Make Billionaires Pay Their Fair Share Act

[Congressional Bills 119th Congress] [From the U.S. Government Publishing Office] [H.R. 7767 Introduced in House (IH)]

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119th CONGRESS 2d Session H. R. 7767

To amend the Internal Revenue Code of 1986 to impose an annual tax on the net value of assets held by a taxpayer, and for other purposes.

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IN THE HOUSE OF REPRESENTATIVES

March 3, 2026

Mr. Khanna introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committees on Energy and Commerce, Financial Services, and Education and Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned

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A BILL

To amend the Internal Revenue Code of 1986 to impose an annual tax on the net value of assets held by a taxpayer, and for other purposes.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE, ETC.

(a) Short Title.--This Act may be cited as the ``Make Billionaires Pay Their Fair Share Act''. (b) Table of Contents.--The table of contents of this Act is as follows:

Sec. 1. Short title, etc. TITLE I--WEALTH TAX

Sec. 101. Imposition of tax on net value of assets. Sec. 102. Enforcement. TITLE II--AFFORDABILITY REBATES

Sec. 201. Affordability rebates. TITLE III--HEALTH CARE PROVISIONS

Sec. 301. Repeal of reconciliation health provisions. Sec. 302. Increase in eligibility for premium tax credit. TITLE IV--MEDICARE DENTAL, HEARING, AND VISION EXPANSION

Sec. 401. Short title. Sec. 402. Coverage of dental and oral health care. Sec. 403. Providing coverage for hearing care under the Medicare program. Sec. 404. Providing coverage for vision care under the Medicare program. Sec. 405. Phase-in of impact of dental and oral health coverage on part B premiums. TITLE V--HOUSING TRUST FUND

Sec. 501. Authorization of appropriations. TITLE VI--AFFORDABLE CHILD CARE FOR WORKING FAMILIES

Sec. 601. Birth through five child care and early learning entitlement. TITLE VII--ESTABLISHING A $60,000 A YEAR MINIMUM SALARY FOR EVERY PUBLIC SCHOOL TEACHER IN THE UNITED STATES

Sec. 701. Purposes. Sec. 702. Definitions. Sec. 703. Ensuring teachers are paid a livable and competitive wage. Sec. 704. Collective bargaining and related rules. TITLE VIII--INVESTMENTS IN HOME AND COMMUNITY-BASED SERVICES AND LONG- TERM CARE QUALITY AND WORKFORCE

Sec. 801. HCBS improvement planning grants. Sec. 802. HCBS Improvement Program. Sec. 803. Funding for Federal activities related to Medicaid HCBS. Sec. 804. Funding for HCBS quality measurement and improvement. Sec. 805. Permanent extension of Medicaid protections against spousal impoverishment for recipients of home and community-based services. Sec. 806. Permanent extension of Money Follows the Person Rebalancing demonstration.

TITLE I--WEALTH TAX

SEC. 101. IMPOSITION OF TAX ON NET VALUE OF ASSETS.

(a) In General.--The Internal Revenue Code of 1986 is amended by inserting after subtitle B the following new subtitle:

``Subtitle B-1--Wealth Tax

``Chapter 18--Determination of Wealth Tax

``CHAPTER 18--DETERMINATION OF WEALTH TAX

``Sec. 2901. Imposition of tax. ``Sec. 2902. Net value of assets. ``Sec. 2903. Special rules. ``Sec. 2904. Administrative provisions.

``SEC. 2901. IMPOSITION OF TAX.

