S939-119

2. Coverage of dental and oral health care Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)) is amended— in subparagraph (JJ), by adding and at the end; and by adding at the end the following new subparagraph: dental and oral health services (as defined in subsection (nnn)); Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended by adding at the end the following new subsection: 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): Preventive and screening services, including oral exams, dental cleanings, dental x-rays, and fluoride treatments. 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. Complete dentures, partial dentures, and implants, including related items and services. 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). 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. Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) is amended— in subparagraph (N), by inserting and dental and oral health services (as defined in section 1861(nnn)) after section 1861(hhh)(1)); by striking and before (HH); and 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). Section 1834 of the Social Security Act (42 U.S.C. 1395m) is amended by adding at the end the following new subsection: 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— the actual charge for the service; or 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 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). 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. 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. 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. Except as provided in clause (iii) and clause (iv), the national median fee for a dental or oral health service shall be equal to— 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 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). The applicable percent increase determined under this subclause for a year is an amount equal to the percentage increase between— the consumer price index for all urban consumers (United States city average) ending with June of the previous year; and the consumer price index for all urban consumers (United States city average) ending with June of 2026 (or 2025, in the case of dentures). 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). 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: The payment basis determined under section 1848. Fee schedules for dental and oral health services which shall include, as practicable, fee schedules— under Medicare Advantage plans under part C; under State plans (or waivers of such plans) under title XIX; and established by other health care payers. The Secretary shall make payment for dentures and associated professional services as a bundled payment as determined by the Secretary. 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. 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). 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. 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. With respect to dental and oral health services that are preventive and screening services described in paragraph (1)(A) of section 1861(nnn)— payment shall be made under this part for— not more than 2 oral exams in a year; not more than 2 dental cleanings in a year; not more than 1 fluoride treatment in a year; and not more than 1 full-mouth series of x-rays as part of a preventive and screening oral exam every 3 years; and 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. 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. 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. 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. 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: With respect to 2028 and each subsequent year, an oral health professional (as defined in section 1861(nnn)(3)). Section 1862(a) of the Social Security Act (42 U.S.C. 1395y(a)) is amended— in paragraph (1)— in subparagraph (O), by striking and at the end; in subparagraph (P), by striking the semicolon at the end and inserting , and; and by adding at the end the following new subparagraph: 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; 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). Section 1821(b)(5)(A) of the Social Security Act (42 U.S.C. 1395i–5(b)(5)(A)) is amended— in clause (ii), by striking or at the end; in clause (iii), by striking the period and inserting , or; and by adding at the end the following new clause: 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. Section 1861(aa) of the Social Security Act (42 U.S.C. 1395x(aa)), is amended— in paragraph (1)— in subparagraph (C), by striking and at the end; in subparagraph (D), by inserting and after the comma at the end; and by inserting after subparagraph (D) the following new subparagraph: 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, in paragraph (3)(A), by striking (D) and inserting (E). Section 1833 of the Social Security Act (42 U.S.C. 1395l) is amended— 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 by adding at the end the following new subsection: 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. 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: 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. 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. (KK)dental and oral health services (as defined in subsection (nnn));. (nnn)Dental and oral health services(1)In generalExcept 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 servicesPreventive and screening services, including oral exams, dental cleanings, dental x-rays, and fluoride treatments.(B)Procedures and treatment servicesServices 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 prostheticsComplete dentures, partial dentures, and implants, including related items and services.(2)ExclusionsSuch 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 professionalThe 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.. (aa)Payment and limits for dental and oral health services(1)PaymentThe 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 generalThe 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)ConsultationIn 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 generalFor 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 generalExcept 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 increaseThe 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 adjustmentAfter 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 dataIf 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 generalThe Secretary shall make payment for dentures and associated professional services as a bundled payment as determined by the Secretary. (II)Payment considerationsIn 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 updateThe 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 generalThe 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 adjustmentsThe 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)LimitationsWith 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 providersIn 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 liabilityThe 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 administratorThe 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.. (ix)With respect to 2028 and each subsequent year, an oral health professional (as defined in section 1861(nnn)(3)).. (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 (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.. (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 (ee)Disregard of costs attributable to certain services from calculation of RHC AIRPayments 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.. (6)Temporary payment rates based on pfs for certain servicesThe 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..

