[Congressional Record Volume 171, Number 112 (Saturday, June 28, 2025)]
[Senate]
[Pages S3979-S3984]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
SA 2435. Mr. SANDERS submitted an amendment intended to be proposed
to amendment SA 2360 proposed by Mr. Thune (for Mr. Graham) to the bill
H.R. 1, to provide for reconciliation pursuant to title II of H. Con.
Res. 14; which was ordered to lie on the table; as follows:
At the end of chapter 2 of title VII, insert the
following:
[[Page S3980]]
SEC. 71205. PROVIDING COVERAGE FOR DENTAL AND ORAL HEALTH
CARE, HEARING CARE, AND VISION CARE UNDER
MEDICARE.
(a) Short Title.--This section may be cited as the
``Medicare Dental, Hearing, and Vision Expansion Act of
2025''.
(b) Coverage of Dental and Oral Health Care.--
(1) Coverage.--Section 1861(s)(2) of the Social Security
Act (42 U.S.C. 1395x(s)(2)) is amended--
(A) in subparagraph (JJ), by adding ``and'' at the end; and
(B) by adding at the end the following new subparagraph:
``(KK) dental and oral health services (as defined in
subsection (nnn));''.
(2) Dental and oral health services defined.--Section 1861
of the Social Security Act (42 U.S.C. 1395x) is amended by
adding at the end the following new subsection:
``(nnn) Dental and Oral Health Services.--
``(1) In general.--Except as provided in paragraph (2), the
term `dental and oral health services' means the following
items and services that are furnished by a doctor of dental
surgery or of dental medicine (as described in subsection
(r)(2)) or an oral health professional (as defined in
paragraph (3)) on or after January 1, 2028:
``(A) Preventive and screening services.--Preventive and
screening services, including oral exams, dental cleanings,
dental x-rays, and fluoride treatments.
``(B) Procedures and treatment services.--Services to
address oral disease, including services such as restorative
services, prosthodontic and endodontic services, including
fillings bridges, crowns, and root canals, periodontal
maintenance, periodontal scaling and root planing, tooth
extractions, therapeutic pulpotomy, and other related items
and services.
``(C) Dentures and dental prosthetics.--Complete dentures,
partial dentures, and implants, including related items and
services.
``(2) Exclusions.--Such term does not include items and
services for which, as of the date of the enactment of this
subsection, coverage was permissible under section
1862(a)(12) and cosmetic services not otherwise covered under
section 1862(a)(10).
``(3) Oral health professional.--The term `oral health
professional' means, with respect to dental and oral health
services, a health professional (other than a doctor of
dental surgery or of dental medicine (as described in
subsection (r)(2))) who is licensed to furnish such services,
acting within the scope of such license, by the State in
which such services are furnished.''.
(3) Payment; coinsurance; and limitations.--
(A) In general.--Section 1833(a)(1) of the Social Security
Act (42 U.S.C. 1395l(a)(1)) is amended--
(i) in subparagraph (N), by inserting ``and dental and oral
health services (as defined in section 1861(nnn))'' after
``section 1861(hhh)(1))'';
(ii) by striking ``and'' before ``(HH)''; and
(iii) 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)''.
(B) Payment and limits specified.--Section 1834 of the
Social Security Act (42 U.S.C. 1395m) is amended by adding at
the end the following new subsection:
``(aa) Payment and Limits for Dental and Oral Health
Services.--
``(1) Payment.--The payment amount under this part for
dental and oral health services (as defined in section
1861(nnn)) shall be, subject to paragraphs (3) and (4), 80
percent (or 100 percent, in the case of preventive and
screening services described in section 1861(nnn)(1)(A)) of
the lesser of--
``(A) the actual charge for the service; or
``(B)(i) in the case of such services furnished by a doctor
of dental surgery or of dental medicine (as described in
section 1861(r)(2)), the amount determined under the fee
schedule established under paragraph (2); or
``(ii) in the case of such services furnished by an oral
health professional (as defined in section 1861(nnn)(3)), 85
percent of the amount determined under the fee schedule
established under paragraph (2).
