[Congressional Record Volume 168, Number 133 (Saturday, August 6, 2022)]
[Senate]
[Pages S4238-S4243]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

  SA 5211. Mr. SANDERS (for himself and Mr. Merkley) proposed an 
amendment to amendment SA 5194 proposed by Mr. Schumer to the bill H.R. 
5376, to provide for reconciliation pursuant to title II of S. Con. 
Res. 14; as follows:

        At the end of subtitle B of title I, add the following:

PART 6--MEDICARE COVERAGE OF DENTAL AND ORAL HEALTH CARE, HEARING CARE, 
                            AND VISION CARE

                      Subpart A--Medicare Coverage

     SEC. 11501. INTERIM DENTAL PROGRAM.

       Title XVIII of the Social Security Act (42 U.S.C. 1395 et 
     seq.) is amended by inserting after section 1866F the 
     following new section:

     ``SEC. 1866G. INTERIM DENTAL PROGRAM.

       ``(a) Establishment.--The Secretary shall establish an 
     interim Medicare dental program (in this section referred to 
     as the `program') by not later than 6 months after the date 
     of the enactment of this section. Under the program, payment 
     shall be made for eligible expenses of eligible beneficiaries 
     in accordance with this section.
       ``(b) Amount.--The Secretary shall pay for eligible 
     expenses under the program per eligible beneficiary in an 
     amount not to exceed $1,000.
       ``(c) Program Implementation.--
       ``(1) In general.--The Secretary shall--
       ``(A) make a Treasury-sponsored account described in 
     paragraph (2)(A)(i) available to eligible beneficiaries so 
     payment may be made to entities described in subsection 
     (d)(2)(B) for eligible expenses at the point-of-sale;
       ``(B) issue cards for making payments described in 
     subparagraph (A), and replacement cards for cards that are 
     lost or stolen; and
       ``(C) provide a toll-free telephone number and website to 
     answer beneficiary questions on the program including the 
     amount available for payment.
       ``(2) Payments.--
       ``(A) Delivery of payments.--
       ``(i) In general.--The account through which the Secretary 
     shall make payment for eligible expenses under the program 
     shall be deemed to be a Treasury-sponsored account, as 
     defined in section 208.2 of title 31, Code of Federal 
     Regulations, without regard to section 913 of the Electronic 
     Fund Transfer Act (15 U.S.C. 1693k), section 1005.10(e)(2) of 
     title 12, Code of Federal Regulations (or any successor 
     regulation), section 1(d) of Executive Order 13681 (31 U.S.C. 
     3321 note; relating to improving the security of consumer 
     financial transactions), section 3332(i) of title 31, United 
     States Code, and subchapter IV of chapter 33 of title 31, 
     United States Code.
       ``(ii) Treatment of accounts.--The Department of the 
     Treasury shall be deemed to be the customer of any financial 
     institution for any account issued under clause (i) for 
     purposes of the Right to Financial Privacy Act (12 U.S.C. 
     3401 et seq.).
       ``(B) Authorized transactions.--
       ``(i) Condition of acceptance of payment.--Acceptance of 
     payment under subparagraph (A)(i) shall be deemed to be an 
     agreement by the entity accepting such payment to furnish 
     such information as may be necessary for the Secretary to 
     verify that such payment is for eligible expenses of an 
     eligible beneficiary.
       ``(ii) Review.--The Secretary shall review payments, as 
     necessary, to verify transactions are for eligible expenses 
     of eligible beneficiaries.
       ``(C) Requirement.--Notwithstanding the provisions of 
     section 1(d) of Executive Order 13681, cards issued under 
     paragraph (1)(B) shall be magnetic stripe-only cards that do 
     not utilize chip and PIN technology.
       ``(3) Expediting implementation.--The Secretary shall 
     implement the program through program instruction.
       ``(4) Administration.--The requirements under section 
     1862(b) (relating to secondary payer) and section 1882(d)(3) 
     (relating to non-duplication of health benefits) are waived. 
     The Secretary shall not impose sanctions under subsection 
     1877(g) with respect to designated health services that are 
     eligible expenses.
       ``(5) Nonapplication of medicaid third party liability.--
     Neither the program nor an entity receiving payment for 
     eligible expenses under the program shall be treated as a 
     legally liable party for purposes of applying section 
