119-s939

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 939 Introduced in Senate

    (IS) ]

<DOC>

119th CONGRESS
 1st Session
 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

 March 11 (legislative day, March 10), 2025

 Mr. Sanders (for himself, Ms. Warren, Mr. Booker, Mr. Welch, Mr. 
Markey, Ms. Duckworth, Mr. Merkley, and Mr. Blumenthal) introduced the 
 following bill; which was read twice and referred to the Committee 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 Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

 This Act may be cited as the ``Medicare Dental, Hearing, and Vision 
Expansion Act of 2025''.

SEC. 2. COVERAGE OF DENTAL AND ORAL HEALTH CARE.

    (a) Coverage.--

Section 1861

    (s)

    (2) of the Social Security Act (42 
U.S.C. 1395x

    (s)

    (2) ) is amended--

    (1) in subparagraph

    (JJ) , by adding ``and'' at the end; and

    (2) by adding at the end the following new subparagraph:
 ``

    (KK) dental and oral health services (as defined in 
 subsection

    (nnn) );''.

    (b) Dental and Oral Health Services Defined.--

Section 1861 of the 
Social Security Act (42 U.S.C. 1395x) is amended by adding at the end 
the following new subsection:
 ``

    (nnn) Dental and Oral Health Services.--
 ``

    (1) In general.--Except as provided in paragraph

    (2) , the 
 term `dental and oral health services' means the following 
 items and services that are furnished by a doctor of dental 
 surgery or of dental medicine (as described in subsection

    (r)

    (2) ) or an oral health professional (as defined in paragraph

    (3) ) on or after January 1, 2027 (or January 1, 2026, in the 
 case of dentures):
 ``
        (A) Preventive and screening services.--
 Preventive and screening services, including oral 
 exams, dental cleanings, dental x-rays, and fluoride 
 treatments.
 ``
        (B) Procedures and treatment services.--Services 
 to address oral disease, including services such as 
 restorative services, prosthodontic and endodontic 
 services, including fillings bridges, crowns, and root 
 canals, periodontal maintenance, periodontal scaling 
 and root planing, tooth extractions, therapeutic 
 pulpotomy, and other related items and services.
 ``
            (C) Dentures and dental prosthetics.--Complete 
 dentures, partial dentures, and implants, including 
 related items and services.
 ``

    (2) Exclusions.--Such term does not include items and 
 services for which, as of the date of the enactment of this 
 subsection, coverage was permissible under 

section 1862

    (a)

    (12) and cosmetic services not otherwise covered under 

section 1862

    (a)

    (10) .
 ``

    (3) Oral health professional.--The term `oral health 
 professional' means, with respect to dental and oral health 
 services, a health professional (other than a doctor of dental 
 surgery or of dental medicine (as described in subsection

    (r)

    (2) )) who is licensed to furnish such services, acting 
 within the scope of such license, by the State in which such 
 services are furnished.''.
            (c) Payment; Coinsurance; and Limitations.--

    (1) In general.--

Section 1833

    (a)

    (1) of the Social Security 
 Act (42 U.S.C. 1395l

    (a)

    (1) ) is amended--
        (A) in subparagraph
        (N) , by inserting ``and dental 
 and oral health services (as defined in 

section 1861

    (nnn) )'' after ``

section 1861

    (hhh)

    (1) )'';
        (B) by striking ``and'' before ``

    (HH) ''; and
            (C) by inserting before the semicolon at the end 
 the following: ``and
            (II) with respect to dental and 
 oral health services (as defined in 

section 1861

    (nnn) ), 
 the amount paid shall be the payment amount specified 
 under 

section 1834

    (aa) ''.

    (2) Payment and limits specified.--

Section 1834 of the 
 Social Security Act (42 U.S.C. 1395m) is amended by adding at 
 the end the following new subsection:
 ``

    (aa) Payment and Limits for Dental and Oral Health Services.--
 ``

    (1) Payment.--The payment amount under this part for 
 dental and oral health services (as defined in 

section 1861

    (nnn) ) shall be, subject to paragraphs

    (3) and

    (4) , 80 
 percent (or 100 percent, in the case of preventive and 
 screening services described in 

section 1861

    (nnn)

    (1)
        (A) ) of the 
 lesser of--
 ``
        (A) the actual charge for the service; or
 ``
        (B)
            (i) in the case of such services furnished by 
 a doctor of dental surgery or of dental medicine (as 
 described in 

section 1861

    (r)

    (2) ), the amount determined 
 under the fee schedule established under paragraph

    (2) ; 
 or
 ``
            (ii) in the case of such services furnished by an 
 oral health professional (as defined in 

section 1861

    (nnn)

    (3) ), 85 percent of the amount determined 
 under the fee schedule established under paragraph

    (2) .
 ``

    (2) Establishment of fee schedule for dental and oral 
 health services.--
 ``
        (A) Establishment.--
 ``
            (i) In general.--The Secretary shall 
 establish a fee schedule for dental and oral 
 health services furnished in 2027 (or 2026, in 
 the case of dentures) and subsequent years. The 
 fee schedule amount for a dental or oral health 
 service shall be equal to 70 percent of the 
 national median fee (as determined under 
 subparagraph
        (B) ) for the service or a similar 
 service for the year (or, in the case of 
 dentures, at the bundled payment amount under 
 clause
            (iv) of such subparagraph), adjusted by 
 the geographic adjustment factor established 
 under 

section 1848

    (e)

