II
119THCONGRESS
1
STSESSION S. 939
To amend title XVIII of the Social Security Act to provide coverage for
dental and oral health care, hearing care, and vision care under the
Medicare program.
IN THE SENATE OF THE UNITED STATES
MARCH11 (legislative day, MARCH10), 2025
Mr. S
ANDERS(for himself, Ms. WARREN, Mr. BOOKER, Mr. WELCH, Mr.
M
ARKEY, Ms. DUCKWORTH, Mr. MERKLEY, and Mr. BLUMENTHAL) in-
troduced the following bill; which was read twice and referred to the Com-
mittee on Finance
A BILL
To amend title XVIII of the Social Security Act to provide
coverage for dental and oral health care, hearing care,
and vision 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, 4
Hearing, and Vision Expansion Act of 2025’’. 5
SEC. 2. COVERAGE OF 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
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(1) in subparagraph (JJ), by adding ‘‘and’’ at 1
the end; and 2
(2) by adding at the end the following new sub-3
paragraph: 4
‘‘(KK) dental and oral health services (as de-5
fined in subsection (nnn));’’. 6
(b) D
ENTAL AND ORALHEALTHSERVICESDE-7
FINED.—Section 1861 of the Social Security Act (42 8
U.S.C. 1395x) is amended by adding at the end the fol-9
lowing new subsection: 10
‘‘(nnn) D
ENTAL ANDORALHEALTHSERVICES.— 11
‘‘(1) I
N GENERAL.—Except as provided in para-12
graph (2), the term ‘dental and oral health services’ 13
means the following items and services that are fur-14
nished by a doctor of dental surgery or of dental 15
medicine (as described in subsection (r)(2)) or an 16
oral health professional (as defined in paragraph 17
(3)) on or after January 1, 2027 (or January 1, 18
2026, in the case of dentures): 19
‘‘(A) P
REVENTIVE AND SCREENING SERV -20
ICES.—Preventive and screening services, in-21
cluding oral exams, dental cleanings, dental x- 22
rays, and fluoride treatments. 23
‘‘(B) P
ROCEDURES AND TREATMENT 24
SERVICES.—Services to address oral disease, in-25
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cluding services such as restorative services, 1
prosthodontic and endodontic services, including 2
fillings bridges, crowns, and root canals, peri-3
odontal maintenance, periodontal scaling and 4
root planing, tooth extractions, therapeutic 5
pulpotomy, and other related items and serv-6
ices. 7
‘‘(C) D
ENTURES AND DENTAL PROS -8
THETICS.—Complete dentures, partial dentures, 9
and implants, including related items and serv-10
ices. 11
‘‘(2) E
XCLUSIONS.—Such term does not include 12
items and services for which, as of the date of the 13
enactment of this subsection, coverage was permis-14
sible under section 1862(a)(12) and cosmetic serv-15
ices not otherwise covered under section 16
1862(a)(10). 17
‘‘(3) O
RAL HEALTH PROFESSIONAL .—The term 18
‘oral health professional’ means, with respect to den-19
tal and oral health services, a health professional 20
(other than a doctor of dental surgery or of dental 21
medicine (as described in subsection (r)(2))) who is 22
licensed to furnish such services, acting within the 23
scope of such license, by the State in which such 24
services are furnished.’’. 25
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(c) 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)) is 3
amended— 4
(A) in subparagraph (N), by inserting 5
‘‘and dental and oral health services (as defined 6
in section 1861(nnn))’’ after ‘‘section 7
1861(hhh)(1))’’; 8
(B) by striking ‘‘and’’ before ‘‘(HH)’’; and 9
(C) by inserting before the semicolon at 10
the end the following: ‘‘and (II) with respect to 11
dental and oral health services (as defined in 12
section 1861(nnn)), the amount paid shall be 13
the payment amount specified under section 14
1834(aa)’’. 15
(2) P
AYMENT AND LIMITS SPECIFIED .—Section 16
1834 of the Social Security Act (42 U.S.C. 1395m) 17
is amended by adding at the end the following new 18
subsection: 19
‘‘(aa) P
AYMENT ANDLIMITS FORDENTAL ANDORAL 20
H
EALTHSERVICES.— 21
‘‘(1) P
AYMENT.—The payment amount under 22
this part for dental and oral health services (as de-23
fined in section 1861(nnn)) shall be, subject to para-24
graphs (3) and (4), 80 percent (or 100 percent, in 25
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the case of preventive and screening services de-1
scribed in section 1861(nnn)(1)(A)) of the lesser 2
of— 3
‘‘(A) the actual charge for the service; or 4
‘‘(B)(i) in the case of such services fur-5
nished by a doctor of dental surgery or of den-6
tal medicine (as described in section 7
1861(r)(2)), the amount determined under the 8
fee schedule established under paragraph (2); 9
or 10
‘‘(ii) in the case of such services furnished 11
by an oral health professional (as defined in 12
section 1861(nnn)(3)), 85 percent of the 13
amount determined under the fee schedule es-14
tablished under paragraph (2). 15
‘‘(2) E
STABLISHMENT OF FEE SCHEDULE FOR 16
DENTAL AND ORAL HEALTH SERVICES .— 17
‘‘(A) E
STABLISHMENT.— 18
‘‘(i) I
N GENERAL.—The Secretary 19
shall establish a fee schedule for dental 20
and oral health services furnished in 2027 21
(or 2026, in the case of dentures) and sub-22
sequent years. The fee schedule amount for 23
a dental or oral health service shall be 24
equal to 70 percent of the national median 25
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fee (as determined under subparagraph 1
(B)) for the service or a similar service for 2
the year (or, in the case of dentures, at the 3
bundled payment amount under clause (iv) 4
of such subparagraph), adjusted by the ge-5
ographic adjustment factor established 6
under section 1848(e)(2) for the area for 7
the year. 8
‘‘(ii) C
ONSULTATION.—In carrying 9
out this paragraph, the Secretary shall 10
consult annually with organizations rep-11
resenting dentists and other providers who 12