     1902(a)(25).
       ``(d) Definitions.--In this section:
       ``(1) Eligible beneficiary.--The term `eligible 
     beneficiary' means an individual who--
       ``(A) is enrolled under part B; and
       ``(B) as of the start of the program, or in the case of an 
     individual who enrolls in part B after the date that is 6 
     months after the date of the enactment of this section, the 
     first month in which the individual is enrolled under such 
     part, is not subject to a reduction in premium subsidy 
     pursuant to section 1839(i).
       ``(2) Eligible expenses.--The term `eligible expenses' 
     means expenses for which payment has not been made by 
     insurance or a party other than the beneficiary, for dental 
     items and services furnished to an eligible beneficiary that 
     are--
       ``(A) to the extent applicable, treated as medical care 
     under section 213(d)(1)(A) of the Internal Revenue Code of 
     1986;
       ``(B) furnished by entities such as those with merchant 
     category code 8021 (or successor codes); and
       ``(C) presented for payment on or after the date of the 
     activation of the card described in subsection (c)(1)(B), and 
     ending on December 31, 2024.
       ``(3) Program.--The term `program' means the program 
     established under this section.
       ``(e) Outreach and Education.--
       ``(1) In general.--The Secretary shall provide outreach and 
     education on the program--
       ``(A) for eligible beneficiaries; and
       ``(B) for entities described in subsection (d)(2)(B).
       ``(2) Funding.--In addition to amounts otherwise available, 
     there is appropriated to the Secretary for fiscal year 2022, 
     out of amounts in the Treasury not otherwise appropriated, 
     $82,000,000, to remain available until December 31, 2025, to 
     carry out this subsection.
       ``(f) No Impact on Benefits Under This Title, Medicaid, or 
     CHIP.--
       ``(1) No impact on benefits under this title.--Any payment 
     made to an entity under this section shall not be treated as 
     benefits under this title or otherwise taken into account in 
     computing--
       ``(A) actuarial rates or premium amounts under section 
     1839; or
       ``(B) the MA area-specific non-drug monthly benchmark 
     amount under section 1853(j).
       ``(2) Disregard of payments for purposes of medicaid and 
     chip.--Any payment made to an entity under this section shall 
     be disregarded when determining income for any purpose under 
     the programs established under title XIX and title XXI.
       ``(g) Exception From Reduction or Offset.--Payments under 
     this section shall not be subject to offset under section 
     3716 of title 31, United States Code.
       ``(h) Implementation.--In addition to amounts otherwise 
     available, there is appropriated to the Secretary for fiscal 
     year 2022, out of amounts in the Treasury not otherwise 
     appropriated, $193,000,000, to remain available until 
     December 31, 2025, to carry out this section (other than 
     subsection (e) and subsection (i)).
       ``(i) Funding for Payments.--In addition to amounts 
     otherwise available, there is appropriated to the Secretary 
     for fiscal year 2022, out of amounts in the Treasury not 
     otherwise appropriated, $58,000,000,000, to remain available 
     until December 31, 2024, for purposes of funding payments for 
     eligible expenses under the program through Treasury-
     sponsored accounts described in subsection (c)(2)(A)(i) which 
     shall supplement and not supplant any other appropriations 
     that may be available for this purpose.''.

     SEC. 11502. 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 (GG), by striking ``and'' after the 
     semicolon at the end;
       (2) in subparagraph (HH), by striking the period at the end 
     and adding ``; and''; and
       (3) by adding at the end the following new subparagraph:
       ``(II) dental and oral health services (as defined in 
     subsection (lll));''.
       (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:
       ``(lll) 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, 2025:
       ``(A) Preventive and screening services.--Preventive and 
     screening services, including oral exams, dental cleanings, 
     dental x-rays, and fluoride treatments.
       ``(B) Basic procedures.--Basic procedures, including 
     services such as minor restorative services, periodontal 
     maintenance, periodontal scaling and root planing, simple

