[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 4357 Introduced in Senate (IS)]
<DOC>
118th CONGRESS
2d Session
S. 4357
To improve access to oral health care for vulnerable and underserved
populations.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 16, 2024
Mr. Sanders (for himself and Mr. Brown) introduced the following bill;
which was read twice and referred to the Committee on Health,
Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To improve access to oral health care for vulnerable and underserved
populations.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Comprehensive
Dental Reform Act of 2024''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--MEDICARE AND MEDICAID
Subtitle A--Medicare
Sec. 101. Coverage of dental services under the Medicare program.
Subtitle B--Medicaid
Sec. 111. Coverage of dental services under the Medicaid program.
TITLE II--PUBLIC HEALTH PROGRAMS
Subtitle A--National Health Service Corps
Sec. 201. National Health Service Corps.
Sec. 202. Community based dental residencies.
Sec. 203. Community-based training of dental students.
Subtitle B--Oral Health Education
Sec. 211. Authorization of appropriations for oral health education for
medical providers.
Sec. 212. Oral health education for other non-health professionals.
Sec. 213. Dental education.
Sec. 214. Oral health professional student loans.
Subtitle C--Other Oral Health Programs
Sec. 221. Access points.
Sec. 222. Dental clinics in schools.
Sec. 223. Emergency department care coordination.
Sec. 224. Research funding.
Sec. 225. Mobile and portable dental services.
Subtitle D--Oral Health Services as an Essential Health Benefit
Sec. 231. Oral health services as an essential health benefit.
TITLE III--DEPARTMENT OF VETERANS AFFAIRS MATTERS
Sec. 301. Requirement that Secretary of Veterans Affairs furnish dental
care in the same manner as any other
medical service.
Sec. 302. Demonstration program on training and employment of
alternative dental health care providers
for dental health care services for
veterans in rural and other underserved
communities.
Sec. 303. Program of education to promote dental health in veterans.
Sec. 304. Student loan repayment program to incentivize dental training
and ensure the dental workforce of the
Department of Veterans Affairs.
Sec. 305. Educational and training partnerships for dentists, dental
hygienists, and oral surgeons.
TITLE IV--FEDERAL BUREAU OF PRISONS
Sec. 401. Demonstration program on training and employment of
alternative dental health care providers
for dental health care services for
prisoners within the custody of the Bureau
of Prisons.
TITLE V--INDIAN HEALTH SERVICE
Sec. 501. Demonstration program on training and employment of
alternative dental health care providers
for dental health care services under the
Indian Health Service.
TITLE VI--REPORTS TO CONGRESS
Sec. 601. Reports on enrollment in coverage for oral health services.
TITLE I--MEDICARE AND MEDICAID
Subtitle A--Medicare
SEC. 101. COVERAGE OF DENTAL SERVICES UNDER THE MEDICARE PROGRAM.
(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 inserting ``and'' after the
semicolon at the end; and
(2) by adding at the end the following new subparagraph:
``(KK) oral health services (as defined in subsection
(nnn));''.
(b) 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:
``Oral Health Services
``(nnn)(1) The term `oral health services' means services (as
defined by the Secretary) that are necessary to prevent disease and
promote oral health, restore oral structures to health and function,
and treat emergency conditions.
``(2) For purposes of paragraph (1), such term shall include mobile
and portable oral health services (as defined by the Secretary) that--
``(A) are provided for the purpose of overcoming mobility,
transportation, and access barriers for individuals; and
``(B) satisfy the standards and certification requirements
established under section 1902(a)(88)(C) for the State in which
the services are provided.''.
(c) Payment and Coinsurance.--Section 1833(a)(1) of the Social
Security Act (42 U.S.C. 1395l(a)(1)) is amended--
(1) by striking ``and'' before ``(HH)''; and
(2) by inserting before the semicolon at the end the
following: ``, and (II) with respect to oral health services
(as defined in section 1861(nnn)), the amount paid shall be (i)
in the case of such services that are preventive, 100 percent
of the lesser of the actual charge for the services or the
amount determined under the payment basis determined under
section 1848, and (ii) in the case of all other such services,
80 percent of the lesser of the actual charge for the services
or the amount determined under the payment basis determined
under section 1848''.
(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)(KK),'' after ``risk assessment),''.
(e) Dentures.--Section 1861(s)(8) of the Social Security Act (42
U.S.C. 1395x(s)(8)) is amended--
(1) by striking ``(other than dental)'' and inserting
``(including dentures)''; and
(2) by striking ``internal body''.
(f) Repeal of Ground for Exclusion.--Section 1862(a) of the Social
Security Act (42 U.S.C. 1395y) is amended by striking paragraph (12).
(g) Effective Date.--The amendments made by this section shall
apply to services furnished on or after January 1, 2025.
Subtitle B--Medicaid
SEC. 111. COVERAGE OF DENTAL SERVICES UNDER THE MEDICAID PROGRAM.
(a) In General.--Section 1905 of the Social Security Act (42 U.S.C.
1396d) is amended--
(1) in subsection (a)(10), by striking ``dental services''
and inserting ``oral health services (as defined in subsection
(kk)(1))''; and
(2) by adding at the end the following:
``(kk)(1) Subject to paragraphs (2) and (3), for purposes of this
title, the term `oral health services' means services (as defined by
the Secretary) that are necessary to prevent disease and promote oral
health, restore oral structures to health and function, and treat
emergency conditions. These services shall include, in the case of
pregnant or postpartum women, such services as are necessary to address
oral health conditions that exist or are exacerbated by pregnancy or
childbirth or which, if left untreated, could adversely affect fetal or
child development.
