I
119THCONGRESS
1
STSESSION H. R. 2045
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
MARCH11, 2025
Mr. D
OGGETT(for himself, Ms. ADAMS, Ms. ANSARI, Ms. BALINT, Ms.
B
ARRAGA´N, Mrs. BEATTY, Mr. BEYER, Mr. BISHOP, Ms. BONAMICI, Mr.
B
OYLEof Pennsylvania, Mr. CARSON, Mr. CARTERof Louisiana, Mr.
C
ASAR, Mr. CASTROof Texas, Ms. CHU, Mr. CLEAVER, Mr. COHEN, Mr.
C
ONNOLLY, Ms. CROCKETT, Mr. CUELLAR, Mr. DAVISof Illinois, Ms.
D
EANof Pennsylvania, Ms. DEGETTE, Mrs. MCCLAINDELANEY, Ms.
D
ELAURO, Mr. DELUZIO, Mr. DESAULNIER, Ms. DEXTER, Mrs. DIN-
GELL, Ms. ESCOBAR, Mr. ESPAILLAT, Mr. EVANSof Pennsylvania, Ms.
L
EGERFERNANDEZ, Mr. FIELDS, Ms. FRIEDMAN, Mr. FROST, Mr.
G
ARAMENDI, Mr. GARCI´Aof Illinois, Mr. GARCIAof California, Ms. GAR-
CIAof Texas, Mr. GOLDMANof New York, Mr. GOTTHEIMER, Mr. GREEN
of Texas, Mr. G
RIJALVA, Mrs. HAYES, Ms. HOYLEof Oregon, Mr.
H
UFFMAN, Mr. JACKSONof Illinois, Ms. JACOBS, Ms. JAYAPAL, Mr.
J
OHNSONof Georgia, Ms. JOHNSONof Texas, Ms. KAPTUR, Mr.
K
HANNA, Mr. KRISHNAMOORTHI, Mr. LANDSMAN, Mr. LARSENof Wash-
ington, Mr. L
ARSONof Connecticut, Ms. LEEof Pennsylvania, Ms. LEE
of Nevada, Mr. L
IEU, Ms. MCBRIDE, Ms. MCCLELLAN, Ms. MCCOLLUM,
Mrs. C
HERFILUS-MCCORMICK, Mr. MCGOVERN, Mr. MEEKS, Ms. MENG,
Mr. M
FUME, Ms. MOOREof Wisconsin, Mr. NADLER, Mr. NORCROSS,
Ms. N
ORTON, Ms. OCASIO-CORTEZ, Ms. OMAR, Ms. PINGREE, Mr.
P
OCAN, Ms. POU, Ms. PRESSLEY, Mrs. RAMIREZ, Mr. RASKIN, Ms. ROSS,
Mr. R
UIZ, Ms. SALINAS, Ms. SA´NCHEZ, Ms. SCANLON, Ms. SCHA-
KOWSKY, Mr. DAVIDSCOTTof Georgia, Ms. SEWELL, Mr. SHERMAN, Ms.
S
HERRILL, Mr. SMITHof Washington, Mr. SOTO, Ms. STANSBURY, Mr.
S
WALWELL, Mr. TAKANO, Mr. THANEDAR, Mr. THOMPSONof Mis-
sissippi, Mr. T
HOMPSONof California, Ms. TITUS, Ms. TLAIB, Ms.
T
OKUDA, Mr. TONKO, Mr. TORRESof New York, Mrs. TRAHAN, Mr.
V
ARGAS, Mr. VEASEY, Ms. VELA´ZQUEZ, Ms. WASSERMANSCHULTZ, Ms.