``(a) In General.--In the case of an applicable taxpayer, there is hereby imposed a tax computed equal to 5 percent of the net value of assets held by the taxpayer for the calendar year. ``(b) Applicable Taxpayer.-- ``(1) In general.--For purposes of this chapter, the term `applicable taxpayer' means any individual or trust if the net value of all assets held by the taxpayer for the calendar year exceeds $1,000,000,000. ``(2) Inflation adjustment.-- ``(A) In general.--In the case of any calendar year after 2026, the $1,000,000,000 amount under paragraph (1) shall be increased by an amount equal to-- ``(i) such dollar amount, multiplied by ``(ii) the cost-of-living adjustment determined under section 1(f)(3) for the calendar year in which the taxable year begins, determined by substituting in subparagraph (A)(ii) thereof `calendar year 2025' for `calendar year 2016'. ``(B) Rounding.--If any amount as adjusted under subparagraph (A) is not a multiple of $1,000,000, such dollar amount shall be rounded to the next lowest multiple of $1,000,000. ``(c) Treatment of Married Individuals.--For purposes of this section, individuals who are married (as defined in section 7703) shall be treated as one taxpayer.

``SEC. 2902. NET VALUE OF ASSETS.

``(a) In General.--The net value of assets held by an applicable taxpayer for any calendar year shall be the excess of-- ``(1) the value of all property of the taxpayer, real or personal, tangible or intangible, wherever situated, on the last day of such calendar year (computed without regard to any debt owed by the taxpayer and secured by the property), over ``(2) the amount of any debt owed by the taxpayer on the last day of such calendar year. ``(b) Inclusion of Property of Related Children.--For purposes of this subtitle, any property of an individual who is a child of the taxpayer (as defined in section 152(f)(1)) and has not attained the age of 18 shall be treated as property held by the taxpayer for any calendar year before the year in which such individual attains the age of 18. ``(c) Establishment of Valuation Rules.-- ``(1) Authority of secretary.--The Secretary shall establish rules and methods for determining the value of any asset for purposes of this subtitle. ``(2) General rules.--Except as otherwise provided in this paragraph, the rules and methods established under paragraph (1) may be similar to the rules of part III of subchapter A of chapter 11 (other than the rules of sections 2031(c), 2032A, 2035, and 2044). ``(3) Rules for assets the value of which is not readily ascertainable.-- ``(A) In general.--In the case of any property the value of which is not readily ascertainable, the Secretary may allow the taxpayer to elect to use a value which is equal to the most recent readily ascertainable value of such property increased by an average rate of appreciation applicable to assets of a similar class. ``(B) Limitation.--The Secretary may not allow a taxpayer to make an election under this paragraph for any calendar year if the taxpayer made an election under this paragraph for the preceding calendar year.

``SEC. 2903. SPECIAL RULES.

``(a) Deceased Individuals.--In the case of any individual who dies during a calendar year-- ``(1) section 2901 shall be applied as if the calendar year ended on the day of the individual's death, and ``(2) the amount of the tax imposed under such section shall be reduced by an amount which bears the same ratio to such amount (determined without regard to this subsection) as-- ``(A) the number of days in the calendar year after the date of the individual's death, bears to ``(B) 365. ``(b) Trusts.-- ``(1) Grantor trusts.--If a grantor or another person is treated as the owner of any portion of a trust under subpart E of part I of subchapter J of chapter 1, then the grantor or such other person shall be treated as holding that portion of the assets of such trust, and any remaining portion shall be subject to tax as provided in section 2901. ``(2) Incomplete gifts.--In the case of any person who makes a transfer of property to a trust which is not treated as a gift for purposes of chapter 11, the portion of such trust attributable to such property shall be treated as the property of the person making the transfer and not the property of such trust. ``(3) Aggregation rules.--The rules of section 643(f) shall apply for purposes of this subtitle. ``(c) Application to Nonresidents.-- ``(1) In general.--In the case of any taxpayer who is a nonresident and not a citizen of the United States, section 2901(a) shall be applied by substituting `net value of domestic assets' for `net value of all assets'. ``(2) Net value of domestic assets.--For purposes of this subtitle, the term `net value of domestic assets' means-- ``(A) the value of all property of the taxpayer, real or personal, tangible or intangible, situated in the United States (determined under rules similar to the rules under subchapter B of chapter 11), on the last day of such calendar year (computed without regard to any debt owed by the taxpayer and secured by the property), over ``(B) the amount of any debt owed by the taxpayer and secured by assets described in subparagraph (A), determined as of the last day of such calendar year. ``(3) Treatment of married individuals.--In the case of married individuals, this subsection shall only apply if both individuals are nonresidents and not citizens of the United States. ``(d) Application to Covered Expatriates.-- ``(1) In general.--In the case of an applicable taxpayer who is a covered expatriate the expatriation date of which occurs during the calendar year-- ``(A) section 2901 shall be applied as if the calendar year ended on the day before the expatriation, and ``(B) the rate of tax under 2901(a) for such calendar year shall be 60 percent. ``(2) Covered expatriate; expatriation date.--For purposes of this subsection-- ``(A) Covered expatriate.--The term `covered expatriate' has the meaning given such term under section 877A, except that in the case of married individuals, such taxpayer shall be treated as a covered expatriate only if neither individual is a United States citizen or lawful permanent resident of the United States (within the meaning of section 7701(b)(6)). ``(B) Expatriation date.--The term `expatriation date' has the meaning given such term under section 877A(g)(3).

