[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 560 Introduced in Senate (IS)]
<DOC>
117th CONGRESS
1st Session
S. 560
To improve coverage of maternal oral health care, and for other
purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
March 3, 2021
Ms. Stabenow introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
A BILL
To improve coverage of maternal oral health care, 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 ``Oral Health for Moms Act''.
SEC. 2. REQUIRING COVERAGE OF ORAL HEALTH SERVICES FOR PREGNANT AND
POSTPARTUM INDIVIDUALS.
(a) In General.--
(1) Medicaid.--Section 1905 of the Social Security Act (42
U.S.C. 1396d) is amended--
(A) in subsection (a)(4)--
(i) by striking ``; and (D)'' and inserting
``; (D)''; and
(ii) by inserting ``; and (E) beginning
January 1, 2022, oral health services for
pregnant and postpartum individuals (as defined
in subsection (hh))'' after ``subsection
(hh))''; and
(B) by adding at the end the following new
subsection:
``(hh) Oral Health Services for Pregnant and Postpartum
Individuals.--
``(1) In general.--For purposes of this title, the term
`oral health services for pregnant and postpartum individuals'
means dental services necessary to prevent disease and promote
oral health, restore oral structures to health and function,
and treat emergency conditions that are furnished to an
individual during pregnancy (or during the 60-day period
beginning on the last day of the pregnancy or such longer
period beginning on the last day of the pregnancy as the State
shall elect).
``(2) Coverage requirements.--To satisfy the requirement to
provide oral health services for pregnant and postpartum
individuals, a State shall, at a minimum, provide coverage to
prevent disease and promote oral health, restore oral
structures to health and function, and treat emergency
conditions, consistent with recommendations for perinatal oral
health care and dental care during pregnancy from the American
Academy of Pediatric Dentistry and the American College of
Obstetricians and Gynecologists. Such coverage shall include--
``(A) routine diagnostic and preventive care such
as dental cleanings, exams, and X-rays;
``(B) basic dental services such as fillings and
extractions;
``(C) major dental services such as root canals,
crowns, and dentures;
``(D) emergency dental care; and
``(E) other necessary services related to dental
and oral health (as defined by the Secretary).''.
(2) Coverage of oral health services for pregnant and
postpartum individuals regardless of eligibility pathway.--
Section 1902(a)(10) of the Social Security Act (42 U.S.C.
1396a(a)(10)) is amended in the matter following subparagraph
(G)--
(A) by striking ``and (XVIII)'' and inserting
``(XVIII)''; and
(B) by striking the semicolon at the end and
inserting ``, and (XIX) beginning January 1, 2022,
medical assistance shall be made available for oral
health services for pregnant and postpartum individuals
for any individual who is eligible for and receiving
medical assistance under the State plan or under a
waiver of such plan during such individual's pregnancy
and during the 60-day period beginning on the last day
of the pregnancy (or such longer period beginning on
the last day of the pregnancy as the State shall
elect), notwithstanding any other provision of law
(including another provision of this paragraph)
limiting such individual's eligibility for medical
assistance under such plan or waiver to coverage for a
limited type of benefits and services that would not
otherwise include coverage of oral health services for
pregnant and postpartum individuals;''.
(3) CHIP.--
(A) In general.--Section 2103(c)(6)(A) of the
Social Security Act (42 U.S.C. 1397cc(c)(6)(A)) is
amended by inserting ``and, in the case that the State
elects to provide pregnancy-related assistance pursuant
to section 2112, the pregnancy-related assistance
provided to a targeted low-income pregnant woman''
after ``targeted low-income child''.
(B) Effective date.--The amendment made by this
section shall take effect on January 1, 2022.