``(2) For purposes of paragraph (1), such term shall include--
``(A) dentures; and
``(B) mobile and portable oral health services (as defined
by the Secretary) that--
``(i) are provided for the purpose of overcoming
mobility, transportation, and access barriers for
individuals; and
``(ii) satisfy the standards and certification
requirements established under section 1902(a)(88)(C)
for the State in which the services are provided.
``(3) For purposes of paragraph (1), such term shall not apply to
dental care or services provided to individuals under the age of 21
under subsection (r)(3).''.
(b) Conforming Amendments.--
(1) State plan requirements.--Section 1902(a) of such Act
(42 U.S.C. 1396a(a)) is amended--
(A) in paragraph (10)(A), in the matter preceding
clause (i), by inserting ``(10),'' after ``(5),'';
(B) in paragraph (86), by striking ``and'' at the
end;
(C) in paragraph (87), by striking the period at
the end and inserting ``; and''; and
(D) by inserting after paragraph (87) the
following:
``(88) provide for--
``(A) informing, in writing, all individuals who
have been determined to be eligible for medical
assistance of the availability of oral health services
(as defined in section 1905(kk));
``(B) conducting targeted outreach to pregnant
women who have been determined to be eligible for
medical assistance about the availability of medical
assistance for such dental services and the importance
of receiving dental care while pregnant; and
``(C) establishing and maintaining standards for
and certification of mobile and portable oral health
services (as described in subsections (r)(3)(C) and
(kk)(2)(B) of section 1905).''.
(2) Definition of medical assistance.--Section 1905(a)(12)
of such Act (42 U.S.C. 1396d(a)(12)) is amended by striking ``,
dentures,''.
(c) Mobile and Portable Oral Health Services Under EPSDT.--Section
1905(r)(3) of the Social Security Act (42 U.S.C. 1396d(r)(3)) is
amended--
(1) in subparagraph (A)(ii), by striking ``; and'' and
inserting a semicolon;
(2) in subparagraph (B), by striking the period at the end
and inserting ``; and''; and
(3) by adding at the end the following new subparagraph:
``(C) which shall include mobile and portable oral health
services (as defined by the Secretary) that--
``(i) are provided for the purpose of overcoming
mobility, transportation, or access barriers for
children; and
``(ii) satisfy the standards and certification
requirements established under section 1902(a)(88)(C)
for the State in which the services are provided.''.
(d) Increased Federal Funding for Dental Services.--
(1) In general.--Section 1905 of the Social Security Act
(42 U.S.C. 1396d), as amended by subsection (a), is further
amended--
(A) in subsection (b), in the first sentence, by
striking ``and (ii)'' and inserting ``(ii), and (ll)'';
and
(B) by adding at the end the following new
subsection:
``(ll) Increased FMAP for Oral Health Services.--
``(1) In general.--Notwithstanding subsection (b) and
section 1903(a)(7) and subject to the requirements described in
paragraphs (3) and (4), with respect to amounts expended on or
after January 1, 2025, for covered oral health expenses (as
described in paragraph (2)), the Federal medical assistance
percentage for a State that is one of the 50 States or the
District of Columbia for such expenses shall be equal to the
Federal medical assistance percentage that would otherwise
apply to the State for the fiscal year, as determined under
subsection (b) or section 1903(a)(7), increased by 15
percentage points.
``(2) Covered oral health expenses.--For purposes of
paragraph (1), the term `covered oral health expenses' means
the amounts expended for medical assistance for oral health
services (as defined in subsection (kk)) and amounts expended
for the proper and efficient administration of the provision of
such oral health services under the State plan.
``(3) Requirements.--For purposes of paragraph (1), the
Federal medical assistance percentage applicable to covered
oral health expenses under this subsection shall not apply to a
State unless--
``(A) the State plan for medical assistance
provides payment for oral health services (as so
defined) furnished by a health care provider at a rate
that is not less than 70 percent of the usual and
customary fee for such services in the State; and
``(B) the State satisfies such additional
requirements as are established by the Secretary, which
shall include--
``(i) streamlining of administrative
procedures for purposes of ensuring adequate
provider participation and increasing patient
utilization of oral health services; and
``(ii) the provision of technical
assistance to health care providers designed to
reduce the number of missed patient
appointments and reduce other barriers to the
delivery of oral health services.
``(4) Limitation.--For purposes of amounts expended for
covered oral health services, in no case shall any increase
under this subsection result in a Federal medical assistance
percentage that exceeds 100 percent.''.
(2) Conforming amendment.--Section 1903(a)(7) of the Social
Security Act (42 U.S.C. 1396b(a)(7)) is amended by striking
``section 1919(g)(3)(B)'' and inserting ``sections 1905(ll) and
1919(g)(3)(B)''.
(e) Secretarial Responsibilities.--
(1) Technical assistance and outreach.--The Secretary of
Health and Human Services, acting through the Administrator of
the Centers for Medicare & Medicaid Services, shall provide
technical assistance to States and conduct outreach to States
for purposes of educating and encouraging States to utilize and
provide payment under each State Medicaid program for
telehealth-enabled dental services in order to provide dental
services to traditionally underserved populations in need of
such services.
