42 U.S.C. 1395x(s)(2)(II)changedby H.R. 2045 Sec. 2(a)
The bill says: in subparagraph (II), by striking "and" after the semicolon at the end;
Bill text · Current law (42 U.S.C. 1395x)
42 U.S.C. 1395x(s)(2)(JJ)changedby H.R. 2045 Sec. 2(a)
The bill says: in subparagraph (JJ), by adding "and" after the semicolon at the end; and
Bill text · Current law (42 U.S.C. 1395x)
42 U.S.C. 1395x(s)(2)added (KK)by H.R. 2045 Sec. 2(a)
(KK) dental and oral health services (as defined in subsection (nnn));
The bill says: by adding at the end the following new subparagraph:
Bill text · Current law (42 U.S.C. 1395x)
42 U.S.C. 1395xadded (nnn)by H.R. 2045 Sec. 2(b)
(nnn) Dental and oral health services.— The term dental and oral health services means—(1) preventative and screening services, such as oral exams, dental cleanings, dental x-rays, and fluoride treatments;(2) basic dental services, such as tooth restorations, basic periodontics services, tooth extractions, and oral disease management services;(3) major dental services, such as major tooth restorations, major periodontics services, bridges, crowns, root canals, and extractions;(4) emergency dental care; and(5) other necessary services related to dental or oral health (as defined by the Secretary).
The bill says: Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended by adding at the end the following new subsection:
Bill text · Current law (42 U.S.C. 1395x)
42 U.S.C. 1395l(a)(1)changedby H.R. 2045 Sec. 2(c)
(1) in the case of services described in section 1395k(a)(1) of this title—80 percent of the reasonable charges for the services; except that (A) an organization which provides medical and other health services (or arranges for their availability) on a prepayment basis (and either is sponsored by a union or employer, or does not provide, or arrange for the provision of, any inpatient hospital services) may elect to be paid…
The bill says: by striking "and" before "(GG)"; and
Bill text · Current law (42 U.S.C. 1395l)
42 U.S.C. 1395l(a)(1)addedby H.R. 2045 Sec. 2(c)
The bill says: by inserting before the semicolon at the end the following: ", and (HH) with respect to dental and oral health services (as defined in section 1861(lll)), the amount paid shall be the payment amount specified under section 1834(aa)".
Bill text · Current law (42 U.S.C. 1395l)
42 U.S.C. 1395madded (aa)by H.R. 2045 Sec. 2(c)
(aa) Payment and limits for dental and oral health services.—(1) In general.— The payment amount under this part for dental and oral health services (as defined in section 1861(nnn)) shall be, subject to paragraph (3), the applicable percent (specified in paragraph (2)) of the lesser of the actual charge for the services or the amount determined under the payment basis determined under section 1848.(2) Applicable percent.—(A) In general.— For purposes of paragraph (1), except as provided in subparagraph (B), the applicable percent specified in this paragraph is—(i) with respect to services described in section 1861(nnn)(1) furnished during 2026 or a subsequent year, 100 percent; and(ii) with respect to services not described in clause (i)—(I) for a year before 2027, 0 percent;(II) for 2027, 30 percent;(III) for 2028, 60 percent; and(IV) for 2029 and each subsequent year, 80 percent.(B) Special rule for certain low-income individuals.— For purposes of paragraph (1), the applicable percent specified in this paragraph is, with respect to services furnished to an individual who is a subsidy eligible individual (as defined in section 1860D–14(a)(3)), or who would be a subsidy eligible individual if the individual were enrolled in a prescription drug plan or MA–PD plan—(i) with respect to services described in section 1861(nnn)(1), for 2026 and each subsequent year, 100 percent; and(ii) with respect to services not described in clause (i), for 2027 and each subsequent year, 80 percent.(3) Limitations and Secretarial authority.—(A) Frequency.— With respect to dental and oral health services that are—(i) routine dental cleanings, payment may be made under this part for only two such cleanings during a 12-month period; and(ii) routine exams, payment may be made under this part for only two such exams during a 12-month period.(B) Secretarial authority.—(i) Authority to apply additional limitations.— The Secretary may apply such other reasonable limitations on the extent to which dental and oral services are covered under this part, including through application of a prior authorization requirement.(ii) Authority to modify coverage.— Notwithstanding any other provision of this title, if the Secretary determines appropriate, the Secretary may modify the coverage under this part of dental and oral health services to the extent that such modification is consistent with the recommendations of the United States Preventive Services Task Force.(iii) Authority to waive frequency limitations.— Notwithstanding subparagraph (A), the Secretary may waive any frequency limitation under such subparagraph for an individual (or category of individuals) if determined appropriate by the Secretary.
