers, Mr. Cummings, Mrs. Dingell,
Mr. Grayson, and Ms. Schakowsky) introduced the following bill; which
was referred to the Committee on Energy and Commerce, and in addition
to the Committee on Ways and Means, for a period to be subsequently
determined by the Speaker, 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 dental, vision, and hearing care under the Medicare program.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Medicare Dental, Vision, and Hearing
Benefit Act of 2016''.
SEC. 2. DENTAL AND ORAL HEALTH CARE.
(a) Coverage.--Section 1861(s)(2) of the Social Security Act (42
U.S.C. 1395x(s)(2)) is amended--
(1) in subparagraph (EE), by striking ``and'' after the
semicolon at the end;
(2) in subparagraph (FF), by adding ``and'' after the
semicolon at the end; and
(3) by adding at the end the following new subparagraph:
``(GG) dental and oral health services (as defined in
subsection (iii));''.
(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:
``Dental and Oral Health Services
``(iii) 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 ``(AA)''; and
(B) by inserting before the semicolon at the end
the following: ``, and (BB) with respect to dental and
oral health services (as defined in section 1861(iii)),
the amount paid shall be the payment amount specified
under section 1834(t)''.
(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:
``(t) 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(iii)) 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)(GG),'' 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.
SEC. 3. VISION CARE.
(a) Coverage.--Section 1861(s)(2) of the Social Security Act (42
U.S.C. 1395x(s)(2)), as amended by section 2, is further amended--
(1) in subparagraph (FF), by striking ``and'' after the
semicolon at the end;
(2) in subparagraph (GG), by adding ``and'' after the
semicolon at the end; and
(3) by adding at the end the following new subparagraph:
``(HH) vision services (as defined in subsection (jjj));''.
(b) Vision Services Defined.--Section 1861 of the Social Security
Act (42 U.S.C. 1395x), as amended by section 2, is further amended by
adding at the end the following new subsection:
``Vision Services
``(jjj) The term `vision services' means--
``(1) routine eye examinations and procedures performed
(during the course of any eye examination) to determine the
refractive state of the eyes; and
``(2) other necessary services related to eye and vision
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)), as amended by section 2, is
further amended--
(A) by striking ``and'' before ``(BB)''; and
(B) by inserting before the semicolon at the end
the following: ``, and (CC) with respect to vision
services (as defined in section 1861(jjj)), the amount
paid shall be the payment amount specified under
section 1834(u)''.
(2) Payment and limits specified.--Section 1834 of the
Social Security Act (42 U.S.C. 1395m), as amended by section 2,
is further amended by adding at the end the following new
subsection:
``(u) Payment and Limits for Vision Services.--
``(1) In general.--The payment amount under this part for
vision services (as defined in section 1861(jjj)) 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 routine eye
exams, payment may be made under this part for only one
such exam during a 12-month period.
``(B) Secretarial authority.--
``(i) Authority to apply additional
limitations.--The Secretary may apply other
reasonable limitations on the extent to which
vision 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 vision 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)(HH),'' after ``(2)(GG),'' (as added by section 2).
(e) Special Payment Rules for Eyeglasses, Contact Lenses, and Low
Vision Devices.--Section 1834(a) of the Social Security Act (42 U.S.C.
1395m(a)), as amended by section 2, is further amended by adding at the
end the following:
``(24) Payment and limits for eyeglasses and contact
lenses.--
``(A) In general.--The payment amount under this
part for eyeglass lenses, eyeglass frames, and contact
lenses shall be, subject to subparagraph (C), the
applicable percent (specified in subparagraph (B)) of
the amount otherwise payable for such eyeglass lenses,
eyeglass frames, and contact lenses, respectively,
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 (other than for eyewear
described in section 1861(s)(8)) for an
individual for--
``(I) not more than one pair of
eyeglass lenses during any 12-month
period;
``(II) not more than one set of
eyeglass frames during any 24-month
period; and
``(III) contact lenses, only to the
extent that the sum of such payments
for contact lenses does not exceed a
limitation of $200 during any 24-month
period beginning during the first year
beginning at least six months after the
date of the enactment of this paragraph
(or, beginning during a subsequent
year, such limitation for a 24-month
period beginning in the previous year
increase by an appropriate inflation
adjustment specified by the Secretary).
``(ii) Secretarial authority.--
``(I) Authority to apply additional
limitations.--The Secretary may apply
such other reasonable limitations on
the extent to which eyeglass lenses,
eyeglass frames, and contact lenses 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 eyeglass lenses, eyeglass
frames, and contact lenses to the
extent that such modification is
consistent with the recommendations of
the United States Preventive Services
Task Force.
``(25) Payment and limits for low vision devices.--
``(A) In general.--The payment amount under this
part for low vision devices shall be, subject to
subparagraph (C), the applicable percent (specified in
subparagraph (B)) of the amount otherwise payable for
low vision devices 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) Secretarial authority.--
``(i) Authority to apply limitations.--The
Secretary may apply reasonable limitations on
the extent to which low vision devices 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 low vision devices to the extent
that such modification is consistent with the
recommendations of the United States Preventive
Services Task Force.