``(2) Establishment of fee schedule for dental and oral
health services.--
``(A) Establishment.--
``(i) In general.--The Secretary shall establish a fee
schedule for dental and oral health services furnished in
2027 and subsequent years. The fee schedule amount for a
dental or oral health service shall be equal to 70 percent of
the national median fee (as determined under subparagraph
(B)) for the service or a similar service for the year (or,
in the case of dentures, at the bundled payment amount under
clause (iv) of such subparagraph), adjusted by the geographic
adjustment factor established under section 1848(e)(2) for
the area for the year.
``(ii) Consultation.--In carrying out this paragraph, the
Secretary shall consult annually with organizations
representing dentists and other providers who furnish dental
and oral health services and shall share with such providers
the data and data analysis used to determine fee schedule
amounts under this paragraph.
``(B) Determination of national median fee.--
``(i) In general.--For purposes of subparagraph (A), the
Secretary shall apply the national median fee for a dental or
oral health service for 2028 and subsequent years in
accordance with this subparagraph.
``(ii) Use of 2020 dental fee survey.--
``(I) In general.--Except as provided in clause (iii) and
clause (iv), the national median fee for a dental or oral
health service shall be equal to--
``(aa) for 2028, 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 2029 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 2027.
``(III) Productivity adjustment.--After determining the
applicable percentage increase under subclause (II) for a
year, the Secretary shall reduce such percentage increase by
the productivity adjustment described in section
1886(b)(3)(B)(xi)(II).
``(iii) Determination if insufficient survey data.--If the
Secretary determines there is insufficient data under the
Survey described in clause (ii) with respect to a dental or
oral health service, the national median fee for the service
for a year shall be equal to an amount established for the
service using 1 or more of the following methods, as
determined appropriate by the Secretary:
``(I) The payment basis determined under section 1848.
``(II) Fee schedules for dental and oral health services
which shall include, as practicable, fee schedules--
``(aa) under Medicare Advantage plans under part C;
``(bb) under State plans (or waivers of such plans) under
title XIX; and
``(cc) established by other health care payers.
``(iv) Special rule for dentures.--
``(I) In general.--The Secretary shall make payment for
dentures and associated professional services as a bundled
payment as determined by the Secretary.
``(II) Payment considerations.--In establishing such
bundled payment, the Secretary shall consider the national
median fee for the service for the year determined under
clause (ii) or (iii) and the rate determined for such
dentures under the Federal Supply Schedule of the General
Services Administration, as published by such Administration
in 2021, updated to the year involved using the applicable
percent increase for the year determined under clause
(ii)(II), as reduced by the productivity adjustment under
clause (ii)(III), and shall ensure that the payment component
for dentures under such bundled payment does not exceed the
maximum rate determined for such dentures under the Federal
Supply Schedule, as so published and updated to the year
involved.
``(C) Annual update and adjustments.--
``(i) Annual update.--The Secretary shall update payment
amounts determined under the fee schedule from year to year
beginning in 2029 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 2029 and subsequent
years to take into account changes in dental practice, coding
changes, new data on work, practice, or malpractice expenses,
or the addition of new procedures.
``(II) Limitation on annual adjustments.--The adjustments
under subclause (I) for a year shall not cause the amount of
expenditures under this part for the year to differ by more
than $20,000,000 from the amount of expenditures under this
part that would have been made if such adjustments had not
been made.
``(3) Limitations.--With respect to dental and oral health
services that are preventive and screening services described
in paragraph (1)(A) of section 1861(nnn)--
``(A) payment shall be made under this part for--
``(i) not more than 2 oral exams in a year;
``(ii) not more than 2 dental cleanings in a year;
``(iii) not more than 1 fluoride treatment in a year; and
``(iv) not more than 1 full-mouth series of x-rays as part
of a preventive and screening oral exam every 3 years; and
``(B) in the case of preventive and screening services not
described in subparagraph (A), payment shall be made under
this part only at such frequencies determined appropriate by
the Secretary.
``(4) Incentives for rural providers.--In the case of
dental and oral health services
[[Page S3981]]
furnished by a doctor of dental surgery or of dental medicine
(as described in section 1861(r)(2)) or an oral health
professional (as defined in section 1861(nnn)(3)) who
predominantly furnishes such services under this part in an
area that is designated by the Secretary (under section
332(a)(1)(A) of the Public Health Service Act) as a health
professional shortage area, in addition to the amount of
payment that would otherwise be made for such services under
this subsection, there also shall be paid an amount equal to
10 percent of the payment amount for the service under this
subsection for such doctor or professional.