(2) Database and annual report on dental benefits for adult
medicaid enrollees.--
(A) Medicaid dental benefits database.--The
Secretary of Health and Human Services, acting through
the Administrator of the Centers for Medicare &
Medicaid Services, shall maintain, as accurately and
up-to-date as possible, a database that contains with
respect to each State (as defined for purposes of title
XIX of the Social Security Act (42 U.S.C. 1396 et
seq.)) information regarding the dental benefits
available for adults enrolled in the State Medicaid
program, including any limits on such benefits and the
amount of reimbursement provided under the State
Medicaid program for such benefits. The database also
shall include a separate description of the dental
benefits, benefit limits, and amount of reimbursement
provided under each State Medicaid program for pregnant
women, if such benefits are not provided to the woman
as part of early and periodic screening, diagnostic,
and treatment services (as defined in section 1905(r)
of the Social Security Act (42 U.S.C. 1396d(r))), and a
description of the use of dental services by children
and adults enrolled in the State Medicaid program.
(B) Annual report.--The Secretary of Health and
Human Services shall make available to the public an
annual report regarding the information collected in
the database required under subparagraph (A). Each
annual report under this subparagraph shall include for
each State Medicaid program and with respect to the
most recent year for which data are available the
yearly dental service utilization rates for children
and adults enrolled in the State Medicaid program.
(f) Effective Date.--
(1) In general.--Except as provided in paragraph (2), the
amendments made by this section shall apply to calendar
quarters beginning on or after January 1, 2025, without regard
to whether or not final regulations to carry out such
amendments have been promulgated by such date.
(2) Delay permitted for state plan amendment.--In the case
of a State plan for medical assistance under title XIX of the
Social Security Act which the Secretary of Health and Human
Services determines requires State legislation (other than
legislation appropriating funds) in order for the plan to meet
the additional requirements imposed by the amendments made by
this section, the State plan shall not be regarded as failing
to comply with the requirements of such title solely on the
basis of its failure to meet these additional requirements
before the first day of the first calendar quarter beginning
after the close of the first regular session of the State
legislature that begins after the date of enactment of this
Act. For purposes of the previous sentence, in the case of a
State that has a 2-year legislative session, each year of such
session shall be deemed to be a separate regular session of the
State legislature.
TITLE II--PUBLIC HEALTH PROGRAMS
Subtitle A--National Health Service Corps
SEC. 201. NATIONAL HEALTH SERVICE CORPS.
(a) In General.--Section 331 of the Public Health Service Act (42
U.S.C. 254d) is amended--
(1) in subsection (a)(3), by adding at the end the
following:
``(F) The term `dental therapist' means, with
respect to a State or Tribal government that licenses
or certifies such dental therapists, a mid-level dental
practitioner who--
``(i)(I) is licensed to practice under the
law of the State; or
``(II) is certified to practice under the
Community Health Aide Program of the Indian
Health Service under section 119 of the Indian
Health Care Improvement Act; and
``(ii) provides preventive and restorative
services directly to the public, commensurate
with the scope of the practice.''; and
(2) in subsection (b)--
(A) in paragraph (1), by inserting ``dental therapy
programs and'' after ``schools at which''; and
(B) in paragraph (2), by inserting ``dental
therapists,'' after ``dentists,''.
(b) Facilitation of Effective Provision of Corps Services.--Section
336(f)(3) of the Public Health Service Act (42 U.S.C. 254h-1(f)(3)) is
amended by inserting ``dental therapists,'' after ``midwives,''.
(c) Scholarship Program and Loan Repayment Program.--
(1) Scholarship program.--Section 338A of the Public Health
Service Act (42 U.S.C. 254l) is amended--
(A) in subsection (a)(1), by inserting ``dental
therapists,'' after ``dentists,''; and
(B) in subsection (b)(1), by inserting ``including
dental therapy,'' after ``or other health
profession,''.
(2) Loan repayment program.--Section 338B of the Public
Health Service Act (42 U.S.C. 254l-1) is amended--
(A) in subsection (a)(1), by inserting ``dental
therapists,'' after ``dentists,''; and
(B) in subsection (b)(1)--
(i) in subparagraph (A), by inserting
``dental therapist,'' after ``nurse
practitioner,'';
(ii) in subparagraph (B), by inserting
``dental therapy,'' after ``mental health,'';
and
(iii) in subparagraph (C)(ii), by inserting
``, including dental therapy'' after ``health
profession''.
(3) Authorization of appropriations.--Section 338H of the
Public Health Service Act (42 U.S.C. 254q) is amended--
(A) in subsection (a), by striking ``this section''
and inserting ``this subpart''; and
(B) by adding at the end the following:
``(d) Authorization of Appropriations With Respect to Oral Health
Professionals.--To carry out this subpart with respect to dentists,
dental therapists, and dental hygienists, in addition to the amounts
authorized under subsection (a), there is authorized to be appropriated
such sums as may be necessary for fiscal years 2025 through 2028, which
shall be used to provide an emergency expansion for scholarships to,
and loan repayments on behalf of, such oral health professionals.''.
SEC. 202. COMMUNITY BASED DENTAL RESIDENCIES.
Section 340H of the Public Health Service Act (42 U.S.C. 256h) is
amended by adding at the ending the following:
``(k) Additional Funding.--For the purpose of expanding dental
residencies at teaching health centers that operate graduate medical
education programs, there is authorized to be appropriated such sums as
may be necessary for each of fiscal years 2025 through 2028''.
SEC. 203. COMMUNITY-BASED TRAINING OF DENTAL STUDENTS.
