[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