``SEC. 2904. ADMINISTRATIVE PROVISIONS.

``(a) Wealth Registry.--The Secretary shall establish a registry of ownership for assets taken into account under section 2902(a)(1), including publicly traded securities, digital assets, shares of closely held businesses, and real estate within the United States. For purposes of establishing and maintaining the registry under the preceding sentence, the Secretary shall-- ``(1) rely on existing sources of information, including central depositories for securities and State, local, and foreign real property records; and ``(2) require timely reporting of newly acquired assets in conjunction with information required under existing information reporting requirements. ``(b) Information Reporting.-- ``(1) In general.--The Secretary shall by regulations require the reporting of information concerning the value of assets, including-- ``(A) the value of any accounts which pay interest reportable under section 6049, ``(B) the value of publicly traded stock with respect to which dividends are reported under section 6042, ``(C) the value of any applicable privately held business, ``(D) the value of any assets held through mutual funds or brokerage accounts, ``(E) the value of any assets held in eligible retirement plans (as defined in section 402(c)(8)(B)), and ``(F) such other assets as the Secretary determines is appropriate. ``(2) Method of reporting.--The Secretary shall, where appropriate, require the reporting made under paragraph (1) to be made as a part of existing income reporting requirements. ``(3) Applicable privately held business.--For purposes of this subsection, the term `applicable privately held business' means any trade or businesses-- ``(A) which does not meet the gross receipts test under section 448(c) for the taxable year ending with or within the calendar year, ``(B) in which an individual who was an applicable taxpayer (other than a covered expatriate, as defined in section 2903(d)(2)) for the preceding calendar year holds (directly or indirectly) 5 percent or more of the ownership interests (by value), and ``(C) to which paragraph (1)(B) does not apply. ``(c) Time for Payment of Tax.--The due date for returns with respect to the tax imposed under this subtitle shall be not later than the latest due date for which a return of tax under subtitle A would be due if the taxpayer's taxable year ended on December 31 and the taxpayer owed tax for such taxable year.''. (b) No Deduction From Income Taxes.--Section 275 of the Internal Revenue Code of 1986 is amended by inserting after paragraph (6) the following new paragraph: ``(7) Taxes imposed by chapter 18.''. (c) Information Reporting Penalties.--Section 6724(d)(1) of the Internal Revenue Code of 1986 is amended by striking ``and'' at the end of subparagraph (C), by striking the period at the end of subparagraph (D) and inserting ``, and'', and by inserting after subparagraph (D) the following new subparagraph: ``(E) any statement or return required to be filed under section 2904(b) which is not reported under any other provision of this paragraph.''. (d) Clerical Amendment.--The table of subtitles of the Internal Revenue Code of 1986 is amended by inserting after the item relating to subtitle B the following new item:

``Subtitle B-1--Wealth Tax''.

(e) Effective Date.--The amendments made by this section shall apply to calendar years beginning after the date of the enactment of this Act.