furnish dental and oral health services and 13
shall share with such providers the data 14
and data analysis used to determine fee 15
schedule amounts under this paragraph. 16
‘‘(B) D
ETERMINATION OF NATIONAL ME -17
DIAN FEE.— 18
‘‘(i) I
N GENERAL.—For purposes of 19
subparagraph (A), the Secretary shall 20
apply the national median fee for a dental 21
or oral health service for 2027 (or 2026, in 22
the case of dentures) and subsequent years 23
in accordance with this subparagraph. 24
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‘‘(ii) USE OF 2020 DENTAL FEE SUR -1
VEY.— 2
‘‘(I) I
N GENERAL.—Except as 3
provided in clause (iii) and clause (iv), 4
the national median fee for a dental 5
or oral health service shall be equal 6
to— 7
‘‘(aa) for 2027 (or 2026, in 8
the case of dentures), the median 9
fee for the service in the table ti-10
tled ‘General Practitioners–Na-11
tional’ of the ‘2020 Survey of 12
Dental Fees’ published by the 13
American Dental Association, in-14
creased by the applicable percent 15
increase for the year determined 16
under subclause (II), as reduced 17
by the productivity adjustment 18
under subclause (III); and 19
‘‘(bb) for 2028 (or 2027, in 20
the case of dentures) and subse-21
quent years, the amount deter-22
mined under this subclause for 23
the preceding year, updated pur-24
suant to subparagraph (C)(i). 25
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‘‘(II) APPLICABLE PERCENT IN -1
CREASE.—The applicable percent in-2
crease determined under this sub-3
clause for a year is an amount equal 4
to the percentage increase between— 5
‘‘(aa) the consumer price 6
index for all urban consumers 7
(United States city average) end-8
ing with June of the previous 9
year; and 10
‘‘(bb) the consumer price 11
index for all urban consumers 12
(United States city average) end-13
ing with June of 2026 (or 2025, 14
in the case of dentures). 15
‘‘(III) P
RODUCTIVITY ADJUST -16
MENT.—After determining the appli-17
cable percentage increase under sub-18
clause (II) for a year, the Secretary 19
shall reduce such percentage increase 20
by the productivity adjustment de-21
scribed in section 22
1886(b)(3)(B)(xi)(II). 23
‘‘(iii) D
ETERMINATION IF INSUFFI -24
CIENT SURVEY DATA.—If the Secretary de-25
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termines there is insufficient data under 1
the Survey described in clause (ii) with re-2
spect to a dental or oral health service, the 3
national median fee for the service for a 4
year shall be equal to an amount estab-5
lished for the service using 1 or more of 6
the following methods, as determined ap-7
propriate by the Secretary: 8
‘‘(I) The payment basis deter-9
mined under section 1848. 10
‘‘(II) Fee schedules for dental 11
and oral health services which shall 12
include, as practicable, fee sched-13
ules— 14
‘‘(aa) under Medicare Ad-15
vantage plans under part C; 16
‘‘(bb) under State plans (or 17
waivers of such plans) under title 18
XIX; and 19
‘‘(cc) established by other 20
health care payers. 21
‘‘(iv) S
PECIAL RULE FOR DEN -22
TURES.— 23
‘‘(I) I
N GENERAL.—The Sec-24
retary shall make payment for den-25
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tures and associated professional serv-1
ices as a bundled payment as deter-2
mined by the Secretary. 3
‘‘(II) P
AYMENT CONSIDER -4
ATIONS.—In establishing such bun-5
dled payment, the Secretary shall con-6
sider the national median fee for the 7
service for the year determined under 8
clause (ii) or (iii) and the rate deter-9
mined for such dentures under the 10
Federal Supply Schedule of the Gen-11
eral Services Administration, as pub-12
lished by such Administration in 13
2021, updated to the year involved 14
using the applicable percent increase 15
for the year determined under clause 16
(ii)(II), as reduced by the productivity 17
adjustment under clause (ii)(III), and 18
shall ensure that the payment compo-19
nent for dentures under such bundled 20
payment does not exceed the max-21
imum rate determined for such den-22
tures under the Federal Supply 23
Schedule, as so published and updated 24
to the year involved. 25
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‘‘(C) ANNUAL UPDATE AND ADJUST -1
MENTS.— 2
‘‘(i) A
NNUAL UPDATE .—The Sec-3
retary shall update payment amounts de-4
termined under the fee schedule from year 5
to year beginning in 2028 (or 2027, in the 6
case of dentures) by increasing such 7
amounts from the prior year by the per-8
centage increase in the consumer price 9
index for all urban consumers (United 10
States city average) for the 12-month pe-11
riod ending with June of the preceding 12
year, reduced by the productivity adjust-13
ment described in section 14
1886(b)(3)(B)(xi)(II). 15
‘‘(ii) A
DJUSTMENTS.— 16
‘‘(I) I
N GENERAL.—The Sec-17
retary shall, to the extent the Sec-18
retary determines to be necessary and 19
subject to subclause (II), adjust the 20
amounts determined under the fee 21
schedule established under this para-22
graph for 2028 (or 2027, in the case 23
of dentures) and subsequent years to 24
take into account changes in dental 25
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practice, coding changes, new data on 1
work, practice, or malpractice ex-2
penses, or the addition of new proce-3
dures. 4
‘‘(II) L
IMITATION ON ANNUAL 5
ADJUSTMENTS.—The adjustments 6
under subclause (I) for a year shall 7
not cause the amount of expenditures 8
under this part for the year to differ 9
by more than $20,000,000 from the 10
amount of expenditures under this 11
part that would have been made if 12
such adjustments had not been made. 13
‘‘(3) L
IMITATIONS.—With respect to dental and 14
oral health services that are preventive and screen-15
ing services described in paragraph (1)(A) of section 16