``(5) Limitation on beneficiary liability.--The provisions
of section 1848(g) shall apply to a nonparticipating doctor
of dental surgery or of dental medicine (as described in
section 1861(r)(2)) who does not accept payment on an
assignment-related basis for dental and oral health services
furnished with respect to an individual enrolled under this
part in the same manner as such provisions apply with respect
to a physician's service.
``(6) Establishment of dental administrator.--The Secretary
shall designate 1 or more (not to exceed 4) medicare
administrative contractors under section 1874A to establish
coverage policies and establish such policies and process
claims for payment for dental and oral health services, as
determined appropriate by the Secretary.''.
(4) Inclusion of oral health professionals as certain
practitioners.--Section 1842(b)(18)(C) of the Social Security
Act (42 U.S.C. 1395u(b)(18)(C)) is amended by adding at the
end the following new clause:
``(ix) With respect to 2028 and each subsequent year, an
oral health professional (as defined in section
1861(nnn)(3)).''.
(5) Exclusion modifications.--Section 1862(a) of the Social
Security Act (42 U.S.C. 1395y(a)) is amended--
(A) in paragraph (1)--
(i) in subparagraph (O), by striking ``and'' at the end;
(ii) in subparagraph (P), by striking the semicolon at the
end and inserting ``, and''; and
(iii) by adding at the end the following new subparagraph:
``(Q) in the case of dental and oral health services (as
defined in section 1861(nnn)) for which a limitation is
applicable under section 1834(aa)(3), which are furnished
more frequently than is provided under such section;''; and
(B) 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)''.
(6) 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--
(A) in clause (ii), by striking ``or'' at the end;
(B) in clause (iii), by striking the period and inserting
``, or''; and
(C) by adding at the end the following new clause:
``(iv) consisting of dental and oral health services (as
defined in subsection (mmm) of section 1861) that are payable
under part B as a result of the amendments made by the
Medicare Dental, Hearing, and Vision Expansion Act of
2025.''.
(7) Rural health clinics and federally qualified health
centers.--
(A) Coverage of dental and oral health services.--Section
1861(aa) of the Social Security Act (42 U.S.C. 1395x(aa)), is
amended--
(i) in paragraph (1)--
(I) in subparagraph (C), by striking ``and'' at the end;
(II) in subparagraph (D), by inserting ``and'' after the
comma at the end; and
(III) by inserting after subparagraph (D) the following new
subparagraph:
``(E) dental and oral health services (as defined in
subsection (nnn)) furnished by a doctor of dental surgery or
of dental medicine (as described in subsection (r)(2)) or an
oral health professional (as defined in subsection (nnn)(3))
who is employed by or working under contract with a rural
health clinic if such rural health clinic furnishes such
services,''; and
(ii) in paragraph (3)(A), by striking ``(D)'' and inserting
``(E)''.
(B) Temporary payment rates for certain services under the
rhc air and fqhc pps.--
(i) AIR.--Section 1833 of the Social Security Act (42
U.S.C. 1395l) is amended--
(I) in subsection (a)(3)(A), by inserting ``(which shall,
in the case of dental and oral health services (as defined in
section 1861(nnn)), in lieu of any limits on reasonable costs
otherwise applicable, be based on the rates payable for such
services under the payment basis determined under section
1848 until such time as the Secretary determines sufficient
data has been collected to otherwise apply such limits (or
January 1, 2031, if no such determination has been made as of
such date))'' after ``may prescribe in regulations''; and
(II) by adding at the end the following new subsection:
``(ee) Disregard of Costs Attributable to Certain Services
From Calculation of RHC AIR.--Payments for rural health
clinic services other than dental and oral health services
(as defined in section 1861(nnn)) under the methodology for
all-inclusive rates (established by the Secretary) under
subsection (a)(3) shall not take into account the costs of
such services while rates for such services are based on
rates payable for such services under the payment basis
established under section 1848.''.