SEC. 102. ENFORCEMENT.

(a) Standard.--The Secretary of the Treasury shall audit not less than 50 percent of taxpayers required to pay the tax imposed under section 2901 of the Internal Revenue Code of 1986 (as added by section 101) in each calendar year. (b) Funding.--There is hereby appropriated to each fiscal year ending after the date of the enactment of this Act, out of any moneys in the Treasury not otherwise appropriated, amounts equivalent to 1 percent of the revenues attributable to the tax imposed under section 2901 of the Internal Revenue Code of 1986 (as added by section 101) for necessary expenses for enforcement activities of the Internal Revenue Service to determine and collect taxes owed under such section.

TITLE II--AFFORDABILITY REBATES

SEC. 201. AFFORDABILITY REBATES.

(a) In General.--Section 6428B of the Internal Revenue Code of 1986 is amended-- (1) in the heading, by striking ``2021 recovery rebates to individuals'' and inserting ``affordability rebates'', (2) in subsection (a), by striking ``2021 an amount equal to the 2021 rebate amount'' and inserting ``2026 an amount equal to the affordability rebate amount'', (3) by striking subsection (b) and inserting the following: ``(b) Affordability Rebate Amount.--For purposes of this section, the term `affordability rebate amount' means, with respect to any taxpayer for any taxable year, the sum of-- ``(1) $3,000 ($6,000 in the case of a joint return), plus ``(2) $3,000 multiplied by the number of dependents of the taxpayer for such taxable year.'', (4) in subsection (e)(2)-- (A) in subparagraph (A), by striking ``$1,400'' and inserting ``$3,000'', and (B) in subparagraph (B)-- (i) in the matter preceding clause (i), by striking ``$2,800'' and inserting ``$6,000'', and (ii) in clause (i), by striking ``$1,400'' and inserting ``$3,000'', and (5) in subsection (g)-- (A) in paragraph (1), by striking ``2019'' and inserting ``2024'', (B) in paragraph (2)(B), by striking ``January 1, 2021'' each place it appears and inserting ``January 1, 2026'', (C) in paragraph (3), by striking ``December 31, 2021'' and inserting ``December 31, 2026'', (D) in paragraph (5)-- (i) in the heading, by striking ``2020'' and inserting ``2025'', (ii) in subparagraph (A)-- (I) in the heading, by striking ``2020'' and inserting ``2025'', and (II) by striking ``beginning in 2020, paragraph (1) shall be applied with respect to such individual by substituting `2020' for `2019''' and inserting ``beginning in 2025, paragraph (1) shall be applied with respect to such individual by substituting `2025' for `2024''', and (iii) in subparagraph (B)-- (I) in clause (i), by striking ``2020'' and inserting ``2025'', (II) in clause (ii)-- (aa) in subclause (I), by striking ``2020'' and inserting ``2025'', and (bb) in subclause (II), by striking ``2021'' and inserting ``2026'', and (III) in clause (iii)-- (aa) in the heading, by striking ``2020'' and inserting ``2025'', and (bb) by striking ``2020'' each place it appears and inserting ``2025'', and (E) in the heading of paragraph (6), by striking ``2019 or 2020'' and inserting ``2024 or 2025''. (b) Conforming Amendment.--The table of sections for subchapter B of chapter 65 of the Internal Revenue Code of 1986 is amended by striking the item relating to section 6428B and inserting the following new item:

``Sec. 6428B. Affordability rebates.''.

TITLE III--HEALTH CARE PROVISIONS

SEC. 301. REPEAL OF RECONCILIATION HEALTH PROVISIONS.

