,,ii  #aacth ,,congress  #ast ,session  
,s4 #aebb  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,september #ah1
 #bjac,mr4 ,sanders 7for himself and    
,mr4 ,schatz7 introduced the following  
bill2 which was read twice and referred 
to the ,committee on ,finance  ,a ,,bill
  ,to improve access to oral health care
 for vulnerable and underserved         
populations4  #a4 ,short title ,this    
,act may be cited as the ,comprehensive 
,dental ,reform ,act of #bjac4  #b4     
,table of contents ,the table of        
contents of this ,act is as follows3    
,sec4 #a4 ,short title4,sec4 #b4 ,table 
of contents4,sec4 #c4 ,findings4,,title 
,i--,medicare and ,medicaid,subtitle    
,a--,medicare,sec4 #aja4 ,coverage of   
dental services under the ,medicare     
program4,subtitle ,b--,medicaid,sec4    
#aaa4 ,coverage of dental services under
 the ,medicaid program4,,title          
,,ii--,public ,health programs,subtitle 
,a--,national ,health ,service          
,corps,sec4 #bja4 ,national ,health     

,service ,corps4,sec4 #bjb4 ,community  
based dental residencies4,subtitle      
,b--,oral health education,sec4 #baa4   
,authorization of appropriations for    
oral health education for medical       
providers4,sec4 #bab4 ,oral health      
education for other non-health          
professionals4,sec4 #bac4 ,dental       
education4,sec4 #bad4 ,oral health      
professional student loans4,subtitle    
,c--,other oral health programs,sec4    
#bba4 ,access points4,sec4 #bbb4 ,dental
 clinics in schools4,sec4 #bbc4         
,emergency room care coordination4,sec4 
#bbd4 ,research funding4,sec4 #bbe4     
,mobile and portable dental             
services4,subtitle ,d--,oral health     
services as an essential health         
benefit,sec4 #bca4 ,oral health services
 as an essential health benefit4,,title 
,,iii--,department of ,veterans ,affairs
 and ,department of ,defense            
,matters,subtitle ,a--,department of    
,veterans ,affairs ,matters,sec4 #cja4  
,requiring the ,secretary of ,veterans  

,affairs to furnish dental care in the  
same manner as any other medical        
service4,sec4 #cjb4 ,demonstration      
program on training and employment of   
alternative dental health care providers
 for dental health care services for    
veterans in rural and other underserved 
communities4,subtitle ,b--,department of
 ,defense ,matters,sec4 #caa4           
,demonstration program on training and  
employment of alternative dental health 
care providers for dental health care   
services for members of the ,armed      
,forces and dependents lacking ready    
access to such services4,,title         
,,iv--,federal ,bureau of ,prisons,sec4 
#dja4 ,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               
,prisons4,,title ,v--,indian ,health    
,service,sec4 #eja4 ,demonstration      
program on training and employment of   
alternative dental health care providers

 for dental health care services under  
the ,indian ,health ,service4,,title    
,,vi--,reports to ,congress,sec4 #fja4  
,evaluation of expansion of coverage for
 dental services4  #c4 ,findings        
,congress makes the following findings3 
7#a7 ,the ,united ,states must establish
 a nationwide and comprehensive approach
 to address the lack of access to needed
 dental care and reduce oral health     
disparities4  7#b7 ,since #bjjj1 when   
the ,surgeon ,general of the ,united    
,states called dental disease a silent  
epidemic1 there has been increasing but 
still insufficient attention given to   
addressing oral health issues4 ,the     
,healthy ,people #bjbj initiative       
includes oral health as a leading health
 indicator for the first time in the    
history of the ,healthy ,people program1
 and in #bjaa1 the ,institute of        
,medicine published #b reports1         
,improving ,access to ,oral ,health     
,care for ,vulnerable and ,underserved  
,populations and ,advancing ,oral       