The bill says: Section 1834 of the Social Security Act (42 U.S.C. 1395m) is amended by adding at the end the following new subsection:
Bill text · Current law (42 U.S.C. 1395m)
42 U.S.C. 1395w-4(j)(3)changedby H.R. 2045 Sec. 2(d)
(2)(KK), (3) Physicians' services. The term "physicians' services" includes items and services described in paragraphs (1), (2)(A), (2)(D), (2)(G), (2)(P) (with respect to services described in subparagraphs (A) and (C) of section 1395x(oo)(2) of…
The bill says: Section 1848(j)(3) of the Social Security Act (42 U.S.C. 1395w–4(j)(3)) is amended by inserting "(2)(KK)," before "(3)".
Bill text · Current law (42 U.S.C. 1395w-4)
42 U.S.C. 1395x(s)(8)changedby H.R. 2045 Sec. 2(e)
(8) prosthetic devices (other than dental)(including dentures) which replace all or part of an internal body organ (including colostomy bags and supplies directly related to colostomy care), including replacement of such devices, and including one pair of conventional eyeglasses or contact lenses furnished subsequent to each cataract surgery with insertion of an intraocular lens;
The bill says: by striking "(other than dental)" and inserting "(including dentures)"; and
Bill text · Current law (42 U.S.C. 1395x)
42 U.S.C. 1395x(s)(8)changedby H.R. 2045 Sec. 2(e)
(8) prosthetic devices (other than dental) which replace all or part of an internal body organ (including colostomy bags and supplies directly related to colostomy care), including replacement of such devices, and including one pair of conventional eyeglasses or contact lenses furnished subsequent to each cataract surgery with insertion of an intraocular lens;
The bill says: by striking "internal body".
Bill text · Current law (42 U.S.C. 1395x)
42 U.S.C. 1395m(a)added (23)by H.R. 2045 Sec. 2(e)
(23) Payment and limits for dentures.—(A) In general.— The payment amount under this part for dentures shall be, subject to subparagraph (C), the applicable percent (specified in subparagraph (B)) of the amount otherwise payable for such dentures under this section.(B) Applicable percent.— For purposes of subparagraph (A), the applicable percent specified in this subparagraph is—(i) for a year before 2027, 0 percent; and(ii) for 2027 and each subsequent year, 80 percent.(C) Limitations and Secretarial authority.—(i) In general.— Payment may be made under this part for an individual for—(I) not more than one full upper and one full lower denture once every five years; and(II) not more than one partial upper denture and one partial lower denture once every five years.(ii) Secretarial authority.—(I) Authority to apply additional limitations.— The Secretary may apply such other reasonable limitations on the extent to which dentures are covered under this part, including through application of a prior authorization requirement.(II) Authority to modify coverage.— Notwithstanding any other provision of this title, if the Secretary determines appropriate, the Secretary may modify the coverage under this part of dentures to the extent that such modification is consistent with the recommendations of the United States Preventive Services Task Force.(III) Authority to waive frequency limitations.— Notwithstanding clause (i), the Secretary may waive any frequency limitation under such clause for an individual (or category of individuals) if determined appropriate by the Secretary.
The bill says: Section 1834(a) of the Social Security Act (42 U.S.C. 1395m(a)) is amended by adding at the end the following new paragraph:
Bill text · Current law (42 U.S.C. 1395m)
42 U.S.C. 1395y(a)removedby H.R. 2045 Sec. 2(f)
The bill says: Section 1862(a) of the Social Security Act (42 U.S.C. 1395y) is amended by striking paragraph (12).