(a) In General.--Except as provided in subsection (b), subtitle B of title VII of An Act to provide for reconciliation pursuant to title II of H. Con. Res. 14 (Public Law 119-21) is repealed and any law or regulation referred to in such subtitle shall be applied as if such subtitle and the amendments made by such subtitle had not been enacted. (b) Exceptions.-- (1) In general.--Subsection (a) shall not apply to the provisions of and amendments made by sections 71202, 71306, and 71401 of such Act. (2) Availability of funds allocated under the rural health transformation program.--Section 2105(h) of the Social Security Act (42 U.S.C. 1397ee(h)), as added by Public Law 119-21, is amended-- (A) in paragraph (1)(B)-- (i) in the subparagraph heading by striking ``Unexpended or unobligated'' and inserting ``Availability of''; (ii) by striking clauses (i) through (iii) and inserting the following: ``(i) In general.--Subject to clause (ii), funds allocated to a State from amounts appropriated under subparagraph (A) shall remain available until expended.''; and (iii) by redesignating clause (iv) as clause (ii); and (B) in paragraph (2)(C), by striking ``paragraph (1)(B)(iv)'' and inserting ``paragraph (1)(B)(ii)''.

SEC. 302. INCREASE IN ELIGIBILITY FOR PREMIUM TAX CREDIT.

(a) In General.--Subparagraph (A) of section 36B(c)(1) of the Internal Revenue Code of 1986 is amended by striking ``but does not exceed 400 percent''. (b) Applicable Percentages.-- (1) In general.--Subparagraph (A) of section 36B(b)(3) of the Internal Revenue Code of 1986 is amended to read as follows: ``(A) Applicable percentage.--The applicable percentage for any taxable year shall be the percentage such that the applicable percentage for any taxpayer whose household income is within an income tier specified in the following table shall increase, on a sliding scale in a linear manner, from the initial premium percentage to the final premium percentage specified in such table for such income tier:

------------------------------------------------------------------------ The initial The final ``In the case of household income (expressed premium premium as a percent of poverty line) within the percentage percentage following income tier: is-- is-- ------------------------------------------------------------------------ Up to 150 percent............................. 0 0 150 percent up to 200 percent................. 0 2.0 200 percent up to 250 percent................. 2.0 4.0 250 percent up to 300 percent................. 4.0 6.0 300 percent up to 400 percent................. 6.0 8.5 400 percent and higher........................ 8.5 8.5.''. ------------------------------------------------------------------------

(2) Conforming amendments relating to affordability of coverage.-- (A) Paragraph (1) of section 36B(c) of such Code is amended by striking subparagraph (E). (B) Subparagraph (C) of section 36B(c)(2) of such Code is amended by striking clause (iv). (C) Paragraph (4) of section 36B(c) of such Code is amended by striking subparagraph (F). (c) Effective Date.--The amendments made by this section shall apply to taxable years beginning after December 31, 2025.

TITLE IV--MEDICARE DENTAL, HEARING, AND VISION EXPANSION

SEC. 401. SHORT TITLE.

This title may be cited as the ``Medicare Dental, Hearing, and Vision Expansion Act of 2026''.

