Us Congress 2025-2026 Regular Session

Us Congress House Bill HB2045 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	I
2	2	119THCONGRESS
3	3	1
4	4	STSESSION H. R. 2045
5	5	To amend title XVIII of the Social Security Act to provide for coverage
6	6	of dental, vision, and hearing care under the Medicare program.
7	7	IN THE HOUSE OF REPRESENTATIVES
8	8	MARCH11, 2025
9	9	Mr. D
10	10	OGGETT(for himself, Ms. ADAMS, Ms. ANSARI, Ms. BALINT, Ms.
11	11	B
12	12	ARRAGA´N, Mrs. BEATTY, Mr. BEYER, Mr. BISHOP, Ms. BONAMICI, Mr.
13	13	B
14	14	OYLEof Pennsylvania, Mr. CARSON, Mr. CARTERof Louisiana, Mr.
15	15	C
16	16	ASAR, Mr. CASTROof Texas, Ms. CHU, Mr. CLEAVER, Mr. COHEN, Mr.
17	17	C
18	18	ONNOLLY, Ms. CROCKETT, Mr. CUELLAR, Mr. DAVISof Illinois, Ms.
19	19	D
20	20	EANof Pennsylvania, Ms. DEGETTE, Mrs. MCCLAINDELANEY, Ms.
21	21	D
22	22	ELAURO, Mr. DELUZIO, Mr. DESAULNIER, Ms. DEXTER, Mrs. DIN-
23	23	GELL, Ms. ESCOBAR, Mr. ESPAILLAT, Mr. EVANSof Pennsylvania, Ms.
24	24	L
25	25	EGERFERNANDEZ, Mr. FIELDS, Ms. FRIEDMAN, Mr. FROST, Mr.
26	26	G
27	27	ARAMENDI, Mr. GARCI´Aof Illinois, Mr. GARCIAof California, Ms. GAR-
28	28	CIAof Texas, Mr. GOLDMANof New York, Mr. GOTTHEIMER, Mr. GREEN
29	29	of Texas, Mr. G
30	30	RIJALVA, Mrs. HAYES, Ms. HOYLEof Oregon, Mr.
31	31	H
32	32	UFFMAN, Mr. JACKSONof Illinois, Ms. JACOBS, Ms. JAYAPAL, Mr.
33	33	J
34	34	OHNSONof Georgia, Ms. JOHNSONof Texas, Ms. KAPTUR, Mr.
35	35	K
36	36	HANNA, Mr. KRISHNAMOORTHI, Mr. LANDSMAN, Mr. LARSENof Wash-
37	37	ington, Mr. L
38	38	ARSONof Connecticut, Ms. LEEof Pennsylvania, Ms. LEE
39	39	of Nevada, Mr. L
40	40	IEU, Ms. MCBRIDE, Ms. MCCLELLAN, Ms. MCCOLLUM,
41	41	Mrs. C
42	42	HERFILUS-MCCORMICK, Mr. MCGOVERN, Mr. MEEKS, Ms. MENG,
43	43	Mr. M
44	44	FUME, Ms. MOOREof Wisconsin, Mr. NADLER, Mr. NORCROSS,
45	45	Ms. N
46	46	ORTON, Ms. OCASIO-CORTEZ, Ms. OMAR, Ms. PINGREE, Mr.
47	47	P
48	48	OCAN, Ms. POU, Ms. PRESSLEY, Mrs. RAMIREZ, Mr. RASKIN, Ms. ROSS,
49	49	Mr. R
50	50	UIZ, Ms. SALINAS, Ms. SA´NCHEZ, Ms. SCANLON, Ms. SCHA-
51	51	KOWSKY, Mr. DAVIDSCOTTof Georgia, Ms. SEWELL, Mr. SHERMAN, Ms.
52	52	S
53	53	HERRILL, Mr. SMITHof Washington, Mr. SOTO, Ms. STANSBURY, Mr.
54	54	S
55	55	WALWELL, Mr. TAKANO, Mr. THANEDAR, Mr. THOMPSONof Mis-
56	56	sissippi, Mr. T
57	57	HOMPSONof California, Ms. TITUS, Ms. TLAIB, Ms.
58	58	T
59	59	OKUDA, Mr. TONKO, Mr. TORRESof New York, Mrs. TRAHAN, Mr.
60	60	V
61	61	ARGAS, Mr. VEASEY, Ms. VELA´ZQUEZ, Ms. WASSERMANSCHULTZ, Ms.
62	62	W
63	63	ATERS, Mrs. WATSONCOLEMAN, Ms. WILLIAMSof Georgia, Ms. WIL-
64	64	SONof Florida, Mr. MCGARVEY, Mrs. FOUSHEE, Mrs. MCIVER, Ms. LOIS
65	65	F
66	66	RANKELof Florida, and Mr. GOMEZ) introduced the following bill;
67	67	which was referred to the Committee on Energy and Commerce, and in
68	68	addition to the Committee on Ways and Means, for a period to be subse-
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71	71	•HR 2045 IH
72	72	quently determined by the Speaker, in each case for consideration of such
73	73	provisions as fall within the jurisdiction of the committee concerned
74	74	A BILL
75	75	To amend title XVIII of the Social Security Act to provide
76	76	for coverage of dental, vision, and hearing care under
77	77	the Medicare program.