3. Providing coverage for hearing care under the Medicare program Section 1861(ll) of the Social Security Act (42 U.S.C. 1395x(ll)) is amended— in paragraph (3)— by inserting (A) after (3); in subparagraph (A), as added by clause (i) of this subparagraph— by striking means such hearing and balance assessment services and inserting “means— 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) in clause (i), as added by subclause (I) of this clause, by striking the period at the end and inserting ; and; and by adding at the end the following new clause: 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. by adding at the end the following new subparagraph: 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. in paragraph (4), by adding at the end the following new subparagraph: The term qualified hearing aid professional means an individual who— 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 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). 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— by striking and before (II); and 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. 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: Beginning on January 1, 2027, a qualified audiologist (as defined in section 1861(ll)(4)(B)). Section 1842(b)(18) of the Social Security Act (42 U.S.C. 1395u(b)(18)) is amended— in each of subparagraphs (A) and (B), by striking subparagraph (C) and inserting subparagraph (C) or, beginning on January 1, 2027, subparagraph (E); and by adding at the end the following new subparagraph: A practitioner described in this subparagraph is a qualified hearing aid professional (as defined in section 1861(ll)(4)(C)). 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. 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: 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. 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— not more than once per ear during a 5-year period; only for types of such hearing aids that are determined appropriate by the Secretary; and 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. 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. In this subsection: The term hearing aid means the item and related services including selection, fitting, adjustment, and patient education and training. The term qualified hearing aid supplier means— a qualified audiologist; a physician (as defined in section 1861(r)(1)); a physician assistant, nurse practitioner, or clinical nurse specialist; a qualified hearing aid professional (as defined in section 1861(ll)(4)(C)); and other suppliers as determined by the Secretary. Section 1834(h)(1)(H) of the Social Security Act (42 U.S.C. 1395m(h)(1)(H)) is amended— in the header, by inserting and hearing aids after orthotics; in the matter preceding clause (i), by inserting or of hearing aids described in paragraph (2)(D) of such section, after 2011,; and in clause (i), by inserting or such hearing aids after such orthotics. 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: Hearing aids described in section 1861(s)(8) for which payment would otherwise be made under section 1834(h). 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: 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. 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: Not later than January 1, 2031, the Secretary shall begin the competition with respect to the items and services described in paragraph (2)(E). 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: In the case of hearing aid examination services and hearing aids— furnished on or after January 1, 2027, and before January 1, 2029; and 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. 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. 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). 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. 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)),. Section 1833 of the Social Security Act (42 U.S.C. 1395l), as amended by section 2(g)(2)(A), is amended— 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 in subsection (ee), by inserting or audiology services (as defined in section 1861(ll)(3)) after (as defined in section 1861(nnn). 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— in the first sentence, by inserting or audiology services (as defined in section 1861(ll)(3)) after (as defined in section 1861(nnn)); and in the second sentence, by inserting or such audiology services after such dental and oral health services. The Secretary of Health and Human Services shall implement this section for 2027 and 2028 through program instruction or other forms of program guidance. 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. (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)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 (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 (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).. (x)Beginning on January 1, 2027, a qualified audiologist (as defined in section 1861(ll)(4)(B)).. (E)A practitioner described in this subparagraph is a qualified hearing aid professional (as defined in section 1861(ll)(4)(C)).. (6)Payment only on an assignment-related basisPayment 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 generalPayment 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 ruleThe 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)DefinitionsIn this subsection:(i)Hearing aidThe term hearing aid means the item and related services including selection, fitting, adjustment, and patient education and training.(ii)Qualified hearing aid supplierThe 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.. (E)Hearing aidsHearing aids described in section 1861(s)(8) for which payment would otherwise be made under section 1834(h).. (C)Certain hearing aidsThose 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.. (8)Competition with respect to hearing aidsNot later than January 1, 2031, the Secretary shall begin the competition with respect to the items and services described in paragraph (2)(E).. (6)Hearing aids and servicesIn 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..

4. Providing coverage for vision care under the Medicare program Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)), as amended by section 2(a), is amended— in subparagraph (JJ), by striking and after the semicolon at the end; in subparagraph (KK), by striking the period at the end and adding ; and; and by adding at the end the following new subparagraph: vision services (as defined in subsection (ooo)); 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: 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. 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: 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. 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). 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. 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: 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). 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. 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. Payment shall not be made under this part for deluxe eyeglasses or conventional reading glasses. 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— in the heading, by striking and hearing aids and inserting hearing aids, and eyeglasses; in the matter preceding clause (i)— by striking or of hearing aids and inserting of hearing aids; and by inserting or of eyeglasses described in paragraph (2)(E) of such section, after paragraph (2)(D) of such section,; and in clause (i), by striking or such hearing aids and inserting , such hearing aids, or such eyeglasses. 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: Eyeglasses described in section 1861(s)(8) for which payment would otherwise be made under section 1834(h). 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: Not later than January 1, 2030, the Secretary shall begin the competition with respect to the items and services described in paragraph (2)(F). Section 1862(a) of the Social Security Act (42 U.S.C. 1395y(a)), as amended by section 2(e), is amended— in paragraph (1)— in subparagraph (P), by striking and at the end; in subparagraph (Q), by striking the semicolon at the end and inserting , and; and by adding at the end the following new subparagraph: 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; in paragraph (7)— 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 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. 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— by striking or hearing aids and inserting hearing aids; and by inserting , or vision services (as defined in subsection (ooo) of such section) after subsection (s)(8) of such section. 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)). 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— in subsection (a)(3)(A)— by striking or audiology and inserting , audiology; and by inserting , or vision services (as defined in section 1861(ooo)) after (as defined in section 1861(ll)(3)); and in subsection (ee)— by striking or audiology and inserting , audiology; and by inserting , or vision services (as defined in section 1861(ooo)) after (as defined in section 1861(ll)(3)). 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— in the first sentence— by striking or audiology and inserting , audiology; and by inserting , or vision services (as defined in section 1861(ooo)) after (as defined in section 1861(ll)(3)); and in the second sentence, by striking or such audiology services and inserting , such audiology services, or such vision services. The Secretary of Health and Human Services shall implement this section for 2027 and 2028 through program instruction or other forms of program guidance. 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. (LL)vision services (as defined in subsection (ooo));. (ooo)Vision servicesThe 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.. (bb)Limitation for vision servicesWith 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.. (8)Payment limitations for eyeglasses(A)In generalWith 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)ExceptionWith 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 ruleThe 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 itemsPayment shall not be made under this part for deluxe eyeglasses or conventional reading glasses.. (F)EyeglassesEyeglasses described in section 1861(s)(8) for which payment would otherwise be made under section 1834(h).. (9)Competition with respect to eyeglassesNot later than January 1, 2030, the Secretary shall begin the competition with respect to the items and services described in paragraph (2)(F).. (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