W
ATERS, Mrs. WATSONCOLEMAN, Ms. WILLIAMSof Georgia, Ms. WIL-
SONof Florida, Mr. MCGARVEY, Mrs. FOUSHEE, Mrs. MCIVER, Ms. LOIS
F
RANKELof Florida, and Mr. GOMEZ) 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 subse-
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quently 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 Representa-1
tives of the United States of America in Congress assembled, 2
SECTION 1. SHORT TITLE. 3
This Act may be cited as the ‘‘Medicare Dental, Vi-4
sion, and Hearing Benefit Act of 2025’’. 5
SEC. 2. DENTAL AND ORAL HEALTH CARE. 6
(a) C
OVERAGE.—Section 1861(s)(2) of the Social Se-7
curity Act (42 U.S.C. 1395x(s)(2)) is amended— 8
(1) in subparagraph (II), by striking ‘‘and’’ 9
after the semicolon at the end; 10
(2) in subparagraph (JJ), by adding ‘‘and’’ 11
after the semicolon at the end; and 12
(3) by adding at the end the following new sub-13
paragraph: 14
‘‘(KK) dental and oral health services (as de-15
fined in subsection (nnn));’’. 16
(b) D
ENTAL AND ORALHEALTHSERVICESDE-17
FINED.—Section 1861 of the Social Security Act (42 18
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U.S.C. 1395x) is amended by adding at the end the fol-1
lowing new subsection: 2
‘‘Dental and Oral Health Services 3
‘‘(nnn) The term ‘dental and oral health services’ 4
means— 5
‘‘(1) preventative and screening services, such 6
as oral exams, dental cleanings, dental x-rays, and 7
fluoride treatments; 8
‘‘(2) basic dental services, such as tooth res-9
torations, basic periodontics services, tooth extrac-10
tions, and oral disease management services; 11
‘‘(3) major dental services, such as major tooth 12
restorations, major periodontics services, bridges, 13
crowns, root canals, and extractions; 14
‘‘(4) emergency dental care; and 15
‘‘(5) other necessary services related to dental 16
or oral health (as defined by the Secretary).’’. 17
(c) P
AYMENT; COINSURANCE; ANDLIMITATIONS.— 18
(1) I
N GENERAL.—Section 1833(a)(1) of the 19
Social Security Act (42 U.S.C. 1395l(a)(1)) is 20
amended— 21
(A) by striking ‘‘and’’ before ‘‘(GG)’’; and 22
(B) by inserting before the semicolon at 23
the end the following: ‘‘, and (HH) with respect 24
to dental and oral health services (as defined in 25
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section 1861(lll)), the amount paid shall be the 1
payment amount specified under section 2
1834(aa)’’. 3
(2) P
AYMENT AND LIMITS SPECIFIED .—Section 4
1834 of the Social Security Act (42 U.S.C. 1395m) 5
is amended by adding at the end the following new 6
subsection: 7
‘‘(aa) P
AYMENT ANDLIMITS FORDENTAL ANDORAL 8
H
EALTHSERVICES.— 9
‘‘(1) I
N GENERAL.—The payment amount 10
under this part for dental and oral health services 11
(as defined in section 1861(nnn)) shall be, subject to 12
paragraph (3), the applicable percent (specified in 13
paragraph (2)) of the lesser of the actual charge for 14
the services or the amount determined under the 15
payment basis determined under section 1848. 16
‘‘(2) A
PPLICABLE PERCENT.— 17
‘‘(A) I
N GENERAL.—For purposes of para-18
graph (1), except as provided in subparagraph 19
(B), the applicable percent specified in this 20
paragraph is— 21
‘‘(i) with respect to services described 22
in section 1861(nnn)(1) furnished during 23
2026 or a subsequent year, 100 percent; 24
and 25
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‘‘(ii) with respect to services not de-1
scribed in clause (i)— 2
‘‘(I) for a year before 2027, 0 3
percent; 4
‘‘(II) for 2027, 30 percent; 5