    (2) for the area for the 
 year.
 ``
            (ii) Consultation.--In carrying out this 
 paragraph, the Secretary shall consult annually 
 with organizations representing dentists and 
 other providers who furnish dental and oral 
 health services and shall share with such 
 providers the data and data analysis used to 
 determine fee schedule amounts under this 
 paragraph.
 ``
        (B) Determination of national median fee.--
 ``
            (i) In general.--For purposes of 
 subparagraph
        (A) , the Secretary shall apply the 
 national median fee for a dental or oral health 
 service for 2027 (or 2026, in the case of 
 dentures) and subsequent years in accordance 
 with this subparagraph.
 ``
            (ii) Use of 2020 dental fee survey.--
 ``
            (I) In general.--Except as 
 provided in clause
            (iii) and clause
            (iv) , the national median fee for a 
 dental or oral health service shall be 
 equal to--
 ``

    (aa) for 2027 (or 2026, 
 in the case of dentures), the 
 median fee for the service in 
 the table titled `General 
 Practitioners-National' of the 
 `2020 Survey of Dental Fees' 
 published by the American 
 Dental Association, increased 
 by the applicable percent 
 increase for the year 
 determined under subclause
            (II) , as reduced by the 
 productivity adjustment under 
 subclause
            (III) ; and
 ``

    (bb) for 2028 (or 2027, 
 in the case of dentures) and 
 subsequent years, the amount 
 determined under this subclause 
 for the preceding year, updated 
 pursuant to subparagraph
            (C) 
            (i) .
 ``
            (II) Applicable percent 
 increase.--The applicable percent 
 increase determined under this 
 subclause for a year is an amount equal 
 to the percentage increase between--
 ``

    (aa) the consumer price 
 index for all urban consumers 
 (United States city average) 
 ending with June of the 
 previous year; and
 ``

    (bb) the consumer price 
 index for all urban consumers 
 (United States city average) 
 ending with June of 2026 (or 
 2025, in the case of dentures).
 ``
            (III) Productivity adjustment.--
 After determining the applicable 
 percentage increase under subclause
            (II) for a year, the Secretary shall 
 reduce such percentage increase by the 
 productivity adjustment described in 
 

section 1886

    (b)

    (3)
        (B)
            (xi) 
            (II) .
 ``
            (iii) Determination if insufficient 
 survey data.--If the Secretary determines there 
 is insufficient data under the Survey described 
 in clause
            (ii) with respect to a dental or oral 
 health service, the national median fee for the 
 service for a year shall be equal to an amount 
 established for the service using 1 or more of 
 the following methods, as determined 
 appropriate by the Secretary:
 ``
            (I) The payment basis determined 
 under 

section 1848.
 ``
            (II) Fee schedules for dental and 
 oral health services which shall 
 include, as practicable, fee 
 schedules--
 ``

    (aa) under Medicare 
 Advantage plans under part C;
 ``

    (bb) under State plans 
 (or waivers of such plans) 
 under title XIX; and
 ``
            (cc) established by other 
 health care payers.
 ``
            (iv) Special rule for dentures.--
 ``
            (I) In general.--The Secretary 
 shall make payment for dentures and 
 associated professional services as a 
 bundled payment as determined by the 
 Secretary.
 ``
            (II) Payment considerations.--In 
 establishing such bundled payment, the 
 Secretary shall consider the national 
 median fee for the service for the year 
 determined under clause
            (ii) or
            (iii) and the rate determined for such 
 dentures under the Federal Supply 
 Schedule of the General Services 
 Administration, as published by such 
 Administration in 2021, updated to the 
 year involved using the applicable 
 percent increase for the year 
 determined under clause
            (ii) 
            (II) , as 
 reduced by the productivity adjustment 
 under clause
            (ii) 
            (III) , and shall 
 ensure that the payment component for 
 dentures under such bundled payment 
 does not exceed the maximum rate 
 determined for such dentures under the 
 Federal Supply Schedule, as so 
 published and updated to the year 
 involved.
 ``
            (C) Annual update and adjustments.--
 ``
            (i) Annual update.--The Secretary shall 
 update payment amounts determined under the fee 
 schedule from year to year beginning in 2028 
 (or 2027, in the case of dentures) by 
 increasing such amounts from the prior year by 
 the percentage increase in the consumer price 
 index for all urban consumers (United States 
 city average) for the 12-month period ending 
 with June of the preceding year, reduced by the 
 productivity adjustment described in 

section 1886

    (b)

    (3)
        (B)
            (xi) 
            (II) .
 ``
            (ii) Adjustments.--
 ``
            (I) In general.--The Secretary 
 shall, to the extent the Secretary 
 determines to be necessary and subject 
 to subclause
            (II) , adjust the amounts 
 determined under the fee schedule 
 established under this paragraph for 
 2028 (or 2027, in the case of dentures) 
 and subsequent years to take into 
 account changes in dental practice, 
 coding changes, new data on work, 
 practice, or malpractice expenses, or 
 the addition of new procedures.
 ``
            (II) Limitation on annual 
 adjustments.--The adjustments under 
 subclause
            (I) for a year shall not 
 cause the amount of expenditures under 
 this part for the year to differ by 
 more than $20,000,000 from the amount 
 of expenditures under this part that 
 would have been made if such 
 adjustments had not been made.
 ``

    (3) Limitations.--With respect to dental and oral health 
 services that are preventive and screening services described 
 in paragraph

    (1)
        (A) of 

section 1861

    (nnn) --
 ``
        (A) payment shall be made under this part for--
 ``
            (i) not more than 2 oral exams in a year;
 ``
            (ii) not more than 2 dental cleanings in 
 a year;
 ``
            (iii) not more than 1 fluoride treatment 
 in a year; and
 ``
            (iv) not more than 1 full-mouth series of 
 x-rays as part of a preventive and screening 
 oral exam every 3 years; and
 ``
        (B) in the case of preventive and screening 
 services not described in subparagraph
        (A) , payment 
 shall be made under this part only at such frequencies 
 determined appropriate by the Secretary.
 ``