78	78	Be it enacted by the Senate and House of Representa-1
79	79	tives of the United States of America in Congress assembled, 2
80	80	SECTION 1. SHORT TITLE. 3
81	81	This Act may be cited as the ‘‘Medicare Dental, Vi-4
82	82	sion, and Hearing Benefit Act of 2025’’. 5
83	83	SEC. 2. DENTAL AND ORAL HEALTH CARE. 6
84	84	(a) C
85	85	OVERAGE.—Section 1861(s)(2) of the Social Se-7
86	86	curity Act (42 U.S.C. 1395x(s)(2)) is amended— 8
87	87	(1) in subparagraph (II), by striking ‘‘and’’ 9
88	88	after the semicolon at the end; 10
89	89	(2) in subparagraph (JJ), by adding ‘‘and’’ 11
90	90	after the semicolon at the end; and 12
91	91	(3) by adding at the end the following new sub-13
92	92	paragraph: 14
93	93	‘‘(KK) dental and oral health services (as de-15
94	94	fined in subsection (nnn));’’. 16
95	95	(b) D
96	96	ENTAL AND ORALHEALTHSERVICESDE-17
97	97	FINED.—Section 1861 of the Social Security Act (42 18
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100	100	•HR 2045 IH
101	101	U.S.C. 1395x) is amended by adding at the end the fol-1
102	102	lowing new subsection: 2
103	103	‘‘Dental and Oral Health Services 3
104	104	‘‘(nnn) The term ‘dental and oral health services’ 4
105	105	means— 5
106	106	‘‘(1) preventative and screening services, such 6
107	107	as oral exams, dental cleanings, dental x-rays, and 7
108	108	fluoride treatments; 8
109	109	‘‘(2) basic dental services, such as tooth res-9
110	110	torations, basic periodontics services, tooth extrac-10
111	111	tions, and oral disease management services; 11
112	112	‘‘(3) major dental services, such as major tooth 12
113	113	restorations, major periodontics services, bridges, 13
114	114	crowns, root canals, and extractions; 14
115	115	‘‘(4) emergency dental care; and 15
116	116	‘‘(5) other necessary services related to dental 16
117	117	or oral health (as defined by the Secretary).’’. 17
118	118	(c) P
119	119	AYMENT; COINSURANCE; ANDLIMITATIONS.— 18
120	120	(1) I
121	121	N GENERAL.—Section 1833(a)(1) of the 19
122	122	Social Security Act (42 U.S.C. 1395l(a)(1)) is 20
123	123	amended— 21
124	124	(A) by striking ‘‘and’’ before ‘‘(GG)’’; and 22
125	125	(B) by inserting before the semicolon at 23
126	126	the end the following: ‘‘, and (HH) with respect 24
127	127	to dental and oral health services (as defined in 25
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130	130	•HR 2045 IH
131	131	section 1861(lll)), the amount paid shall be the 1
132	132	payment amount specified under section 2
133	133	1834(aa)’’. 3
134	134	(2) P
135	135	AYMENT AND LIMITS SPECIFIED .—Section 4
136	136	1834 of the Social Security Act (42 U.S.C. 1395m) 5
137	137	is amended by adding at the end the following new 6
138	138	subsection: 7
139	139	‘‘(aa) P
140	140	AYMENT ANDLIMITS FORDENTAL ANDORAL 8
141	141	H
142	142	EALTHSERVICES.— 9
143	143	‘‘(1) I
144	144	N GENERAL.—The payment amount 10
145	145	under this part for dental and oral health services 11
146	146	(as defined in section 1861(nnn)) shall be, subject to 12
147	147	paragraph (3), the applicable percent (specified in 13
148	148	paragraph (2)) of the lesser of the actual charge for 14
149	149	the services or the amount determined under the 15
150	150	payment basis determined under section 1848. 16
151	151	‘‘(2) A
152	152	PPLICABLE PERCENT.— 17
153	153	‘‘(A) I
154	154	N GENERAL.—For purposes of para-18
155	155	graph (1), except as provided in subparagraph 19
156	156	(B), the applicable percent specified in this 20
157	157	paragraph is— 21
158	158	‘‘(i) with respect to services described 22
159	159	in section 1861(nnn)(1) furnished during 23
160	160	2026 or a subsequent year, 100 percent; 24
161	161	and 25
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164	164	•HR 2045 IH
165	165	‘‘(ii) with respect to services not de-1
166	166	scribed in clause (i)— 2
167	167	‘‘(I) for a year before 2027, 0 3
168	168	percent; 4
169	169	‘‘(II) for 2027, 30 percent; 5
170	170	‘‘(III) for 2028, 60 percent; and 6
171	171	‘‘(IV) for 2029 and each subse-7
172	172	quent year, 80 percent. 8
173	173	‘‘(B) S
174	174	PECIAL RULE FOR CERTAIN LOW -IN-9
175	175	COME INDIVIDUALS.—For purposes of para-10
176	176	graph (1), the applicable percent specified in 11
177	177	this paragraph is, with respect to services fur-12
178	178	nished to an individual who is a subsidy eligible 13