(a) In General.--The Secretary of Health and Human Services
(referred to in this section as the ``Secretary'') shall establish a
pilot program under which the Secretary awards grants to eligible
entities for the purpose of supporting the community-based training of
dental students. Such grants shall be for a 5-year period, beginning in
fiscal year 2025.
(b) Eligible Entities.--To be eligible to receive a grant under
this section, an entity shall--
(1) be a Federally-qualified health center, rural health
center, or Tribal health facility; and
(2) submit an application to the Secretary at such time, in
such manner, and containing such information as the Secretary
may require.
(c) Selection of Awardees.--
(1) In general.--The Secretary shall award 6 grants under
this section to eligible entities described in subsection (b).
In making such awards, the Secretary shall ensure that each
entity receiving a grant operates in a different State
(including each of the several States and the District of
Columbia), territory, or Tribal territory.
(2) Priority.--In awarding grants under this section, the
Secretary shall give priority to eligible entities that--
(A) have a focus on training students in rural and
underserved areas;
(B) partner with dental professional schools and
programs associated with a historically Black college
or university (as defined by the term ``part B
institution'' in section 322 of the Higher Education
Act of 1965 (20 U.S.C. 1061)) or minority-serving
institutions (as described in section 371 of such Act
(20 U.S.C. 1067q)); or
(C) are located in a State or geographic area
without a dental school.
(d) Use of Funds.--An eligible entity receiving a grant under this
section--
(1) shall use such funds to establish a training program
for dental, dental hygienist, dental therapy, and dental
assistant students in a community-based, outpatient setting;
(2) may use such funds--
(A) to support faculty and preceptor wages and
living stipends for trainees;
(B) to purchase equipment, education tools, and
make renovations or alterations to a training site; and
(C) to provide supportive services such as child
care, transportation, and food assistance to enable
students to persist in and complete a training program;
and
(3) may use up to 5 percent of the grant amount for
planning and development, data collection and reporting, other
administrative purposes.
(e) Reporting.--
(1) Reports from eligible entities.--Each eligible entity
receiving a grant under this section shall submit such reports
on the program supported by the grant as the Secretary may
require.
(2) Reports to congress.--Not later than 1 year after the
date on which the program under this section terminates under
subsection (f), the Secretary shall submit to the Committee on
Health, Education, Labor, and Pensions of the Senate and the
Committee on Energy and Commerce of the House of
Representatives a report on the program.
(f) Sunset.--The grant program under this section shall terminate
on September 30, 2029.
(g) Appropriations.--To carry out this section, there is
appropriated, out of amounts in the Treasury not otherwise
appropriated, $4,500,000 for fiscal year 2025, to remain available
through the end of fiscal year 2029.
Subtitle B--Oral Health Education
SEC. 211. AUTHORIZATION OF APPROPRIATIONS FOR ORAL HEALTH EDUCATION FOR
MEDICAL PROVIDERS.
Section 747(c) of the Public Health Service Act (42 U.S.C. 293k(c))
is amended by adding at the end the following:
``(4) Oral health education.--In addition to other amounts
authorized under this subsection for purposes of carrying out
this section, there is authorized to be appropriated such sums
as may be necessary for fiscal years 2025 through 2028 for the
purpose of educating nondental medical professionals (including
physicians, nurses, nurse practitioners, physician assistants,
and pharmacists and particularly such professionals who provide
care to children and pregnant and postpartum women) about oral
health, including issues such as oral hygiene instruction,
topical application of fluoride, and oral health screenings,
with the goal of integrating oral health care into overall
health care.''.
SEC. 212. ORAL HEALTH EDUCATION FOR OTHER NON-HEALTH PROFESSIONALS.
Subpart I of part C of title VII of the Public Health Service Act
(42 U.S.C. 293k et seq.) is amended by inserting after section 748 the
following:
``SEC. 748A. ORAL HEALTH EDUCATION FOR OTHER NON-ORAL HEALTH
PROFESSIONALS.
``(a) In General.--The Secretary may make grants to, or enter into
contracts with, an accredited public or nonprofit private hospital,
educational institutions, or public or private nonprofit entities that
the Secretary has determined to be capable of carrying out such grant
or contract to educate individuals, such as community health workers,
social workers, nutritionists, health educators, occupational
therapists, and psychologists, to promote oral health education and
literacy and to provide support for behavior change and assistance with
care coordination with respect to oral health.
``(b) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated such sums as may be necessary
for fiscal years 2025 through 2028.''.
SEC. 213. DENTAL EDUCATION.
Section 748 of the Public Health Service Act (42 U.S.C. 293k-2) is
amended--
(1) in subsection (a)(1)(H), by striking ``pediatric
training programs'' and inserting ``pediatric dental training
programs''; and
(2) in subsection (c)--
(A) by striking the subsection heading and
inserting ``Requirements for Award.--'';
(B) by amending the matter preceding paragraph (1)
to read as follows: ``With respect to training provided
for under this section, the Secretary shall award
grants or contracts only to eligible entities that meet
at least 7 of the following criteria:'';
(C) in paragraph (2), by striking ``have a record
of training the greatest percentage of providers, or
that have demonstrated significant improvements in the
percentage of providers, who enter and'' and inserting
``train significant numbers of providers who'';
(D) in paragraph (3)--
(i) by striking ``have a record of
training'' and inserting ``intend to train'';
and
(ii) by striking the period at the end and
inserting ``and have faculty with experience in
treating underserved populations.'';
(E) in paragraph (8), by inserting ``or have
established'' after ``establish''; and
(F) by adding at the end the following:
``(9) Qualified applicants that require not less than 200
hours of community-based education rotations.''.