‘‘(III) for 2028, 60 percent; and 6
‘‘(IV) for 2029 and each subse-7
quent year, 80 percent. 8
‘‘(B) S
PECIAL RULE FOR CERTAIN LOW -IN-9
COME INDIVIDUALS.—For purposes of para-10
graph (1), the applicable percent specified in 11
this paragraph is, with respect to services fur-12
nished to an individual who is a subsidy eligible 13
individual (as defined in section 1860D– 14
14(a)(3)), or who would be a subsidy eligible in-15
dividual if the individual were enrolled in a pre-16
scription drug plan or MA–PD plan— 17
‘‘(i) with respect to services described 18
in section 1861(nnn)(1), for 2026 and 19
each subsequent year, 100 percent; and 20
‘‘(ii) with respect to services not de-21
scribed in clause (i), for 2027 and each 22
subsequent year, 80 percent. 23
‘‘(3) L
IMITATIONS AND SECRETARIAL AUTHOR -24
ITY.— 25
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‘‘(A) FREQUENCY.—With respect to dental 1
and oral health services that are— 2
‘‘(i) routine dental cleanings, payment 3
may be made under this part for only two 4
such cleanings during a 12-month period; 5
and 6
‘‘(ii) routine exams, payment may be 7
made under this part for only two such 8
exams during a 12-month period. 9
‘‘(B) S
ECRETARIAL AUTHORITY .— 10
‘‘(i) A
UTHORITY TO APPLY ADDI -11
TIONAL LIMITATIONS.—The Secretary may 12
apply such other reasonable limitations on 13
the extent to which dental and oral services 14
are covered under this part, including 15
through application of a prior authoriza-16
tion requirement. 17
‘‘(ii) A
UTHORITY TO MODIFY COV -18
ERAGE.—Notwithstanding any other provi-19
sion of this title, if the Secretary deter-20
mines appropriate, the Secretary may mod-21
ify the coverage under this part of dental 22
and oral health services to the extent that 23
such modification is consistent with the 24
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recommendations of the United States Pre-1
ventive Services Task Force. 2
‘‘(iii) A
UTHORITY TO WAIVE FRE -3
QUENCY LIMITATIONS .—Notwithstanding 4
subparagraph (A), the Secretary may 5
waive any frequency limitation under such 6
subparagraph for an individual (or cat-7
egory of individuals) if determined appro-8
priate by the Secretary.’’. 9
(d) P
AYMENTUNDERPHYSICIANFEESCHEDULE.— 10
Section 1848(j)(3) of the Social Security Act (42 U.S.C. 11
1395w–4(j)(3)) is amended by inserting ‘‘(2)(KK),’’ be-12
fore ‘‘(3)’’. 13
(e) D
ENTURES.— 14
(1) I
N GENERAL.—Section 1861(s)(8) of the 15
Social Security Act (42 U.S.C. 1395x(s)(8)) is 16
amended— 17
(A) by striking ‘‘(other than dental)’’ and 18
inserting ‘‘(including dentures)’’; and 19
(B) by striking ‘‘internal body’’. 20
(2) S
PECIAL PAYMENT RULES .—Section 21
1834(a) of the Social Security Act (42 U.S.C. 22
1395m(a)) is amended by adding at the end the fol-23
lowing new paragraph: 24
‘‘(23) P
AYMENT AND LIMITS FOR DENTURES .— 25
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‘‘(A) IN GENERAL.—The payment amount 1
under this part for dentures shall be, subject to 2
subparagraph (C), the applicable percent (speci-3
fied in subparagraph (B)) of the amount other-4
wise payable for such dentures under this sec-5
tion. 6
‘‘(B) A
PPLICABLE PERCENT .—For pur-7
poses of subparagraph (A), the applicable per-8
cent specified in this subparagraph is— 9
‘‘(i) for a year before 2027, 0 percent; 10
and 11
‘‘(ii) for 2027 and each subsequent 12
year, 80 percent. 13
‘‘(C) L
IMITATIONS AND SECRETARIAL AU -14
THORITY.— 15
‘‘(i) I
N GENERAL.—Payment may be 16