179	179	individual (as defined in section 1860D– 14
180	180	14(a)(3)), or who would be a subsidy eligible in-15
181	181	dividual if the individual were enrolled in a pre-16
182	182	scription drug plan or MA–PD plan— 17
183	183	‘‘(i) with respect to services described 18
184	184	in section 1861(nnn)(1), for 2026 and 19
185	185	each subsequent year, 100 percent; and 20
186	186	‘‘(ii) with respect to services not de-21
187	187	scribed in clause (i), for 2027 and each 22
188	188	subsequent year, 80 percent. 23
189	189	‘‘(3) L
190	190	IMITATIONS AND SECRETARIAL AUTHOR -24
191	191	ITY.— 25
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194	194	•HR 2045 IH
195	195	‘‘(A) FREQUENCY.—With respect to dental 1
196	196	and oral health services that are— 2
197	197	‘‘(i) routine dental cleanings, payment 3
198	198	may be made under this part for only two 4
199	199	such cleanings during a 12-month period; 5
200	200	and 6
201	201	‘‘(ii) routine exams, payment may be 7
202	202	made under this part for only two such 8
203	203	exams during a 12-month period. 9
204	204	‘‘(B) S
205	205	ECRETARIAL AUTHORITY .— 10
206	206	‘‘(i) A
207	207	UTHORITY TO APPLY ADDI -11
208	208	TIONAL LIMITATIONS.—The Secretary may 12
209	209	apply such other reasonable limitations on 13
210	210	the extent to which dental and oral services 14
211	211	are covered under this part, including 15
212	212	through application of a prior authoriza-16
213	213	tion requirement. 17
214	214	‘‘(ii) A
215	215	UTHORITY TO MODIFY COV -18
216	216	ERAGE.—Notwithstanding any other provi-19
217	217	sion of this title, if the Secretary deter-20
218	218	mines appropriate, the Secretary may mod-21
219	219	ify the coverage under this part of dental 22
220	220	and oral health services to the extent that 23
221	221	such modification is consistent with the 24
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224	224	•HR 2045 IH
225	225	recommendations of the United States Pre-1
226	226	ventive Services Task Force. 2
227	227	‘‘(iii) A
228	228	UTHORITY TO WAIVE FRE -3
229	229	QUENCY LIMITATIONS .—Notwithstanding 4
230	230	subparagraph (A), the Secretary may 5
231	231	waive any frequency limitation under such 6
232	232	subparagraph for an individual (or cat-7
233	233	egory of individuals) if determined appro-8
234	234	priate by the Secretary.’’. 9
235	235	(d) P
236	236	AYMENTUNDERPHYSICIANFEESCHEDULE.— 10
237	237	Section 1848(j)(3) of the Social Security Act (42 U.S.C. 11
238	238	1395w–4(j)(3)) is amended by inserting ‘‘(2)(KK),’’ be-12
239	239	fore ‘‘(3)’’. 13
240	240	(e) D
241	241	ENTURES.— 14
242	242	(1) I
243	243	N GENERAL.—Section 1861(s)(8) of the 15
244	244	Social Security Act (42 U.S.C. 1395x(s)(8)) is 16
245	245	amended— 17
246	246	(A) by striking ‘‘(other than dental)’’ and 18
247	247	inserting ‘‘(including dentures)’’; and 19
248	248	(B) by striking ‘‘internal body’’. 20
249	249	(2) S
250	250	PECIAL PAYMENT RULES .—Section 21
251	251	1834(a) of the Social Security Act (42 U.S.C. 22
252	252	1395m(a)) is amended by adding at the end the fol-23
253	253	lowing new paragraph: 24
254	254	‘‘(23) P
255	255	AYMENT AND LIMITS FOR DENTURES .— 25
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258	258	•HR 2045 IH
259	259	‘‘(A) IN GENERAL.—The payment amount 1
260	260	under this part for dentures shall be, subject to 2
261	261	subparagraph (C), the applicable percent (speci-3
262	262	fied in subparagraph (B)) of the amount other-4
263	263	wise payable for such dentures under this sec-5
264	264	tion. 6
265	265	‘‘(B) A
266	266	PPLICABLE PERCENT .—For pur-7
267	267	poses of subparagraph (A), the applicable per-8
268	268	cent specified in this subparagraph is— 9
269	269	‘‘(i) for a year before 2027, 0 percent; 10
270	270	and 11
271	271	‘‘(ii) for 2027 and each subsequent 12
272	272	year, 80 percent. 13
273	273	‘‘(C) L
274	274	IMITATIONS AND SECRETARIAL AU -14
275	275	THORITY.— 15
276	276	‘‘(i) I
277	277	N GENERAL.—Payment may be 16
278	278	made under this part for an individual 17
279	279	for— 18
280	280	‘‘(I) not more than one full upper 19
281	281	and one full lower denture once every 20
282	282	five years; and 21
283	283	‘‘(II) not more than one partial 22
284	284	upper denture and one partial lower 23
285	285	denture once every five years. 24
286	286	‘‘(ii) S
