[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4439 Introduced in House (IH)]
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117th CONGRESS
1st Session
H. R. 4439
To amend title XIX of the Social Security Act to improve coverage of
adult oral health care under the Medicaid program, and for other
purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 16, 2021
Ms. Barragan (for herself, Mr. Grijalva, Ms. Velazquez, Mr. Payne, Mr.
Soto, and Ms. Norton) introduced the following bill; which was referred
to the Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To amend title XIX of the Social Security Act to improve coverage of
adult oral health care under the Medicaid program, 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.
This Act may be cited as the ``Medicaid Dental Benefit Act''.
SEC. 2. REQUIRING COVERAGE OF ORAL HEALTH SERVICES FOR ADULTS UNDER THE
MEDICAID PROGRAM.
(a) In General.--
(1) Mandatory coverage.--
(A) In general.--
(i) Requirement.--Section 1902(a)(10)(A) of
the Social Security Act (42 U.S.C.
1396a(a)(10)(A)) is amended by inserting
``(10),'' after ``(5),''.
(ii) Effective date.--The amendment made by
clause (i) shall apply with respect to medical
assistance furnished in calendar quarters
beginning on or after the date that is 1 year
after the date of the enactment of this Act.
(B) Benchmark coverage.--Section 1937(b)(5) of the
Social Security Act (42 U.S.C. 1396u-7(b)(5)) is
amended by striking the period and inserting ``, and,
beginning with the first quarter beginning on or after
the date that is 1 year after the date of the enactment
of the Medicaid Dental Benefit Act, coverage of dental
and oral health services (as defined in section
1905(jj)).''.
(2) Definition of services.--Section 1905 of the Social
Security Act (42 U.S.C. 1396d) is amended--
(A) in subsection (a)(10), by striking ``dental
services'' and inserting ``dental and oral health
services (as defined in subsection (jj))''; and
(B) by adding at the end the following new
subsection:
``(jj) Definition of Dental and Oral Health Services.--
``(1) In general.--For purposes of this title, the term
`dental and oral health services' means services necessary to
prevent disease and promote oral health, restore oral
structures to health and function, reduce oral pain, and treat
emergency oral conditions. Such term includes the services
specified in paragraph (2).
``(2) Specified services.--For purposes of paragraph (1),
the services specified in this paragraph are the following:
``(A) Routine diagnostic and preventive care (such
as dental cleanings, exams, and x-rays).
``(B) Basic dental services (such as fillings and
extractions) and major dental services (such as root
canals, crowns, and dentures).
``(C) Emergency dental care.
``(D) Temporomandibular (TMD) and orofacial pain
disorder treatment.
``(E) Other necessary services related to dental
and oral health (as specified by the Secretary).''.
(b) Enhanced FMAP; Maintenance of Effort.--
(1) Medicaid.--Section 1905 of the Social Security Act (42
U.S.C. 1396d), as amended by subsection (a), is further
amended--
(A) in subsection (b), by striking ``and (ii)'' and
inserting ``(ii), and (kk)''; and
(B) by adding at the end the following new
subsection:
``(kk) Increased FMAP for Expenditures for Dental and Oral Health
Services.--
``(1) In general.--The Federal medical assistance
percentage with respect to amounts expended by such State for
medical assistance consisting of dental and oral health
services (as defined in subsection (jj)) furnished during the
first calendar quarter beginning on or after the date that is 1
year after the date of the enactment of this subsection (or
during any subsequent quarter) to individuals 21 years of age
or older shall be equal to, in the case of such services
furnished--
``(A) during the 3-year period beginning on the
first day of such first calendar quarter, 100 percent;
``(B) during the 1-year period immediately
following the period described in subparagraph (A), 95
percent;
``(C) during each subsequent 1-year period (through
the third such subsequent period), the percentage
specified under this paragraph for the preceding 1-year
period, reduced by 5 percentage points; and
``(D) during any quarter beginning after the 7-year
period beginning on the first day described in
subparagraph (A), 80 percent.
``(2) No reduction in fmap.--Paragraph (1) shall not apply
with respect to amounts expended by a State if the Federal
medical assistance percentage otherwise applicable to such
amounts without application of such paragraph would be higher
than such percentage applicable to such amounts with
application of such paragraph.''.