1861(nnn)— 17
‘‘(A) payment shall be made under this 18
part for— 19
‘‘(i) not more than 2 oral exams in a 20
year; 21
‘‘(ii) not more than 2 dental cleanings 22
in a year; 23
‘‘(iii) not more than 1 fluoride treat-24
ment in a year; and 25
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‘‘(iv) not more than 1 full-mouth se-1
ries of x-rays as part of a preventive and 2
screening oral exam every 3 years; and 3
‘‘(B) in the case of preventive and screen-4
ing services not described in subparagraph (A), 5
payment shall be made under this part only at 6
such frequencies determined appropriate by the 7
Secretary. 8
‘‘(4) I
NCENTIVES FOR RURAL PROVIDERS .—In 9
the case of dental and oral health services furnished 10
by a doctor of dental surgery or of dental medicine 11
(as described in section 1861(r)(2)) or an oral 12
health professional (as defined in section 13
1861(nnn)(3)) who predominantly furnishes such 14
services under this part in an area that is designated 15
by the Secretary (under section 332(a)(1)(A) of the 16
Public Health Service Act) as a health professional 17
shortage area, in addition to the amount of payment 18
that would otherwise be made for such services 19
under this subsection, there also shall be paid an 20
amount equal to 10 percent of the payment amount 21
for the service under this subsection for such doctor 22
or professional. 23
‘‘(5) L
IMITATION ON BENEFICIARY LIABIL -24
ITY.—The provisions of section 1848(g) shall apply 25
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to a nonparticipating doctor of dental surgery or of 1
dental medicine (as described in section 1861(r)(2)) 2
who does not accept payment on an assignment-re-3
lated basis for dental and oral health services fur-4
nished with respect to an individual enrolled under 5
this part in the same manner as such provisions 6
apply with respect to a physician’s service. 7
‘‘(6) E
STABLISHMENT OF DENTAL ADMINIS -8
TRATOR.—The Secretary shall designate 1 or more 9
(not to exceed 4) medicare administrative contrac-10
tors under section 1874A to establish coverage poli-11
cies and establish such policies and process claims 12
for payment for dental and oral health services, as 13
determined appropriate by the Secretary.’’. 14
(d) I
NCLUSION OFORALHEALTHPROFESSIONALS 15
ASCERTAINPRACTITIONERS.—Section 1842(b)(18)(C) of 16
the Social Security Act (42 U.S.C. 1395u(b)(18)(C)) is 17
amended by adding at the end the following new clause: 18
‘‘(ix) With respect to 2028 and each subsequent 19
year, an oral health professional (as defined in sec-20
tion 1861(nnn)(3)).’’. 21
(e) E
XCLUSIONMODIFICATIONS.—Section 1862(a) 22
of the Social Security Act (42 U.S.C. 1395y(a)) is amend-23
ed— 24
(1) in paragraph (1)— 25
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(A) in subparagraph (O), by striking 1
‘‘and’’ at the end; 2
(B) in subparagraph (P), by striking the 3
semicolon at the end and inserting ‘‘, and’’; and 4
(C) by adding at the end the following new 5
subparagraph: 6
‘‘(Q) in the case of dental and oral health serv-7
ices (as defined in section 1861(nnn)) for which a 8
limitation is applicable under section 1834(aa)(3), 9
which are furnished more frequently than is pro-10
vided under such section;’’; and 11
(2) in paragraph (12), by inserting before the 12
semicolon at the end the following: ‘‘and except that 13
payment shall be made under part B for dental and 14
oral health services that are covered under section 15
1861(s)(2)(KK)’’. 16
(f) I
NCLUSION AS EXCEPTEDMEDICALTREAT-17
MENT.—Section 1821(b)(5)(A) of the Social Security Act 18
(42 U.S.C. 1395i–5(b)(5)(A)) is amended— 19
(1) in clause (ii), by striking ‘‘or’’ at the end; 20
(2) in clause (iii), by striking the period and in-21
serting ‘‘, or’’; and 22
(3) by adding at the end the following new 23
clause: 24
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‘‘(iv) consisting of dental and oral 1
health services (as defined in subsection 2
(mmm) of section 1861) that are payable 3
under part B as a result of the amend-4
ments made by the Medicare Dental, Hear-5
ing, and Vision Expansion Act of 2025.’’. 6
(g) R
URALHEALTHCLINICS AND FEDERALLY 7
Q
UALIFIEDHEALTHCENTERS.— 8
(1) C
OVERAGE OF DENTAL AND ORAL HEALTH 9
SERVICES.—Section 1861(aa) of the Social Security 10
Act (42 U.S.C. 1395x(aa)), is amended— 11
(A) in paragraph (1)— 12
(i) in subparagraph (C), by striking 13
‘‘and’’ at the end; 14
(ii) in subparagraph (D), by inserting 15
‘‘and’’ after the comma at the end; and 16
(iii) by inserting after subparagraph 17
(D) the following new subparagraph: 18
‘‘(E) dental and oral health services (as de-19
fined in subsection (nnn)) furnished by a doctor 20
of dental surgery or of dental medicine (as de-21
scribed in subsection (r)(2)) or an oral health 22
professional (as defined in subsection (nnn)(3)) 23
who is employed by or working under contract 24
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with a rural health clinic if such rural health 1
clinic furnishes such services,’’; and 2
(B) in paragraph (3)(A), by striking ‘‘(D)’’ 3
and inserting ‘‘(E)’’. 4
(2) T
EMPORARY PAYMENT RATES FOR CERTAIN 5
SERVICES UNDER THE RHC AIR AND FQHC PPS .— 6
(A) AIR.—Section 1833 of the Social Se-7
curity Act (42 U.S.C. 1395l) is amended— 8
(i) in subsection (a)(3)(A), by insert-9
ing ‘‘(which shall, in the case of dental and 10
oral health services (as defined in section 11
1861(nnn)), in lieu of any limits on rea-12
sonable costs otherwise applicable, be 13
based on the rates payable for such serv-14
ices under the payment basis determined 15
under section 1848 until such time as the 16
Secretary determines sufficient data has 17
been collected to otherwise apply such lim-18
its (or January 1, 2031, if no such deter-19