287	287	ECRETARIAL AUTHORITY .— 25
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291	291	‘‘(I) AUTHORITY TO APPLY ADDI -1
292	292	TIONAL LIMITATIONS.—The Secretary 2
293	293	may apply such other reasonable limi-3
294	294	tations on the extent to which den-4
295	295	tures are covered under this part, in-5
296	296	cluding through application of a prior 6
297	297	authorization requirement. 7
298	298	‘‘(II) A
299	299	UTHORITY TO MODIFY 8
300	300	COVERAGE.—Notwithstanding any 9
301	301	other provision of this title, if the Sec-10
302	302	retary determines appropriate, the 11
303	303	Secretary may modify the coverage 12
304	304	under this part of dentures to the ex-13
305	305	tent that such modification is con-14
306	306	sistent with the recommendations of 15
307	307	the United States Preventive Services 16
308	308	Task Force. 17
309	309	‘‘(III) A
310	310	UTHORITY TO WAIVE 18
311	311	FREQUENCY LIMITATIONS .—Notwith-19
312	312	standing clause (i), the Secretary may 20
313	313	waive any frequency limitation under 21
314	314	such clause for an individual (or cat-22
315	315	egory of individuals) if determined ap-23
316	316	propriate by the Secretary.’’. 24
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319	319	•HR 2045 IH
320	320	(f) REPEAL OFGROUND FOREXCLUSION.—Section 1
321	321	1862(a) of the Social Security Act (42 U.S.C. 1395y) is 2
322	322	amended by striking paragraph (12). 3
323	323	(g) E
324	324	FFECTIVEDATE.—The amendments made by 4
325	325	this section shall apply to services furnished on or after 5
326	326	January 1, 2026. 6
327	327	SEC. 3. VISION CARE. 7
328	328	(a) C
329	329	OVERAGE.—Section 1861(s)(2) of the Social Se-8
330	330	curity Act (42 U.S.C. 1395x(s)(2)), as amended by section 9
331	331	2, is further amended— 10
332	332	(1) in subparagraph (JJ), by striking ‘‘and’’ 11
333	333	after the semicolon at the end; 12
334	334	(2) in subparagraph (KK), by adding ‘‘and’’ 13
335	335	after the semicolon at the end; and 14
336	336	(3) by adding at the end the following new sub-15
337	337	paragraph: 16
338	338	‘‘(LL) vision services (as defined in subsection 17
339	339	(ooo));’’. 18
340	340	(b) V
341	341	ISIONSERVICESDEFINED.—Section 1861 of 19
342	342	the Social Security Act (42 U.S.C. 1395x), as amended 20
343	343	by section 2, is further amended by adding at the end the 21
344	344	following new subsection: 22
345	345	‘‘Vision Services 23
346	346	‘‘(ooo) The term ‘vision services’ means— 24
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349	349	•HR 2045 IH
350	350	‘‘(1) routine eye examinations and procedures 1
351	351	performed (during the course of any eye examina-2
352	352	tion) to determine the refractive state of the eyes; 3
353	353	and 4
354	354	‘‘(2) other necessary services related to eye and 5
355	355	vision health (as defined by the Secretary).’’. 6
356	356	(c) P
357	357	AYMENT; COINSURANCE; ANDLIMITATIONS.— 7
358	358	(1) I
359	359	N GENERAL.—Section 1833(a)(1) of the 8
360	360	Social Security Act (42 U.S.C. 1395l(a)(1)), as 9
361	361	amended by section 2, is further amended— 10
362	362	(A) by striking ‘‘and’’ before ‘‘(HH)’’; and 11
363	363	(B) by inserting before the semicolon at 12
364	364	the end the following: ‘‘, and (II) with respect 13
365	365	to vision services (as defined in section 14
366	366	1861(mmm)), the amount paid shall be the 15
367	367	payment amount specified under section 16
368	368	1834(bb)’’. 17
369	369	(2) P
370	370	AYMENT AND LIMITS SPECIFIED .—Section 18
371	371	1834 of the Social Security Act (42 U.S.C. 1395m), 19
372	372	as amended by section 2, is further amended by add-20
373	373	ing at the end the following new subsection: 21
374	374	‘‘(bb) P
375	375	AYMENT AND LIMITS FORVISIONSERV-22
376	376	ICES.— 23
377	377	‘‘(1) I
378	378	N GENERAL.—The payment amount 24
379	379	under this part for vision services (as defined in sec-25
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382	382	•HR 2045 IH
383	383	tion 1861(ooo)) shall be, subject to paragraph (2), 1
384	384	80 percent of the lesser of the actual charge for the 2
385	385	services or the amount determined under the pay-3
386	386	ment basis determined under section 1848. 4
387	387	‘‘(2) L
388	388	IMITATIONS AND SECRETARIAL AUTHOR -5
389	389	ITY.— 6
390	390	‘‘(A) F
391	391	REQUENCY.—With respect to rou-7