(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)(1), is further
amended--
(A) in subsection (b), by striking ``and (ff)'' and
inserting ``(ff), and (ii)''; and
(B) by adding at the end the following:
``(ii) Increased FMAP for Additional Expenditures for Low-Income
Pregnant People.--
``(1) In general.--Subject to paragraph (2), for calendar
quarters beginning on or after January 1, 2022, notwithstanding
subsection (b), the Federal medical assistance percentage for a
State, with respect to the additional amounts expended by such
State for medical assistance under the State plan under this
title or a waiver of such plan that are attributable to
requirements imposed by the amendments made by the Oral Health
for Moms Act (as determined by the Secretary), shall be equal
to 100 percent.
``(2) Maintenance of effort.--Paragraph (1) shall not apply
with respect to a State if, for any calendar quarter during the
period beginning with the date of enactment of this subsection
and ending with January 1, 2025, the State--
``(A) has in effect under such plan eligibility
standards, methodologies, or procedures (including any
enrollment cap or other numerical limitation on
enrollment, any waiting list, any procedures designed
to delay the consideration of applications for
enrollment, or similar limitation with respect to
enrollment) for individuals described in subsection
(l)(1) who are eligible for medical assistance under
the State plan or waiver under subsection
(a)(10)(A)(ii)(IX) that are more restrictive than the
eligibility standards, methodologies, or procedures,
respectively, for such individuals under such plan or
waiver that are in effect on the date of the enactment
of this subsection; or
``(B) provides pregnancy-related assistance to
targeted low-income pregnant women under the State plan
under title XXI (or a waiver of such a plan) at a level
that is less than the level at which the State provides
such assistance to such women under such plan on the
date of the enactment of this subsection.''.
(2) CHIP.--Section 2105 of the Social Security Act (42
U.S.C. 1397ee) is amended--
(A) in subsection (b), by adding at the end the
following: ``For calendar quarters beginning on or
after January 1, 2022, the enhanced FMAP for a State
shall, subject to paragraph (2) of subsection (h), be
100 percent with respect to amounts described in
paragraph (1) of such subsection.''; and
(B) by adding at the end the following new
subsection:
``(h) Increased eFMAP for Additional Expenditures for Targeted Low-
Income Pregnant Women.--
``(1) Amounts described.--For purposes of subsection (b),
the amounts described in this paragraph are additional amounts
expended by a State for pregnancy-related assistance that is
provided under the State plan under this title or a waiver of
such plan during a calendar quarter beginning on or after
January 1, 2022, that are attributable to the provision of
dental coverage to targeted low-income pregnant women (as
determined by the Secretary).
``(2) Maintenance of effort.--The fourth sentence of
subsection (b) shall not apply with respect to a State if, for
any calendar quarter during the period beginning with the date
of enactment of this subsection and ending with January 1,
2025, the State--
``(A) has in effect under the State plan under
title XIX (or a waiver of such a plan) eligibility
standards, methodologies, or procedures (including any
enrollment cap or other numerical limitation on
enrollment, any waiting list, any procedures designed
to delay the consideration of applications for
enrollment, or similar limitation with respect to
enrollment) for individuals described in subsection
(l)(1) of section 1902 who are eligible for medical
assistance under such State plan or waiver under
subsection (a)(10)(A)(ii)(IX) of such section that are
more restrictive than the eligibility standards,
methodologies, or procedures, respectively, for such
individuals under such plan or waiver that are in
effect on the date of the enactment of this subsection;
or
``(B) provides pregnancy-related assistance to
targeted low-income pregnant women under the State plan
under this title (or a waiver of such a plan) at a
level that is less than the level at which the State
provides such assistance to such women under such plan
or waiver on the date of the enactment of this
subsection.''.
(3) 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 Oral Health Services for Pregnant and Postpartum
Individuals.--Any payment made to a territory for expenditures on
medical assistance that are subject to the Federal medical assistance
percentage specified under section 1905(ii) 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.''.
(4) Adjustment of chip allotments to account for increased
efmap.--Section 2104 of the Social Security Act (42 U.S.C.