made under this part for an individual 17
for— 18
‘‘(I) not more than one full upper 19
and one full lower denture once every 20
five years; and 21
‘‘(II) not more than one partial 22
upper denture and one partial lower 23
denture once every five years. 24
‘‘(ii) S
ECRETARIAL AUTHORITY .— 25
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‘‘(I) AUTHORITY TO APPLY ADDI -1
TIONAL LIMITATIONS.—The Secretary 2
may apply such other reasonable limi-3
tations on the extent to which den-4
tures are covered under this part, in-5
cluding through application of a prior 6
authorization requirement. 7
‘‘(II) A
UTHORITY TO MODIFY 8
COVERAGE.—Notwithstanding any 9
other provision of this title, if the Sec-10
retary determines appropriate, the 11
Secretary may modify the coverage 12
under this part of dentures to the ex-13
tent that such modification is con-14
sistent with the recommendations of 15
the United States Preventive Services 16
Task Force. 17
‘‘(III) A
UTHORITY TO WAIVE 18
FREQUENCY LIMITATIONS .—Notwith-19
standing clause (i), the Secretary may 20
waive any frequency limitation under 21
such clause for an individual (or cat-22
egory of individuals) if determined ap-23
propriate by the Secretary.’’. 24
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(f) REPEAL OFGROUND FOREXCLUSION.—Section 1
1862(a) of the Social Security Act (42 U.S.C. 1395y) is 2
amended by striking paragraph (12). 3
(g) E
FFECTIVEDATE.—The amendments made by 4
this section shall apply to services furnished on or after 5
January 1, 2026. 6
SEC. 3. VISION CARE. 7
(a) C
OVERAGE.—Section 1861(s)(2) of the Social Se-8
curity Act (42 U.S.C. 1395x(s)(2)), as amended by section 9
2, is further amended— 10
(1) in subparagraph (JJ), by striking ‘‘and’’ 11
after the semicolon at the end; 12
(2) in subparagraph (KK), by adding ‘‘and’’ 13
after the semicolon at the end; and 14
(3) by adding at the end the following new sub-15
paragraph: 16
‘‘(LL) vision services (as defined in subsection 17
(ooo));’’. 18
(b) V
ISIONSERVICESDEFINED.—Section 1861 of 19
the Social Security Act (42 U.S.C. 1395x), as amended 20
by section 2, is further amended by adding at the end the 21
following new subsection: 22
‘‘Vision Services 23
‘‘(ooo) The term ‘vision services’ means— 24
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‘‘(1) routine eye examinations and procedures 1
performed (during the course of any eye examina-2
tion) to determine the refractive state of the eyes; 3
and 4
‘‘(2) other necessary services related to eye and 5
vision health (as defined by the Secretary).’’. 6
(c) P
AYMENT; COINSURANCE; ANDLIMITATIONS.— 7
(1) I
N GENERAL.—Section 1833(a)(1) of the 8
Social Security Act (42 U.S.C. 1395l(a)(1)), as 9
amended by section 2, is further amended— 10
(A) by striking ‘‘and’’ before ‘‘(HH)’’; and 11
(B) by inserting before the semicolon at 12
the end the following: ‘‘, and (II) with respect 13
to vision services (as defined in section 14
1861(mmm)), the amount paid shall be the 15
payment amount specified under section 16
1834(bb)’’. 17
(2) P
AYMENT AND LIMITS SPECIFIED .—Section 18
1834 of the Social Security Act (42 U.S.C. 1395m), 19
as amended by section 2, is further amended by add-20
ing at the end the following new subsection: 21
‘‘(bb) P
AYMENT AND LIMITS FORVISIONSERV-22
ICES.— 23
‘‘(1) I
N GENERAL.—The payment amount 24
under this part for vision services (as defined in sec-25
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tion 1861(ooo)) shall be, subject to paragraph (2), 1