[[Page S4239]]

     tooth extractions, therapeutic pulpotomy, and other related 
     items and services.
       ``(C) Dentures.--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)), as amended by section 11101, is 
     amended--
       (A) in subparagraph (N), by inserting ``and dental and oral 
     health services (as defined in section 1861(lll))'' after 
     ``section 1861(hhh)(1))'';
       (B) by striking ``and'' before ``(EE)''; and
       (C) by inserting before the semicolon at the end the 
     following: ``and (FF) 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(z)''.
       (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:
       ``(z) 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(lll)) shall be, subject to paragraphs (3) and (4), 80 
     percent 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(lll)(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 
     2025 and subsequent years. The fee schedule amount for a 
     dental or oral health service shall be equal 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 2025 and subsequent years in 
     accordance with this subparagraph.
       ``(ii) Use of 2020 dental fee survey.--

       ``(I) In general.--Except as provided in clause (iii) or 
     clause (iv), the national median fee for a dental or oral 
     health service shall be equal to--

       ``(aa) for 2025, 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 2026 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 2020.

       ``(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 one 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.--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.
       ``(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 2026 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 2026 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(lll)--
       ``(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(lll)(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 
     subsection (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 one 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:
       ``(vii) With respect to 2026 and each subsequent year, an 
     oral health professional (as defined in section 
     1861(lll)(3)).''.
       (e) Exclusion Modifications.--Section 1862(a) of the Social 
     Security Act (42 U.S.C. 1395y(a)) is amended--
       (1) in paragraph (1)--

[[Page S4240]]

       (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(lll)) for which a limitation is 
     applicable under section 1834(z)(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)(II)''.
       (f) Inclusion as Excepted Medical Treatment.--Section 
     1821(b)(5)(A)(iii) of the Social Security Act (42 U.S.C. 
     1395i-5(b)(5)(A)), as added by section 11501(d), is amended--
       (1) by striking ``or hearing aids'' and inserting ``hearing 
     aids''; and
       (2) by inserting ``, or dental and oral health services (as 
     defined in subsection (lll) of such section)'' after 
     ``subsection (s)(8) of such section''.
       (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 (B), by striking ``and'' at the end;
       (ii) in subparagraph (C), by inserting ``and'' after the 
     comma at the end; and
       (iii) by inserting after subparagraph (C) the following new 
     subparagraph:
       ``(D) dental and oral health services (as defined in 
     subsection (lll)) 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 (lll)(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 ``(C)'' and inserting 
     ``(D)''.
       (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(lll)), 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, 2030, 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(lll)) 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 dental and oral health services (as defined in section 
     1861(lll) 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, 2030, 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 2022, 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, 2022, and ending on September 30, 
     2031.

     SEC. 11503. 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, 2024, 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, 2024, 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, 2024, 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 11101(b) and 11501, is 
     further amended--
       (A) by striking ``and'' before ``(FF)''; and
       (B) by inserting before the semicolon at the end the 
     following: ``and (GG) 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 11502, is amended by adding at the end the 
     following new clause:
       ``(viii) Beginning on January 1, 2024, 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, 2024, 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, 2024, 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 (B)) on or after January 1, 2024--

[[Page S4241]]

       ``(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 so 
     defined), physician assistant, nurse practitioner, or 
     clinical nurse specialist.
       ``(B) 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 
     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) 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:
       ``(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.''.
       (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, 2029, the Secretary shall begin the 
     competition with respect to the items and services described 
     in paragraph (2)(D).''.
       (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, 2024, and before 
     January 1, 2026; and
       ``(B) furnished on or after January 1, 2026, 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) 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 Act titled 
     `An Act to provide for reconciliation pursuant to title II of 
     S. Con. Res. 14'.''.
       (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 11502(g), is amended--
       (i) in subsection (a)(3)(A), by inserting ``and audiology 
     services (as defined in section 1861(ll)(3))'' after ``(as 
     defined in section 1861(lll)''; and
       (ii) in subsection (e), by inserting ``and audiology 
     services (as defined in section 1861(ll)(3))'' after ``(as 
     defined in section 1861(lll)''.
       (B) PPS.--Section 1834(o)(5) of the Social Security Act (42 
     U.S.C. 1395m(o)), as added by section 11501(e), is amended--
       (i) in the first sentence, by inserting `` and audiology 
     services (as defined in section 1861(ll)(3))'' after ``(as 
     defined in section 1861(lll))''; and
       (ii) in the second sentence, by inserting ``and such 
     audiology services'' after ``such dental and oral health 
     services''.
       (f) Implementation for 2023 Through 2025.--The Secretary of 
     Health and Human Services shall implement the provisions of, 
     and the amendments made by, this section for 2023, 2024, and 
     2025 by 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 2022, 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, 2023, and ending on September 30, 2032.