mination has been made as of such date))’’ 20
after ‘‘may prescribe in regulations’’; and 21
(ii) by adding at the end the following 22
new subsection: 23
‘‘(ee) D
ISREGARD OFCOSTSATTRIBUTABLE TOCER-24
TAINSERVICESFROMCALCULATION OF RHC AIR.— 25
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Payments for rural health clinic services other than dental 1
and oral health services (as defined in section 1861(nnn)) 2
under the methodology for all-inclusive rates (established 3
by the Secretary) under subsection (a)(3) shall not take 4
into account the costs of such services while rates for such 5
services are based on rates payable for such services under 6
the payment basis established under section 1848.’’. 7
(B) PPS.—Section 1834(o) of the Social 8
Security Act (42 U.S.C. 1395m(o)) is amended 9
by adding at the end the following new para-10
graph: 11
‘‘(6) T
EMPORARY PAYMENT RATES BASED ON 12
PFS FOR CERTAIN SERVICES .—The Secretary shall, 13
in establishing payment rates for dental and oral 14
health services (as defined in section 1861(nnn)) 15
that are Federally qualified health center services 16
under the prospective payment system established 17
under this subsection, in lieu of the rates otherwise 18
applicable under such system, base such rates on 19
rates payable for such services under the payment 20
basis established under section 1848 until such time 21
as the Secretary determines sufficient data has been 22
collected to otherwise establish rates for such serv-23
ices under such system (or January 1, 2031, if no 24
such determination has been made as of such date). 25
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Payments for Federally qualified health center serv-1
ices other than such dental and oral health services 2
under such system shall not take into account the 3
costs of such services while rates for such services 4
are based on rates payable for such services under 5
the payment basis established under section 1848.’’. 6
(h) I
MPLEMENTATION.—In addition to amounts oth-7
erwise available, there is appropriated to the Secretary of 8
Health and Human Services for fiscal year 2025, out of 9
any money in the Treasury not otherwise appropriated, 10
$900,000,000, to remain available until expended, for pur-11
poses of implementing the amendments made by this sec-12
tion during the period beginning on January 1, 2025, and 13
ending on September 30, 2034. 14
SEC. 3. PROVIDING COVERAGE FOR HEARING CARE UNDER 15
THE MEDICARE PROGRAM. 16
(a) P
ROVISION OFAUDIOLOGYSERVICES BYQUALI-17
FIEDAUDIOLOGISTS AND HEARINGAIDEXAMINATION 18
S
ERVICES BY QUALIFIEDHEARINGAIDPROFES-19
SIONALS.— 20
(1) I
N GENERAL.—Section 1861(ll) of the So-21
cial Security Act (42 U.S.C. 1395x(ll)) is amend-22
ed— 23
(A) in paragraph (3)— 24
(i) by inserting ‘‘(A)’’ after ‘‘(3)’’; 25
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(ii) in subparagraph (A), as added by 1
clause (i) of this subparagraph— 2
(I) by striking ‘‘means such hear-3
ing and balance assessment services’’ 4
and inserting ‘‘means— 5
‘‘(i) such hearing and balance assess-6
ment services and, beginning January 1, 7
2027, such hearing aid examination serv-8
ices and treatment services (including 9
aural rehabilitation, vestibular rehabilita-10
tion, and cerumen management)’’; 11
(II) in clause (i), as added by 12
subclause (I) of this clause, by strik-13
ing the period at the end and insert-14
ing ‘‘; and’’; and 15
(III) by adding at the end the 16
following new clause: 17
‘‘(ii) beginning January 1, 2027, such 18
hearing aid examination services furnished 19
by a qualified hearing aid professional (as 20
defined in paragraph (4)(C)) as the profes-21
sional is legally authorized to perform 22
under State law (or the State regulatory 23
mechanism provided by State law), as 24
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would otherwise be covered if furnished by 1
a physician.’’; and 2
(iii) by adding at the end the fol-3
lowing new subparagraph: 4
‘‘(B) Beginning January 1, 2027, audi-5
ology services described in subparagraph (A)(i) 6
shall be furnished without a requirement for an 7
order from a physician or practitioner.’’; and 8
(B) in paragraph (4), by adding at the end 9
the following new subparagraph: 10
‘‘(C) The term ‘qualified hearing aid pro-11
fessional’ means an individual who— 12
‘‘(i) is licensed or registered as a 13
hearing aid dispenser, hearing aid spe-14
cialist, hearing instrument dispenser, or re-15
lated professional by the State in which the 16
individual furnishes such services; and 17
‘‘(ii) is accredited by the National 18
Board for Certification in Hearing Instru-19
ment Sciences or meets such other require-20
ments as the Secretary determines appro-21
priate (including requirements relating to 22
educational certifications or accreditations) 23
taking into account any additional relevant 24
requirements for hearing aid specialists, 25
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hearing aid dispensers, and hearing instru-1
ment dispensers established by Medicare 2
Advantage organizations under part C, 3
State plans (or waivers of such plans) 4
under title XIX, and group health plans 5
and health insurance issuers (as such 6
terms are defined in section 2791 of the 7
Public Health Service Act).’’. 8
(2) P
AYMENT FOR QUALIFIED HEARING AID 9
PROFESSIONALS.—Section 1833(a)(1) of the Social 10
Security Act (42 U.S.C. 1395l(a)(1)), as amended 11
by section 2(c)(1), is amended— 12
(A) by striking ‘‘and’’ before ‘‘(II)’’; and 13
(B) by inserting before the semicolon at 14
the end the following: ‘‘and (JJ) with respect to 15
hearing aid examination services (as described 16
in paragraph (3)(A)(ii) of section 1861(ll)) fur-17