,health in ,america1 that focused on    
oral health4  7#c7 ,dental caries1      
commonly known as cavities1 are the most
 common chronic disease for children in 
the ,united ,states4 ,additionally1 #be 
percent of ,american adults who have    
attained #fe years of age have lost all 
of their teeth4  7#d7 ,untreated oral   
health problems contribute to an        
increased risk for serious medical      
conditions such as diabetes1            
hospital-acquired pneumonia1 and poor   
birth outcomes4  7#e7 ,according to a   
report by the ,surgeon ,general of the  
,united ,states1 students miss more than
 #ea1jjj1jjj hours of school and        
employed adults lose more than          
#afd1jjj1jjj hours of work each year due
 to dental disease and dental visits4   
7#f7 ,while the lack of access to oral  
health services is a national problem1  
those who are most likely to remain     
underserved are individuals with low    
incomes1 racial and ethnic minorities1  
pregnant women1 older adults1           

individuals with special needs1 and     
individuals living in rural communities4
  7#g7 ,more than #a in #d ,americans do
 not have dental health insurance which 
is far greater than the number of       
individuals who lack general health     
insurance4  7#h7 ,the ,medicare program 
and the ,department of ,veterans        
,affairs do not provide dental coverage 
to the majority of their beneficiaries1 
and ,states can elect whether to provide
 dental coverage to adults under the    
,medicaid program4  7#i7 ,only #bj      
percent of practicing dentists in the   
,united ,states provide care to         
individuals enrolled in ,medicaid1 and a
 very small percentage of dentists      
devote a substantial part of their      
practice towards caring for individuals 
who are underserved4  7#aj7 ,the ,united
 ,states spends more than               
#ajj1jjj1jjj1jjj on dental care and that
 number is expected to rise to nearly   
#agj1jjj1jjj1jjj by #bjbj4 ,over        
#cj1jjj1jjj1jjj dollars was spent       

out-of-pocket for dental services in    
#bjjh4  7#aa7 ,the lack of access to    
oral health services results in higher  
health care expenditures4 ,in #bjji1    
there were over #hcj1jjj visits to      
emergency rooms across the ,united      
,states for preventable dental          
conditions1 which is #af percent higher 
than in #bjjf4 ,the treatment of dental 
conditions in hospital emergency rooms  
in #bjaj cost as much as #b1ajj1jjj1jjj4
  ,i ,medicare and ,medicaid  ,a        
,medicare  #aja4 ,coverage of dental    
services under the ,medicare program    
7a7 ,coverage ,section #ahfa7s77#b7 of  
the ,social ,security ,act 7#db         
,u4,s4,c4 #aciex7s77#b77 is amended--   
7#a7 in subparagraph 7,,ee71 by striking
 and after the semicolon at the end2    
7#b7 in subparagraph 7,,ff71 by adding  
and after the semicolon at the end2 and 
7#c7 by adding at the end the following 
new subparagraph3  7,,gg7 dental        
services 7as defined in subsection      
7iii772  4  7b7 ,dental services defined

 ,section #ahfa7s7 of the ,social       
,security ,act 7#db ,u4,s4,c4 #aciex7s77
 is amended by adding at the end the    
following new subsection3  7iii7 ,dental
 services  7#a7 ,the term dental        
services means oral health services 7as 
defined by the ,secretary7 provided by a
 licensed oral health care provider that
 are necessary to prevent disease and   
promote oral health1 restore oral       
structures to health and function1 and  
treat emergency conditions4  7#b7 ,for  
purposes of paragraph 7#a71 such term   
shall include mobile and portable oral  
health services 7as defined by the      
,secretary7 that-- 7,a7 are provided for
 the purpose of overcoming mobility1    
transportation1 and access barriers for 
individuals2 and  7,b7 satisfy the      
standards and certification requirements
 established under section              
#aijb7;a77#hd77;,b7 for the ,state in   
which the services are provided4  4  7c7
 ,payment and coinsurance ,section      
#ahcc7;a77#a7 of the ,social ,security  

,act 7#db ,u4,s4,c4 #aciel7a77#a77 is   
amended-- 7#a7 by striking and before   
7,z72 and  7#b7 by inserting before the 
semicolon at the end the following3 1   
and 7,,aa7 with respect to dental       
services 7as defined in section         
#ahfa7;iii771 the amount paid shall be  
7i7 in the case of such services that   
are dental health preventive services   
described in paragraph 7#a77;,d7 of such
 section1 #ajj percent of the lesser of 
the actual charge for the services or   
the amount determined under the payment 
basis determined under section #ahdh1   
and 7ii7 in the case of all other such  
services1 #hj percent of the lesser of  
the actual charge for the services or   
the amount determined under the payment 
basis determined under section #ahdh4   
7d7 ,payment under physician fee        
schedule ,section #ahdh7;j77#c7 of the  
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#d7;j77#c77 is amended by        
inserting 7#b77;,,gg71 after risk       
assessment714  7e7 ,dentures ,section   