80 percent of the lesser of the actual charge for the 2
services or the amount determined under the pay-3
ment basis determined under section 1848. 4
‘‘(2) L
IMITATIONS AND SECRETARIAL AUTHOR -5
ITY.— 6
‘‘(A) F
REQUENCY.—With respect to rou-7
tine eye exams, payment may be made under 8
this part for only one such exam during a 12- 9
month period. 10
‘‘(B) S
ECRETARIAL AUTHORITY .— 11
‘‘(i) A
UTHORITY TO APPLY ADDI -12
TIONAL LIMITATIONS.—The Secretary may 13
apply other reasonable limitations on the 14
extent to which vision services are covered 15
under this part, including through applica-16
tion of a prior authorization requirement. 17
‘‘(ii) A
UTHORITY TO MODIFY COV -18
ERAGE.—Notwithstanding any other provi-19
sion of this title, if the Secretary deter-20
mines appropriate, the Secretary may mod-21
ify the coverage under this part of vision 22
services to the extent that such modifica-23
tion is consistent with the recommenda-24
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tions of the United States Preventive Serv-1
ices Task Force. 2
‘‘(iii) A
UTHORITY TO WAIVE FRE -3
QUENCY LIMITATIONS .—Notwithstanding 4
subparagraph (A), the Secretary may 5
waive any frequency limitation under such 6
subparagraph for an individual (or cat-7
egory of individuals) if determined appro-8
priate by the Secretary.’’. 9
(d) P
AYMENTUNDERPHYSICIANFEESCHEDULE.— 10
Section 1848(j)(3) of the Social Security Act (42 U.S.C. 11
1395w–4(j)(3)) is amended by inserting ‘‘(2)(LL),’’ after 12
‘‘(2)(KK),’’ (as added by section 2). 13
(e) S
PECIALPAYMENTRULES FOREYEGLASSES, 14
C
ONTACTLENSES, ANDLOWVISIONDEVICES.—Section 15
1834(a) of the Social Security Act (42 U.S.C. 1395m(a)), 16
as amended by section 2, is further amended by adding 17
at the end the following: 18
‘‘(24) P
AYMENT AND LIMITS FOR EYEGLASSES 19
AND CONTACT LENSES .— 20
‘‘(A) I
N GENERAL.—The payment amount 21
under this part for eyeglass lenses, eyeglass 22
frames, and contact lenses shall be, subject to 23
subparagraph (B), 80 percent of the amount 24
otherwise payable for such eyeglass lenses, eye-25
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glass frames, and contact lenses, respectively, 1
under this section. 2
‘‘(B) L
IMITATIONS AND SECRETARIAL AU -3
THORITY.— 4
‘‘(i) I
N GENERAL.—Subject to clause 5
(iii), payment may be made under this part 6
(other than for eyewear described in sec-7
tion 1861(s)(8)) for an individual for— 8
‘‘(I) not more than one pair of 9
eyeglass lenses during any 12-month 10
period in an amount not exceeding 11
$100; 12
‘‘(II) not more than one set of 13
eyeglass frames during any 24-month 14
period in an amount not exceeding 15
$100; and 16
‘‘(III) contact lenses, only to the 17
extent that the sum of such payments 18
for contact lenses does not exceed a 19
limitation of $200 during any 24- 20
month period beginning during the 21
first year beginning at least six 22
months after the date of the enact-23
ment of this paragraph (or, beginning 24
during a subsequent year, such limita-25
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tion for a 24-month period beginning 1
in the previous year increase by an 2
appropriate inflation adjustment spec-3
ified by the Secretary). 4
‘‘(ii) S
ECRETARIAL AUTHORITY .— 5
‘‘(I) A
UTHORITY TO APPLY ADDI -6
TIONAL LIMITATIONS.—The Secretary 7
may apply such other reasonable limi-8
tations on the extent to which eye-9
glass lenses, eyeglass frames, and con-10
tact lenses are covered under this 11