nished by a qualified hearing aid professional 18
(as defined in paragraph (4)(C) of such sec-19
tion), the amounts paid shall be equal to 80 20
percent of the lesser of the actual charge for 21
such services or 85 percent of the amount for 22
such services determined under the payment 23
basis determined under section 1848’’. 24
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(3) INCLUSION OF QUALIFIED AUDIOLOGISTS 1
AND QUALIFIED HEARING AID PROFESSIONALS AS 2
CERTAIN PRACTITIONERS TO RECEIVE PAYMENT ON 3
AN ASSIGNMENT-RELATED BASIS.— 4
(A) Q
UALIFIED AUDIOLOGISTS .—Section 5
1842(b)(18)(C) of the Social Security Act (42 6
U.S.C. 1395u(b)(18)(C)), as amended by sec-7
tion 2(d), is amended by adding at the end the 8
following new clause: 9
‘‘(x) Beginning on January 1, 2027, a qualified 10
audiologist (as defined in section 1861(ll)(4)(B)).’’. 11
(B) Q
UALIFIED HEARING AID PROFES -12
SIONALS.—Section 1842(b)(18) of the Social 13
Security Act (42 U.S.C. 1395u(b)(18)) is 14
amended— 15
(i) in each of subparagraphs (A) and 16
(B), by striking ‘‘subparagraph (C)’’ and 17
inserting ‘‘subparagraph (C) or, beginning 18
on January 1, 2027, subparagraph (E)’’; 19
and 20
(ii) by adding at the end the following 21
new subparagraph: 22
‘‘(E) A practitioner described in this subparagraph 23
is a qualified hearing aid professional (as defined in sec-24
tion 1861(ll)(4)(C)).’’. 25
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(b) COVERAGE OFHEARINGAIDS.— 1
(1) I
NCLUSION OF HEARING AIDS AS PROS -2
THETIC DEVICES.—Section 1861(s)(8) of the Social 3
Security Act (42 U.S.C. 1395x(s)(8)) is amended by 4
inserting ‘‘, and including hearing aids (as described 5
in section 1834(h)(7)) furnished on or after January 6
1, 2027, to individuals with moderately severe, se-7
vere, or profound hearing loss’’ before the semicolon 8
at the end. 9
(2) P
AYMENT LIMITATIONS FOR HEARING 10
AIDS.—Section 1834(h) of the Social Security Act 11
(42 U.S.C. 1395m(h)) is amended by adding at the 12
end the following new paragraphs: 13
‘‘(6) P
AYMENT ONLY ON AN ASSIGNMENT -RE-14
LATED BASIS.—Payment for hearing aids for which 15
payment may be made under this part may be made 16
only on an assignment-related basis. The provisions 17
of subparagraphs (A) and (B) of section 18
1842(b)(18) shall apply to hearing aids in the same 19
manner as they apply to services furnished by a 20
practitioner described in subparagraph (C) of such 21
section. 22
‘‘(7) L
IMITATIONS FOR HEARING AIDS .— 23
‘‘(A) I
N GENERAL.—Payment may be 24
made under this part with respect to an indi-25
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vidual, with respect to hearing aids furnished 1
by a qualified hearing aid supplier (as defined 2
in subparagraph (C)) on or after January 1, 3
2027— 4
‘‘(i) not more than once per ear dur-5
ing a 5-year period; 6
‘‘(ii) only for types of such hearing 7
aids that are determined appropriate by 8
the Secretary; and 9
‘‘(iii) only if furnished pursuant to a 10
written order of a physician, qualified au-11
diologist (as defined in section 12
1861(ll)(4)), qualified hearing aid profes-13
sional (as defined in subparagraph (C) of 14
such section), physician assistant, nurse 15
practitioner, or clinical nurse specialist. 16
‘‘(B) S
PECIAL RULE.—The payment basis 17
determined under this subsection (including 18
after application of paragraph (1)(H), relating 19
to application of competitive acquisition) for 20
hearing aids furnished by a qualified hearing 21
aid supplier on or after January 1, 2027, shall 22
not exceed the rate determined for such hearing 23
aids under the Federal Supply Schedule of the 24
General Services Administration, as published 25
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by such Administration in 2021, updated to the 1
year involved using the applicable percent in-2
crease for the year. 3
‘‘(C) D
EFINITIONS.—In this subsection: 4
‘‘(i) H
EARING AID.—The term ‘hear-5
ing aid’ means the item and related serv-6
ices including selection, fitting, adjustment, 7
and patient education and training. 8
‘‘(ii) Q
UALIFIED HEARING AID SUP -9
PLIER.—The term ‘qualified hearing aid 10
supplier’ means— 11
‘‘(I) a qualified audiologist; 12
‘‘(II) a physician (as defined in 13
section 1861(r)(1)); 14
‘‘(III) a physician assistant, 15
nurse practitioner, or clinical nurse 16
specialist; 17
‘‘(IV) a qualified hearing aid pro-18
fessional (as defined in section 19
1861(ll)(4)(C)); and 20
‘‘(V) other suppliers as deter-21
mined by the Secretary.’’. 22
(3) A
PPLICATION OF COMPETITIVE ACQUISI -23
TION.— 24
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(A) IN GENERAL.—Section 1834(h)(1)(H) 1
of the Social Security Act (42 U.S.C. 2
1395m(h)(1)(H)) is amended— 3
(i) in the header, by inserting ‘‘
AND 4
HEARING AIDS’’ after ‘‘ORTHOTICS’’; 5
(ii) in the matter preceding clause (i), 6
by inserting ‘‘or of hearing aids described 7
in paragraph (2)(D) of such section,’’ after 8
‘‘2011,’’; and 9
(iii) in clause (i), by inserting ‘‘or 10
such hearing aids’’ after ‘‘such orthotics’’. 11
(B) C
ONFORMING AMENDMENTS .— 12
(i) I
N GENERAL.—Section 1847(a)(2) 13
of the Social Security Act (42 U.S.C. 14
1395w–3(a)(2)) is amended by adding at 15
the end the following new subparagraph: 16
‘‘(E) H
EARING AIDS.—Hearing aids de-17
scribed in section 1861(s)(8) for which payment 18
would otherwise be made under section 19
1834(h).’’. 20
(ii) E
XEMPTION OF CERTAIN ITEMS 21
FROM COMPETITIVE ACQUISITION .—Sec-22
tion 1847(a)(7) of the Social Security Act 23
(42 U.S.C. 1395w–3(a)(7)) is amended by 24
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adding at the end the following new sub-1
paragraph: 2
‘‘(C) C
ERTAIN HEARING AIDS .—Those 3
items and services described in paragraph 4