     SEC. 11504. 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 11502(a), 
     is amended--
       (1) in subparagraph (HH), by striking ``and'' after the 
     semicolon at the end;
       (2) in subparagraph (II), by striking the period at the end 
     and adding ``; and''; and
       (3) by adding at the end the following new subparagraph:
       ``(JJ) vision services (as defined in subsection (mmm));''.
       (b) Vision Services Defined.--Section 1861 of the Social 
     Security Act (42 U.S.C. 1395x), as amended by section 
     11502(b), is amended by adding at the end the following new 
     subsection:
       ``(mmm) 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, 2023, 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 
     11502(c), 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(mmm)) 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)(JJ),'' 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 11503(b), 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, 2023, and including (as described in 
     section 1834(h)(8)) conventional eyeglasses, whether or not 
     furnished subsequent to such a surgery, if furnished on or 
     after January 1, 2023''.
       (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 11503(b), 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, 2023, 
     subject to subparagraph (B), payment shall be made under this 
     part only during a 2-year period, for one 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 one pair of 
     conventional eyeglasses furnished subsequent to such cataract 
     surgery during such period.
       ``(C) 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 11503(b), is amended--
       (i) in the header, by striking ``and hearing aids'' and 
     inserting ``hearing aids, and eyeglasses''

[[Page S4242]]

       (ii) by striking ``or of hearing aids'' and inserting ``of 
     hearing aids'';
       (iii) by inserting ``or of eyeglasses described in 
     paragraph (2)(E) of such section,'' after ``paragraph (2)(D) 
     of such section,''; and
       (iv) 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 
     11503(b), is amended by adding at the end the following new 
     subparagraph:
       ``(E) 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 11503(b), 
     is amended by adding at the end the following new paragraph:
       ``(9) Competition with respect to eyeglasses.--Not later 
     than January 1, 2028, the Secretary shall begin the 
     competition with respect to the items and services described 
     in paragraph (2)(E).''.
       (g) Exclusion Modifications.--Section 1862(a) of the Social 
     Security Act (42 U.S.C. 1395y(a)), as amended by section 
     11502(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(mmm)) 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)(JJ))'' 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)(JJ))'' after ``refractive state of the eyes''.
       (h) Inclusion as Excepted Medical Treatment.--Section 
     1821(b)(5)(A)(iii) of the Social Security Act (42 U.S.C. 
     1395i-5(b)(5)(A)), as added by section 11501(d) and amended 
     by section 11503(f), is amended--
       (1) by striking ``or dental'' and inserting ``dental''; and
       (2) by inserting ``, or vision services (as defined in 
     subsection (mmm) of such section)'' after ``(as defined in 
     subsection (lll) 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 11501(e), 
     is amended by inserting ``and vision services (as defined in 
     subsection (mmm))'' 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 11502(g) and 11503(e), 
     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(mmm))'' after ``(as defined in section 
     1861(ll)(3))''; and

       (ii) in subsection (e)--

       (I) by striking ``or audiology'' and inserting ``, 
     audiology''; and
       (II) by inserting ``, and vision services (as defined in 
     section 1861(mmm))'' after ``(as defined in section 
     1861(ll)(3))''.

       (B) PPS.--Section 1834(o)(5) of the Social Security Act (42 
     U.S.C. 1395m(o)), as added by section 11502(g) and amended by 
     section 11503(e), is amended--
       (i) in the first sentence--

       (I) by striking ``and audiology'' and inserting ``, 
     audiology''; and
       (II) by inserting ``, and vision services (as defined in 
     section 1861(mmm))'' after ``(as defined in section 
     1861(ll)(3))''; and

       (ii) in the second sentence, by striking ``and such 
     audiology services'' and inserting ``, such audiology 
     services, and such vision services''.
       (j) Expediting Implementation.--The Secretary shall 
     implement this section for the period beginning on January 1, 
     2023, and ending on December 31, 2024, 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 2022, 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, 2023, and ending on September 30, 2031.