SEC. 214. ORAL HEALTH PROFESSIONAL STUDENT LOANS.
Subpart 3 of part E of title VII of the Public Health Service Act
(42 U.S.C. 295f et seq.) is amended by adding at the end the following:
``SEC. 779. ORAL HEALTH PROFESSIONAL STUDENT LOANS.
``(a) In General.--The Secretary shall establish and operate a
student loan fund for oral health professional students, including
dental hygienists, dental therapists, and dentists.
``(b) Content.--The Secretary shall establish and operate the
student loan fund program under subsection (a) in the same manner and
subject to the same terms as the loan fund program established with
schools of nursing under section 835.
``(c) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for fiscal years 2025 through 2028.''.
Subtitle C--Other Oral Health Programs
SEC. 221. ACCESS POINTS.
Subpart X of part D of title III of the Public Health Service Act
(42 U.S.C. 256f et seq.) is amended by adding at the end the following:
``SEC. 340G-2. FUNDING FOR ORAL HEALTH SERVICES.
``(a) In General.--The Secretary, acting through the Administrator
of the Health Resources and Services Administration, shall establish a
program to award grants to eligible entities to provide oral health
services, or to contract with private dental practices to provide
comprehensive oral health services, to low-income individuals and
individuals who are underserved with respect to oral health care.
``(b) Technical Assistance.--The Secretary shall provide technical
assistance to entities receiving grants under subsection (a) to provide
technical assistance to such entities in order to--
``(1) with respect to oral health care services, increase
utilization and efficiency and minimize missed appointments,
contract with offsite providers, recruit providers (including
oral health specialists), and operate programs outside the
physical facilities to take advantage of new systems to improve
access to oral health services;
``(2) address barriers to access to such services and
conduct targeted outreach to special populations such as
pregnant women, individuals with disabilities, individuals with
chronic conditions such as diabetes, and individuals residing
in long-term care facilities; or
``(3) contract with private dental practices that will
provide oral health services other than preventive oral health
care, including restoration and maintenance of oral health, in
order to meet the need for oral health services in the
community.
``(c) Eligible Entities.--To be eligible to receive a grant under
subsection (a), an entity shall--
``(1) be--
``(A) a Federally qualified health center (as
defined in section 1861(aa) of the Social Security
Act);
``(B) a safety net clinic or a free clinic (as
defined by the Secretary);
``(C) a health care clinic that provides services
to Tribal organizations or urban Indian organizations
(as such terms are defined in section 4 of the Indian
Health Care Improvement Act); or
``(D) any other interested public or private sector
health care provider or organization that the Secretary
determines has a demonstrated history of serving a high
number of uninsured and or low-income individuals or
those who lack ready access to oral health services;
and
``(2) demonstrate a clear need to expand oral health care
services beyond preventive oral health care.
``(d) Allocation for Hiring Oral Health Care Specialists.--A
portion of the funds available under this section shall be allocated
toward hiring oral health care specialists, such as oral surgeons and
endodontists, at entities receiving grants under this section.
``(e) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated such sums as may be necessary
for each of fiscal years 2025 through 2028.''.
SEC. 222. DENTAL CLINICS IN SCHOOLS.
Part Q of title III of the Public Health Service Act (42 U.S.C.
280h et seq.) is amended by adding at the end the following:
``SEC. 399Z-3. DENTAL CLINICS IN SCHOOLS.
``(a) In General.--The Secretary shall award grants to qualified
entities for the purpose of funding the building, operation, or
expansion of dental clinics in schools.
``(b) Qualified Entities.--To receive a grant under this section, a
qualified entity shall submit an application to the Secretary at such
time, in such manner, and containing such information as the Secretary
may require.
``(c) Requirements.--An entity receiving a grant under this section
shall--
``(1) provide comprehensive oral health services at a
dental clinic based at a school, including oral health
education, oral screening, fluoride application, prophylaxis,
sealants, and basic restorative services;
``(2) develop a coordinated system of care by referring
patients to an available qualified oral health provider in the
community for any required oral health services not provided in
the dental clinic in the school, including restorative
services, to ensure that all the oral health needs of students
are met; and
``(3) maintain clinic hours that extend beyond school
hours.
``(d) Authorization of Appropriations.--For purposes of carrying
out this section, there is authorized to be appropriated such sums as
may be necessary for fiscal years 2025 through 2028.''.
SEC. 223. EMERGENCY DEPARTMENT CARE COORDINATION.
Part P of title III of the Public Health Service Act (42 U.S.C.
280g et seq.) is amended by adding at the end the following:
``SEC. 399V-8. EMERGENCY DEPARTMENT CARE COORDINATION WITH RESPECT TO
DENTAL CARE.
``(a) In General.--The Secretary shall establish a grant program to
facilitate individuals receiving dental care at facilities other than
hospital emergency departments, under which the Secretary awards grants
to eligible entities to cover costs related to construction and
renovation, equipment, staff, outreach and education, and any other
allowable uses, with respect to the entity's facilities, as the
Secretary determines appropriate.
``(b) Eligible Entities.--To be eligible to receive a grant under
this section an entity shall--
``(1) be--
``(A) a Federally qualified health center (as
defined in paragraph (4) of section 1861(aa) of the
Social Security Act) or rural health clinic (as defined
in paragraph (2) of such section);
``(B) a private dental practice; or
``(C) any other interested public or private sector
health care provider or organization, such as a dental
school, that the Secretary determines has the capacity
to serve in a coordinated, cost-effective manner, a
high number of individuals who lack access to oral
health services; and
``(2) partner with a hospital or urgent care center.