392	392	tine eye exams, payment may be made under 8
393	393	this part for only one such exam during a 12- 9
394	394	month period. 10
395	395	‘‘(B) S
396	396	ECRETARIAL AUTHORITY .— 11
397	397	‘‘(i) A
398	398	UTHORITY TO APPLY ADDI -12
399	399	TIONAL LIMITATIONS.—The Secretary may 13
400	400	apply other reasonable limitations on the 14
401	401	extent to which vision services are covered 15
402	402	under this part, including through applica-16
403	403	tion of a prior authorization requirement. 17
404	404	‘‘(ii) A
405	405	UTHORITY TO MODIFY COV -18
406	406	ERAGE.—Notwithstanding any other provi-19
407	407	sion of this title, if the Secretary deter-20
408	408	mines appropriate, the Secretary may mod-21
409	409	ify the coverage under this part of vision 22
410	410	services to the extent that such modifica-23
411	411	tion is consistent with the recommenda-24
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414	414	•HR 2045 IH
415	415	tions of the United States Preventive Serv-1
416	416	ices Task Force. 2
417	417	‘‘(iii) A
418	418	UTHORITY TO WAIVE FRE -3
419	419	QUENCY LIMITATIONS .—Notwithstanding 4
420	420	subparagraph (A), the Secretary may 5
421	421	waive any frequency limitation under such 6
422	422	subparagraph for an individual (or cat-7
423	423	egory of individuals) if determined appro-8
424	424	priate by the Secretary.’’. 9
425	425	(d) P
426	426	AYMENTUNDERPHYSICIANFEESCHEDULE.— 10
427	427	Section 1848(j)(3) of the Social Security Act (42 U.S.C. 11
428	428	1395w–4(j)(3)) is amended by inserting ‘‘(2)(LL),’’ after 12
429	429	‘‘(2)(KK),’’ (as added by section 2). 13
430	430	(e) S
431	431	PECIALPAYMENTRULES FOREYEGLASSES, 14
432	432	C
433	433	ONTACTLENSES, ANDLOWVISIONDEVICES.—Section 15
434	434	1834(a) of the Social Security Act (42 U.S.C. 1395m(a)), 16
435	435	as amended by section 2, is further amended by adding 17
436	436	at the end the following: 18
437	437	‘‘(24) P
438	438	AYMENT AND LIMITS FOR EYEGLASSES 19
439	439	AND CONTACT LENSES .— 20
440	440	‘‘(A) I
441	441	N GENERAL.—The payment amount 21
442	442	under this part for eyeglass lenses, eyeglass 22
443	443	frames, and contact lenses shall be, subject to 23
444	444	subparagraph (B), 80 percent of the amount 24
445	445	otherwise payable for such eyeglass lenses, eye-25
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448	448	•HR 2045 IH
449	449	glass frames, and contact lenses, respectively, 1
450	450	under this section. 2
451	451	‘‘(B) L
452	452	IMITATIONS AND SECRETARIAL AU -3
453	453	THORITY.— 4
454	454	‘‘(i) I
455	455	N GENERAL.—Subject to clause 5
456	456	(iii), payment may be made under this part 6
457	457	(other than for eyewear described in sec-7
458	458	tion 1861(s)(8)) for an individual for— 8
459	459	‘‘(I) not more than one pair of 9
460	460	eyeglass lenses during any 12-month 10
461	461	period in an amount not exceeding 11
462	462	$100; 12
463	463	‘‘(II) not more than one set of 13
464	464	eyeglass frames during any 24-month 14
465	465	period in an amount not exceeding 15
466	466	$100; and 16
467	467	‘‘(III) contact lenses, only to the 17
468	468	extent that the sum of such payments 18
469	469	for contact lenses does not exceed a 19
470	470	limitation of $200 during any 24- 20
471	471	month period beginning during the 21
472	472	first year beginning at least six 22
473	473	months after the date of the enact-23
474	474	ment of this paragraph (or, beginning 24
475	475	during a subsequent year, such limita-25
476	476	VerDate Sep 11 2014 22:53 Mar 24, 2025 Jkt 059200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\H2045.IH H2045
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478	478	•HR 2045 IH
479	479	tion for a 24-month period beginning 1
480	480	in the previous year increase by an 2
481	481	appropriate inflation adjustment spec-3
482	482	ified by the Secretary). 4
483	483	‘‘(ii) S
484	484	ECRETARIAL AUTHORITY .— 5
485	485	‘‘(I) A
486	486	UTHORITY TO APPLY ADDI -6
487	487	TIONAL LIMITATIONS.—The Secretary 7
488	488	may apply such other reasonable limi-8
489	489	tations on the extent to which eye-9
490	490	glass lenses, eyeglass frames, and con-10
491	491	tact lenses are covered under this 11
492	492	part, including through application of 12
493	493	a prior authorization requirement. 13
494	494	‘‘(II) A
495	495	UTHORITY TO MODIFY 14
496	496	COVERAGE.—Notwithstanding any 15