``(D) Low vision device defined.--In this
paragraph, the term `low vision device' means a device,
prescribed by a physician, that magnifies, enhances, or
otherwise augments or interprets visual images
irrespective of the size, form, or technological
features of such device and does not include ordinary
eyeglasses or contact lenses. In the previous sentence,
the term `ordinary eyeglasses or contact lenses' means
lenses that are intended to fully correct visual acuity
or fully eliminate refractive error.''.
(f) Definition of Durable Medical Equipment To Include Eyeglasses,
Contact Lenses, and Low Vision Devices.--Section 1861(n) of the Social
Security Act (42 U.S.C. 1395x(n)) is amended--
(1) by striking ``and'' before ``eye tracking'' and
inserting a comma; and
(2) by inserting ``, and eyeglass lenses, low vision
devices (as defined in section 1834(a)(25)), eyeglass frames,
and contact lenses'' before ``; except''.
(g) Repeal of Ground for Exclusion.--Section 1862(a)(7) of the
Social Security Act (42 U.S.C. 1395y(a)(7)) is amended by striking ``,
eyeglasses (other than eyewear described in section 1861(s)(8)) or eye
examinations for the purpose of prescribing, fitting, or changing
eyeglasses, procedures performed (during the course of any eye
examination) to determine the refractive state of the eyes''.
(h) 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.
SEC. 4. HEARING CARE.
(a) Coverage.--
(1) In general.--Section 1861(s)(2) of the Social Security
Act (42 U.S.C. 1395x(s)(2)), as amended by sections 2 and 3, is
further amended--
(A) in subparagraph (GG), by striking ``and'' at
the end;
(B) in subparagraph (HH), by inserting ``and'' at
the end; and
(C) by adding at the end the following new
subparagraph:
``(II) audiology services (as defined in subsection
(ll)(3)) and hearing services (as defined in subsection
(ll)(5));''.
(2) Hearing services defined.--Section 1861(ll) of the
Social Security Act (42 U.S.C. 1395x(ll)) is amended--
(A) in the subsection heading, by inserting ``;
Hearing Services'' after ``Audiology Services''; and
(B) by adding at the end the following new
paragraph:
``(5) The term `hearing services' means--
``(A) routine hearing exams and exams for hearing aids; and
``(B) other necessary services related to hearing health
(as defined by the Secretary).''.
(b) Payment; Coinsurance; and Limitations.--
(1) In general.--Section 1833(a)(1) of the Social Security
Act (42 U.S.C. 1395l(a)(1)), as amended by sections 2 and 3, is
further amended--
(A) by striking ``and'' before ``(CC)''; and
(B) by inserting before the semicolon at the end
the following: ``, and (DD) with respect to audiology
services (as defined in section 1861(ll)(3)) and
hearing services (as defined in section 1861(ll)(5)),
the amount paid shall be the payment amount specified
under section 1834(v)''.
(2) Payment and limits specified.--Section 1834 of the
Social Security Act (42 U.S.C. 1395m), as amended by sections 2
and 3, is further amended by adding at the end the following
new subsection:
``(v) Payment and Limits for Hearing Services.--
``(1) In general.--The payment amount under this part for
audiology services (as defined in section 1861(ll)(3)) and
hearing services (as defined in section 1861(ll)(5)), 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) Secretarial authority.--
``(A) Authority to apply limitations.--The
Secretary may apply reasonable limitations on the
extent to which audiology services and hearing services
are covered under this part, including through
application of a prior authorization requirement.
``(B) 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 audiology
services and hearing services to the extent that such
modification is consistent with the recommendations of
the United States Preventive Services Task Force.''.
(c) Payment Under the Physician Fee Schedule.--Section 1848(j)(3)
of the Social Security Act (42 U.S.C. 1395w-4(j)(3)), as amended by
section 2(d), is further amended by inserting ``(2)(II),'' before
``(3)''.
(d) Hearing Aids.--
(1) Repeal of ground for exclusion.--Section 1862(a)(7) of
the Social Security Act (42 U.S.C. 1395y(a)(7)), as amended by
section 3(g), is further amended by striking ``, hearing aids
or examinations therefor,''.
(2) Definition of durable medical equipment to include
hearing aids.--Section 1861(n) of the Social Security Act (42
U.S.C. 1395x(n)), as amended by section 3, is further amended
by inserting ``hearing aids,'' before ``and eyeglass lenses''.
(3) Special payment rules for hearing aids.--Section
1834(a) of the Social Security Act (42 U.S.C. 1395m(a)), as
amended by sections 2 and 3, is further amended by adding at
the end the following new paragraph:
``(26) Payment and limits for hearing aids.--
``(A) In general.--The payment amount under this
part for hearing aids shall be, subject to subparagraph
(C), the applicable percent (specified in subparagraph
(B)) of the amount otherwise payable for hearing aids
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 not more
than one hearing aid per ear during a 48-month
period.
``(ii) Secretarial authority.--
``(I) Authority to apply additional
limitations.--The Secretary may apply
additional limitations on the extent to
which hearing aids are covered under
this part, 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 aid.
``(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 hearing aids to the extent
that such modification is consistent
with the recommendations of the United
States Preventive Services Task
Force.''.
(e) 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.
<all>
Introduced in House
Introduced in House
Sponsor introductory remarks on measure. (CR E843-844)
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
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