    (4) Incentives for rural providers.--In the case of 
 dental and oral health services furnished by a doctor of dental 
 surgery or of dental medicine (as described in 

section 1861

    (r)

    (2) ) or an oral health professional (as defined in 
 

section 1861

    (nnn)

    (3) ) who predominantly furnishes such services 
 under this part in an area that is designated by the Secretary 
 (under 

section 332

    (a)

    (1)
        (A) of the Public Health Service Act) 
 as a health professional shortage area, in addition to the 
 amount of payment that would otherwise be made for such 
 services under this subsection, there also shall be paid an 
 amount equal to 10 percent of the payment amount for the 
 service under this subsection for such doctor or professional.
 ``

    (5) Limitation on beneficiary liability.--The provisions 
 of 

section 1848

    (g) shall apply to a nonparticipating doctor of 
 dental surgery or of dental medicine (as described in 

section 1861

    (r)

    (2) ) who does not accept payment on an assignment-
 related basis for dental and oral health services furnished 
 with respect to an individual enrolled under this part in the 
 same manner as such provisions apply with respect to a 
 physician's service.
 ``

    (6) Establishment of dental administrator.--The Secretary 
 shall designate 1 or more (not to exceed 4) medicare 
 administrative contractors under 

section 1874A to establish 
 coverage policies and establish such policies and process 
 claims for payment for dental and oral health services, as 
 determined appropriate by the Secretary.''.
            (d) Inclusion of Oral Health Professionals as Certain 
Practitioners.--

Section 1842

    (b)

    (18)
            (C) of the Social Security Act (42 
U.S.C. 1395u

    (b)

    (18)
            (C) ) is amended by adding at the end the following 
new clause:
 ``
            (ix) With respect to 2028 and each subsequent year, an 
 oral health professional (as defined in 

section 1861

    (nnn)

    (3) ).''.

    (e) Exclusion Modifications.--

Section 1862

    (a) of the Social 
Security Act (42 U.S.C. 1395y

    (a) ) is amended--

    (1) in paragraph

    (1) --
        (A) in subparagraph
        (O) , by striking ``and'' at the 
 end;
        (B) in subparagraph
        (P) , by striking the semicolon 
 at the end and inserting ``, and''; and
            (C) by adding at the end the following new 
 subparagraph:
 ``
        (Q) in the case of dental and oral health services (as 
 defined in 

section 1861

    (nnn) ) for which a limitation is 
 applicable under 

section 1834

    (aa)

    (3) , which are furnished more 
 frequently than is provided under such section;''; and

    (2) in paragraph

    (12) , by inserting before the semicolon at 
 the end the following: ``and except that payment shall be made 
 under part B for dental and oral health services that are 
 covered under 

section 1861

    (s)

    (2) (KK) ''.

    (f) Inclusion as Excepted Medical Treatment.--

Section 1821

    (b)

    (5)
        (A) of the Social Security Act (42 U.S.C. 1395i-5

    (b)

    (5)
        (A) ) is amended--

    (1) in clause
            (ii) , by striking ``or'' at the end;

    (2) in clause
            (iii) , by striking the period and inserting 
 ``, or''; and

    (3) by adding at the end the following new clause:
 ``
            (iv) consisting of dental and oral health 
 services (as defined in subsection
            (mmm) of 
 

section 1861) that are payable under part B as 
 a result of the amendments made by the Medicare 
 Dental, Hearing, and Vision Expansion Act of 
 2025.''.

    (g) Rural Health Clinics and Federally Qualified Health Centers.--

    (1) Coverage of dental and oral health services.--

Section 1861

    (aa) of the Social Security Act (42 U.S.C. 1395x

    (aa) ), is 
 amended--
        (A) in paragraph

    (1) --
            (i) in subparagraph
            (C) , by striking 
 ``and'' at the end;
            (ii) in subparagraph
            (D) , by inserting 
 ``and'' after the comma at the end; and
            (iii) by inserting after subparagraph
            (D) the following new subparagraph:
 ``
        (E) dental and oral health services (as defined 
 in subsection

    (nnn) ) furnished by a doctor of dental 
 surgery or of dental medicine (as described in 
 subsection

    (r)

    (2) ) or an oral health professional (as 
 defined in subsection

    (nnn)

    (3) ) who is employed by or 
 working under contract with a rural health clinic if 
 such rural health clinic furnishes such services,''; 
 and
        (B) in paragraph

    (3)
        (A) , by striking ``
            (D) '' and 
 inserting ``
        (E) ''.

    (2) Temporary payment rates for certain services under the 
 rhc air and fqhc pps.--
        (A) AIR.--

Section 1833 of the Social Security Act 
 (42 U.S.C. 1395l) is amended--
            (i) in subsection

    (a)

    (3)
        (A) , by inserting 
 ``(which shall, in the case of dental and oral 
 health services (as defined in 

section 1861

    (nnn) ), in lieu of any limits on reasonable 
 costs otherwise applicable, be based on the 
 rates payable for such services under the 
 payment basis determined under 

section 1848 
 until such time as the Secretary determines 
 sufficient data has been collected to otherwise 
 apply such limits (or January 1, 2031, if no 
 such determination has been made as of such 
 date))'' after ``may prescribe in 
 regulations''; and
            (ii) by adding at the end the following new 
 subsection:
 ``

    (ee) Disregard of Costs Attributable to Certain Services From 
Calculation of RHC AIR.--Payments for rural health clinic services 
other than dental and oral health services (as defined in 

section 1861

    (nnn) ) under the methodology for all-inclusive rates (established 
by the Secretary) under subsection

    (a)