Bill text · Current law (42 U.S.C. 1395y)
42 U.S.C. 1395w-4(j)(3)changedby H.R. 2045 Sec. 3(d)
The bill says: Section 1848(j)(3) of the Social Security Act (42 U.S.C. 1395w–4(j)(3)) is amended by inserting "(2)(LL)," after "(2)(KK)," (as added by section 2).
Bill text · Current law (42 U.S.C. 1395w-4)
42 U.S.C. 1395x(n)changedby H.R. 2045 Sec. 3(f)
(n) Durable medical equipment. The term "durable medical equipment" includes iron lungs, oxygen tents, hospital beds, and wheelchairs (which may include a power-operated vehicle that may be appropriately used as a wheelchair, but only where the use of such a vehicle is determined to be necessary on the basis of the individual's medical and physical condition…
The bill says: by striking "and" before "eye tracking" and inserting a comma; and
Bill text · Current law (42 U.S.C. 1395x)
42 U.S.C. 1395x(n)changedby H.R. 2045 Sec. 3(f)
…established by the Secretary in consultation with the appropriate organizations) and eye tracking and gaze interaction accessories for speech generating devices furnished to individuals with a demonstrated medical need for such accessories, and eyeglass lenses, low vision devices (as defined in section 1834(a)(25)), eyeglass frames, and contact lenses ; except that such term does not include such equipment furnished by a supplier who has used, for the demonstration and use of specific equipment, an individual who has not met such minimum training standards as the Secretary may establish…
The bill says: by inserting ", and eyeglass lenses, low vision devices (as defined in section 1834(a)(25)), eyeglass frames, and contact lenses" before "; except".
Bill text · Current law (42 U.S.C. 1395x)
42 U.S.C. 1395y(a)(7)changedby H.R. 2045 Sec. 3(g)
The bill says: Section 1862(a)(7) of the Social Security Act (42 U.S.C. 1395y(a)(7)) is amended by striking ", eyeglasses (other than eyewear described in section 1861(s)(8)) or eye examinations for the purpose of prescribing, fitting, or changing eyeglasses, procedures performed (during the course of any eye examination) to determine the refractive state of the eyes".
Bill text · Current law (42 U.S.C. 1395y)
42 U.S.C. 1395x(ll)changedby H.R. 2045 Sec. 4(a)
The bill says: in the subsection heading, by inserting "; Hearing Services" after "Audiology Services"; and
Bill text · Current law (42 U.S.C. 1395x)
42 U.S.C. 1395x(ll)added (5)by H.R. 2045 Sec. 4(a)
(5) The term hearing services means—(A) routine hearing exams and exams for hearing aids; and(B) other necessary services related to hearing health (as defined by the Secretary).
The bill says: by adding at the end the following new paragraph:
Bill text · Current law (42 U.S.C. 1395x)
42 U.S.C. 1395w-3(a)(2)changedby H.R. 2045 Sec. 5(1)
…E1237, E1238, and K0008 or any successor to such codes) (and related accessories when furnished in connection with such complex rehabilitative power wheelchairs, complex rehabilitative manual wheelchairs, and certain manual wheelchairs), and excludingexcluding drugs and biologicals described in section 1395u(o)(1)(D) of this title. Items and services described in section 1395u(s)(2)(D) of this title, other than parenteral nutrients, equipment, and supplies. Orthotics described in section…
The bill says: by striking "and excluding" and inserting "excluding"; and
Bill text · Current law (42 U.S.C. 1395w-3)
42 U.S.C. 1395w-3(a)(2)changedby H.R. 2045 Sec. 5(2)
The bill says: by inserting ", and excluding dentures, eyeglass lenses, contact lenses, and hearing aids" before the period at the end.
Bill text · Current law (42 U.S.C. 1395w-3)
42 U.S.C. 299b-4(a)(1)changedby H.R. 2045 Sec. 6(a)
The bill says: The first sentence of section 915(a)(1) of the Public Health Service Act (42 U.S.C. 299b–4(a)(1)) is amended by inserting ", including at least 1 oral health professional" before the period at the end.
Bill text · Current law (42 U.S.C. 299b-4)