1397dd) is amended--
(A) in subsection (c)--
(i) in paragraph (1), by inserting
``paragraph (5) and'' before ``subsections (d)
and (m)(5)''; and
(ii) by adding at the end the following new
paragraph:
``(5) Adjusting allotments to account for increased federal
payments for coverage of dental services for pregnant people.--
If a commonwealth or territory described in paragraph (3)
receives payment for a fiscal year under subsection (a) of
section 2105 for expenditures that are subject to the enhanced
FMAP specified under subsection (h) of such section, the amount
of the allotment determined for such commonwealth or territory
under this subsection shall be increased by the amount by
which--
``(A) the amount of the payment received by the
commonwealth or territory for such expenditures for the
fiscal year; exceeds
``(B) the amount of the payment that the
commonwealth or territory would have received for such
expenditures for the fiscal year without regard to such
subsection (h).''; and
(B) in subsection (m)--
(i) in paragraph (2)(B), in the matter
preceding clause (i), by striking ``paragraphs
(5) and (7)'' and inserting ``paragraphs (5),
(7), and (12)''; and
(ii) by adding at the end the following new
paragraph:
``(12) Adjusting allotments to account for increased
federal payments for coverage of dental services for pregnant
people.--If a State receives payment for a fiscal year under
subsection (a) of section 2105 for expenditures that are
subject to the enhanced FMAP specified under subsection (h) of
such section, the amount of the allotment determined for the
State and fiscal year under this subsection shall be increased
by the amount by which--
``(A) the amount of the payment received by the
State for such expenditures for the fiscal year;
exceeds
``(B) the amount of the payment that the State
would have received for such expenditures for the
fiscal year without regard to such subsection (h).''.
SEC. 3. MATERNAL ORAL HEALTH QUALITY MEASURES.
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. MATERNAL ORAL HEALTH QUALITY MEASURES.
``(a) Development of Core Set of Maternal Oral Health Care Quality
Measures.--
``(1) In general.--The Secretary shall identify and publish
a recommended core set of health quality measures for enrolled
pregnant individuals 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 maternal 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 pregnant
individuals.
``(2) Alignment with existing core set.--In identifying and
publishing the recommended core set of maternal oral health
quality 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
measures identified, published, and revised under section
1139B.
``(3) Process for maternal oral health quality measures
program.--In identifying gaps in existing maternal oral health
quality measures and establishing priorities for the
development and advancement of such measures, the Secretary
shall consult with--
``(A) States;
``(B) health care providers, including physicians
in the fields of general obstetrics, maternal-fetal
medicine, family medicine, neonatology, and pediatrics;
``(C) dental professionals; and
``(D) national organizations with expertise in
maternal oral health quality measurement.
``(4) Definition of enrolled pregnant individual.--The term
`enrolled pregnant individual' means an individual who--
``(A) is pregnant or is in the 60-day period
beginning on the last day of the individual's
pregnancy; and
``(B) is enrolled for medical assistance, child
health assistance, or pregnancy-related assistance (as
applicable) under a State plan under title XIX or XXI
(or a waiver of such a plan).
``(b) Deadlines.--
``(1) Recommended measures.--Not later than January 1,
2023, the Secretary shall identify and publish for comment a
recommended core set of maternal oral health quality measures
that includes the following:
``(A) Measures of utilization of oral health and
dental services during pregnancy across health care
settings.
``(B) Measures that address the availability of
oral evaluations during or following medical visits for
enrolled pregnant individuals.
``(C) Measures that address the incidence of
emergency department visits for non-traumatic dental
conditions during pregnancy.
``(D) Measures that address the availability 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 pregnant individuals and
postpartum individuals aimed at improving the oral
health of enrolled pregnant individuals and infants.
``(F) 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 pregnant
individuals who have caries risk documented in
the reporting year involved.
``(ii) The percentage of enrolled pregnant
individuals 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 pregnant
individuals who received a comprehensive or
periodic oral evaluation or a comprehensive
periodontal evaluation during the reporting
year involved.