    (3) shall not take into account 
the costs of such services while rates for such services are based on 
rates payable for such services under the payment basis established 
under 

section 1848.''.
        (B) PPS.--

Section 1834

    (o) of the Social Security 
 Act (42 U.S.C. 1395m

    (o) ) is amended by adding at the 
 end the following new paragraph:
 ``

    (6) Temporary payment rates based on pfs for certain 
 services.--The Secretary shall, in establishing payment rates 
 for dental and oral health services (as defined in 

section 1861

    (nnn) ) that are Federally qualified health center services 
 under the prospective payment system established under this 
 subsection, in lieu of the rates otherwise applicable under 
 such system, base such rates on rates payable for such services 
 under the payment basis established under 

section 1848 until 
 such time as the Secretary determines sufficient data has been 
 collected to otherwise establish rates for such services under 
 such system (or January 1, 2031, if no such determination has 
 been made as of such date). Payments for Federally qualified 
 health center services other than such dental and oral health 
 services under such system shall not take into account the 
 costs of such services while rates for such services are based 
 on rates payable for such services under the payment basis 
 established under 

section 1848.''.

    (h) Implementation.--In addition to amounts otherwise available, 
there is appropriated to the Secretary of Health and Human Services for 
fiscal year 2025, out of any money in the Treasury not otherwise 
appropriated, $900,000,000, to remain available until expended, for 
purposes of implementing the amendments made by this section during the 
period beginning on January 1, 2025, and ending on September 30, 2034.

SEC. 3. PROVIDING COVERAGE FOR HEARING CARE UNDER THE MEDICARE PROGRAM.

    (a) Provision of Audiology Services by Qualified Audiologists and 
Hearing Aid Examination Services by Qualified Hearing Aid 
Professionals.--

    (1) In general.--

Section 1861
            (ll) of the Social Security 
 Act (42 U.S.C. 1395x
            (ll) ) is amended--
        (A) in paragraph

    (3) --
            (i) by inserting ``
        (A) '' after ``

    (3) '';
            (ii) in subparagraph
        (A) , as added by 
 clause
            (i) of this subparagraph--
            (I) by striking ``means such 
 hearing and balance assessment 
 services'' and inserting ``means--
 ``
            (i) such hearing and balance assessment 
 services and, beginning January 1, 2027, such 
 hearing aid examination services and treatment 
 services (including aural rehabilitation, 
 vestibular rehabilitation, and cerumen 
 management)'';
            (II) in clause
            (i) , as added by 
 subclause
            (I) of this clause, by 
 striking the period at the end and 
 inserting ``; and''; and
            (III) by adding at the end the 
 following new clause:
 ``
            (ii) beginning January 1, 2027, such 
 hearing aid examination services furnished by a 
 qualified hearing aid professional (as defined 
 in paragraph

    (4)
            (C) ) as the professional is 
 legally authorized to perform under State law 
 (or the State regulatory mechanism provided by 
 State law), as would otherwise be covered if 
 furnished by a physician.''; and
            (iii) by adding at the end the following 
 new subparagraph:
 ``
        (B) Beginning January 1, 2027, audiology services 
 described in subparagraph
        (A)
            (i) shall be furnished 
 without a requirement for an order from a physician or 
 practitioner.''; and
        (B) in paragraph

    (4) , by adding at the end the 
 following new subparagraph:
 ``
            (C) The term `qualified hearing aid professional' 
 means an individual who--
 ``
            (i) is licensed or registered as a 
 hearing aid dispenser, hearing aid specialist, 
 hearing instrument dispenser, or related 
 professional by the State in which the 
 individual furnishes such services; and
 ``
            (ii) is accredited by the National Board 
 for Certification in Hearing Instrument 
 Sciences or meets such other requirements as 
 the Secretary determines appropriate (including 
 requirements relating to educational 
 certifications or accreditations) taking into 
 account any additional relevant requirements 
 for hearing aid specialists, hearing aid 
 dispensers, and hearing instrument dispensers 
 established by Medicare Advantage organizations 
 under part C, State plans (or waivers of such 
 plans) under title XIX, and group health plans 
 and health insurance issuers (as such terms are 
 defined in 

section 2791 of the Public Health 
 Service Act).''.

    (2) Payment for qualified hearing aid professionals.--
 

Section 1833

    (a)

    (1) of the Social Security Act (42 U.S.C. 
 1395l

    (a)

    (1) ), as amended by 

section 2
            (c) (1) , is amended--
        (A) by striking ``and'' before ``
            (II) ''; and
        (B) by inserting before the semicolon at the end 
 the following: ``and

    (JJ) with respect to hearing aid 
 examination services (as described in paragraph

    (3)
        (A)
            (ii) of 

section 1861
            (ll) ) furnished by a 
 qualified hearing aid professional (as defined in 
 paragraph

    (4)
            (C) of such section), the amounts paid 
 shall be equal to 80 percent of the lesser of the 
 actual charge for such services or 85 percent of the 
 amount for such services determined under the payment 
 basis determined under 

section 1848''.

    (3) Inclusion of qualified audiologists and qualified 
 hearing aid professionals as certain practitioners to receive 
 payment on an assignment-related basis.--
        (A) Qualified audiologists.--

Section 1842

    (b)

    (18)
            (C) of the Social Security Act (42 U.S.C. 1395u

    (b)

    (18)
            (C) ), 
 as amended by 

section 2
            (d) , is amended by adding at the 
 end the following new clause:
 ``
            (x) Beginning on January 1, 2027, a qualified audiologist 
 (as defined in 

section 1861
            (ll) (4)
        (B) ).''.
        (B) Qualified hearing aid professionals.--

Section 1842

    (b)

    (18) of the Social Security Act (42 U.S.C. 
 1395u

    (b)

    (18) ) is amended--
            (i) in each of subparagraphs
        (A) and
        (B) , 
 by striking ``subparagraph
            (C) '' and inserting 
 ``subparagraph
            (C) or, beginning on January 1, 
 2027, subparagraph
        (E) ''; and
            (ii) by adding at the end the following new 
 subparagraph:
 ``
        (E) A practitioner described in this subparagraph is a qualified 
hearing aid professional (as defined in 

section 1861
            (ll) (4)
            (C) ).''.