497	497	other provision of this title, if the Sec-16
498	498	retary determines appropriate, the 17
499	499	Secretary may modify the coverage 18
500	500	under this part of eyeglass lenses, eye-19
501	501	glass frames, and contact lenses to 20
502	502	the extent that such modification is 21
503	503	consistent with the recommendations 22
504	504	of the United States Preventive Serv-23
505	505	ices Task Force. 24
506	506	VerDate Sep 11 2014 22:53 Mar 24, 2025 Jkt 059200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\H2045.IH H2045
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508	508	•HR 2045 IH
509	509	‘‘(III) AUTHORITY TO WAIVE 1
510	510	FREQUENCY LIMITATIONS .—Notwith-2
511	511	standing clause (i), the Secretary may 3
512	512	waive any frequency limitation under 4
513	513	such clause for an individual (or cat-5
514	514	egory of individuals) if determined ap-6
515	515	propriate by the Secretary. 7
516	516	‘‘(iii) U
517	517	PDATE OF PAYMENT LIMITS 8
518	518	TO ACCOUNT FOR INFLATION .—With re-9
519	519	spect to eyeglass lenses and contact lenses 10
520	520	furnished during 2027 or a subsequent 11
521	521	year, the Secretary shall increase the dollar 12
522	522	amounts in effect under this subparagraph 13
523	523	for such year by the percentage change in 14
524	524	the consumer price index for all urban con-15
525	525	sumers (United States city average) for 16
526	526	the 12-month period ending with June of 17
527	527	the previous year. 18
528	528	‘‘(25) P
529	529	AYMENT AND LIMITS FOR LOW VISION 19
530	530	DEVICES.— 20
531	531	‘‘(A) I
532	532	N GENERAL.—The payment amount 21
533	533	under this part for low vision devices shall be 22
534	534	80 percent of the amount otherwise payable for 23
535	535	low vision devices under this section. 24
536	536	‘‘(B) S
537	537	ECRETARIAL AUTHORITY .— 25
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540	540	•HR 2045 IH
541	541	‘‘(i) AUTHORITY TO APPLY LIMITA -1
542	542	TIONS.—The Secretary may apply reason-2
543	543	able limitations on the extent to which low 3
544	544	vision devices are covered under this part, 4
545	545	including through application of a prior 5
546	546	authorization requirement. 6
547	547	‘‘(ii) A
548	548	UTHORITY TO MODIFY COV -7
549	549	ERAGE.—Notwithstanding any other provi-8
550	550	sion of this title, if the Secretary deter-9
551	551	mines appropriate, the Secretary may mod-10
552	552	ify the coverage under this part of low vi-11
553	553	sion devices to the extent that such modi-12
554	554	fication is consistent with the recommenda-13
555	555	tions of the United States Preventive Serv-14
556	556	ices Task Force. 15
557	557	‘‘(C) L
558	558	OW VISION DEVICE DEFINED .—In 16
559	559	this paragraph, the term ‘low vision device’ 17
560	560	means a device, prescribed by a physician, that 18
561	561	magnifies, enhances, or otherwise augments or 19
562	562	interprets visual images irrespective of the size, 20
563	563	form, or technological features of such device 21
564	564	and does not include ordinary eyeglasses or con-22
565	565	tact lenses. In the previous sentence, the term 23
566	566	‘ordinary eyeglasses or contact lenses’ means 24
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569	569	•HR 2045 IH
570	570	lenses that are intended to fully correct visual 1
571	571	acuity or fully eliminate refractive error.’’. 2
572	572	(f) D
573	573	EFINITION OFDURABLEMEDICALEQUIPMENT 3
574	574	T
575	575	OINCLUDEEYEGLASSES, CONTACTLENSES, ANDLOW 4
576	576	V
577	577	ISIONDEVICES.—Section 1861(n) of the Social Security 5
578	578	Act (42 U.S.C. 1395x(n)) is amended— 6
579	579	(1) by striking ‘‘and’’ before ‘‘eye tracking’’ and 7
580	580	inserting a comma; and 8
581	581	(2) by inserting ‘‘, and eyeglass lenses, low vi-9
582	582	sion devices (as defined in section 1834(a)(25)), eye-10
583	583	glass frames, and contact lenses’’ before ‘‘; except’’. 11
584	584	(g) R
585	585	EPEAL OFGROUND FOREXCLUSION.—Section 12
586	586	1862(a)(7) of the Social Security Act (42 U.S.C. 13
587	587	1395y(a)(7)) is amended by striking ‘‘, eyeglasses (other 14
588	588	than eyewear described in section 1861(s)(8)) or eye ex-15
589	589	aminations for the purpose of prescribing, fitting, or 16
590	590	changing eyeglasses, procedures performed (during the 17