(ii) PPS.--Section 1834(o) of the Social Security Act (42
U.S.C. 1395m(o)) is amended by adding at the end the
following new paragraph:
``(6) Temporary payment rates based on pfs for certain
services.--The Secretary shall, in establishing payment rates
for dental and oral health services (as defined in section
1861(nnn)) that are Federally qualified health center
services under the prospective payment system established
under this subsection, in lieu of the rates otherwise
applicable under such system, base such rates on rates
payable for such services under the payment basis established
under section 1848 until such time as the Secretary
determines sufficient data has been collected to otherwise
establish rates for such services under such system (or
January 1, 2031, if no such determination has been made as of
such date). Payments for Federally qualified health center
services other than such dental and oral health services
under such system shall not take into account the costs of
such services while rates for such services are based on
rates payable for such services under the payment basis
established under section 1848.''.
(8) Implementation.--In addition to amounts otherwise
available, there is appropriated to the Secretary of Health
and Human Services for fiscal year 2025, out of any money in
the Treasury not otherwise appropriated, $900,000,000, to
remain available until expended, for purposes of implementing
the amendments made by this section during the period
beginning on January 1, 2025, and ending on September 30,
2034.
(c) Providing Coverage for Hearing Care Under the Medicare
Program.--
(1) Provision of audiology services by qualified
audiologists and hearing aid examination services by
qualified hearing aid professionals.--
(A) In general.--Section 1861(ll) of the Social Security
Act (42 U.S.C. 1395x(ll)) is amended--
(i) in paragraph (3)--
(I) by inserting ``(A)'' after ``(3)'';
(II) in subparagraph (A), as added by subclause (I) of this
clause--
(aa) by striking ``means such hearing and balance
assessment services'' and inserting ``means--
``(i) such hearing and balance assessment services and,
beginning January 1, 2027, such hearing aid examination
services and treatment services (including aural
rehabilitation, vestibular rehabilitation, and cerumen
management)'';
(bb) in clause (i), as added by item (aa) of this
subclause, by striking the period at the end and inserting
``; and''; and
(cc) by adding at the end the following new clause:
``(ii) beginning January 1, 2027, such hearing aid
examination services furnished by a qualified hearing aid
professional (as defined in paragraph (4)(C)) as the
professional is legally authorized to perform under State law
(or the State regulatory mechanism provided by State law), as
would otherwise be covered if furnished by a physician.'';
and
(III) by adding at the end the following new subparagraph:
``(B) Beginning January 1, 2027, audiology services
described in subparagraph (A)(i) shall be furnished without a
requirement for an order from a physician or practitioner.'';
and
(ii) 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).''.
(B) 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 subsection (b)(3)(A), is
amended--
(i) by striking ``and'' before ``(II)''; and
(ii) 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''.
(C) Inclusion of qualified audiologists and qualified
hearing aid professionals as certain practitioners to receive
payment on an assignment-related basis.--
[[Page S3982]]
(i) Qualified audiologists.--Section 1842(b)(18)(C) of the
Social Security Act (42 U.S.C. 1395u(b)(18)(C)), as amended
by subsection (b)(4), is amended by adding at the end the
following new clause:
``(x) Beginning on January 1, 2027, a qualified audiologist
(as defined in section 1861(ll)(4)(B)).''.
(ii) Qualified hearing aid professionals.--Section
1842(b)(18) of the Social Security Act (42 U.S.C.
1395u(b)(18)) is amended--
(I) in each of subparagraphs (A) and (B), by striking
``subparagraph (C)'' and inserting ``subparagraph (C) or,
beginning on January 1, 2027, subparagraph (E)''; and
(II) by adding at the end the following new subparagraph:
``(E) A practitioner described in this subparagraph is a
qualified hearing aid professional (as defined in section
1861(ll)(4)(C)).''.
(2) Coverage of hearing aids.--
(A) Inclusion of hearing aids as prosthetic devices.--
Section 1861(s)(8) of the Social Security Act (42 U.S.C.
1395x(s)(8)) is amended by inserting ``, and including
hearing aids (as described in section 1834(h)(7)) furnished
on or after January 1, 2027, to individuals with moderately
severe, severe, or profound hearing loss'' before the
semicolon at the end.
(B) Payment limitations for hearing aids.--Section 1834(h)
of the Social Security Act (42 U.S.C. 1395m(h)) is amended by
adding at the end the following new paragraphs:
``(6) Payment only on an assignment-related basis.--Payment
for hearing aids for which payment may be made under this
part may be made only on an assignment-related basis. The
provisions of subparagraphs (A) and (B) of section
1842(b)(18) shall apply to hearing aids in the same manner as
they apply to services furnished by a practitioner described
in subparagraph (C) of such section.