    (b) Coverage of Hearing Aids.--

    (1) Inclusion of hearing aids as prosthetic devices.--
 

Section 1861

    (s)

    (8) of the Social Security Act (42 U.S.C. 
 1395x

    (s)

    (8) ) is amended by inserting ``, and including hearing 
 aids (as described in 

section 1834

    (h)

    (7) ) furnished on or after 
 January 1, 2027, to individuals with moderately severe, severe, 
 or profound hearing loss'' before the semicolon at the end.

    (2) Payment limitations for hearing aids.--

Section 1834

    (h) of the Social Security Act (42 U.S.C. 1395m

    (h) ) is amended by 
 adding at the end the following new paragraphs:
 ``

    (6) Payment only on an assignment-related basis.--Payment 
 for hearing aids for which payment may be made under this part 
 may be made only on an assignment-related basis. The provisions 
 of subparagraphs
        (A) and
        (B) of 

section 1842

    (b)

    (18) shall apply 
 to hearing aids in the same manner as they apply to services 
 furnished by a practitioner described in subparagraph
            (C) of 
 such section.
 ``

    (7) Limitations for hearing aids.--
 ``
        (A) In general.--Payment may be made under this 
 part with respect to an individual, with respect to 
 hearing aids furnished by a qualified hearing aid 
 supplier (as defined in subparagraph
            (C) ) on or after 
 January 1, 2027--
 ``
            (i) not more than once per ear during a 
 5-year period;
 ``
            (ii) only for types of such hearing aids 
 that are determined appropriate by the 
 Secretary; and
 ``
            (iii) only if furnished pursuant to a 
 written order of a physician, qualified 
 audiologist (as defined in 

section 1861
            (ll) (4) ), qualified hearing aid 
 professional (as defined in subparagraph
            (C) of 
 such section), physician assistant, nurse 
 practitioner, or clinical nurse specialist.
 ``
        (B) Special rule.--The payment basis determined 
 under this subsection (including after application of 
 paragraph

    (1)
        (H) , relating to application of 
 competitive acquisition) for hearing aids furnished by 
 a qualified hearing aid supplier on or after January 1, 
 2027, shall not exceed the rate determined for such 
 hearing aids under the Federal Supply Schedule of the 
 General Services Administration, as published by such 
 Administration in 2021, updated to the year involved 
 using the applicable percent increase for the year.
 ``
            (C) === Definitions. ===
-In this subsection:
 ``
            (i) Hearing aid.--The term `hearing aid' 
 means the item and related services including 
 selection, fitting, adjustment, and patient 
 education and training.
 ``
            (ii) Qualified hearing aid supplier.--The 
 term `qualified hearing aid supplier' means--
 ``
            (I) a qualified audiologist;
 ``
            (II) a physician (as defined in 
 

section 1861

    (r)

    (1) );
 ``
            (III) a physician assistant, 
 nurse practitioner, or clinical nurse 
 specialist;
 ``
            (IV) a qualified hearing aid 
 professional (as defined in 

section 1861
            (ll) (4)
            (C) ); and
 ``
            (V) other suppliers as determined 
 by the Secretary.''.

    (3) Application of competitive acquisition.--
        (A) In general.--

Section 1834

    (h)

    (1)
        (H) of the 
 Social Security Act (42 U.S.C. 1395m

    (h)

    (1)
        (H) ) is 
 amended--
            (i) in the header, by inserting ``and 
 hearing aids'' after ``orthotics'';
            (ii) in the matter preceding clause
            (i) , by 
 inserting ``or of hearing aids described in 
 paragraph

    (2)
            (D) of such section,'' after 
 ``2011,''; and
            (iii) in clause
            (i) , by inserting ``or such 
 hearing aids'' after ``such orthotics''.
        (B) Conforming amendments.--
            (i) In general.--

Section 1847

    (a)

    (2) of the 
 Social Security Act (42 U.S.C. 1395w-3

    (a)

    (2) ) 
 is amended by adding at the end the following 
 new subparagraph:
 ``
        (E) Hearing aids.--Hearing aids described in 
 

section 1861

    (s)

    (8) for which payment would otherwise be 
 made under 

section 1834

    (h) .''.
            (ii) Exemption of certain items from 
 competitive acquisition.--

Section 1847

    (a)

    (7) of 
 the Social Security Act (42 U.S.C. 1395w-
 3

    (a)

    (7) ) is amended by adding at the end the 
 following new subparagraph:
 ``
            (C) Certain hearing aids.--Those items and 
 services described in paragraph

    (2)
        (E) if furnished by 
 a physician or other practitioner (as defined by the 
 Secretary) to the physician's or practitioner's own 
 patients as part of the physician's or practitioner's 
 professional service.''.
            (iii) Implementation.--

Section 1847

    (a) of 
 the Social Security Act (42 U.S.C. 1395w-3

    (a) ) 
 is amended by adding at the end the following 
 new paragraph:
 ``

    (8) Competition with respect to hearing aids.--Not later 
 than January 1, 2031, the Secretary shall begin the competition 
 with respect to the items and services described in paragraph

    (2)
        (E) .''.