``(iv) The percentage of enrolled pregnant
individuals 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.
``(2) Dissemination.--Not later than January 1, 2024, the
Secretary shall publish an initial core set of maternal oral
health quality measures that are applicable to enrolled
pregnant individuals.
``(3) Standardized reporting.--Not later than January 1,
2025, the Secretary, in consultation with States, shall develop
a standardized format for reporting information based on the
initial core set of maternal oral health quality measures
(stratified by race, ethnicity, primary language, and
disability status) and create procedures to encourage States to
use such measures to voluntarily report information regarding
the quality of oral health care for enrolled pregnant
individuals.
``(4) Reports to congress.--Not later than January 1, 2026,
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 Maternal Oral
Health Quality Measures Applied Under Medicaid or CHIP.--
``(1) In general.--Each State with a plan or waiver
approved under title XIX or XXI shall annually report
(separately or as part of the annual report required under
section 1139A(c)) to the Secretary on--
``(A) the State-specific maternal oral health
quality 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
of oral health care furnished to enrolled pregnant
individuals 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; and
``(C) the State-specific information regarding the
dental benefits available to enrolled pregnant
individuals 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.
``(2) Publication.--Not later than September 30, 2026, 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.''.
SEC. 4. INCLUSION OF ORAL HEALTH SERVICES FOR PREGNANT AND POSTPARTUM
INDIVIDUALS AS AN ESSENTIAL HEALTH BENEFIT.
(a) In General.--Section 1302(b) of the Patient Protection and
Affordable Care Act (42 U.S.C. 18022(b)) is amended--
(1) in paragraph (1), by adding at the end the following:
``(K) Oral health services for pregnant and
postpartum individuals.''; and
(2) in paragraph (4)(F)--
(A) by striking ``section 1311(b)(2)(B)(ii)'' and
inserting ``section 1311(d)(2)(B)(ii)''; and
(B) by inserting ``or (1)(K)'' after ``paragraph
(1)(J)''.
(b) State Exchange Requirements.--Section 1311(d)(2)(B)(ii) of the
Patient Protection and Affordable Care Act (42 U.S.C.
18031(d)(2)(B)(ii)) is amended by inserting ``or oral health benefits
meeting the requirements of section 1302(d)(1)(K)'' before the period.
(c) Premium Assistance Credit Amount.--Section 36B(b)(3)(E) of the
Internal Revenue Code of 1986 is amended--
(1) by striking ``section 1311(d)(2)(B)(ii)(I)'' and
inserting ``section 1311(d)(2)(B)(ii)''; and
(2) by striking ``section 1302(b)(1)(J)'' and inserting
``subparagraph (J) or (K) of section 1302(b)(1)''.
(d) Conforming Amendment.--Section 2715(b)(3)(B)(i) of the Public
Health Service Act (42 U.S.C. 300gg-15(b)(3)(B)(i)) is amended by
striking ``through (J)'' and inserting ``through (K)''.
SEC. 5. FEDERALLY QUALIFIED HEALTH CENTER GRANT PROGRAM.
(a) In General.--Not later than 1 year after the date of enactment
of this Act, the Secretary of Health and Human Services (in this Act
referred to as the ``Secretary'') shall establish a grant program under
which the Secretary shall award grants to Federally qualified health
centers (as defined in section 1861(aa)(4) of the Social Security Act
(42 U.S.C. 1395x(aa)(4))) to enter into arrangements with private
dental providers to provide dental services to eligible individuals.
(b) Authorization of Appropriations.--There are authorized to be
appropriated to the Secretary such sums as are necessary to carry out
this section.