``(7) Limitations for hearing aids.--
``(A) In general.--Payment may be made under this part with
respect to an individual, with respect to hearing aids
furnished by a qualified hearing aid supplier (as defined in
subparagraph (C)) on or after January 1, 2027--
``(i) not more than once per ear during a 5-year period;
``(ii) only for types of such hearing aids that are
determined appropriate by the Secretary; and
``(iii) only if furnished pursuant to a written order of a
physician, qualified audiologist (as defined in section
1861(ll)(4)), qualified hearing aid professional (as defined
in subparagraph (C) of such section), physician assistant,
nurse practitioner, or clinical nurse specialist.
``(B) Special rule.--The payment basis determined under
this subsection (including after application of paragraph
(1)(H), relating to application of competitive acquisition)
for hearing aids furnished by a qualified hearing aid
supplier on or after January 1, 2027, shall not exceed the
rate determined for such hearing aids under the Federal
Supply Schedule of the General Services Administration, as
published by such Administration in 2021, updated to the year
involved using the applicable percent increase for the year.
``(C) Definitions.--In this subsection:
``(i) Hearing aid.--The term `hearing aid' means the item
and related services including selection, fitting,
adjustment, and patient education and training.
``(ii) Qualified hearing aid supplier.--The term `qualified
hearing aid supplier' means--
``(I) a qualified audiologist;
``(II) a physician (as defined in section 1861(r)(1));
``(III) a physician assistant, nurse practitioner, or
clinical nurse specialist;
``(IV) a qualified hearing aid professional (as defined in
section 1861(ll)(4)(C)); and
``(V) other suppliers as determined by the Secretary.''.
(C) Application of competitive acquisition.--
(i) In general.--Section 1834(h)(1)(H) of the Social
Security Act (42 U.S.C. 1395m(h)(1)(H)) is amended--
(I) in the header, by inserting ``and hearing aids'' after
``orthotics'';
(II) in the matter preceding clause (i), by inserting ``or
of hearing aids described in paragraph (2)(D) of such
section,'' after ``2011,''; and
(III) in clause (i), by inserting ``or such hearing aids''
after ``such orthotics''.
(ii) Conforming amendments.--
(I) In general.--Section 1847(a)(2) of the Social Security
Act (42 U.S.C. 1395w-3(a)(2)) is amended by adding at the end
the following new subparagraph:
``(E) Hearing aids.--Hearing aids described in section
1861(s)(8) for which payment would otherwise be made under
section 1834(h).''.
(II) Exemption of certain items from competitive
acquisition.--Section 1847(a)(7) of the Social Security Act
(42 U.S.C. 1395w-3(a)(7)) is amended by adding at the end the
following new subparagraph:
``(C) Certain hearing aids.--Those items and services
described in paragraph (2)(E) if furnished by a physician or
other practitioner (as defined by the Secretary) to the
physician's or practitioner's own patients as part of the
physician's or practitioner's professional service.''.
(III) Implementation.--Section 1847(a) of the Social
Security Act (42 U.S.C. 1395w-3(a)) is amended by adding at
the end the following new paragraph:
``(8) Competition with respect to hearing aids.--Not later
than January 1, 2031, the Secretary shall begin the
competition with respect to the items and services described
in paragraph (2)(E).''.
(D) Physician self-referral law.--Section 1877(b) of the
Social Security Act (42 U.S.C. 1395nn(b)) is amended by
adding at the end the following new paragraph:
``(6) Hearing aids and services.--In the case of hearing
aid examination services and hearing aids--
``(A) furnished on or after January 1, 2027, and before
January 1, 2029; and
``(B) furnished on or after January 1, 2029, if the
financial relationship specified in subsection (a)(2) meets
such requirements the Secretary imposes by regulation to
protect against program or patient abuse.''.
(3) 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''.
(4) Inclusion as excepted medical treatment.--Section
1821(b)(5)(A)(iv) of the Social Security Act (42 U.S.C.
1395i-5(b)(5)(A)(iv)), as added by subsection (b)(6), 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)''.
