[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1326 Introduced in House (IH)]
<DOC>
118th CONGRESS
1st Session
H. R. 1326
To modify the limitation on the deduction by individuals of certain
State and local taxes and to provide coverage for hearing and vision
care under the Medicare program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 1, 2023
Ms. Porter introduced the following bill; which was referred to the
Committee on Ways and Means, and in addition to the Committee on Energy
and Commerce, for a period to be subsequently determined by the
Speaker, in each case for consideration of such provisions as fall
within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To modify the limitation on the deduction by individuals of certain
State and local taxes and to provide coverage for hearing 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 ``Supporting Americans with Lower
Taxes Act'' or as the ``SALT Act''.
SEC. 2. MODIFICATION OF LIMITATION ON THE DEDUCTION BY INDIVIDUALS OF
CERTAIN STATE AND LOCAL, ETC., TAXES.
(a) In General.--Section 164(b)(6) of the Internal Revenue Code of
1986 is amended to read as follows:
``(6) Limitation on deduction by certain high-income
individuals.--
``(A) In general.--In the case of a taxpayer with
adjusted gross income which equals or exceeds $400,000
for any taxable year--
``(i) foreign real property taxes shall not
be taken into account under subsection (a)(1)
(or section 216(a)) for such taxable year, and
``(ii) the aggregate amount of taxes taken
into account under paragraphs (1), (2), and (3)
of subsection (a) and paragraph (5) of this
subsection (and any tax described in any such
paragraph taken into account under section
216(a)(1)) for such taxable year shall not
exceed $60,000.
``(B) Phasedown of limitation based on adjusted
gross income.--The $60,000 amount in subparagraph
(A)(ii) shall be reduced (but not below zero) by the
dollar amount which bears the same ratio to $60,000
as--
``(i) the excess of the taxpayer's adjusted
gross income over $400,000, bears to
``(ii) $600,000.
``(C) Application restricted to certain taxpayers
and taxes.--
``(i) Application to individuals.--
Subparagraph (A) shall only apply to
individuals, estates, and trusts.
``(ii) Exclusion of certain business
taxes.--Subparagraph (A) shall not apply to any
foreign taxes described in subsection (a)(3) or
to any taxes described in paragraph (1) and (2)
of subsection (a) which are paid or accrued in
carrying on a trade or business or an activity
described in section 212.
``(D) Married individuals filing a separate
return.--In the case of a married individual filing a
separate return, subparagraphs (A) and (B) shall be
applied--
``(i) by substituting `$200,000' for
`$400,000' each place it appears,
``(ii) by substituting `$30,000' for
`$60,000' each place it appears, and
``(iii) by substituting `$300,000' for
`$600,000' in subparagraph (B)(ii).
``(E) Estates and trusts.--In the case of an estate
or trust, adjusted gross income shall be determined as
provided in section 67(e).
``(F) Denial of deduction to billionaires.--Unless
the taxpayer has less than $1,000,000,000 ($500,000,000
in the case of a married individual filing a separate
return) in assets as of the close of the taxable year
(and attests to such fact under penalty of perjury at
such time and in such manner as the Secretary may
provide)--
``(i) subparagraph (A) shall be applied--
``(I) by substituting `zero' for
`$400,000', and
``(II) by substituting `zero' for
`$60,000', and
``(ii) subparagraphs (B) and (D) shall not
apply.
For purposes of this subparagraph, the term `assets'
means all property, real or personal, tangible or
intangible, wherever situated (within the meaning of
section 2031) and such property shall be valued in the
same manner as for purposes of part III of subchapter A
of chapter 11.''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply to taxable years beginning after the date of the enactment of
this Act.
(c) Appropriations to Federal Supplementary Medical Insurance Trust
Fund.--
(1) In general.--There are hereby appropriated to the
Federal Supplementary Medical Insurance Trust Fund amounts
equivalent to the amounts received in the Treasury by reason of
the amendment made by subsection (a). Rules similar to the
rules of section 9601 of the Internal Revenue Code of 1986
shall apply with respect to transfers made by reason of the
preceding sentence.
(2) Conforming amendment.--Section 1841(a) of the Social
Security Act (42 U.S.C. 1395t) is amended by inserting ``, or
section 2(b) of the SALT Act,'' after ``this part''.
SEC. 3. PROVIDING COVERAGE FOR HEARING CARE UNDER THE MEDICARE PROGRAM.
(a) Provision of Audiology Services by Qualified Audiologists and
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 ``(and, beginning January
1, 2025, such aural rehabilitation and
treatment services)'' after ``assessment
services'';
(ii) by inserting ``, and, beginning on
January 1, 2025, such hearing assessment
services furnished by a qualified hearing aid
professional,'' after ``by a qualified
audiologist''; and
(iii) by striking ``the audiologist'' and
inserting ``the audiologist or qualified
hearing aid professional''; and
(B) in paragraph (4), by adding at the end the
following new subparagraph:
``(C) The term `qualified hearing aid professional' means,
with respect to hearing assessment services described in
paragraph (3), 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) meets such other requirements as the
Secretary determines appropriate (including
requirements relating to educational certifications or
accreditations), taking into account any additional
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 the 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)) is amended--
(A) by striking ``and'' before ``(HH)''; and
(B) by inserting before the semicolon at the end
the following: ``and (II) with respect to hearing
assessment services (as described in paragraph (3) 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''.