     SEC. 11505. 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 2025 Through 2028.--
       ``(A) Determination of alternative monthly actuarial rate 
     for each of 2025 through 2028.--For each of 2025 through 
     2028, 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 2024 
     through 2027 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 2025, the monthly actuarial rate for enrollees 
     age 65 and over for the year, determined as if the amendments 
     made by section 11502 of the Act titled `An Act to provide 
     for reconciliation pursuant to title II of S. Con. Res. 14' 
     did not apply; and
       ``(II) for 2026, 2027, and 2028, the monthly actuarial rate 
     for enrollees age 65 and over for the year, determined as if 
     the amendments made by such section 11502 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 11502 did not apply.

       ``(ii) Definition of applicable percent.--For purposes of 
     this subparagraph, the term `applicable percent' means--
       ``(I) for 2026, 25 percent;
       ``(II) for 2027, 50 percent; and
       ``(III) for 2028, 75 percent.
       ``(C) Application to part b premium and other provisions of 
     this part.--For each of 2025 through 2028, 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).''.

                       Subpart B--Tax Provisions

     SEC. 11511. APPLICATION OF NET INVESTMENT INCOME TAX TO TRADE 
                   OR BUSINESS INCOME OF CERTAIN HIGH INCOME 
                   INDIVIDUALS.

       (a) In General.--Section 1411 of the Internal Revenue Code 
     of 1986 is amended by adding at the end the following new 
     subsection:
       ``(f) Application to Certain High Income Individuals.--
       ``(1) In general.--In the case of any individual whose 
     modified adjusted gross income for the taxable year exceeds 
     the high income threshold amount, subsection (a)(1) shall be 
     applied by substituting `the greater of specified net income 
     or net investment income' for `net investment income' in 
     subparagraph (A) thereof.
       ``(2) Phase-in of increase.--The increase in the tax 
     imposed under subsection (a)(1) by reason of the application 
     of paragraph (1) of this subsection shall not exceed the 
     amount which bears the same ratio to the amount of such 
     increase (determined without regard to this paragraph) as--
       ``(A) the excess described in paragraph (1), bears to
       ``(B) $100,000 (\1/2\ such amount in the case of a married 
     taxpayer (as defined in section 7703) filing a separate 
     return).
       ``(3) High income threshold amount.--For purposes of this 
     subsection, the term `high income threshold amount' means--
       ``(A) except as provided in subparagraph (B) or (C), 
     $400,000,
       ``(B) in the case of a taxpayer making a joint return under 
     section 6013 or a surviving spouse (as defined in section 
     2(a)), $500,000, and
       ``(C) in the case of a married taxpayer (as defined in 
     section 7703) filing a separate return, \1/2\ of the dollar 
     amount determined under subparagraph (B).
       ``(4) Specified net income.--For purposes of this section, 
     the term `specified net income' means net investment income 
     determined--
       ``(A) without regard to the phrase `other than such income 
     which is derived in the ordinary course of a trade or 
     business not described in paragraph (2),' in subsection 
     (c)(1)(A)(i),
       ``(B) without regard to the phrase `described in paragraph 
     (2)' in subsection (c)(1)(A)(ii),
       ``(C) without regard to the phrase `other than property 
     held in a trade or business not described in paragraph (2)' 
     in subsection (c)(1)(A)(iii),
       ``(D) without regard to paragraphs (2), (3), and (4) of 
     subsection (c), and
       ``(E) by treating paragraphs (5) and (6) of section 469(c) 
     (determined without regard to the phrase `To the extent 
     provided in regulations,' in such paragraph (6)) as applying 
     for purposes of subsection (c) of this section.''.
       (b) Application to Trusts and Estates.--Section 
     1411(a)(2)(A) of the Internal Revenue Code of 1986 is amended 
     by striking ``undistributed net investment income'' and 
     inserting ``the greater of undistributed specified net income 
     or undistributed net investment income''.