(5) Rural health clinics and federally qualified health
centers.--
(A) 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''.
(B) 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)),''.
(C) Temporary payment rates for certain services under the
rhc air and fqhc pps.--
(i) AIR.--Section 1833 of the Social Security Act (42
U.S.C. 1395l), as amended by subsection (b)(7)(B)(i), is
amended--
(I) in subsection (a)(3)(A), by inserting ``or audiology
services (as defined in section 1861(ll)(3))'' after ``(as
defined in section 1861(nnn)''; and
(II) in subsection (ee), by inserting ``or audiology
services (as defined in section 1861(ll)(3))'' after ``(as
defined in section 1861(nnn)''.
(ii) PPS.--Section 1834(o)(6) of the Social Security Act
(42 U.S.C. 1395m(o)(6)), as added by subsection
(b)(7)(B)(ii), is amended--
(I) in the first sentence, by inserting ``or audiology
services (as defined in section 1861(ll)(3))'' after ``(as
defined in section 1861(nnn))''; and
(II) in the second sentence, by inserting ``or such
audiology services'' after ``such dental and oral health
services''.
(6) Expediting implementation.--The Secretary of Health and
Human Services shall implement this section for 2027 and 2028
through program instruction or other forms of program
guidance.
(7) Funding.--In addition to amounts otherwise available,
there is appropriated to the Secretary of Health and Human
Services for fiscal year 2025, out of any money in the
Treasury not otherwise appropriated, $370,000,000, to remain
available until expended, for purposes of implementing the
amendments made by this section during the period beginning
on January 1, 2026, and ending on September 30, 2035.
(d) Providing Coverage for Vision Care Under the Medicare
Program.--
(1) Coverage.--Section 1861(s)(2) of the Social Security
Act (42 U.S.C. 1395x(s)(2)), as amended by subsection (b)(1),
is amended--
(A) in subparagraph (JJ), by striking ``and'' after the
semicolon at the end;
(B) in subparagraph (KK), by striking the period at the end
and adding ``; and''; and
(C) by adding at the end the following new subparagraph:
``(LL) vision services (as defined in subsection (ooo));''.
(2) Vision services defined.--Section 1861 of the Social
Security Act (42 U.S.C. 1395x), as amended by subsection
(b)(2), is amended by adding at the end the following new
subsection:
``(ooo) Vision Services.--The term `vision services' means
routine eye examinations to determine the refractive state of
the eyes, including procedures performed during the course of
such examination, furnished on or after January 1, 2027, by
or under the direct supervision of an ophthalmologist or
optometrist who is legally authorized to furnish such
examinations or procedures (as applicable) under State law
(or the State regulatory mechanism provided by State law) of
the State in which the examinations or procedures are
furnished.''.
(3) Payment limitations.--Section 1834 of the Social
Security Act (42 U.S.C. 1395m), as amended by subsection
(b)(3)(B), is amended by adding at the end the following new
subsection:
``(bb) Limitation for Vision Services.--With respect to
vision services (as defined in section 1861(ooo)) and an
individual, payment shall be made under this part for only 1
routine eye examination described in such subsection during a
2-year period.''.
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(4) Payment under physician fee schedule.--Section
1848(j)(3) of the Social Security Act (42 U.S.C. 1395w-
4(j)(3)) is amended by inserting ``(2)(LL),'' before ``(3)''.
(5) Coverage of conventional eyeglasses.--Section
1861(s)(8) of the Social Security Act (42 U.S.C.
1395x(s)(8)), as amended by subsection (c)(2)(A), 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''.
(6) Special payment rules for eyeglasses.--
(A) Limitations.--Section 1834(h) of the Social Security
Act (42 U.S.C. 1395m(h)), as amended by subsection (c)(2)(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, 2027,
subject to subparagraph (B), payment shall be made under this
part only during a 2-year period, for 1 pair of eyeglasses
(including lenses and the frame).
``(B) Exception.--With respect to a 2-year period described
in subparagraph (A), in the case of an individual who
receives cataract surgery with insertion of an intraocular
lens, payment shall be made under this part for 1 pair of
conventional eyeglasses furnished subsequent to such cataract
surgery during such period.
