[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