#ahfa7s77#h7 of the ,social ,security   
,act 7#db ,u4,s4,c4 #aciex7s77#h77 is   
amended-- 7#a7 by striking 7other than  
dental7 and inserting 7including        
dentures72 and  7#b7 by striking        
internal body4  7f7 ,repeal of ground   
for exclusion ,section #ahfb7;a7 of the 
,social ,security ,act 7#db ,u4,s4,c4   
#aciey7 is amended by striking paragraph
 7#ab74  7g7 ,effective date ,the       
amendments made by this section shall   
apply to services furnished on or after 
,january #a1 #bjad4  ,b ,medicaid  #aaa4
 ,coverage of dental services under the 
,medicaid program  7a7 ,in general      
,section #aije of the ,social ,security 
,act 7#db ,u4,s4,c4 #acif;d7 is         
amended-- 7#a7 in subsection 7a77#aj71  
by adding 7as described in subsection   
7ee77#a77 after dental services2 and    
7#b7 by adding at the end the following3
  7ee7 7#a7 ,subject to paragraphs 7#b7 
and 7#c71 for purposes of this title1   
the term dental services means oral     
health services 7as defined by the      

,secretary7 provided by a licensed oral 
health care provider that are necessary 
to prevent disease and promote oral     
health1 restore oral structures to      
health and function1 and treat emergency
 conditions4  7#b7 ,for purposes of     
paragraph 7#a71 such term shall         
include-- 7,a7 dentures2 and  7,b7      
mobile and portable oral health services
 7as defined by the ,secretary7 that--  
7i7 are provided for the purpose of     
overcoming mobility1 transportation1 and
 access barriers for individuals2 and   
7ii7 satisfy the standards and          
certification requirements established  
under section #aijb7;a77#hb77;,c7 for   
the ,state in which the services are    
provided4  7#c7 ,for purposes of        
paragraph 7#a71 such term shall not     
apply to dental care or services        
provided to individuals under the age of
 #ba under subsection 7r77#c74  4  7b7  
,conforming amendments  7#a7 ,state plan
 requirements ,section #aijb7;a7 of such
 ,act 7#db ,u4,s4,c4 #acif;a7a77 is     

amended-- 7,a7 in paragraph 7#aj77;,a71 
in the matter preceding clause 7i71 by  
inserting 7#aj71 after 7#e712  7,b7 in  
paragraph 7#hj71 by striking and at the 
end2  7,c7 in paragraph 7#ha71 by       
striking the period at the end and      
inserting 2 and2 and  7,d7 by inserting 
after paragraph 7#ha7 the following3    
7#hb7 provide for-- 7,a7 informing1 in  
writing1 all individuals who have been  
determined to be eligible for medical   
assistance of the availability of dental
 services 7as defined in section        
#aije7;ee772  7,b7 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 pregnant2 and  7,c7  
establishing and maintaining standards  
for and certification of mobile and     
portable oral health services 7as       
described in subsections 7r77#c77;,c7   
and 7ee77#b77;,b7 of section #aije74  4 

7#b7 ,definition of medical assistance  
,section #aije7;a77#ab7 of such ,act    
7#db ,u4,s4,c4 #acif;d7a77#ab77 is      
amended by striking 1 dentures14  7c7   
,mobile and portable oral health        
services under ,,epsdt ,section         
#aije7r77#c7 of the ,social ,security   
,act 7#db ,u4,s4,c4 #acif;d7r77#c77 is  
amended-- 7#a7 in subparagraph 7,a77ii71
 by striking 2 and and inserting a      
semicolon2  7#b7 in subparagraph 7,b71  
by striking the period at the end and   
inserting 2 and2 and  7#c7 by adding at 
the end the following new subparagraph3 
7,c7 which shall include mobile and     
portable oral health services 7as       
defined by the ,secretary7 that-- 7i7   
are provided for the purpose of         
overcoming mobility1 transportation1 or 
access barriers for children2 and  7ii7 
satisfy the standards and certification 
requirements established under section  
#aijb7;a77#hb77;,c7 for the ,state in   
which the services are provided4  4  7d7
 ,increased federal funding for dental  