[[Page S4243]]

       (c) Clarifications With Respect to Determination of Net 
     Investment Income.--
       (1) Certain exceptions.--Section 1411(c)(6) of the Internal 
     Revenue Code of 1986 is amended to read as follows:
       ``(6) Special rules.--Net investment income shall not 
     include--
       ``(A) any item taken into account in determining self-
     employment income for such taxable year on which a tax is 
     imposed by section 1401(b),
       ``(B) wages received with respect to employment on which a 
     tax is imposed under section 3101(b) or 3201(a) (including 
     amounts taken into account under section 3121(v)(2)), and
       ``(C) wages received from the performance of services 
     earned outside the United States for a foreign employer.''.
       (2) Net operating losses not taken into account.--Section 
     1411(c)(1)(B) of such Code is amended by inserting ``(other 
     than section 172)'' after ``this subtitle''.
       (3) Inclusion of certain foreign income.--
       (A) In general.--Section 1411(c)(1)(A) of such Code is 
     amended by striking ``and'' at the end of clause (ii), by 
     striking ``over'' at the end of clause (iii) and inserting 
     ``and'', and by adding at the end the following new clause:
       ``(iv) any amount includible in gross income under section 
     951, 951A, 1293, or 1296, over''.
       (B) Proper treatment of certain previously taxed income.--
     Section 1411(c) of such Code is amended by adding at the end 
     the following new paragraph:
       ``(7) Certain previously taxed income.--The Secretary shall 
     issue regulations or other guidance providing for the 
     treatment of--
       ``(A) distributions of amounts previously included in gross 
     income for purposes of chapter 1 but not previously subject 
     to tax under this section, and
       ``(B) distributions described in section 962(d).''.
       (d) Deposit Into Medicare Hospital Insurance Trust Fund.--
     Section 1817(a) of the Social Security Act (42 U.S.C. 
     1395i(a)) is amended--
       (1) in paragraph (1), by striking ``and'' at the end;
       (2) in paragraph (2), by striking the period at the end and 
     inserting ``; and''; and
       (3) by inserting after paragraph (2) the following new 
     paragraph:
       ``(3) the excess of--
       ``(A) the taxes imposed by 1411(a) of the Internal Revenue 
     Code of 1986, as reported to the Secretary of the Treasury or 
     his delegate pursuant to subtitle F of such Code after 
     December 31, 2022, over
       ``(B) the taxes which would have been imposed under such 
     section after such date, determined as if the amendments made 
     by section 11511 of the Act titled `An Act to provide for 
     reconciliation pursuant to title II of S. Con. Res. 14') did 
     not apply, as estimated by the Secretary of the Treasury.''.
       (e) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after December 31, 
     2022.
       (f) Transition Rule.--The regulations or other guidance 
     issued by the Secretary under section 1411(c)(7) of the 
     Internal Revenue Code of 1986 (as added by this section) 
     shall include provisions which provide for the proper 
     coordination and application of clauses (i) and (iv) of 
     section 1411(c)(1)(A) with respect to--
       (1) taxable years beginning on or before December 31, 2022, 
     and
       (2) taxable years beginning after such date.

     SEC. 11512. INCREASE IN TOP MARGINAL INDIVIDUAL INCOME TAX 
                   RATE.

       (a) Re-establishment of 39.6 Percent Rate Bracket.--
       (1) Married individuals filing joint returns and surviving 
     spouses.--The table contained in section 1(j)(2)(A) of the 
     Internal Revenue Code of 1986 is amended by striking the last 
     two rows and inserting the following: ``

$91,379, plus 35% of the excess over $400,000..........................
$108,879, plus 39.6% of the excess over $450,000.''....................
       (2) Heads of households.--The table contained in section 
     1(j)(2)(B) of such Code is amended by striking the last two 
     rows and inserting the following: ``

$44,298, plus 35% of the excess over $200,000..........................
$123,048, plus 39.6% of the excess over $425,000.''....................
       (3) Unmarried individuals other than surviving spouses and 
     heads of households.--The table contained in section 
     1(j)(2)(C) of such Code is amended by striking the last two 
     rows and inserting the following: ``