``(C) Special rule.--The payment basis determined under
this subsection (including after application of paragraph
(1)(H), relating to application of competitive acquisition)
for conventional eyeglasses furnished to an individual on or
after January 1, 2027, shall not exceed the rate determined
for such eyeglasses under the Federal Supply Schedule of the
General Services Administration, as published by such
Administration in 2021, updated to the year involved using
the applicable percent increase for the year.
``(D) No coverage of certain items.--Payment shall not be
made under this part for deluxe eyeglasses or conventional
reading glasses.''.
(B) Application of competitive acquisition.--
(i) In general.--Section 1834(h)(1)(H) of the Social
Security Act (42 U.S.C. 1395m(h)(1)(H)), as amended by
subsection (c)(2)(C)(i), is amended--
(I) in the heading, by striking ``and hearing aids'' and
inserting ``hearing aids, and eyeglasses'';
(II) in the matter preceding clause (i)--
(aa) by striking ``or of hearing aids'' and inserting ``of
hearing aids''; and
(bb) by inserting ``or of eyeglasses described in paragraph
(2)(E) of such section,'' after ``paragraph (2)(D) of such
section,''; and
(III) in clause (i), by striking ``or such hearing aids''
and inserting ``, such hearing aids, or such eyeglasses''.
(ii) Conforming amendment.--Section 1847(a)(2) of the
Social Security Act (42 U.S.C. 1395w-3(a)(2)), as amended by
subsection (c)(2)(C)(ii)(I), is amended by adding at the end
the following new subparagraph:
``(F) Eyeglasses.--Eyeglasses described in section
1861(s)(8) for which payment would otherwise be made under
section 1834(h).''.
(iii) Implementation.--Section 1847(a) of the Social
Security Act (42 U.S.C. 1395w-3(a)), as amended by subsection
(c)(2)(C)(ii)(III), is amended by adding at the end the
following new paragraph:
``(9) Competition with respect to eyeglasses.--Not later
than January 1, 2030, the Secretary shall begin the
competition with respect to the items and services described
in paragraph (2)(F).''.
(7) Exclusion modifications.--Section 1862(a) of the Social
Security Act (42 U.S.C. 1395y(a)), as amended by subsection
(b)(5), is amended--
(A) in paragraph (1)--
(i) in subparagraph (P), by striking ``and'' at the end;
(ii) in subparagraph (Q), by striking the semicolon at the
end and inserting ``, and''; and
(iii) by adding at the end the following new subparagraph:
``(R) in the case of vision services (as defined in section
1861(ooo)) that are routine eye examinations as described in
such section, which are furnished more frequently than once
during a 2-year period;''; and
(B) in paragraph (7)--
(i) 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
(ii) 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''.
(8) Inclusion as excepted medical treatment.--Section
1821(b)(5)(A)(iv) of the Social Security Act (42 U.S.C.
1395i-5(b)(5)(A)(iv)), as added by subsection (b)(6) and
amended by subsection (c)(4), is amended--
(A) by striking ``or hearing aids'' and inserting ``hearing
aids''; and
(B) by inserting ``, or vision services (as defined in
subsection (ooo) of such section)'' after ``subsection (s)(8)
of such section''.
(9) Rural health clinics and federally qualified health
centers.--
(A) 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 subsection
(c)(5)(A), is amended by inserting ``and vision services (as
defined in subsection (ooo))'' after ``(as defined in
subsection (ll)(3))''.
(B) Temporary payment rates for certain services under the
rhc air and fqhc pps.--
(i) AIR.--Section 1833 of the Social Security Act (42
U.S.C. 1395l), as amended by subsections (b)(7)(B)(i) and
(c)(5)(C)(i), is amended--
(I) in subsection (a)(3)(A)--
(aa) by striking ``or audiology'' and inserting ``,
audiology''; and
(bb) by inserting ``, or vision services (as defined in
section 1861(ooo))'' after ``(as defined in section
1861(ll)(3))''; and
(II) in subsection (ee)--
(aa) by striking ``or audiology'' and inserting ``,
audiology''; and
(bb) by inserting ``, or vision services (as defined in
section 1861(ooo))'' after ``(as defined in section
1861(ll)(3))''.