(2)(E) if furnished by a physician or other 5
practitioner (as defined by the Secretary) to the 6
physician’s or practitioner’s own patients as 7
part of the physician’s or practitioner’s profes-8
sional service.’’. 9
(iii) I
MPLEMENTATION.—Section 10
1847(a) of the Social Security Act (42 11
U.S.C. 1395w–3(a)) is amended by adding 12
at the end the following new paragraph: 13
‘‘(8) C
OMPETITION WITH RESPECT TO HEARING 14
AIDS.—Not later than January 1, 2031, the Sec-15
retary shall begin the competition with respect to the 16
items and services described in paragraph (2)(E).’’. 17
(4) P
HYSICIAN SELF-REFERRAL LAW.—Section 18
1877(b) of the Social Security Act (42 U.S.C. 19
1395nn(b)) is amended by adding at the end the fol-20
lowing new paragraph: 21
‘‘(6) H
EARING AIDS AND SERVICES .—In the 22
case of hearing aid examination services and hearing 23
aids— 24
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‘‘(A) furnished on or after January 1, 1
2027, and before January 1, 2029; and 2
‘‘(B) furnished on or after January 1, 3
2029, if the financial relationship specified in 4
subsection (a)(2) meets such requirements the 5
Secretary imposes by regulation to protect 6
against program or patient abuse.’’. 7
(c) E
XCLUSIONMODIFICATION.—Section 1862(a)(7) 8
of the Social Security Act (42 U.S.C. 1395y(a)(7)) is 9
amended by inserting ‘‘(except such hearing aids or exami-10
nations therefor as described in and otherwise allowed 11
under section 1861(s)(8))’’ after ‘‘hearing aids or exami-12
nations therefor’’. 13
(d) I
NCLUSION AS EXCEPTEDMEDICALTREAT-14
MENT.—Section 1821(b)(5)(A)(iv) of the Social Security 15
Act (42 U.S.C. 1395i–5(b)(5)(A)(iv)), as added by section 16
2(f), is amended by inserting ‘‘, audiology services de-17
scribed in subsection (ll)(3) of such section, or hearing 18
aids described in subsection (s)(8) of such section’’ after 19
‘‘section 1861)’’. 20
(e) R
URALHEALTHCLINICS AND FEDERALLY 21
Q
UALIFIEDHEALTHCENTERS.— 22
(1) C
LARIFYING COVERAGE OF AUDIOLOGY 23
SERVICES AS PHYSICIANS ’ SERVICES.—Section 24
1861(aa)(1)(A) of the Social Security Act (42 25
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U.S.C. 1395x(aa)(1)(A)) is amended by inserting 1
‘‘(including audiology services (as defined in sub-2
section (ll)(3)))’’ after ‘‘physicians’ services’’. 3
(2) I
NCLUSION OF QUALIFIED AUDIOLOGISTS 4
AND QUALIFIED HEARING AID PROFESSIONALS AS 5
RHC AND FQHC PRACTITIONERS .—Section 6
1861(aa)(1)(B) of the Social Security Act (42 7
U.S.C. 1395x(aa)(1)(B)) is amended by inserting 8
‘‘or by a qualified audiologist or a qualified hearing 9
aid professional (as such terms are defined in sub-10
section (ll)),’’ after ‘‘(as defined in subsection 11
(hh)(1)),’’. 12
(3) T
EMPORARY PAYMENT RATES FOR CERTAIN 13
SERVICES UNDER THE RHC AIR AND FQHC PPS .— 14
(A) AIR.—Section 1833 of the Social Se-15
curity Act (42 U.S.C. 1395l), as amended by 16
section 2(g)(2)(A), is amended— 17
(i) in subsection (a)(3)(A), by insert-18
ing ‘‘or audiology services (as defined in 19
section 1861(ll)(3))’’ after ‘‘(as defined in 20
section 1861(nnn)’’; and 21
(ii) in subsection (ee), by inserting ‘‘or 22
audiology services (as defined in section 23
1861(ll)(3))’’ after ‘‘(as defined in section 24
1861(nnn)’’. 25
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(B) PPS.—Section 1834(o)(6) of the So-1
cial Security Act (42 U.S.C. 1395m(o)(6)), as 2
added by section 2(g)(2)(B), is amended— 3
(i) in the first sentence, by inserting 4
‘‘or audiology services (as defined in sec-5
tion 1861(ll)(3))’’ after ‘‘(as defined in sec-6
tion 1861(nnn))’’; and 7
(ii) in the second sentence, by insert-8
ing ‘‘or such audiology services’’ after 9
‘‘such dental and oral health services’’. 10
(f) E
XPEDITINGIMPLEMENTATION.—The Secretary 11
of Health and Human Services shall implement this sec-12
tion for 2027 and 2028 through program instruction or 13
other forms of program guidance. 14
(g) F
UNDING.—In addition to amounts otherwise 15
available, there is appropriated to the Secretary of Health 16
and Human Services for fiscal year 2025, out of any 17
money in the Treasury not otherwise appropriated, 18
$370,000,000, to remain available until expended, for pur-19
poses of implementing the amendments made by this sec-20
tion during the period beginning on January 1, 2026, and 21
ending on September 30, 2035. 22
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SEC. 4. PROVIDING COVERAGE FOR VISION CARE UNDER 1
THE MEDICARE PROGRAM. 2
(a) C
OVERAGE.—Section 1861(s)(2) of the Social Se-3
curity Act (42 U.S.C. 1395x(s)(2)), as amended by section 4
2(a), is amended— 5
(1) in subparagraph (JJ), by striking ‘‘and’’ 6
after the semicolon at the end; 7
(2) in subparagraph (KK), by striking the pe-8
riod at the end and adding ‘‘; and’’; and 9
(3) by adding at the end the following new sub-10
paragraph: 11
‘‘(LL) vision services (as defined in subsection 12
(ooo));’’. 13
(b) V
ISIONSERVICESDEFINED.—Section 1861 of 14
the Social Security Act (42 U.S.C. 1395x), as amended 15
by section 2(b), is amended by adding at the end the fol-16
lowing new subsection: 17
‘‘(ooo) V
ISIONSERVICES.—The term ‘vision services’ 18
means routine eye examinations to determine the refrac-19
tive state of the eyes, including procedures performed dur-20
ing the course of such examination, furnished on or after 21
January 1, 2027, by or under the direct supervision of 22
an ophthalmologist or optometrist who is legally author-23
ized to furnish such examinations or procedures (as appli-24
cable) under State law (or the State regulatory mechanism 25
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provided by State law) of the State in which the examina-1
tions or procedures are furnished.’’. 2
(c) P
AYMENTLIMITATIONS.—Section 1834 of the 3