part, including through application of 12
a prior authorization requirement. 13
‘‘(II) A
UTHORITY TO MODIFY 14
COVERAGE.—Notwithstanding any 15
other provision of this title, if the Sec-16
retary determines appropriate, the 17
Secretary may modify the coverage 18
under this part of eyeglass lenses, eye-19
glass frames, and contact lenses to 20
the extent that such modification is 21
consistent with the recommendations 22
of the United States Preventive Serv-23
ices Task Force. 24
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‘‘(III) AUTHORITY TO WAIVE 1
FREQUENCY LIMITATIONS .—Notwith-2
standing clause (i), the Secretary may 3
waive any frequency limitation under 4
such clause for an individual (or cat-5
egory of individuals) if determined ap-6
propriate by the Secretary. 7
‘‘(iii) U
PDATE OF PAYMENT LIMITS 8
TO ACCOUNT FOR INFLATION .—With re-9
spect to eyeglass lenses and contact lenses 10
furnished during 2027 or a subsequent 11
year, the Secretary shall increase the dollar 12
amounts in effect under this subparagraph 13
for such year by the percentage change in 14
the consumer price index for all urban con-15
sumers (United States city average) for 16
the 12-month period ending with June of 17
the previous year. 18
‘‘(25) P
AYMENT AND LIMITS FOR LOW VISION 19
DEVICES.— 20
‘‘(A) I
N GENERAL.—The payment amount 21
under this part for low vision devices shall be 22
80 percent of the amount otherwise payable for 23
low vision devices under this section. 24
‘‘(B) S
ECRETARIAL AUTHORITY .— 25
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‘‘(i) AUTHORITY TO APPLY LIMITA -1
TIONS.—The Secretary may apply reason-2
able limitations on the extent to which low 3
vision devices are covered under this part, 4
including through application of a prior 5
authorization requirement. 6
‘‘(ii) A
UTHORITY TO MODIFY COV -7
ERAGE.—Notwithstanding any other provi-8
sion of this title, if the Secretary deter-9
mines appropriate, the Secretary may mod-10
ify the coverage under this part of low vi-11
sion devices to the extent that such modi-12
fication is consistent with the recommenda-13
tions of the United States Preventive Serv-14
ices Task Force. 15
‘‘(C) L
OW VISION DEVICE DEFINED .—In 16
this paragraph, the term ‘low vision device’ 17
means a device, prescribed by a physician, that 18
magnifies, enhances, or otherwise augments or 19
interprets visual images irrespective of the size, 20
form, or technological features of such device 21
and does not include ordinary eyeglasses or con-22
tact lenses. In the previous sentence, the term 23
‘ordinary eyeglasses or contact lenses’ means 24
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lenses that are intended to fully correct visual 1
acuity or fully eliminate refractive error.’’. 2
(f) D
EFINITION OFDURABLEMEDICALEQUIPMENT 3
T
OINCLUDEEYEGLASSES, CONTACTLENSES, ANDLOW 4
V
ISIONDEVICES.—Section 1861(n) of the Social Security 5
Act (42 U.S.C. 1395x(n)) is amended— 6
(1) by striking ‘‘and’’ before ‘‘eye tracking’’ and 7
inserting a comma; and 8
(2) by inserting ‘‘, and eyeglass lenses, low vi-9
sion devices (as defined in section 1834(a)(25)), eye-10
glass frames, and contact lenses’’ before ‘‘; except’’. 11
(g) R
EPEAL OFGROUND FOREXCLUSION.—Section 12
1862(a)(7) of the Social Security Act (42 U.S.C. 13
1395y(a)(7)) is amended by striking ‘‘, eyeglasses (other 14
than eyewear described in section 1861(s)(8)) or eye ex-15
aminations for the purpose of prescribing, fitting, or 16
changing eyeglasses, procedures performed (during the 17