SEC. 6. MATERNAL 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 issue a report on
issues related to maternal oral health across the 50 States and the
territories, including--
(1) the availability of maternal oral health coverage, and
enrollment in such coverage;
(2) a survey of oral health status among low-income women
of childbearing age;
(3) barriers to accessing maternal oral health care;
(4) innovations and potential solutions to problems of
access to maternal oral health care, including innovations that
would expand access to such care beyond dental offices; and
(5) the impact of the requirement (imposed by the
amendments made by section 2) that State Medicaid programs
cover oral health services for pregnant and postpartum
individuals on providers of maternal health care services, and
such recommendations for improving reimbursement rates for such
providers as the Commission deems appropriate.
SEC. 7. INDIAN HEALTH SERVICE MATERNAL ORAL HEALTH INITIATIVE.
(a) In General.--Not later than 1 year after the date of enactment
of this Act, the Secretary shall develop and implement, in consultation
with Indian tribes and tribal organizations (as those terms are defined
in section 4 of the Indian Health Care Improvement Act (25 U.S.C.
1603)), a formal initiative to improve the oral health status of
pregnant individuals, postpartum individuals, and infants and address
barriers to oral health care during pregnancy for American Indian and
Alaska Native populations. This initiative shall include strategies
to--
(1) reduce the prevalence and severity of oral disease
among pregnant individuals, postpartum individuals, and their
infants;
(2) improve access to oral health care during pregnancy and
the postpartum period;
(3) establish a data collection system to monitor
prevalence of oral disease and access to care;
(4) educate health and dental providers on the importance
of oral health care during pregnancy and the postpartum period
and build competencies in the delivery of such care;
(5) increase rates of patient referral to oral health care
by non-dental providers; and
(6) establish mechanisms for outreach and education of
pregnant individuals and postpartum individuals for the
purposes of improving oral health practices and access to care.
(b) Authorization of Appropriations.--There are authorized to be
appropriated to the Secretary such sums as are necessary to carry out
this section.
SEC. 8. PERINATAL 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 by entities that
fund or provide maternal health care, oral health care, and maternal
and infant support services, to provide--
(1) interactive oral health education aimed at promoting
good oral health practices for pregnant individuals and
postpartum individuals who are eligible for or enrolled in the
Medicaid program under title XIX of the Social Security Act or
the Children's Health Insurance Program under title XXI of the
Social Security Act (42 U.S.C. 1396 et seq., 1397aa et seq.);
(2) information on oral health and dental coverage for
pregnant individuals, postpartum individuals, and children; and
(3) assistance in connecting pregnant individuals,
postpartum individuals, and children to oral health care.
SEC. 9. MATERNAL ORAL HEALTH TRAINING.
(a) In General.--Not later than 1 year after the date of enactment
of this Act, the Secretary, acting through the Associate Administrator
of the Maternal and Child Health Bureau of the Health Resources and
Services Administration, shall establish a grant program under which
the Secretary shall award grants to eligible entities for the purpose
of--
(1) integrating oral health care into maternal health care
settings;
(2) improving oral health outcomes during pregnancy and the
postpartum period;
(3) developing core competencies in oral health among
maternal health providers, including obstetrician-gynecologists
and certified nurse-midwives, and non-clinical perinatal health
workers, including community health workers and doulas; and
(4) improving access to oral health care during pregnancy
and closing referral gaps.
(b) Eligible Entities.--The Secretary may make grants under this
section to, or enter into contracts with State health departments or
other State health agencies, academic institutions, schools of medicine
or dentistry, nonprofit hospitals, nonprofit accredited birth centers,
or public or private nonprofit entities which the Secretary has
determined are capable of carrying out such a grant or contract to--
(1) plan, develop, and provide training of maternal health
providers to establish core competencies in oral health during
pregnancy and the postpartum period;
(2) provide information to maternal health providers,
including information on periodontal disease, dental caries,
oral health screening and risk assessment, beneficial oral
health practices for pregnant individuals and infants; and
(3) provide tools and resources aimed at facilitating the
integration of oral health care and referral to dental care
into maternity care settings.
(c) Authorization of Appropriations.--There are authorized to be
appropriated to the Secretary such sums as are necessary to carry out
this section.
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