(2) Exclusion of amounts attributable to increased fmap
from territorial caps.--Section 1108 of the Social Security Act
(42 U.S.C. 1308) is amended--
(A) in subsection (f), in the matter preceding
paragraph (1), by striking ``subsections (g) and (h)''
and inserting ``subsections (g), (h), and (i)''; and
(B) by adding at the end the following:
``(i) Exclusion From Caps of Amounts Attributable to Increased FMAP
for Coverage of Dental and Oral Health Services.--Any payment made to a
territory for expenditures for medical assistance that are subject to
an increase the Federal medical assistance percentage applicable to
such expenditures under section 1905(kk) shall not be taken into
account for purposes of applying payment limits under subsections (f)
and (g) to the extent that such payment exceeds the amount of the
payment that would have been made to the territory for such
expenditures without regard to such section.''.
SEC. 3. ADULT ORAL HEALTH QUALITY AND EQUITY MEASURES.
(a) In General.--Title XI of the Social Security Act (42 U.S.C.
1301 et seq.) is amended by inserting after section 1139B the following
new section:
``SEC. 1139C. ADULT ORAL HEALTH QUALITY AND EQUITY MEASURES.
``(a) Development of Core Set of Adult Oral Health Care Quality and
Equity Measures.--
``(1) In general.--The Secretary shall identify and publish
a recommended core set of health quality and equity measures
for individuals enrolled in a State plan (or waiver of such
plan) under title XIX who are over the age of 21 in the same
manner as the Secretary identifies and publishes a core set of
child health quality measures under section 1139A, including
with respect to identifying and publishing existing oral health
quality measures for such individuals that are in use under
public and privately sponsored health care coverage
arrangements, or that are part of reporting systems that
measure both the presence and duration of health insurance
coverage over time, that may be applicable to enrolled adults.
``(2) Alignment with existing core set.--In identifying and
publishing the recommended core set of adult oral health
quality and equity measures required under paragraph (1), the
Secretary shall ensure that, to the extent possible, such
measures align with and do not duplicate the core set of adult
health quality and equity measures identified, published, and
revised under section 1139B.
``(3) Process for adult oral health quality and equity
measures program.--In identifying gaps in existing adult oral
health quality and equity measures and establishing priorities
for the development and advancement of such measures, the
Secretary shall consult with--
``(A) States;
``(B) health care providers;
``(C) patient representatives;
``(D) dental professionals; and
``(E) national organizations with expertise in oral
health quality or equity measurement.
``(b) Deadlines.--
``(1) Recommended measures.--Not later than 1 year after
enactment of this Act, the Secretary shall identify and publish
for comment a recommended core set of adult oral health quality
and equity measures that includes the following:
``(A) Measures of utilization of oral health and
dental services across health care settings.
``(B) Measures that address the availability of
oral evaluations during or following medical visits for
enrolled adults.
``(C) Measures that address the incidence of
emergency department visits for non-traumatic dental
conditions.
``(D) Measures that address the availability and
receipt of follow-up dental care after emergency
department visits for non-traumatic dental conditions
during pregnancy.
``(E) Measures that address the availability of
counseling of enrolled adults aimed at improving oral
health outcomes.
``(F) Measures that address the availability and
receipt of care for beneficiaries who meet the medical
necessity criteria for general anesthesia and
intravenous sedation.
``(G) Measures that address screening and
evaluation for caries risk and periodontitis and
treatment for caries risk and periodontitis, including
the following:
``(i) The percentage of enrolled adults who
have caries risk documented in the reporting
year involved.
``(ii) The percentage of enrolled adults
who received a topical fluoride application or
sealants based on an oral health risk
assessment demonstrating the need for such
application or sealants during the reporting
year involved.
``(iii) The percentage of enrolled adults
who received a comprehensive or periodic oral
evaluation or a comprehensive periodontal
evaluation during the reporting year involved.
``(iv) The percentage of enrolled adults
with a history of periodontitis who received an
oral prophylaxis, scaling or root planing, or
periodontal maintenance visit at least 2 times
during the reporting year involved.
``(v) The percentage of enrolled adults
with diabetes who receive a comprehensive or
periodic evaluation or a comprehensive
periodontal evaluation during the reporting
year involved.
``(vi) The percentage of enrolled adults
who require tooth extraction during the
reporting year involved.
``(vii) The percentage of enrolled adults
who require partial or full dentures during the
reporting year involved.
``(2) Dissemination.--Not later than 1 year after enactment
of this Act, the Secretary shall publish an initial core set of
oral health quality and equity measures that are applicable to
enrolled adults.
``(3) Standardized reporting.--Not later than 2 years after
the date of the enactment of this Act, the Secretary, in
consultation with States, shall develop a standardized format
for the collection and reporting of information based on the
initial core set of adult oral health quality and equity
measures (stratified by race, ethnicity, primary language,
disability status, sexual orientation and gender identity) and
create guidelines, procedures, and incentives to States to use
such measures and to collect and report information regarding
the quality and equity of oral health care for enrolled adults.