$45,689.50, plus 35% of the excess over $200,000.......................
$115,689.50, plus 39.6% of the excess over $400,000.''.................
       (4) Married individuals filing separate returns.--The table 
     contained in section 1(j)(2)(D) of such Code is amended by 
     striking the last two rows and inserting the following: ``

$45,689.50, plus 35% of the excess over $200,000.......................
$54,439.50, plus 39.6% of the excess over $225,000.''..................
       (5) Estates and trusts.--The table contained in section 
     1(j)(2)(E) of such Code is amended by striking the last row 
     and inserting the following: ``

$3,011.50, plus 39.6% of the excess over $12,500.''....................
       (b) Application of Adjustments.--Section 1(j)(3) of the 
     Internal Revenue Code of 1986 is amended to read as follows:
       ``(3) Adjustments.--For taxable years beginning after 
     December 31, 2022, the Secretary shall prescribe tables which 
     shall apply in lieu of the tables contained in paragraph (2) 
     in the same manner as under paragraphs (1) and (2) of 
     subsection (f) (applied without regard to clauses (i) and 
     (ii) of subsection (f)(2)(A)), except that in prescribing 
     such tables--
       ``(A) except as provided in subparagraph (B), subsection 
     (f)(3) shall be applied by substituting `calendar year 2017' 
     for `calendar year 2016' in subparagraph (A)(ii) thereof,
       ``(B) in the case of adjustments to the dollar amounts at 
     which the 39.6 percent rate bracket begins (other than such 
     dollar amount in paragraph (2)(E))--
       ``(i) no adjustment shall be made for taxable years 
     beginning after December 31, 2022, and before January 1, 
     2024, and
       ``(ii) in the case of any taxable year beginning after 
     December 31, 2023, subsection (f)(3) shall be applied by 
     substituting `calendar year 2022' for `calendar year 2016',
       ``(C) subsection (f)(7)(B) shall apply to any unmarried 
     individual other than a surviving spouse, and
       ``(D) subsection (f)(8) shall not apply.''.
       (c) Modification to 39.6 Percent Rate Bracket for High-
     income Taxpayers After 2025.--Section 1(i)(3) of the Internal 
     Revenue Code of 1986 is amended to read as follows:
       ``(3) Modifications to 39.6 percent rate bracket.--In the 
     case of taxable years beginning after December 31, 2025--
       ``(A) In general.--The rate of tax under subsections (a), 
     (b), (c), and (d) on a taxpayer's taxable income in excess of 
     the 39.6 percent rate bracket threshold shall be taxed at a 
     rate of 39.6 percent.
       ``(B) 39.6 percent rate bracket threshold.--For purposes of 
     this paragraph, the term `39.6 percent rate bracket 
     threshold' means--
       ``(i) in the case any taxpayer described in subsection (a), 
     $450,000,
       ``(ii) in the case of any taxpayer described in subsection 
     (b), $425,000,
       ``(iii) in the case of any taxpayer described in subsection 
     (c), $400,000, and
       ``(iv) in the case of any taxpayer described in subsection 
     (d), $225,000.
       ``(C) Inflation adjustment.--For purposes of this 
     paragraph, with respect to taxable years beginning in 
     calendar years after 2025, each of the dollar amounts in 
     subparagraph (B) shall be adjusted in the same manner as 
     under paragraph (1)(C)(i), except that subsection 
     (f)(3)(A)(ii) shall be applied by substituting `2022' for 
     `2016'.''.
       (d) Conforming Amendments.--
       (1) Section 1(j)(1) of the Internal Revenue Code of 1986 is 
     amended by striking ``December 31, 2017'' and inserting 
     ``December 31, 2022''.
       (2) The heading of section 1(j) is amended by striking 
     ``2018'' and inserting ``2023''.
       (3) The heading of section 1(i) is amended by striking 
     ``Rate Reductions'' and inserting ``Modifications''
       (4) Section 15(f) is amended by striking ``rate 
     reductions'' and inserting ``modifications''.
       (e) Section 15 Not to Apply.--For rules providing that 
     section 15 of the Internal Revenue Code of 1986 does not 
     apply to the amendments made by this section, see sections 
     1(j)(6) and 15(f) of the Internal Revenue Code of 1986.
       (f) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after December 31, 
     2022.
                                 ______