``(c) Oral Health Education for Primary Care and ED Health Care
Providers.--The Secretary shall allocate a portion of the amounts
appropriated under subsection (e) toward medical education for primary
care and emergency department physicians, nurses, nurse practitioners,
and physician assistants to be trained in oral health.
``(d) Report.--Not later than January 1, 2028, the Secretary shall
submit to Congress a report on the best practices determined by the
program established under this section to address oral health needs of
individuals who go to emergency departments in need of oral health
care.
``(e) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated such sums as may be necessary
for fiscal years 2025 through 2028.''.
SEC. 224. RESEARCH FUNDING.
(a) In General.--For the period of fiscal years 2025 through 2027,
there is authorized to be appropriated for the Secretary of Health and
Human Services (referred to in this section as the ``Secretary'') such
sums as may be necessary to conduct, in consultation with the heads of
agencies and offices of the Department of Health and Human Services,
including the Director of the Centers for Disease Control and
Prevention, the Director of the Agency for Healthcare Research and
Quality, the Director of the National Institutes of Health, and the
Administrator of the Health Resources and Services Administration--
(1) research on--
(A) the prevention of oral disease;
(B) oral disease management;
(C) evidence-based strategies to prevent tooth
decay;
(D) rigorous, multidisciplinary research-based
approaches to overcome disparities in oral health;
(E) perinatal, postnatal, and childhood oral health
issues, including the integration of dental providers
in settings where pediatricians practice;
(F) access, quality, and outcomes with respect to
oral health services; and
(G) other topics as the Secretary determines
appropriate; and
(2) an evaluation of oral health service delivery to
underserved and vulnerable populations, including an evaluation
of workforce models to enhance oral health service delivery.
(b) Supplement Not Supplant.--Funds appropriated under this section
shall be used to supplement, and not supplant, other Federal, State,
and local public funds provided for activities described in subsection
(a).
SEC. 225. MOBILE AND PORTABLE DENTAL SERVICES.
Subpart X of part D of title III of the Public Health Service Act
(42 U.S.C. 256f et seq.), as amended by section 221, is further amended
by adding at the end the following:
``SEC. 340G-3. MOBILE AND PORTABLE DENTAL SERVICES.
``(a) In General.--The Secretary shall award grants to Federally
qualified health centers (as defined in paragraph (4) of section
1861(aa) of the Social Security Act), rural health clinics (as defined
in paragraph (2) of such section), nonprofit dental clinics, and dental
schools to provide mobile and portable, comprehensive dental services
that provide for the restoration or maintenance of oral health and
function (including dental services provided by licensed providers
through telehealth-enabled collaboration and supervision) and outreach
for dental services to underserved populations.
``(b) Eligible Entities.--To be eligible to receive a grant under
this section, an eligible entity shall submit an application to the
Secretary at such time, in such manner, and containing such information
as the Secretary may require, including information to demonstrate that
the entity is capable of providing coordinated care and continuity of
care to patients.
``(c) Use of Funds.--Eligible entities receiving a grant under this
section shall deliver the dental services described in subsection (a)
at locations such as senior centers, nursing homes, assisted living
facilities, schools, licensed child care centers that serve eligible
individuals who receive benefits under the State Children's Health
Insurance Program under title XXI of the Social Security Act or the
Medicaid program under title XIX of the Social Security Act, and
facilities that provide services under the Special Supplemental
Nutrition Program for Women, Infants, and Children established by
section 17 of the Child Nutrition Act of 1966 or under the Head Start
Act.
``(d) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be
necessary.''.
Subtitle D--Oral Health Services as an Essential Health Benefit
SEC. 231. ORAL HEALTH SERVICES AS AN ESSENTIAL HEALTH BENEFIT.
Section 1302(b) of the Patient Protection and Affordable Care Act
(42 U.S.C. 18022(b)) is amended--
(1) in paragraph (1)--
(A) in subparagraph (J), by striking ``oral and'';
and
(B) by adding at the end the following:
``(K) Oral health services for children and
adults.''; and
(2) by adding at the end the following:
``(6) Oral health services.--For purposes of paragraph
(1)(K), the term `oral health services' means services (as
defined by the Secretary), that are necessary to prevent
disease and promote oral health, restore oral structures to
health and function, and treat emergency conditions.''.
TITLE III--DEPARTMENT OF VETERANS AFFAIRS MATTERS
SEC. 301. REQUIREMENT THAT SECRETARY OF VETERANS AFFAIRS FURNISH DENTAL
CARE IN THE SAME MANNER AS ANY OTHER MEDICAL SERVICE.
(a) In General.--Title 38, United States Code, is amended--
(1) in section 1701(6)(B), by striking ``as described in
sections 1710 and 1712 of this title'';
(2) in section 1710(c), by striking the second sentence;
(3) in section 1712--
(A) by striking subsections (a) and (b);
(B) by redesignating subsections (c), (d), and (e)
as subsections (a), (b), and (c), respectively; and
(C) in subsection (a), as redesignated by
subparagraph (B)--
(i) by striking ``Dental appliances'' and
inserting ``The Secretary may furnish dentures,
dental appliances''; and
(ii) by striking ``to be furnished by the
Secretary under this section may be procured by
the Secretary'' and inserting ``under this
section and may procure such appliances'';
(4) in section 1712C(h)--
(A) by striking ``section 1712 of this title'' and
inserting ``this chapter''; and
(B) by striking ``outpatient dental services and
treatment, and related dental appliances, under such
section 1712'' and inserting ``dental services and
appliances under this chapter''; and
(5) by striking section 2062.