course of any eye examination) to determine the refractive 18
state of the eyes’’. 19
(h) E
FFECTIVEDATE.—The amendments made by 20
this section shall apply to services furnished on or after 21
January 1, 2026. 22
SEC. 4. HEARING CARE. 23
(a) C
OVERAGE.— 24
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(1) IN GENERAL.—Section 1861(s)(2) of the 1
Social Security Act (42 U.S.C. 1395x(s)(2)), as 2
amended by sections 2 and 3, is further amended— 3
(A) in subparagraph (KK), by striking 4
‘‘and’’ at the end; 5
(B) in subparagraph (LL), by inserting 6
‘‘and’’ at the end; and 7
(C) by adding at the end the following new 8
subparagraph: 9
‘‘(MM) audiology services (as defined in sub-10
section (ll)(3)) and hearing services (as defined in 11
subsection (ll)(5));’’. 12
(2) H
EARING SERVICES DEFINED .—Section 13
1861(ll) of the Social Security Act (42 U.S.C. 14
1395x(ll)) is amended— 15
(A) in the subsection heading, by inserting 16
‘‘; H
EARINGSERVICES’’ after ‘‘AUDIOLOGY 17
S
ERVICES’’; and 18
(B) by adding at the end the following new 19
paragraph: 20
‘‘(5) The term ‘hearing services’ means— 21
‘‘(A) routine hearing exams and exams for 22
hearing aids; and 23
‘‘(B) other necessary services related to hearing 24
health (as defined by the Secretary).’’. 25
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(b) PAYMENT; COINSURANCE; ANDLIMITATIONS.— 1
(1) I
N GENERAL.—Section 1833(a)(1) of the 2
Social Security Act (42 U.S.C. 1395l(a)(1)), as 3
amended by sections 2 and 3, is further amended— 4
(A) by striking ‘‘and’’ before ‘‘(II)’’; and 5
(B) by inserting before the semicolon at 6
the end the following: ‘‘, and (JJ) with respect 7
to audiology services (as defined in section 8
1861(ll)(3)) and hearing services (as defined in 9
section 1861(ll)(5)), the amount paid shall be 10
the payment amount specified under section 11
1834(cc)’’. 12
(2) P
AYMENT AND LIMITS SPECIFIED .—Section 13
1834 of the Social Security Act (42 U.S.C. 1395m), 14
as amended by sections 2 and 3, is further amended 15
by adding at the end the following new subsection: 16
‘‘(cc) P
AYMENT AND LIMITS FORHEARINGSERV-17
ICES.— 18
‘‘(1) I
N GENERAL.—The payment amount 19
under this part for audiology services (as defined in 20
section 1861(ll)(3)) and hearing services (as defined 21
in section 1861(ll)(5)), shall be, subject to para-22
graph (2), 80 percent of the lesser of the actual 23
charge for the services or the amount determined 24
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under the payment basis determined under section 1
1848. 2
‘‘(2) S
ECRETARIAL AUTHORITY .— 3
‘‘(A) A
UTHORITY TO APPLY LIMITA -4
TIONS.—The Secretary may apply reasonable 5
limitations on the extent to which audiology 6
services and hearing services are covered under 7
this part, including through application of a 8
prior authorization requirement. 9
‘‘(B) A
UTHORITY TO MODIFY COVERAGE .— 10
Notwithstanding any other provision of this 11
title, if the Secretary determines appropriate, 12
the Secretary may modify the coverage under 13
this part of audiology services and hearing serv-14
ices to the extent that such modification is con-15
sistent with the recommendations of the United 16
States Preventive Services Task Force.’’. 17
(c) P
AYMENTUNDER THEPHYSICIANFEESCHED-18
ULE.—Section 1848(j)(3) of the Social Security Act (42 19
U.S.C. 1395w–4(j)(3)), as amended by section 2(d), is 20
further amended by inserting ‘‘(2)(MM),’’ before ‘‘(3)’’. 21
(d) H
EARINGAIDS.— 22
(1) R