(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, 2025, to individuals diagnosed 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 section 1842(b)(18)(B) shall apply to hearing aids in the
same manner as they apply to services furnished by a
practitioner described in subsection (b)(18)(C).
``(7) Limitations for hearing aids.--Payment may be made
under this part with respect to an individual, with respect to
hearing aids furnished on or after January 1, 2025--
``(A) not more than once per ear during a 5-year
period;
``(B) only for types of such hearing aids that are
determined appropriate by the Secretary; and
``(C) 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 so defined), physician assistant,
nurse practitioner, or clinical nurse specialist.''.
(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) 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 amendment.--
(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:
``(D) 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)(D) 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.''.
(4) Inclusion of qualified audiologists and qualified
hearing aid professionals as certain practitioners to receive
payment on an assignment-related basis.--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 clauses:
``(ix) Beginning on January 1, 2025, a
qualified audiologist (as defined in section
1861(ll)(4)(B)).
``(x) A qualified hearing aid professional
(as defined in section 1861(ll)(4)(C)).''.
(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)
of the Social Security Act (42 U.S.C. 1395i-5(b)(5)(A)) is amended--
(1) in clause (i), by striking ``or'';
(2) in clause (ii), by striking the period and inserting
``, or''; and
(3) by adding at the end the following new clause:
``(iii) consisting of audiology services
described in subsection (ll)(3) of section
1861, or hearing aids described in subsection
(s)(8) of such section, that are payable under
part B as a result of the amendments made by
the SALT Act.''.
(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) is amended--
(i) in subsection (a)(3)(A), by inserting
``(which shall, in the case of audiology
services (as defined in section 1861(ll)(3)),
in lieu of any limits on reasonable charges
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 audiology services (as defined in section 1861(ll)(3)) 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:
``(5) Temporary payment rates based on pfs for certain
services.--The Secretary shall, in establishing payment rates
for audiology services (as defined in section 1861(ll)(3)) 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 audiology 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.''.
(f) Implementation.--
(1) In general.--In addition to amounts otherwise
available, the Secretary of Health and Human Services shall
provide for the transfer from the Federal Supplementary Medical
Insurance Trust Fund established under section 1841 of the
Social Security Act (42 U.S.C. 1395t) to the Centers for
Medicare & Medicaid Services Program Management Account of--
(A) $20,000,000 for each of fiscal years 2024 and
2025 for purposes of implementing the amendments made
by this section; and
(B) such sums as determined appropriate by the
Secretary for each subsequent fiscal year for purposes
of administering the provisions of such amendments.
(2) Availability and additional use of funds.--Funds
transferred pursuant to paragraph (1) shall remain available
until expended and may be used, in addition to the purposes
specified in paragraph (1), to implement the amendments made by
section 4.
(3) Administration.--The Secretary may implement, by
program instruction or otherwise, any of the provisions of, or
amendments made by, this section.
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)) is amended--
(1) in subparagraph (II), by striking ``and'' after the
semicolon at the end;
(2) in subparagraph (JJ), by striking the period at the end
and adding ``; and''; and
(3) by adding at the end the following new subparagraph:
``(KK) vision services (as defined in subsection (nnn));''.
(b) Vision 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) Vision Services.--The term `vision services' means--
``(1) routine eye examinations to determine the refractive
state of the eyes, including procedures performed during the
course of such examination; and
``(2) contact lens fitting services,
furnished on or after January 1, 2025, by or under the direct
supervision of an ophthalmologist or optometrist who is legally
authorized to furnish such examinations, procedures, or fitting
services (as applicable) under State law (or the State regulatory
mechanism provided by State law) of the State in which the
examinations, procedures, or fitting services are furnished.''.
(c) Payment Limitations.--Section 1834 of the Social Security Act
(42 U.S.C. 1395m) is amended by adding at the end the following new
subsection:
``(aa) Limitation for Vision Services.--With respect to vision
services (as defined in section 1861(nnn)) and an individual, payment
may be made under this part for only 1 routine eye examination
described in paragraph (1) of such section and 1 contact lens fitting
service described in paragraph (2) of such section 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)(KK),'' before ``(3)''.
(e) Coverage of Conventional Eyeglasses and Contact Lenses.--
(1) In general.--Section 1861(s)(8) of the Social Security
Act (42 U.S.C. 1395x(s)(8)) 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 one pair of
conventional eyeglasses or contact lenses furnished subsequent
to each cataract surgery with insertion of an intraocular lens,
if furnished before January 1, 2025, and including conventional
eyeglasses or contact lenses (as described in section
1834(h)(8)), whether or not furnished subsequent to such a
surgery, if furnished on or after January 1, 2025''.
