[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 570 Introduced in Senate (IS)]
<DOC>
118th CONGRESS
1st Session
S. 570
To amend title XIX of the Social Security Act to improve coverage of
dental and oral health services for adults under Medicaid, and for
other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
February 28, 2023
Mr. Cardin (for himself and Ms. Stabenow) introduced the following
bill; which was read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend title XIX of the Social Security Act to improve coverage of
dental and oral health services for adults under Medicaid, 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 of
2023''.
SEC. 2. REQUIRING MEDICAID COVERAGE OF DENTAL AND ORAL HEALTH SERVICES
FOR ADULTS.
(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)), as amended by section
11405(a)(1)(A) of Public Law 117-169, is
amended by inserting ``(10),'' before
``(13)(B),''.
(ii) Medically needy.--
(I) In general.--Section
1902(a)(10)(C)(iv) of such Act (42
U.S.C. 1396a(a)(10)(C)(iv)), as amended
by section 11405(a)(1)(B) of Public Law
117-169, is amended by inserting
``(10),'' before ``(13)(B)''.
(II) Rule of construction.--Nothing
in this section or the amendments made
by this section shall be construed to
limit the access of an individual
residing in an institutional setting to
dental and oral health services (as
such term is defined in section
1905(jj) of the Social Security Act, as
added by paragraph (2)(B)).
(iii) Effective date.--The amendments made
by clauses (i) and (ii) shall apply with
respect to expenditures for medical assistance
in calendar quarters beginning on or after
January 1, 2025.
(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 January 1, 2025, coverage of dental and oral
health services (as such term is defined in section
1905(jj)).''.
(C) Optional application to territories.--Section
1902(j) of the Social Security Act (42 U.S.C. 1396a(j))
is amended--
(i) by striking ``this title, the
Secretary'' and inserting ``this title--
``(1) in the case of a State other than the 50 States and
the District of Columbia the requirement under subsection
(a)(10)(A) to provide the care and services listed in paragraph
(10) of section 1905(a) shall be optional; and
``(2) the Secretary''; and
(ii) by striking the second comma after
``section 1108(f)''.
(2) Definition of dental and oral health services.--Section
1905 of the Social Security Act (42 U.S.C. 1396d) is amended--
(A) in subsection (a)(10), by inserting ``and
dental and oral health services (as defined in
subsection (jj))'' after ``dental services''; and
(B) by adding at the end the following new
subsection:
``(jj) Dental and Oral Health Services.--For purposes of subsection
(a)(10), the term `dental and oral health services' means dentures and
denture services, implants and implant services, and services necessary
to prevent oral disease and promote oral health, restore oral
structures to health and function, reduce oral pain, and treat
emergency oral conditions, that are furnished by a provider who is
legally authorized to furnish such items and services under State law
(or the State regulatory mechanism provided by State law).''.
(3) Conforming amendment.--
(A) In general.--Section 1905(a)(10) of the Social
Security Act (42 U.S.C. 1396d(a)(10)), as amended by
paragraph (2), is amended by striking ``dental services
and''.
(B) Effective date.--The amendment made by
subparagraph (A) shall take effect on January 1, 2025.
(b) State Option for Additional Dental and Oral Health Benefits.--
Section 1905(a)(13) of the Social Security Act (42 U.S.C. 1396d(a)(13))
is amended by inserting the following new subparagraph after
subparagraph (C):
``(D) at State option, such items and services
related to dental and oral health services (as defined
in subsection (jj)) that are in addition to those
identified in such subsection (jj) as the State may
specify;''.
(c) Increased FMAP.--
(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)'';
(B) in subsection (ff), by striking ``and (ii)''
and inserting ``, (ii), and (kk)''; and
(C) by adding at the end the following new
subsection:
``(kk) Increased FMAP for Expenditures Related to Dental and Oral
Health Services.--
``(1) In general.--
``(A) 50 states and dc.--Notwithstanding subsection
(b), in the case of a State that is 1 of the 50 States
or the District of Columbia, during the 12-quarter
period that begins on January 1, 2025, the Federal
medical assistance percentage shall be equal to 100
percent with respect to amounts expended by the State
for medical assistance for dental and oral health
services authorized under paragraph (10) of subsection
(a). In no case may the application of this
subparagraph result in the Federal medical assistance
percentage determined for a State with respect to
expenditures described in this subparagraph exceeding
100 percent.
``(B) Territories.--
``(i) In general.--Notwithstanding
subsection (b), in the case of a State that is
Puerto Rico, the Virgin Islands, Guam, the
Northern Mariana Islands, or American Samoa,
during a period described in clause (ii), the
Federal medical assistance percentage shall be
equal to 100 percent with respect to amounts
expended by the State for medical assistance
for any item or service that is included in
dental and oral health services authorized
under paragraph (10) of subsection (a). In no
case may the application of this clause result
in the Federal medical assistance percentage
determined for a State with respect to
expenditures described in this clause exceeding
100 percent.
``(ii) Period described.--A period
described in this clause is, with respect to an
item or service described in clause (i) and a
State described in such clause, the 12-quarter
period that begins with the first quarter
beginning on or after January 1, 2025, in which
such item or service is first covered under the
State plan or under a waiver of such plan.
``(2) Exclusions.--The Federal medical assistance
percentage specified in paragraph (1) shall not apply to
amounts expended for medical assistance during any period for--
``(A) additional items and services authorized
under paragraph (13)(D) of subsection (a); or
``(B) items and services furnished to an individual
if, as of the date of enactment of this subsection,
medical assistance was available to such individual for
such items and services or medicare cost-sharing under
the State plan or a waiver of such plan.''.
(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 (j)''; and
(B) by adding at the end the following:
``(j) Exclusion From Caps of Amounts Attributable to Increased FMAP
for Coverage of Dental and Oral Health Services.--Any additional amount
paid to Puerto Rico, the Virgin Islands, Guam, the Northern Mariana
Islands, and American Samoa for expenditures for medical assistance
that is attributable to an increase in 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).''.
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.
<all>