(ii) PPS.--Section 1834(o)(6) of the Social Security Act
(42 U.S.C. 1395m(o)(6)), as added by subsection (b)(7)(B)(ii)
and amended by subsection (c)(5)(C)(ii), is amended--
(I) in the first sentence--
(aa) by striking ``or audiology'' and inserting ``,
audiology''; and
(bb) by inserting ``, or vision services (as defined in
section 1861(ooo))'' after ``(as defined in section
1861(ll)(3))''; and
(II) in the second sentence, by striking ``or such
audiology services'' and inserting ``, such audiology
services, or such vision services''.
(10) Expediting implementation.--The Secretary of Health
and Human Services shall implement this section for 2027 and
2028 through program instruction or other forms of program
guidance.
(11) Funding.--In addition to amounts otherwise available,
there is appropriated to the Secretary of Health and Human
Services for fiscal year 2025, out of any money in the
Treasury not otherwise appropriated, $500,000,000, to remain
available until expended, for purposes of implementing the
amendments made by this section during the period beginning
on January 1, 2026, and ending on September 30, 2034.
SEC. 71206. IMPROVEMENTS TO THE MEDICARE DRUG PRICE
NEGOTIATION PROGRAM.
(a) Acceleration of the Selection of Negotiation-Eligible
Drugs.--Section 1192(a) of the Social Security Act (42 U.S.C.
1320f-1(a)) is amended--
(1) in paragraph (2), by adding ``and'' at the end;
(2) in paragraph (3)--
(A) by striking ``2028, 15 negotiation-eligible drugs'' and
inserting ``2028 or a subsequent initial price applicability
year, at least 50 negotiation-eligible drugs'';
(B) by striking ``less than 15'' and inserting ``less than
50''; and
(C) by striking ``; and'' at the end and inserting a
period; and
(3) by striking paragraph (4).
(b) Improvements to the Definition of Negotiation-Eligible
Drugs.--Subparagraphs (A) and (B) of section 1192(d)(1) of
the Social Security Act (42 U.S.C. 1320f-1(d)(1)) are each
amended by striking ``among the 50'' and inserting ``among
the 50 (or, in the case of initial price applicability year
2028 or a subsequent initial price applicability year,
125)''.
(c) Improvements to the Definition of Qualifying Single
Source Drugs.--Subparagraphs (A)(ii) and (B)(ii) of section
1192(e)(1) of the Social Security Act (42 U.S.C. 1320f-
1(e)(1)) are each amended by striking ``for which'' and
inserting ``with respect to initial price applicability year
2026 and 2027, for which''.
(d) Improvement to the Ceiling for Maximum Fair Price.--
Section 1194(c)(1) of the Social Security Act (42 U.S.C.
1320f-3(c)(1)) is amended--
(1) in subparagraph (A), by striking ``or the amount under
subparagraph (C)'' and inserting ``, the amount under
subparagraph (C), or, if available, the amount under
subparagraph (D)''; and
(2) by adding at the end the following new subparagraph:
``(D) Subparagraph (D) amount.--
``(i) In general.--An amount equal to the international
maximum fair price for the drug or biological product.
``(ii) International maximum fair price.--For purposes of
clause (i), the term `international maximum fair price'
means, with respect to a drug or biological product, an
amount equal to the highest price (which shall be the net
price, if practicable, and volume-weighted, if practicable)
for a unit (as defined in section 1191(c)(6)) of such drug or
biological product for sales of such drug or biological
product (calculated across different dosage forms and
strengths of the drug or biological product and not based on
the specific formulation or package size or package type), as
computed (as of the date of publication of such drug or
biological product as a selected drug) among any applicable
countries for which pricing information is available with
respect to such drug or biological product.
``(iii) Applicable countries.--
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``(I) In general.--For purposes of clause (ii), the term
`applicable countries' includes any country described in
subclause (II) for which, with respect to a drug or
biological product, there is available a price for any unit
of such drug or biological product for sales of such drug or
biological product in such country.
``(II) Countries described.--For purposes of subclause (I),
the following countries are described in this subclause:
``(aa) Australia.
``(bb) Canada.
``(cc) France.
``(dd) Germany.
``(ee) Japan.
``(ff) The United Kingdom.''.
(e) Effective Date.--The amendments made by this section
shall apply with respect to initial price applicability years
(as defined in section 1191(b) of the Social Security Act (42
U.S.C. 1320f(b)) beginning with initial price applicability
year 2028.
______