Medicare Dental Benefit Act of 2026

year following the year specified in subparagraph (A) and each subsequent year through the seventh year following the year specified in subparagraph (A), the applicable percent specified in this paragraph for the previous year increased by 10 percentage points; and ``(iii) for the eighth year following the year specified in subparagraph (A) and each subsequent year, 80 percent. ``(B) Special rule for certain low-income individuals.--For purposes of paragraph (1), with respect to dental and oral health services described in such paragraph that are furnished to an individual who is a subsidy eligible individual (as defined in section 1860D-14(a)(3)), or who would be a subsidy eligible individual if the individual were enrolled in a prescription drug plan or an MA-PD plan under part D, for the first year beginning at least 6 months after the date of the enactment of this subsection and each subsequent year, the applicable percent specified in this paragraph is 80 percent. ``(3) Limitations and secretarial authority.-- ``(A) Frequency.--With respect to dental and oral health services that are-- ``(i) routine dental cleanings, payment may be made under this part for only 2 such cleanings during a 12-month period; and ``(ii) routine exams, payment may be made under this part for only 2 such exams during a 12-month period. ``(B) Secretarial authority.-- ``(i) Authority to apply additional limitations.--The Secretary may apply such other reasonable limitations on the extent to which dental and oral services are covered under this part, including through application of a prior authorization requirement. ``(ii) Authority to modify coverage.-- Notwithstanding any other provision of this title, if the Secretary determines appropriate, the Secretary may modify the coverage under this part of dental and oral health services to the extent that such modification is consistent with the recommendations of the United States Preventive Services Task Force. ``(iii) Authority to waive frequency limitations.--The Secretary may waive any frequency limitation or other limitation as described in this paragraph for an individual (or category of individuals) as determined appropriate by the Secretary.''. (e) 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 striking ``risk assessment),'' and inserting ``risk assessment), (2)(LL),''. (f) Dental Prostheses.-- (1) In general.--Section 1861(s)(8) of the Social Security Act (42 U.S.C. 1395x(s)(8)) is amended-- (A) by striking ``(other than dental)'' and inserting ``(including dental)''; and (B) by striking ``internal body''. (2) Special payment rules.--Section 1834(a) of the Social Security Act (42 U.S.C. 1395m(a)) is amended by adding at the end the following new paragraph: ``(24) Payment and limits for dental prostheses.-- ``(A) In general.--The payment amount under this part for dental prostheses shall be, subject to subparagraph (C), the applicable percent (specified in subparagraph (B)) of the amount otherwise payable for such dental prostheses under this section. ``(B) Applicable percent.-- ``(i) In general.--For purposes of subparagraph (A), subject to clause (ii), the applicable percent specified in this subparagraph is-- ``(I) for the first year beginning at least 6 months after the date of the enactment of this paragraph, 0 percent; ``(II) for the year following the year specified in clause (i) and each subsequent year through the seventh year following the year specified in clause (i), the applicable percent specified in this subparagraph for the previous year increased by 10 percentage points; and ``(III) for the eighth year following the year specified in clause (i) and each subsequent year, 80 percent. ``(ii) Special rule for certain low-income individuals.--For purposes of subparagraph (A), with respect to dental prostheses furnished to an individual who is a subsidy eligible individual (as defined in section 1860D- 14(a)(3)), or who would be a subsidy eligible individual if the individual were enrolled in a prescription drug plan or an MA-PD plan under part D, for the first year beginning at least 6 months after the date of the enactment of this paragraph and each subsequent year, the applicable percent specified in this subparagraph is 80 percent. ``(C) Limitations and secretarial authority.-- ``(i) In general.--Payment may be made under this part for an individual for-- ``(I) not more than 1 full upper and 1 full lower dental prostheses once every 5 years; and ``(II) not more than 1 partial upper dental prostheses and 1 partial lower dental prostheses once every 5 years. ``(ii) Secretarial authority.-- ``(I) Authority to apply additional limitations.--The Secretary may apply such other reasonable limitations on the extent to which dental prostheses are covered under this part, including through application of a prior authorization requirement. ``(II) Authority to modify coverage.--Notwithstanding any other provision of this title, if the Secretary determines appropriate, the Secretary may modify the coverage under this part of dental prostheses to the extent that such modification is consistent with the recommendations of the United States Preventive Services Task Force. ``(III) Authority to waive frequency limitations.--The Secretary may waive any frequency limitation or other limitation as described in this subparagraph for an individual (or category of individuals) as determined appropriate by the Secretary.''. (g) Repeal of Ground for Exclusion.--Section 1862(a) of the Social Security Act (42 U.S.C. 1395y) is amended by striking paragraph (12). (h) Effective Date.--The amendments made by this section shall apply to services furnished on or after January 1, 2028. SEC. 3. INCREASED FMAP FOR ADDITIONAL EXPENDITURES FOR MEDICARE COST- SHARING FOR DENTAL AND ORAL HEALTH SERVICES. Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended-- (1) in subsection (b), by striking ``and (ii)'' and inserting ``(ii), and (ll)''; and (2) by adding at the end the following new subsection: ``(ll) Increased FMAP for Additional Expenditures for Medicare Cost-Sharing for Dental and Oral Health Services.--Notwithstanding subsection (b), with respect to the portion of the amounts expended by a State for medical assistance for medicare cost-sharing (as defined in subsection (p)(3)) for qualified medicare beneficiaries described in subsection (p)(1) that is attributable to the coverage under part B of title XVIII of dental and oral health services (as defined in section 1861(ooo)), as determined by the Secretary, the Federal medical assistance percentage for a State that is one of the 50 States or the District of Columbia shall be equal to 100 percent.''. SEC. 4. PREVENTIVE SERVICES TASKFORCE. (a) In General.--Section 915(a)(1) of the Public Health Service Act (42 U.S.C. 299b-4(a)(1)) is amended, in the first sentence, by inserting ``, including at least 1 oral health professional'' after ``expertise''. (b) Effective Date.--The amendment made by subsection (a) shall take effect January 1, 2028. <all>