SEC. 402. 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 (JJ), by striking ``and'' at the end; (2) in subparagraph (KK), by inserting ``and'' after the semicolon; and (3) by adding at the end the following new subparagraph: ``(LL) dental and oral health services (as defined in subsection (ooo));''. (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: ``(ooo) 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 (or January 1, 2027, in the case of dentures): ``(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.''. (c) Payment; Coinsurance; and Limitations.-- (1) In general.--Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) is amended-- (A) in subparagraph (N), by inserting ``and dental and oral health services (as defined in section 1861(ooo))'' after ``section 1861(hhh)(1))''; (B) by striking ``and'' before ``(HH)''; and (C) 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(ooo)), the amount paid shall be the payment amount specified under section 1834(bb)''. (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: ``(bb) 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(ooo)) 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(ooo)(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(ooo)(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 2028 (or 2027, in the case of dentures) and subsequent years. The fee schedule amount for a dental or oral health service shall be equal to 70 percent of the national median fee (as determined under subparagraph (B)) for the service or a similar service for the year (or, in the case of dentures, at the bundled payment amount under clause (iv) of such subparagraph), adjusted by the geographic adjustment factor established under section 1848(e)(2) for the area for the year. ``(ii) 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 (or 2027, in the case of dentures) 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 (or 2027, in the case of dentures), the median fee for the service in the table titled `General Practitioners-National' of the `2020 Survey of Dental Fees' published by the American Dental Association, increased by the applicable percent increase for the year determined under subclause (II), as reduced by the productivity adjustment under subclause (III); and ``(bb) for 2029 (or 2028, in the case of dentures) and subsequent years, the amount determined under this subclause for the preceding year, updated pursuant to subparagraph (C)(i). ``(II) Applicable percent 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 (or 2026, in the case of dentures). ``(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 (or 2028, in the case of dentures) by increasing such amounts from the prior year by the percentage increase in the consumer price index for all urban consumers (United States city average) for the 12-month period ending with June of the preceding year, reduced by the productivity adjustment described in section 1886(b)(3)(B)(xi)(II). ``(ii) Adjustments.-- ``(I) In 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 (or 2028, in the case of dentures) and subsequent years to take into account changes in dental practice, coding changes, new data on work, practice, or malpractice expenses, or the addition of new procedures. ``(II) Limitation on annual 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(ooo)-- ``(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(ooo)(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.''. (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: ``(ix) With respect to 2029 and each subsequent year, an oral health professional (as defined in section 1861(ooo)(3)).''. (e) Exclusion Modifications.--Section 1862(a) of the Social Security Act (42 U.S.C. 1395y(a)) is amended-- (1) in paragraph (1)-- (A) in subparagraph (O), by striking ``and'' at the end; (B) in subparagraph (P), by striking the semicolon at the end and inserting ``, and''; and (C) by adding at the end the following new subparagraph: ``(Q) in the case of dental and oral health services (as defined in section 1861(ooo)) for which a limitation is applicable under section 1834(bb)(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)(LL)''. (f) 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 (ii), by striking ``or'' at the end; (2) in clause (iii), by striking the period and inserting ``, or''; and (3) by adding at the end the following new clause: ``(iv) consisting of dental and oral health services (as defined in subsection (ooo) 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 2026.''. (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 (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 (ooo)) 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 (ooo)(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 ``(D)'' and inserting ``(E)''. (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(ooo)), 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(ooo)) 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: ``(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(ooo)) 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.''. (h) Implementation.--In addition to amounts otherwise available, there is appropriated to the Secretary of Health and Human Services for fiscal year 2026, 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, 2026, and ending on September 30, 2035.

SEC. 403. 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, 2028, 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, 2028, 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, 2028, 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 402(c)(1), is amended-- (A) by striking ``and'' before ``(II)''; and (B) 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''. (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 402(d), is amended by adding at the end the following new clause: ``(x) Beginning on January 1, 2028, 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, 2028, 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, 2028, 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 (C)) on or after January 1, 2028-- ``(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, 2028, 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.''. (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) in the matter preceding clause (i), by inserting ``or of hearing aids described in paragraph (2)(E) 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: ``(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).''. (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, 2028, and before January 1, 2030; and ``(B) furnished on or after January 1, 2030, 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)(iv) of the Social Security Act (42 U.S.C. 1395i- 5(b)(5)(A)(iv)), as added by section 402(f), is amended by inserting ``, audiology services described in subsection (ll)(3) of such section, or hearing aids described in subsection (s)(8) of such section'' after ``section 1861)''. (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 402(g)(2)(A), 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(ooo))''; and (ii) in subsection (ee), by inserting ``or audiology services (as defined in section 1861(ll)(3))'' after ``(as defined in section 1861(ooo))''. (B) PPS.--Section 1834(o)(6) of the Social Security Act (42 U.S.C. 1395m(o)(6)), as added by section 402(g)(2)(B), 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(ooo))''; and (ii) in the second sentence, by inserting ``or such audiology services'' after ``such dental and oral health services''. (f) Expediting Implementation.--The Secretary of Health and Human Services shall implement this section for 2028 and 2029 through 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 2026, 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, 2027, and ending on September 30, 2036.