    (4) Physician self-referral law.--

Section 1877

    (b) of the 
 Social Security Act (42 U.S.C. 1395nn

    (b) ) is amended by adding 
 at the end the following new paragraph:
 ``

    (6) Hearing aids and services.--In the case of hearing 
 aid examination services and hearing aids--
 ``
        (A) furnished on or after January 1, 2027, and 
 before January 1, 2029; and
 ``
        (B) furnished on or after January 1, 2029, if the 
 financial relationship specified in subsection

    (a)

    (2) meets such requirements the Secretary imposes by 
 regulation to protect against program or patient 
 abuse.''.
            (c) Exclusion Modification.--

Section 1862

    (a)

    (7) of the Social 
Security Act (42 U.S.C. 1395y

    (a)

    (7) ) is amended by inserting ``(except 
such hearing aids or examinations therefor as described in and 
otherwise allowed under 

section 1861

    (s)

    (8) )'' after ``hearing aids or 
examinations therefor''.
            (d) Inclusion as Excepted Medical Treatment.--

Section 1821

    (b)

    (5)
        (A)
            (iv) of the Social Security Act (42 U.S.C. 1395i-
5

    (b)

    (5)
        (A)
            (iv) ), as added by 

section 2

    (f) , is amended by inserting ``, 
audiology services described in subsection
            (ll) (3) of such section, or 
hearing aids described in subsection

    (s)

    (8) of such section'' after 
``

section 1861)''.

    (e) Rural Health Clinics and Federally Qualified Health Centers.--

    (1) Clarifying coverage of audiology services as 
 physicians' services.--

Section 1861

    (aa)

    (1)
        (A) of the Social 
 Security Act (42 U.S.C. 1395x

    (aa)

    (1)
        (A) ) is amended by 
 inserting ``(including audiology services (as defined in 
 subsection
            (ll) (3) ))'' after ``physicians' services''.

    (2) Inclusion of qualified audiologists and qualified 
 hearing aid professionals as rhc and fqhc practitioners.--
 

Section 1861

    (aa)

    (1)
        (B) of the Social Security Act (42 U.S.C. 
 1395x

    (aa)

    (1)
        (B) ) is amended by inserting ``or by a qualified 
 audiologist or a qualified hearing aid professional (as such 
 terms are defined in subsection
            (ll) ),'' after ``(as defined in 
 subsection

    (hh)

    (1) ),''.

    (3) Temporary payment rates for certain services under the 
 rhc air and fqhc pps.--
        (A) AIR.--

Section 1833 of the Social Security Act 
 (42 U.S.C. 1395l), as amended by 

section 2

    (g)

    (2)
        (A) , is 
 amended--
            (i) in subsection

    (a)

    (3)
        (A) , by inserting 
 ``or audiology services (as defined in 

section 1861
            (ll) (3) )'' after ``(as defined in 

section 1861

    (nnn) ''; and
            (ii) in subsection

    (ee) , by inserting ``or 
 audiology services (as defined in 

section 1861
            (ll) (3) )'' after ``(as defined in 

section 1861

    (nnn) ''.
        (B) PPS.--

Section 1834

    (o)

    (6) of the Social Security 
 Act (42 U.S.C. 1395m

    (o)

    (6) ), as added by 

section 2

    (g)

    (2)
        (B) , is amended--
            (i) in the first sentence, by inserting 
 ``or audiology services (as defined in 

section 1861
            (ll) (3) )'' after ``(as defined in 

section 1861

    (nnn) )''; and
            (ii) in the second sentence, by inserting 
 ``or such audiology services'' after ``such 
 dental and oral health services''.

    (f) Expediting Implementation.--The Secretary of Health and Human 
Services shall implement this section for 2027 and 2028 through program 
instruction or other forms of program guidance.

    (g) Funding.--In addition to amounts otherwise available, there is 
appropriated to the Secretary of Health and Human Services for fiscal 
year 2025, out of any money in the Treasury not otherwise appropriated, 
$370,000,000, to remain available until expended, for purposes of 
implementing the amendments made by this section during the period 
beginning on January 1, 2026, and ending on September 30, 2035.

SEC. 4. PROVIDING COVERAGE FOR VISION CARE UNDER THE MEDICARE PROGRAM.

    (a) Coverage.--

Section 1861

    (s)

    (2) of the Social Security Act (42 
U.S.C. 1395x

    (s)

    (2) ), as amended by 

section 2

    (a) , is amended--

    (1) in subparagraph

    (JJ) , by striking ``and'' after the 
 semicolon at the end;

    (2) in subparagraph

    (KK) , by striking the period at the end 
 and adding ``; and''; and

    (3) by adding at the end the following new subparagraph:
 ``
            (LL) vision services (as defined in subsection

    (ooo) );''.

    (b) Vision Services Defined.--

Section 1861 of the Social Security 
Act (42 U.S.C. 1395x), as amended by 

section 2

    (b) , is amended by adding 
at the end the following new subsection:
 ``

    (ooo) Vision Services.--The term `vision services' means routine 
eye examinations to determine the refractive state of the eyes, 
including procedures performed during the course of such examination, 
furnished on or after January 1, 2027, by or under the direct 
supervision of an ophthalmologist or optometrist who is legally 
authorized to furnish such examinations or procedures (as applicable) 
under State law (or the State regulatory mechanism provided by State 
law) of the State in which the examinations or procedures are 
furnished.''.
            (c) Payment Limitations.--

Section 1834 of the Social Security Act 
(42 U.S.C. 1395m), as amended by 

section 2
            (c) (2) , is amended by adding 
at the end the following new subsection:
 ``

    (bb) Limitation for Vision Services.--With respect to vision 
services (as defined in 

section 1861

    (ooo) ) and an individual, payment 
shall be made under this part for only 1 routine eye examination 
described in such subsection during a 2-year period.''.
            (d) Payment Under Physician Fee Schedule.--

Section 1848

    (j)

    (3) of 
the Social Security Act (42 U.S.C. 1395w-4

    (j)

    (3) ) is amended by 
inserting ``

    (2)
            (LL) ,'' before ``

    (3) ''.