EPEAL OF GROUND FOR EXCLUSION .— 23
Section 1862(a)(7) of the Social Security Act (42 24
U.S.C. 1395y(a)(7)), as amended by section 3(g), is 25
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further amended by striking ‘‘, hearing aids or ex-1
aminations therefor,’’. 2
(2) D
EFINITION OF DURABLE MEDICAL EQUIP -3
MENT TO INCLUDE HEARING AIDS .—Section 1861(n) 4
of the Social Security Act (42 U.S.C. 1395x(n)), as 5
amended by section 3, is further amended by insert-6
ing ‘‘hearing aids,’’ before ‘‘and eyeglass lenses’’. 7
(3) S
PECIAL PAYMENT RULES FOR HEARING 8
AIDS.—Section 1834(a) of the Social Security Act 9
(42 U.S.C. 1395m(a)), as amended by sections 2 10
and 3, is further amended by adding at the end the 11
following new paragraph: 12
‘‘(26) P
AYMENT AND LIMITS FOR HEARING 13
AIDS.— 14
‘‘(A) I
N GENERAL.—The payment amount 15
under this part for hearing aids shall be, sub-16
ject to subparagraph (B), 80 percent of the 17
amount otherwise payable for hearing aids 18
under this section. 19
‘‘(B) L
IMITATIONS AND SECRETARIAL AU -20
THORITY.— 21
‘‘(i) I
N GENERAL.—Payment may be 22
made under this part for an individual for 23
not more than one hearing aid per ear dur-24
ing a 48-month period. 25
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‘‘(ii) SECRETARIAL AUTHORITY .— 1
‘‘(I) A
UTHORITY TO APPLY ADDI -2
TIONAL LIMITATIONS.—The Secretary 3
may apply additional limitations on 4
the extent to which hearing aids are 5
covered under this part, including 6
through application of a prior author-7
ization requirement and through ap-8
plication of criteria for a minimum 9
level of hearing loss for coverage of an 10
initial or replacement hearing aid. 11
‘‘(II) A
UTHORITY TO MODIFY 12
COVERAGE.—Notwithstanding any 13
other provision of this title, if the Sec-14
retary determines appropriate, the 15
Secretary may modify the coverage 16
under this part of hearing aids to the 17
extent that such modification is con-18
sistent with the recommendations of 19
the United States Preventive Services 20
Task Force. 21
‘‘(iii) A
UTHORITY TO WAIVE FRE -22
QUENCY LIMITATIONS .—Notwithstanding 23
clause (i), the Secretary may waive any 24
frequency limitation under such clause for 25
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an individual (or category of individuals) if 1
determined appropriate by the Secretary.’’. 2
(e) E
FFECTIVEDATE.—The amendments made by 3
this section shall apply to services furnished on or after 4
January 1, 2026. 5
SEC. 5. NONAPPLICATION OF COMPETITIVE ACQUISITION 6
TO CERTAIN ITEMS. 7
Section 1847(a)(2) of the Social Security Act (42 8
U.S.C. 1395w–3(a)(2)) is amended— 9
(1) by striking ‘‘and excluding’’ and inserting 10
‘‘excluding’’; and 11
(2) by inserting ‘‘, and excluding dentures, eye-12
glass lenses, contact lenses, and hearing aids’’ before 13
the period at the end. 14
SEC. 6. INCLUSION OF AN ORAL HEALTH PROFESSIONAL 15
ON THE UNITED STATES PREVENTIVE SERV-16
ICES TASK FORCE. 17
(a) I
NGENERAL.—The first sentence of section 18
915(a)(1) of the Public Health Service Act (42 U.S.C. 19
299b–4(a)(1)) is amended by inserting ‘‘, including at 20
least 1 oral health professional’’ before the period at the 21
end. 22
(b) E
FFECTIVEDATE.—The amendment made by 23
subsection (a) shall apply beginning on January 1 of the 24
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first year beginning at least 6 months after the date of 1
the enactment of this Act. 2
Æ
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