SEC. 404. 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 402(a), is amended-- (1) in subparagraph (KK), by striking ``and'' at the end; (2) in subparagraph (LL), by inserting ``and'' after the semicolon; and (3) by adding at the end the following new subparagraph: ``(MM) vision services (as defined in subsection (ppp));''. (b) Vision Services Defined.--Section 1861 of the Social Security Act (42 U.S.C. 1395x), as amended by section 402(b), is amended by adding at the end the following new subsection: ``(ppp) 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, 2028, 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 402(c)(2), is amended by adding at the end the following new subsection: ``(cc) Limitation for Vision Services.--With respect to vision services (as defined in section 1861(ppp)) 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)(MM),'' 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 403(b)(1), is amended by striking ``, and including one pair of conventional eyeglasses or contact lenses furnished subsequent to each cataract surgery with insertion of an intraocular lens'' and inserting ``, including 1 pair of conventional eyeglasses or contact lenses furnished subsequent to each cataract surgery with insertion of an intraocular lens, if furnished before January 1, 2028, 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, 2028''. (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 403(b)(2), 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, 2028, 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, 2028, 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.''. (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 403(b)(3)(A), is amended-- (i) in the heading, by striking ``and hearing aids'' and inserting ``hearing aids, and eyeglasses''; (ii) in the matter preceding clause (i)-- (I) by striking ``or of hearing aids'' and inserting ``of hearing aids''; and (II) by inserting ``or of eyeglasses described in paragraph (2)(F) of such section,'' after ``paragraph (2)(E) of such section,''; and (iii) 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 403(b)(3)(B)(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).''. (C) Implementation.--Section 1847(a) of the Social Security Act (42 U.S.C. 1395w-3(a)), as amended by section 403(b)(3)(B)(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).''. (g) Exclusion Modifications.--Section 1862(a) of the Social Security Act (42 U.S.C. 1395y(a)), as amended by section 402(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(ppp)) 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)(MM))'' 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)(MM))'' after ``refractive state of the eyes''. (h) 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 section 402(f) and amended by section 403(d), is amended-- (1) by striking ``or hearing aids'' and inserting ``hearing aids''; and (2) by inserting ``, or vision services (as defined in subsection (ppp) of such section)'' after ``subsection (s)(8) 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 403(e)(1), is amended by inserting ``and vision services (as defined in subsection (ppp))'' 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 402(g)(2)(A) and 403(e)(3)(A), 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(ppp))'' after ``(as defined in section 1861(ll)(3))''; and (ii) in subsection (ee)-- (I) by striking ``or audiology'' and inserting ``, audiology''; and (II) by inserting ``, or vision services (as defined in section 1861(ppp))'' after ``(as defined in section 1861(ll)(3))''. (B) PPS.--Section 1834(o)(6) of the Social Security Act (42 U.S.C. 1395m(o)(6)), as added by section 402(g)(2)(B) and amended by section 403(e)(3)(B), is amended-- (i) in the first sentence-- (I) by striking ``or audiology'' and inserting ``, audiology''; and (II) by inserting ``, or vision services (as defined in section 1861(ppp))'' 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''. (j) Expediting Implementation.--The Secretary of Health and Human Services shall implement this section for 2028 and 2029 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 2026, 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, 2027, and ending on September 30, 2035.

SEC. 405. 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 2027 through 2031.-- ``(A) Determination of alternative monthly actuarial rate for each of 2027 through 2031.--For each of 2027 through 2031, 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 2026 through 2030 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 2027 and 2028, the monthly actuarial rate for enrollees age 65 and over for the year, determined as if the amendments made by section 402 of the Medicare Dental, Hearing, and Vision Expansion Act of 2026 did not apply; and ``(II) for 2029, 2030, and 2031, the monthly actuarial rate for enrollees age 65 and over for the year, determined as if the amendments made by such section 402 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

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