(b) Conforming Amendment.--Section 1525(a) of such title is amended
by striking ``medicines under section 1712(d)'' and inserting
``medicines under section 1712(b)''.
(c) Clerical Amendments.--Such title is further amended--
(1) in section 1712, in the heading for such section, by
striking ``Dental care'' and inserting ``Appliances'';
(2) in the table of sections at the beginning of chapter
17, by striking the item relating to section 1712 and inserting
the following new item:
``1712. Appliances; drugs and medicines for certain disabled veterans;
vaccines.'';
and
(3) in the table of sections at the beginning of chapter
20, by striking the item relating to section 2062.
SEC. 302. DEMONSTRATION PROGRAM ON TRAINING AND EMPLOYMENT OF
ALTERNATIVE DENTAL HEALTH CARE PROVIDERS FOR DENTAL
HEALTH CARE SERVICES FOR VETERANS IN RURAL AND OTHER
UNDERSERVED COMMUNITIES.
(a) Demonstration Program Authorized.--The Secretary of Veterans
Affairs may carry out a demonstration program to establish programs to
train and employ alternative dental health care providers in order to
increase access to dental health care services for veterans who are
entitled to such services from the Department of Veterans Affairs and
reside in rural and other underserved communities.
(b) Telehealth.--For purposes of alternative dental health care
providers and other dental care providers who are licensed to provide
clinical care, dental services provided under the demonstration program
under this section may be administered by such providers through
telehealth-enabled collaboration and supervision when appropriate and
feasible.
(c) Alternative Dental Health Care Providers Defined.--In this
section, the term ``alternative dental health care providers'' has the
meaning given that term in section 340G-1(a)(2) of the Public Health
Service Act (42 U.S.C. 256g-1(a)(2)).
(d) Authorization of Appropriations.--There are authorized to be
appropriated such sums as are necessary to carry out the demonstration
program under this section.
SEC. 303. PROGRAM OF EDUCATION TO PROMOTE DENTAL HEALTH IN VETERANS.
(a) Program Required.--The Secretary of Veterans Affairs shall
carry out a program of education to promote dental health for veterans
who are enrolled in the system of annual patient enrollment of the
Department of Veterans Affairs established and operated under section
1705(a) of title 38, United States Code.
(b) Elements.--The program required by subsection (a) shall provide
education for veterans on the following:
(1) The association between dental health and overall
health and well-being.
(2) Proper techniques for dental care.
(3) Signs and symptoms of commonly occurring dental
conditions.
(4) Treatment options for commonly occurring dental issues.
(5) Options for obtaining access to dental care, including
information on eligibility for dental care through the
Department.
(6) Available and accessible options for obtaining low or
no-cost dental care, including through dental schools and
Federally Qualified Health Centers.
(7) Such other matters relating to dental health as the
Secretary considers appropriate.
(c) Delivery of Educational Materials.--
(1) In general.--The Secretary shall provide educational
materials to veterans under the program required by subsection
(a) through a variety of mechanisms, including the following:
(A) The availability and distribution of print
materials at facilities of the Department (including at
medical centers, clinics, Vet Centers, and readjustment
counseling centers) and to providers (including members
of Patient Aligned Care Teams).
(B) The availability and distribution of materials
over the Internet, including through webinars, My
HealtheVet, and VA.gov.
(C) Presentations by the dental program office of
the Department of information, including both small
group and large group presentations, and distribution
of such information to all locations in which the
program is being carried out.
(2) Selection of mechanisms.--In selecting mechanisms under
paragraph (1), the Secretary shall select mechanisms designed
to maximize the number of veterans who receive education under
the program.
(d) Construction.--Nothing in this section shall be construed to
alter or revise the eligibility of any veteran for dental care under
the laws administered by the Secretary.
(e) Definitions.--In this section:
(1) Federally qualified health center.--The term
``Federally Qualified Health Center'' means a Federally-
qualified health center as defined in section 1905(l)(2)(B) of
the Social Security Act (42 U.S.C. 1396d(l)(2)(B)).
(2) Vet center.--The term ``Vet Center'' has the meaning
given that term in section 1712A(h) of title 38, United States
Code.
(f) Effective Date.--This section shall take effect on the date
that is one year after the date of the enactment of this Act.
SEC. 304. STUDENT LOAN REPAYMENT PROGRAM TO INCENTIVIZE DENTAL TRAINING
AND ENSURE THE DENTAL WORKFORCE OF THE DEPARTMENT OF
VETERANS AFFAIRS.
(a) Program Required.--The Secretary of Veterans Affairs, to ensure
that the Department of Veterans Affairs has sufficient staff to provide
dental services to veterans, shall implement a loan reimbursement
program for qualified dentists, dental hygienists, and oral surgeons
who agree--
(1) to be appointed by the Secretary as a dentist, dental
hygienist, or oral surgeon, as the case may be, under section
7401 of title 38, United States Code; and
(2) to serve as a dentist, dental hygienist, or oral
surgeon, as the case may be, of the Department pursuant to such
appointment at a dental clinic of the Department for a period
of not less than five years.
(b) Maximum Amount.--The Secretary may reimburse not more than--
(1) $75,000 for each dentist participating in the program
under subsection (a);
(2) $10,000 for each dental hygienist participating in such
program; and
(3) $20,000 for each oral surgeon participating in such
program.