Social Security Act (42 U.S.C. 1395m), as amended by 4
section 2(c)(2), is amended by adding at the end the fol-5
lowing new subsection: 6
‘‘(bb) L
IMITATION FORVISIONSERVICES.—With re-7
spect to vision services (as defined in section 1861(ooo)) 8
and an individual, payment shall be made under this part 9
for only 1 routine eye examination described in such sub-10
section during a 2-year period.’’. 11
(d) P
AYMENTUNDERPHYSICIANFEESCHEDULE.— 12
Section 1848(j)(3) of the Social Security Act (42 U.S.C. 13
1395w–4(j)(3)) is amended by inserting ‘‘(2)(LL),’’ before 14
‘‘(3)’’. 15
(e) C
OVERAGE OF CONVENTIONAL EYEGLASSES.— 16
Section 1861(s)(8) of the Social Security Act (42 U.S.C. 17
1395x(s)(8)), as amended by section 3(b)(1), is amended 18
by striking ‘‘, and including one pair of conventional eye-19
glasses or contact lenses furnished subsequent to each cat-20
aract surgery with insertion of an intraocular lens’’ and 21
inserting ‘‘, including 1 pair of conventional eyeglasses or 22
contact lenses furnished subsequent to each cataract sur-23
gery with insertion of an intraocular lens, if furnished be-24
fore January 1, 2027, and including conventional eye-25
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glasses (as described in section 1834(h)(8)), whether or 1
not furnished subsequent to such a surgery, if furnished 2
on or after January 1, 2027’’. 3
(f) S
PECIALPAYMENTRULES FOREYEGLASSES.— 4
(1) L
IMITATIONS.—Section 1834(h) of the So-5
cial Security Act (42 U.S.C. 1395m(h)), as amended 6
by section 3(b)(2), is amended by adding at the end 7
the following new paragraph: 8
‘‘(8) P
AYMENT LIMITATIONS FOR EYE -9
GLASSES.— 10
‘‘(A) I
N GENERAL.—With respect to con-11
ventional eyeglasses furnished to an individual 12
on or after January 1, 2027, subject to sub-13
paragraph (B), payment shall be made under 14
this part only during a 2-year period, for 1 pair 15
of eyeglasses (including lenses and the frame). 16
‘‘(B) E
XCEPTION.—With respect to a 2- 17
year period described in subparagraph (A), in 18
the case of an individual who receives cataract 19
surgery with insertion of an intraocular lens, 20
payment shall be made under this part for 1 21
pair of conventional eyeglasses furnished subse-22
quent to such cataract surgery during such pe-23
riod. 24
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‘‘(C) SPECIAL RULE.—The payment basis 1
determined under this subsection (including 2
after application of paragraph (1)(H), relating 3
to application of competitive acquisition) for 4
conventional eyeglasses furnished to an indi-5
vidual on or after January 1, 2027, shall not 6
exceed the rate determined for such eyeglasses 7
under the Federal Supply Schedule of the Gen-8
eral Services Administration, as published by 9
such Administration in 2021, updated to the 10
year involved using the applicable percent in-11
crease for the year. 12
‘‘(D) N
O COVERAGE OF CERTAIN ITEMS .— 13
Payment shall not be made under this part for 14
deluxe eyeglasses or conventional reading glass-15
es.’’. 16
(2) A
PPLICATION OF COMPETITIVE ACQUISI -17
TION.— 18
(A) I
N GENERAL.—Section 1834(h)(1)(H) 19
of the Social Security Act (42 U.S.C. 20
1395m(h)(1)(H)), as amended by section 21
3(b)(3)(A), is amended— 22
(i) in the heading, by striking ‘‘
AND 23
HEARING AIDS’’ and inserting ‘‘HEARING 24
AIDS, AND EYEGLASSES’’; 25
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(ii) in the matter preceding clause 1
(i)— 2
(I) by striking ‘‘or of hearing 3
aids’’ and inserting ‘‘of hearing aids’’; 4
and 5
(II) by inserting ‘‘or of eyeglasses 6
described in paragraph (2)(E) of such 7
section,’’ after ‘‘paragraph (2)(D) of 8
such section,’’; and 9
(iii) in clause (i), by striking ‘‘or such 10
hearing aids’’ and inserting ‘‘, such hear-11
ing aids, or such eyeglasses’’. 12
(B) C
ONFORMING AMENDMENT .—Section 13
1847(a)(2) of the Social Security Act (42 14
U.S.C. 1395w–3(a)(2)), as amended by section 15
3(b)(3)(B)(i), is amended by adding at the end 16
the following new subparagraph: 17
‘‘(F) E
YEGLASSES.—Eyeglasses described 18
in section 1861(s)(8) for which payment would 19
otherwise be made under section 1834(h).’’. 20
(C) I
MPLEMENTATION.—Section 1847(a) 21
of the Social Security Act (42 U.S.C. 1395w– 22
3(a)), as amended by section 3(b)(3)(B)(iii), is 23
amended by adding at the end the following 24
new paragraph: 25
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‘‘(9) COMPETITION WITH RESPECT TO EYE -1
GLASSES.—Not later than January 1, 2030, the Sec-2
retary shall begin the competition with respect to the 3
items and services described in paragraph (2)(F).’’. 4
(g) E
XCLUSIONMODIFICATIONS.—Section 1862(a) 5
of the Social Security Act (42 U.S.C. 1395y(a)), as 6
amended by section 2(e), is amended— 7
(1) in paragraph (1)— 8
(A) in subparagraph (P), by striking 9
‘‘and’’ at the end; 10
(B) in subparagraph (Q), by striking the 11
semicolon at the end and inserting ‘‘, and’’; and 12
(C) by adding at the end the following new 13
subparagraph: 14
‘‘(R) in the case of vision services (as defined 15
in section 1861(ooo)) that are routine eye examina-16
tions as described in such section, which are fur-17
nished more frequently than once during a 2-year 18
period;’’; and 19
(2) in paragraph (7)— 20
(A) by inserting ‘‘(other than such an ex-21
amination that is a vision service that is cov-22
ered under section 1861(s)(2)(LL))’’ after ‘‘eye 23
examinations’’; and 24
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(B) by inserting ‘‘(other than such a proce-1
dure that is a vision service that is covered 2
under section 1861(s)(2)(LL))’’ after ‘‘refrac-3
tive state of the eyes’’. 4
(h) I
NCLUSION AS EXCEPTEDMEDICALTREAT-5
MENT.—Section 1821(b)(5)(A)(iv) of the Social Security 6