591	591	course of any eye examination) to determine the refractive 18
592	592	state of the eyes’’. 19
593	593	(h) E
594	594	FFECTIVEDATE.—The amendments made by 20
595	595	this section shall apply to services furnished on or after 21
596	596	January 1, 2026. 22
597	597	SEC. 4. HEARING CARE. 23
598	598	(a) C
599	599	OVERAGE.— 24
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602	602	•HR 2045 IH
603	603	(1) IN GENERAL.—Section 1861(s)(2) of the 1
604	604	Social Security Act (42 U.S.C. 1395x(s)(2)), as 2
605	605	amended by sections 2 and 3, is further amended— 3
606	606	(A) in subparagraph (KK), by striking 4
607	607	‘‘and’’ at the end; 5
608	608	(B) in subparagraph (LL), by inserting 6
609	609	‘‘and’’ at the end; and 7
610	610	(C) by adding at the end the following new 8
611	611	subparagraph: 9
612	612	‘‘(MM) audiology services (as defined in sub-10
613	613	section (ll)(3)) and hearing services (as defined in 11
614	614	subsection (ll)(5));’’. 12
615	615	(2) H
616	616	EARING SERVICES DEFINED .—Section 13
617	617	1861(ll) of the Social Security Act (42 U.S.C. 14
618	618	1395x(ll)) is amended— 15
619	619	(A) in the subsection heading, by inserting 16
620	620	‘‘; H
621	621	EARINGSERVICES’’ after ‘‘AUDIOLOGY 17
622	622	S
623	623	ERVICES’’; and 18
624	624	(B) by adding at the end the following new 19
625	625	paragraph: 20
626	626	‘‘(5) The term ‘hearing services’ means— 21
627	627	‘‘(A) routine hearing exams and exams for 22
628	628	hearing aids; and 23
629	629	‘‘(B) other necessary services related to hearing 24
630	630	health (as defined by the Secretary).’’. 25
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633	633	•HR 2045 IH
634	634	(b) PAYMENT; COINSURANCE; ANDLIMITATIONS.— 1
635	635	(1) I
636	636	N GENERAL.—Section 1833(a)(1) of the 2
637	637	Social Security Act (42 U.S.C. 1395l(a)(1)), as 3
638	638	amended by sections 2 and 3, is further amended— 4
639	639	(A) by striking ‘‘and’’ before ‘‘(II)’’; and 5
640	640	(B) by inserting before the semicolon at 6
641	641	the end the following: ‘‘, and (JJ) with respect 7
642	642	to audiology services (as defined in section 8
643	643	1861(ll)(3)) and hearing services (as defined in 9
644	644	section 1861(ll)(5)), the amount paid shall be 10
645	645	the payment amount specified under section 11
646	646	1834(cc)’’. 12
647	647	(2) P
648	648	AYMENT AND LIMITS SPECIFIED .—Section 13
649	649	1834 of the Social Security Act (42 U.S.C. 1395m), 14
650	650	as amended by sections 2 and 3, is further amended 15
651	651	by adding at the end the following new subsection: 16
652	652	‘‘(cc) P
653	653	AYMENT AND LIMITS FORHEARINGSERV-17
654	654	ICES.— 18
655	655	‘‘(1) I
656	656	N GENERAL.—The payment amount 19
657	657	under this part for audiology services (as defined in 20
658	658	section 1861(ll)(3)) and hearing services (as defined 21
659	659	in section 1861(ll)(5)), shall be, subject to para-22
660	660	graph (2), 80 percent of the lesser of the actual 23
661	661	charge for the services or the amount determined 24
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664	664	•HR 2045 IH
665	665	under the payment basis determined under section 1
666	666	1848. 2
667	667	‘‘(2) S
668	668	ECRETARIAL AUTHORITY .— 3
669	669	‘‘(A) A
670	670	UTHORITY TO APPLY LIMITA -4
671	671	TIONS.—The Secretary may apply reasonable 5
672	672	limitations on the extent to which audiology 6
673	673	services and hearing services are covered under 7
674	674	this part, including through application of a 8
675	675	prior authorization requirement. 9
676	676	‘‘(B) A
677	677	UTHORITY TO MODIFY COVERAGE .— 10
678	678	Notwithstanding any other provision of this 11
679	679	title, if the Secretary determines appropriate, 12
680	680	the Secretary may modify the coverage under 13
681	681	this part of audiology services and hearing serv-14
682	682	ices to the extent that such modification is con-15
683	683	sistent with the recommendations of the United 16
684	684	States Preventive Services Task Force.’’. 17
685	685	(c) P
686	686	AYMENTUNDER THEPHYSICIANFEESCHED-18
687	687	ULE.—Section 1848(j)(3) of the Social Security Act (42 19
688	688	U.S.C. 1395w–4(j)(3)), as amended by section 2(d), is 20
689	689	further amended by inserting ‘‘(2)(MM),’’ before ‘‘(3)’’. 21
690	690	(d) H
691	691	EARINGAIDS.— 22
692	692	(1) R
693	693	EPEAL OF GROUND FOR EXCLUSION .— 23