(c) Selection of Locations.--The Secretary shall monitor demand
among veterans for dental care and require participants in the program
under subsection (a) to choose from dental clinics of the Department
with the greatest need for dentists, dental hygienists, or oral
surgeons, as the case may be, according to facility enrollment and
patient demand.
SEC. 305. EDUCATIONAL AND TRAINING PARTNERSHIPS FOR DENTISTS, DENTAL
HYGIENISTS, AND ORAL SURGEONS.
The Secretary of Veterans Affairs shall enter into educational and
training partnerships with dental schools, including dental programs
within a community college, to provide training and employment
opportunities for dentists, dental hygienists, and oral surgeons.
TITLE IV--FEDERAL BUREAU OF PRISONS
SEC. 401. DEMONSTRATION PROGRAM ON TRAINING AND EMPLOYMENT OF
ALTERNATIVE DENTAL HEALTH CARE PROVIDERS FOR DENTAL
HEALTH CARE SERVICES FOR PRISONERS WITHIN THE CUSTODY OF
THE BUREAU OF PRISONS.
(a) Demonstration Program Authorized.--The Attorney General, acting
through the Director of the Bureau of Prisons, may carry out a
demonstration program to establish programs to train and employ
alternative dental health care providers in order to increase access to
dental health services for prisoners within the custody of the Bureau
of Prisons.
(b) Telehealth.--For purposes of alternative dental health care
providers and any other dental care providers who are licensed to
provide clinical care, dental services provided under the demonstration
program under this section may be administered by such providers
through telehealth-enabled collaboration and supervision when deemed
appropriate and feasible.
(c) Alternative Dental Health Care Providers Defined.--In this
section, the term ``alternative dental health care providers'' has the
meaning given that term in section 340G-1 of the Public Health Service
Act (42 U.S.C. 256g-1).
(d) Authorization Of Appropriations.--There are authorized to be
appropriated such sums as are necessary to carry out the demonstration
program under this section.
TITLE V--INDIAN HEALTH SERVICE
SEC. 501. DEMONSTRATION PROGRAM ON TRAINING AND EMPLOYMENT OF
ALTERNATIVE DENTAL HEALTH CARE PROVIDERS FOR DENTAL
HEALTH CARE SERVICES UNDER THE INDIAN HEALTH SERVICE.
(a) Demonstration Program Authorized.--The Secretary of Health and
Human Services, acting through the Indian Health Service, may carry out
a demonstration program to establish programs to train and employ
alternative dental health care providers in order to help eliminate
oral health disparities and increase access to dental services through
health programs operated by the Indian Health Service, Indian tribes,
tribal organizations, and urban Indian organizations (as those terms
are defined in section 4 of the Indian Health Care Improvement Act (25
U.S.C. 1603)).
(b) Telehealth.--For purposes of alternative dental health care
providers and any other dental care providers who are licensed to
provide clinical care, dental services provided under the demonstration
program under this section may be administered by such providers
through telehealth-enabled collaboration and supervision when deemed
appropriate and feasible.
(c) Alternative Dental Health Care Providers Defined.--In this
section, the term ``alternative dental health care providers'' has the
meaning given that term in section 340G-1(a)(2) of the Public Health
Service Act (42 U.S.C. 256g-1(a)(2)).
(d) Authorization of Appropriations.--There are authorized to be
appropriated such sums as are necessary to carry out the demonstration
program under this section.
TITLE VI--REPORTS TO CONGRESS
SEC. 601. REPORTS ON ENROLLMENT IN COVERAGE FOR ORAL HEALTH SERVICES.
(a) Secretary of Health and Human Services.--The Secretary of
Health and Human Services shall submit to Congress the following
reports:
(1) Cost-benefit analysis.--Not later than October 1, 2028,
a report that provides a comprehensive cost-benefit analysis
regarding the expansion of coverage for dental services
pursuant to this Act, including whether the provision of such
services resulted in a reduction in total health care costs for
individuals under the Medicare and Medicaid programs.
(2) Annual report on enrollment, utilization, and
expenditures in dental insurance plans.--Not later than 1 year
after the date of the enactment of this Act, and annually
thereafter, an annual report containing detailed information
on--
(A) enrollment in private insurance plans providing
pediatric and adult dental coverage, whether such
coverage is provided through a qualified health plan
(as defined in section 1301(a) of the Patient
Protection and Affordable Care Act (Public Law 111-
148)) or a stand-alone dental plan;
(B) the utilization of oral health services by
children and adults who receive dental coverage under a
qualified health plan or a stand-alone dental plan; and
(C) expenditures related to oral health services by
individuals and families who receive dental coverage in
a qualified health plan or stand-alone dental plan.
(b) Comptroller General.--
(1) Medicaid and medicare.--Not later than January 1, 2028,
the Comptroller General of the United States shall submit to
Congress a report that provides a comprehensive analysis and
evaluation of the implementation and utilization of the
expanded coverage for dental services pursuant to this Act for
individuals enrolled in the Medicare and Medicaid programs.
(2) Demonstration programs.--Not later than January 1,
2028, the Comptroller General of the United States shall submit
to Congress a report that provides a comprehensive analysis and
evaluation of the demonstration programs described in sections
302, 401, and 501, including--
(A) the extent to which the programs improved
access to oral health care and increased utilization of
oral health services; and
(B) an examination of the training provided under
the programs to alternative dental health care
providers and the quality of care provided by such
providers.
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