    (e) Coverage of Conventional Eyeglasses.--

Section 1861

    (s)

    (8) of the 
Social Security Act (42 U.S.C. 1395x

    (s)

    (8) ), as amended by 

section 3

    (b)

    (1) , is amended by striking ``, and including one pair of 
conventional eyeglasses or contact lenses furnished subsequent to each 
cataract surgery with insertion of an intraocular lens'' and inserting 
``, including 1 pair of conventional eyeglasses or contact lenses 
furnished subsequent to each cataract surgery with insertion of an 
intraocular lens, if furnished before January 1, 2027, and including 
conventional eyeglasses (as described in 

section 1834

    (h)

    (8) ), whether 
or not furnished subsequent to such a surgery, if furnished on or after 
January 1, 2027''.

    (f) Special Payment Rules for Eyeglasses.--

    (1) Limitations.--

Section 1834

    (h) of the Social Security 
 Act (42 U.S.C. 1395m

    (h) ), as amended by 

section 3

    (b)

    (2) , is 
 amended by adding at the end the following new paragraph:
 ``

    (8) Payment limitations for eyeglasses.--
 ``
        (A) In general.--With respect to conventional 
 eyeglasses furnished to an individual on or after 
 January 1, 2027, subject to subparagraph
        (B) , payment 
 shall be made under this part only during a 2-year 
 period, for 1 pair of eyeglasses (including lenses and 
 the frame).
 ``
        (B) Exception.--With respect to a 2-year period 
 described in subparagraph
        (A) , in the case of an 
 individual who receives cataract surgery with insertion 
 of an intraocular lens, payment shall be made under 
 this part for 1 pair of conventional eyeglasses 
 furnished subsequent to such cataract surgery during 
 such period.
 ``
            (C) Special rule.--The payment basis determined 
 under this subsection (including after application of 
 paragraph

    (1)
        (H) , relating to application of 
 competitive acquisition) for conventional eyeglasses 
 furnished to an individual on or after January 1, 2027, 
 shall not exceed the rate determined for such 
 eyeglasses under the Federal Supply Schedule of the 
 General Services Administration, as published by such 
 Administration in 2021, updated to the year involved 
 using the applicable percent increase for the year.
 ``
            (D) No coverage of certain items.--Payment shall 
 not be made under this part for deluxe eyeglasses or 
 conventional reading glasses.''.

    (2) Application of competitive acquisition.--
        (A) In general.--

Section 1834

    (h)

    (1)
        (H) of the 
 Social Security Act (42 U.S.C. 1395m

    (h)

    (1)
        (H) ), as 
 amended by 

section 3

    (b)

    (3)
        (A) , is amended--
            (i) in the heading, by striking ``and 
 hearing aids'' and inserting ``hearing aids, 
 and eyeglasses'';
            (ii) in the matter preceding clause
            (i) --
            (I) by striking ``or of hearing 
 aids'' and inserting ``of hearing 
 aids''; and
            (II) by inserting ``or of 
 eyeglasses described in paragraph

    (2)
        (E) of such section,'' after 
 ``paragraph

    (2)
            (D) of such section,''; 
 and
            (iii) in clause
            (i) , by striking ``or such 
 hearing aids'' and inserting ``, such hearing 
 aids, or such eyeglasses''.
        (B) Conforming amendment.--

Section 1847

    (a)

    (2) of 
 the Social Security Act (42 U.S.C. 1395w-3

    (a)

    (2) ), as 
 amended by 

section 3

    (b)

    (3)
        (B)
            (i) , is amended by adding 
 at the end the following new subparagraph:
 ``
        (F) Eyeglasses.--Eyeglasses described in 

section 1861

    (s)

    (8) for which payment would otherwise be made 
 under 

section 1834

    (h) .''.
            (C) Implementation.--

Section 1847

    (a) of the Social 
 Security Act (42 U.S.C. 1395w-3

    (a) ), as amended by 
 

section 3

    (b)

    (3)
        (B)
            (iii) , is amended by adding at the 
 end the following new paragraph:
 ``

    (9) Competition with respect to eyeglasses.--Not later 
 than January 1, 2030, the Secretary shall begin the competition 
 with respect to the items and services described in paragraph

    (2)
        (F) .''.

    (g) Exclusion Modifications.--

Section 1862

    (a) of the Social 
Security Act (42 U.S.C. 1395y

    (a) ), as amended by 

section 2

    (e) , is 
amended--

    (1) in paragraph

    (1) --
        (A) in subparagraph
        (P) , by striking ``and'' at the 
 end;
        (B) in subparagraph
        (Q) , by striking the semicolon 
 at the end and inserting ``, and''; and
            (C) by adding at the end the following new 
 subparagraph:
 ``
        (R) in the case of vision services (as defined in 

section 1861

    (ooo) ) that are routine eye examinations as described in 
 such section, which are furnished more frequently than once 
 during a 2-year period;''; and

    (2) in paragraph

    (7) --
        (A) by inserting ``(other than such an examination 
 that is a vision service that is covered under 

section 1861

    (s)

    (2)
            (LL) )'' after ``eye examinations''; and
        (B) by inserting ``(other than such a procedure 
 that is a vision service that is covered under 

section 1861

    (s)

    (2)
            (LL) )'' after ``refractive state of the 
 eyes''.

    (h) Inclusion as Excepted Medical Treatment.--

Section 1821

    (b)

    (5)
        (A)
            (iv) of the Social Security Act (42 U.S.C. 1395i-
5

    (b)

    (5)
        (A)
            (iv) ), as added by 

section 2

    (f) and amended by 

section 3
            (d) , 
is amended--

    (1) by striking ``or hearing aids'' and inserting ``hearing 
 aids''; and

    (2) by inserting ``, or vision services (as defined in 
 subsection

    (ooo) of such section)'' after ``subsection

    (s)

    (8) of such section''.
            (i) Rural Health Clinics and Federally Qualified Health Centers.--

    (1) Clarifying coverage of vision services as physicians' 
 services.--

Section 1861

    (aa)

    (1)
        (A) of the Social Security Act 
 (42 U.S.C. 1395x

    (aa)

    (1)
        (A) ), as amended by 

section 3

    (e)

    (1) , is 
 amended by inserting ``and vision services (as defined in 
 subsection

    (ooo) )'' after ``(as defined in subsection
            (ll) (3) )''.