(2) Conforming amendment.--Section 1842(b)(11)(A) of the
Social Security Act (42 U.S.C. 1395u(b)(11)(A)) is amended by
inserting ``furnished prior to January 1, 2025,'' after
``relating to them,''.
(f) Special Payment Rules for Eyeglasses and Contact Lenses.--
(1) Limitations.--Section 1834(h) of the Social Security
Act (42 U.S.C. 1395m(h)), as amended by section 3, is further
amended by adding at the end the following new paragraph:
``(8) Payment limitations for eyeglasses and contact
lenses.--
``(A) In general.--With respect to eyeglasses and
contact lenses furnished to an individual on or after
January 1, 2025, subject to subparagraph (B), payment
may be made under this part only--
``(i) during a 2-year period, for either 1
pair of eyeglasses (including lenses and
frames) or not more than a 2-year supply of
contact lenses;
``(ii) with respect to amounts attributable
to the lenses and frames of such a pair of
eyeglasses or amounts attributable to such a 2-
year supply of contact lenses, in an amount not
greater than--
``(I) for a pair of eyeglasses
furnished in, or a 2-year supply of
contact lenses beginning in, 2025--
``(aa) $85 for the lenses
of such pair of eyeglasses and
$85 for the frames of such pair
of eyeglasses; or
``(bb) $85 for such 2-year
supply of contact lenses; and
``(II) for the lenses and frames of
a pair of eyeglasses furnished in, or a
2-year supply of contact lenses
beginning in, a subsequent year, the
dollar amounts specified under this
subparagraph for the previous year,
increased by the percentage change in
the consumer price index for all urban
consumers (United States city average)
for the 12-month period ending with
June of the previous year;
``(iii) if furnished pursuant to a written
order of an ophthalmologist or optometrist
described in subsection (nnn); and
``(iv) if during the 2-year period
described in clause (i), the individual did not
already receive (as described in subparagraph
(B)) one pair of conventional eyeglasses or
contact lenses subsequent to a cataract surgery
with insertion of an intraocular lens furnished
during such period.
``(B) Exception.--With respect to a 2-year period
described in subparagraph (A)(i), in the case of an
individual who receives cataract surgery with insertion
of an intraocular lens, notwithstanding subparagraph
(A), payment may be made under this part for one pair
of conventional eyeglasses or contact lenses furnished
subsequent to such cataract surgery during such period.
``(C) Limitation on judicial review.--There shall
be no administrative or judicial review under section
1869 or otherwise of--
``(i) the determination of the types of
eyeglasses and contact lenses covered under
this paragraph; or
``(ii) the determination of fee schedule
rates under this subsection for eyeglasses and
contact lenses.''.
(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, is further amended--
(i) in the header, by striking ``and
hearing aids'' and inserting ``hearing aids,
eyeglasses, and contact lenses'';
(ii) by inserting ``and of eyeglasses and
contact lenses described in paragraph (2)(E) of
such section,'' after ``paragraph (2)(D) of
such section,''; and
(iii) in clause (i), by inserting ``, or
such eyeglasses and contact lenses'' after
``such hearing aids''.
(B) Conforming amendment.--
(i) In general.--Section 1847(a)(2) of the
Social Security Act (42 U.S.C. 1395w-3(a)(2)),
as amended by section 3, is further amended by
adding at the end the following new
subparagraph:
``(E) Eyeglasses and contact lenses.--Eyeglasses
and contact lenses 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)), as amended by section 3, is further
amended by adding at the end the following new
subparagraph:
``(D) Certain eyeglasses and contact lenses.--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.''.
(g) 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 vision services (as defined in section
1861(nnn)) that are routine eye examinations and contact lens
fitting services (as described in paragraph (1) or (2),
respectively, of 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)(KK))'' 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)(KK))'' after ``refractive state of the
eyes''.
(h) Implementation.--
(1) Funding.--
(A) In general.--In addition to amounts otherwise
available, the Secretary of Health and Human Services
(in this subsection referred to as the ``Secretary'')
shall provide for the transfer from the Federal
Supplementary Medical Insurance Trust Fund under
section 1841 of the Social Security Act (42 U.S.C.
1395t) to the Centers for Medicare & Medicaid Services
Program Management Account of--
(i) $20,000,000 for each of fiscal years
2024 and 2025 for purposes of implementing the
amendments made by this section; and
(ii) such sums as determined appropriate by
the Secretary for each subsequent fiscal year
for purposes of administering the provisions of
such amendments.
(B) Availability and additional use of funds.--
Funds transferred pursuant to subparagraph (A) shall
remain available until expended and may be used, in
addition to the purpose specified in subparagraph
(A)(i), to implement the amendments made by section 3.
(2) Administration.--The Secretary may implement, by
program instruction or otherwise, any of the provisions of, or
amendments made by, this section.
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