694	694	Section 1862(a)(7) of the Social Security Act (42 24
695	695	U.S.C. 1395y(a)(7)), as amended by section 3(g), is 25
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698	698	•HR 2045 IH
699	699	further amended by striking ‘‘, hearing aids or ex-1
700	700	aminations therefor,’’. 2
701	701	(2) D
702	702	EFINITION OF DURABLE MEDICAL EQUIP -3
703	703	MENT TO INCLUDE HEARING AIDS .—Section 1861(n) 4
704	704	of the Social Security Act (42 U.S.C. 1395x(n)), as 5
705	705	amended by section 3, is further amended by insert-6
706	706	ing ‘‘hearing aids,’’ before ‘‘and eyeglass lenses’’. 7
707	707	(3) S
708	708	PECIAL PAYMENT RULES FOR HEARING 8
709	709	AIDS.—Section 1834(a) of the Social Security Act 9
710	710	(42 U.S.C. 1395m(a)), as amended by sections 2 10
711	711	and 3, is further amended by adding at the end the 11
712	712	following new paragraph: 12
713	713	‘‘(26) P
714	714	AYMENT AND LIMITS FOR HEARING 13
715	715	AIDS.— 14
716	716	‘‘(A) I
717	717	N GENERAL.—The payment amount 15
718	718	under this part for hearing aids shall be, sub-16
719	719	ject to subparagraph (B), 80 percent of the 17
720	720	amount otherwise payable for hearing aids 18
721	721	under this section. 19
722	722	‘‘(B) L
723	723	IMITATIONS AND SECRETARIAL AU -20
724	724	THORITY.— 21
725	725	‘‘(i) I
726	726	N GENERAL.—Payment may be 22
727	727	made under this part for an individual for 23
728	728	not more than one hearing aid per ear dur-24
729	729	ing a 48-month period. 25
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732	732	•HR 2045 IH
733	733	‘‘(ii) SECRETARIAL AUTHORITY .— 1
734	734	‘‘(I) A
735	735	UTHORITY TO APPLY ADDI -2
736	736	TIONAL LIMITATIONS.—The Secretary 3
737	737	may apply additional limitations on 4
738	738	the extent to which hearing aids are 5
739	739	covered under this part, including 6
740	740	through application of a prior author-7
741	741	ization requirement and through ap-8
742	742	plication of criteria for a minimum 9
743	743	level of hearing loss for coverage of an 10
744	744	initial or replacement hearing aid. 11
745	745	‘‘(II) A
746	746	UTHORITY TO MODIFY 12
747	747	COVERAGE.—Notwithstanding any 13
748	748	other provision of this title, if the Sec-14
749	749	retary determines appropriate, the 15
750	750	Secretary may modify the coverage 16
751	751	under this part of hearing aids to the 17
752	752	extent that such modification is con-18
753	753	sistent with the recommendations of 19
754	754	the United States Preventive Services 20
755	755	Task Force. 21
756	756	‘‘(iii) A
757	757	UTHORITY TO WAIVE FRE -22
758	758	QUENCY LIMITATIONS .—Notwithstanding 23
759	759	clause (i), the Secretary may waive any 24
760	760	frequency limitation under such clause for 25
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763	763	•HR 2045 IH
764	764	an individual (or category of individuals) if 1
765	765	determined appropriate by the Secretary.’’. 2
766	766	(e) E
767	767	FFECTIVEDATE.—The amendments made by 3
768	768	this section shall apply to services furnished on or after 4
769	769	January 1, 2026. 5
770	770	SEC. 5. NONAPPLICATION OF COMPETITIVE ACQUISITION 6
771	771	TO CERTAIN ITEMS. 7
772	772	Section 1847(a)(2) of the Social Security Act (42 8
773	773	U.S.C. 1395w–3(a)(2)) is amended— 9
774	774	(1) by striking ‘‘and excluding’’ and inserting 10
775	775	‘‘excluding’’; and 11
776	776	(2) by inserting ‘‘, and excluding dentures, eye-12
777	777	glass lenses, contact lenses, and hearing aids’’ before 13
778	778	the period at the end. 14
779	779	SEC. 6. INCLUSION OF AN ORAL HEALTH PROFESSIONAL 15
780	780	ON THE UNITED STATES PREVENTIVE SERV-16
781	781	ICES TASK FORCE. 17
782	782	(a) I
783	783	NGENERAL.—The first sentence of section 18
784	784	915(a)(1) of the Public Health Service Act (42 U.S.C. 19
785	785	299b–4(a)(1)) is amended by inserting ‘‘, including at 20
786	786	least 1 oral health professional’’ before the period at the 21
787	787	end. 22
788	788	(b) E
789	789	FFECTIVEDATE.—The amendment made by 23
790	790	subsection (a) shall apply beginning on January 1 of the 24
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793	793	•HR 2045 IH
794	794	first year beginning at least 6 months after the date of 1
795	795	the enactment of this Act. 2
796	796	Æ
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