    (2) Temporary payment rates for certain services under the 
 rhc air and fqhc pps.--
        (A) AIR.--

Section 1833 of the Social Security Act 
 (42 U.S.C. 1395l), as amended by sections 2

    (g)

    (2)
        (A) and 3

    (e)

    (3)
        (A) , is amended--
            (i) in subsection

    (a)

    (3)
        (A) --
            (I) by striking ``or audiology'' 
 and inserting ``, audiology''; and
            (II) by inserting ``, or vision 
 services (as defined in 

section 1861

    (ooo) )'' after ``(as defined in 
 

section 1861
            (ll) (3) )''; and
            (ii) in subsection

    (ee) --
            (I) by striking ``or audiology'' 
 and inserting ``, audiology''; and
            (II) by inserting ``, or vision 
 services (as defined in 

section 1861

    (ooo) )'' after ``(as defined in 
 

section 1861
            (ll) (3) )''.
        (B) PPS.--

Section 1834

    (o)

    (6) of the Social Security 
 Act (42 U.S.C. 1395m

    (o)

    (6) ), as added by 

section 2

    (g)

    (2)
        (B) and amended by 

section 3

    (e)

    (3)
        (B) , is 
 amended--
            (i) in the first sentence--
            (I) by striking ``or audiology'' 
 and inserting ``, audiology''; and
            (II) by inserting ``, or vision 
 services (as defined in 

section 1861

    (ooo) )'' after ``(as defined in 
 

section 1861
            (ll) (3) )''; and
            (ii) in the second sentence, by striking 
 ``or such audiology services'' and inserting 
 ``, such audiology services, or such vision 
 services''.

    (j) Expediting Implementation.--The Secretary of Health and Human 
Services shall implement this section for 2027 and 2028 through program 
instruction or other forms of program guidance.

    (k) Funding.--In addition to amounts otherwise available, there is 
appropriated to the Secretary of Health and Human Services for fiscal 
year 2025, out of any money in the Treasury not otherwise appropriated, 
$500,000,000, to remain available until expended, for purposes of 
implementing the amendments made by this section during the period 
beginning on January 1, 2026, and ending on September 30, 2034.

SEC. 5. PHASE-IN OF IMPACT OF DENTAL AND ORAL HEALTH COVERAGE ON PART B 
 PREMIUMS.

 

Section 1839

    (a) of the Social Security Act (42 U.S.C. 1395r

    (a) ) is 
amended--

    (1) in the second sentence of paragraph

    (1) , by striking 
 ``and

    (7) '' and inserting ``

    (7) , and

    (8) '';

    (2) in paragraph

    (3) , by striking ``The Secretary'' and 
 inserting ``Subject to paragraph

    (8)
            (C) , the Secretary''; and

    (3) by adding at the end the following:
 ``

    (8) Special rule for 2026 through 2030.--
 ``
        (A) Determination of alternative monthly 
 actuarial rate for each of 2026 through 2030.--For each 
 of 2026 through 2030, the Secretary shall, at the same 
 time as and in addition to the determination of the 
 monthly actuarial rate for enrollees age 65 and over 
 determined in each of 2025 through 2029 for the 
 succeeding calendar year according to paragraph

    (1) , 
 determine an alternative monthly actuarial rate for 
 enrollees age 65 and over for the year as described in 
 subparagraph
        (B) .
 ``
        (B) Alternative monthly actuarial rate 
 described.--
 ``
            (i) In general.--The alternative monthly 
 actuarial rate described in this subparagraph 
 is--
 ``
            (I) for 2026 and 2027, the 
 monthly actuarial rate for enrollees 
 age 65 and over for the year, 
 determined as if the amendments made by 
 

section 2 of the Medicare Dental, 
 Hearing, and Vision Expansion Act of 
 2025 did not apply; and
 ``
            (II) for 2028, 2029, and 2030, 
 the monthly actuarial rate for 
 enrollees age 65 and over for the year, 
 determined as if the amendments made by 
 such 

section 2 did not apply, plus the 
 applicable percent of the amount by 
 which--
 ``

    (aa) the monthly 
 actuarial rate for enrollees 
 age 65 and over for the year 
 determined according to 
 paragraph

    (1) ; exceeds
 ``

    (bb) the monthly 
 actuarial rate for enrollees 
 age 65 and over for the year, 
 determined as if the amendments 
 made by such 

section 2 did not 
 apply.
 ``
            (ii) Definition of applicable percent.--
 For purposes of this subparagraph, the term 
 `applicable percent' means--
 ``
            (I) for 2028, 25 percent;
 ``
            (II) for 2029, 50 percent; and
 ``
            (III) for 2030, 75 percent.
 ``
            (C) Application to part b premium and other 
 provisions of this part.--For each of 2026 through 
 2030, the Secretary shall use the alternative monthly 
 actuarial rate for enrollees age 65 and over for the 
 year determined under subparagraph
        (A) , in lieu of the 
 monthly actuarial rate for such enrollees for the year 
 determined according to paragraph

    (1) , when determining 
 the monthly premium rate for the year under paragraph

    (3) and subsection

    (j) , the part B deductible under 
 

section 1833

    (b) , and the premium subsidy and monthly 
 adjustment amount under subsection
            (i) .''.
 <all>