``(4) Reports to congress.--Not later than 3 years after
enactment of this act, and every 3 years thereafter, the
Secretary shall include in the report to Congress required
under section 1139A(a)(6) information similar to the
information required under that section with respect to the
measures established under this section.
``(c) Annual State Reports Regarding State-Specific Oral Health
Quality and Equity Measures Applied Under Medicaid.--
``(1) In general.--Each State with a plan approved under
title XIX (or with a waiver of such plan in effect) shall
annually report (separately or as part of the annual report
required under section 1139A(c)) to the Secretary on--
``(A) the State-specific adult oral health quality
and equity measures applied by the State under such a
plan or waiver, including measures described in
subsection (b)(1);
``(B) the State-specific information on the quality
and equity of oral health care furnished to enrolled
adults under such a plan or waiver, including
information collected through external quality reviews
of managed care organizations under section 1932 and
benchmark plans under section 1937, disaggregated by
race, ethnicity, primary language, disability status,
sexual orientation, and gender identity;
``(C) the State-specific information regarding the
dental benefits available to enrolled adults under such
a plan or waiver, including any limits on such benefits
and the amount of reimbursement provided under such
plan or waiver for such benefits; and
``(D) the State-specific plan to identify,
evaluate, and reduce in meaningful and measurable ways,
to the extent practicable, health disparities based on
age, sex, race, ethnicity, primary language, sexual
orientation and gender identity, and disability status.
``(2) Publication.--Not later than 2 years after the date
of enactment of this Act, and annually thereafter, the
Secretary shall collect, analyze, and make publicly available
the information reported by States under paragraph (1).
``(d) Authorization of Appropriations.--There are authorized to be
appropriated $10,000,000 to carry out this section. Funds appropriated
under this subsection shall remain available until expended.''.
(b) Required Reporting.--
(1) Medicaid.--Section 1902(a) of the Social Security Act
(42 U.S.C. 1396a(a)) is amended--
(A) in paragraph (86), by striking ``and'' at the
end;
(B) in paragraph (87)(D), by striking the period
and inserting ``; and''; and
(C) by inserting after paragraph (87) the following
new paragraph:
``(88) provide for the reporting required under section
1139C(c).''.
(2) CHIP.--Section 2102 of the Social Security Act (42
U.S.C. 1397bb) is amended by adding at the end the following
new subsection:
``(d) Reporting Requirements.--A State child health plan shall
provide for the reporting required under section 1139C(c).''.
SEC. 4. ADULT ORAL HEALTH CARE REPORT.
Not later than 2 years after the date of enactment of this Act, the
Medicaid and CHIP Payment and Access Commission shall submit to
Congress a report on issues related to adult oral health across the 50
States, tribes, and the territories, including--
(1) the availability of adult oral health coverage, and
enrollment in such coverage;
(2) a survey of adult oral health status among low-income
women of childbearing age;
(3) barriers to accessing adult oral health care, including
for racially diverse, ethnically diverse, and limited English
proficient communities;
(4) innovations and potential solutions to problems of
access (including disparities in access) to adult oral health
care, including innovations that would expand access to such
care beyond dental offices; and
(5) the impact of the amendments made by section 2 and
recommendations for improving reimbursement rates for such
provider of dental and oral health services under the Medicaid
program.
SEC. 5. ORAL HEALTH OUTREACH AND EDUCATION.
Not later than 1 year after the date of enactment of this Act, the
Secretary shall develop a program, to be implemented through contracts
with entities that fund or provide oral health care, to provide--
(1) culturally competent and linguistically appropriate
information on the availability and scope of oral health and
dental coverage for adults who are eligible for or enrolled
under a State plan (or waiver of such plan) under title XIX of
the Social Security Act (42 U.S.C. 1396 et seq.);
(2) assistance in connecting adults and underserved
populations enrolled in such a plan (or waiver) to oral health
care;
(3) education to dental, oral health, and medical
professionals to strengthen core competencies in delivering
culturally competent oral health care to adults enrolled in
such a plan (or waiver), including: individuals with physical
and intellectual disabilities, pregnant and postpartum
individuals, Alaskan Native and American Indian populations,
and people living in urban, rural and, other underserved
communities; and
(4) culturally competent and linguistically appropriate
interactive oral health education aimed at promoting good oral
health practices for adults, including racially and ethnically
diverse Medicaid beneficiaries.
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