Act (42 U.S.C. 1395i–5(b)(5)(A)(iv)), as added by section 7
2(f) and amended by section 3(d), is amended— 8
(1) by striking ‘‘or hearing aids’’ and inserting 9
‘‘hearing aids’’; and 10
(2) by inserting ‘‘, or vision services (as defined 11
in subsection (ooo) of such section)’’ after ‘‘sub-12
section (s)(8) of such section’’. 13
(i) R
URALHEALTHCLINICS AND FEDERALLY 14
Q
UALIFIEDHEALTHCENTERS.— 15
(1) C
LARIFYING COVERAGE OF VISION SERV -16
ICES AS PHYSICIANS ’ SERVICES.—Section 17
1861(aa)(1)(A) of the Social Security Act (42 18
U.S.C. 1395x(aa)(1)(A)), as amended by section 19
3(e)(1), is amended by inserting ‘‘and vision services 20
(as defined in subsection (ooo))’’ after ‘‘(as defined 21
in subsection (ll)(3))’’. 22
(2) T
EMPORARY PAYMENT RATES FOR CERTAIN 23
SERVICES UNDER THE RHC AIR AND FQHC PPS .— 24
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(A) AIR.—Section 1833 of the Social Se-1
curity Act (42 U.S.C. 1395l), as amended by 2
sections 2(g)(2)(A) and 3(e)(3)(A), is amend-3
ed— 4
(i) in subsection (a)(3)(A)— 5
(I) by striking ‘‘or audiology’’ 6
and inserting ‘‘, audiology’’; and 7
(II) by inserting ‘‘, or vision serv-8
ices (as defined in section 1861(ooo))’’ 9
after ‘‘(as defined in section 10
1861(ll)(3))’’; and 11
(ii) in subsection (ee)— 12
(I) by striking ‘‘or audiology’’ 13
and inserting ‘‘, audiology’’; and 14
(II) by inserting ‘‘, or vision serv-15
ices (as defined in section 1861(ooo))’’ 16
after ‘‘(as defined in section 17
1861(ll)(3))’’. 18
(B) PPS.—Section 1834(o)(6) of the So-19
cial Security Act (42 U.S.C. 1395m(o)(6)), as 20
added by section 2(g)(2)(B) and amended by 21
section 3(e)(3)(B), is amended— 22
(i) in the first sentence— 23
(I) by striking ‘‘or audiology’’ 24
and inserting ‘‘, audiology’’; and 25
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(II) by inserting ‘‘, or vision serv-1
ices (as defined in section 1861(ooo))’’ 2
after ‘‘(as defined in section 3
1861(ll)(3))’’; and 4
(ii) in the second sentence, by striking 5
‘‘or such audiology services’’ and inserting 6
‘‘, such audiology services, or such vision 7
services’’. 8
(j) E
XPEDITINGIMPLEMENTATION.—The Secretary 9
of Health and Human Services shall implement this sec-10
tion for 2027 and 2028 through program instruction or 11
other forms of program guidance. 12
(k) F
UNDING.—In addition to amounts otherwise 13
available, there is appropriated to the Secretary of Health 14
and Human Services for fiscal year 2025, out of any 15
money in the Treasury not otherwise appropriated, 16
$500,000,000, to remain available until expended, for pur-17
poses of implementing the amendments made by this sec-18
tion during the period beginning on January 1, 2026, and 19
ending on September 30, 2034. 20
SEC. 5. PHASE-IN OF IMPACT OF DENTAL AND ORAL 21
HEALTH COVERAGE ON PART B PREMIUMS. 22
Section 1839(a) of the Social Security Act (42 U.S.C. 23
1395r(a)) is amended— 24
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(1) in the second sentence of paragraph (1), by 1
striking ‘‘and (7)’’ and inserting ‘‘(7), and (8)’’; 2
(2) in paragraph (3), by striking ‘‘The Sec-3
retary’’ and inserting ‘‘Subject to paragraph (8)(C), 4
the Secretary’’; and 5
(3) by adding at the end the following: 6
‘‘(8) S
PECIAL RULE FOR 2026 THROUGH 2030 .— 7
‘‘(A) D
ETERMINATION OF ALTERNATIVE 8
MONTHLY ACTUARIAL RATE FOR EACH OF 2026 9
THROUGH 2030.—For each of 2026 through 10
2030, the Secretary shall, at the same time as 11
and in addition to the determination of the 12
monthly actuarial rate for enrollees age 65 and 13
over determined in each of 2025 through 2029 14
for the succeeding calendar year according to 15
paragraph (1), determine an alternative month-16
ly actuarial rate for enrollees age 65 and over 17
for the year as described in subparagraph (B). 18
‘‘(B) A
LTERNATIVE MONTHLY ACTUARIAL 19
RATE DESCRIBED.— 20
‘‘(i) I
N GENERAL.—The alternative 21
monthly actuarial rate described in this 22
subparagraph is— 23
‘‘(I) for 2026 and 2027, the 24
monthly actuarial rate for enrollees 25
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age 65 and over for the year, deter-1
mined as if the amendments made by 2
section 2 of the Medicare Dental, 3
Hearing, and Vision Expansion Act of 4
2025 did not apply; and 5
‘‘(II) for 2028, 2029, and 2030, 6
the monthly actuarial rate for enroll-7
ees age 65 and over for the year, de-8
termined as if the amendments made 9
by such section 2 did not apply, plus 10
the applicable percent of the amount 11
by which— 12
‘‘(aa) the monthly actuarial 13
rate for enrollees age 65 and over 14
for the year determined accord-15
ing to paragraph (1); exceeds 16
‘‘(bb) the monthly actuarial 17
rate for enrollees age 65 and over 18
for the year, determined as if the 19
amendments made by such sec-20
tion 2 did not apply. 21
‘‘(ii) D
EFINITION OF APPLICABLE 22
PERCENT.—For purposes of this subpara-23
graph, the term ‘applicable percent’ 24
means— 25
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‘‘(I) for 2028, 25 percent; 1
‘‘(II) for 2029, 50 percent; and 2
‘‘(III) for 2030, 75 percent. 3
‘‘(C) A
PPLICATION TO PART B PREMIUM 4
AND OTHER PROVISIONS OF THIS PART .—For 5
each of 2026 through 2030, the Secretary shall 6
use the alternative monthly actuarial rate for 7
enrollees age 65 and over for the year deter-8
mined under subparagraph (A), in lieu of the 9
monthly actuarial rate for such enrollees for the 10
year determined according to paragraph (1), 11
when determining the monthly premium rate 12
for the year under paragraph (3) and sub-13
section (j), the part B deductible under section 14
1833(b), and the premium subsidy and monthly 15
adjustment amount under subsection (i).’’. 16
Æ
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