services  7#a7 ,in general ,section     
#aije of the ,social ,security ,act 7#db
 ,u4,s4,c4 #acif;d71 as amended by      
subsection 7a71 is amended-- 7,a7 in    
subsection 7b71 in the first sentence1  
by striking and 7aa7 and inserting 7aa71
 and 7ff72 and  7,b7 by adding at the   
end the following new subsection3  7ff7 
,increased ,,fmap for dental services   
7#a7 ,in general ,notwithstanding       
subsection 7b7 and section #aijc7;a77#g7
 and subject to the requirements        
described in paragraphs 7#c7 and 7#d71  
with respect to amounts expended on or  
after ,january #a1 #bjad1 for covered   
dental expenses 7as described in        
paragraph 7#b771 the ,federal medical   
assistance percentage for a ,state that 
is one of the #ej ,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 year1 as determined under        
subsection 7b7 or section #aijc7;a77#g71

 increased by #ae percentage points4    
7#b7 ,covered dental expenses ,for      
purposes of paragraph 7#a71 the term    
covered dental expenses means the       
amounts expended for medical assistance 
for dental services 7as described in    
subsection 7ee77 and amounts expended   
for the proper and efficient            
administration of the provision of such 
dental services under the ,state plan4  
7#c7 ,requirements ,for purposes of     
paragraph 7#a71 the ,federal medical    
assistance percentage applicable to     
covered dental expenses under this      
subsection shall not apply to a ,state  
unless-- 7,a7 the ,state plan for       
medical assistance provides payment for 
dental services 7as so defined7         
furnished by a dental provider at a rate
 that is not less than #gj percent of   
the usual and customary fee for such    
services in the ,state2 and  7,b7 the   
,state satisfies such additional        
requirements as are established by the  
,secretary1 which shall include-- 7i7   

streamlining of administrative          
procedures for purposes of ensuring     
adequate provider participation and     
increasing patient utilization of dental
 services2 and  7ii7 the provision of   
technical assistance to dental providers
 designed to reduce the number of missed
 patient appointments and reduce other  
barriers to the delivery of oral health 
services4  7#d7 ,limitation ,for        
purposes of amounts expended for covered
 dental services1 in no case shall any  
increase under this subsection result in
 a ,federal medical assistance          
percentage that exceeds #ajj percent4  4
  7#b7 ,conforming amendment ,section   
#aijc7;a77#g7 of the ,social ,security  
,act 7#db ,u4,s4,c4 #acif;b7a77#g77 is  
amended by striking section             
#aiai7;g77#c77;,b7 and inserting        
sections #aije7;ff7 and                 
#aiai7;g77#c77;,b74  7e7 ,secretarial   
responsibilities  7#a7 ,technical       
assistance and outreach ,the ,secretary 
of ,health and ,human ,services1 acting 

through the ,administrator of the       
,centers for ,medicare  ,medicaid       
,services1 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 services4  7#b7 ,database 
and annual report on dental benefits for
 adult ,medicaid enrollees  7,a7        
,medicaid dental benefits database ,the 
,secretary of ,health and ,human        
,services1 acting through the           
,administrator of the ,centers for      
,medicare  ,medicaid ,services1 shall   
maintain1 as accurately and up-to-date  
as possible1 a database that contains   
with respect to the each ,state 7as     
defined for purposes of title ,,xix of  
the ,social ,security ,act 7#db         
,u4,s4,c4 #acif et seq477 information   

regarding the dental benefits available 
for adults enrolled in the ,state       
,medicaid program1 including any limits 
on such benefits and the amount of      
reimbursement provided under the ,state 
,medicaid program for such benefits4    
,the database also shall include a      
separate description of the dental      
benefits1 benefit limits1 and amount of 
reimbursement provided under each ,state
 ,medicaid program for pregnant women1  
if such benefits are not provided to the
 woman as part of early and periodic    
screening1 diagnostic1 and treatment    
services 7as defined in section #aije7r7
 of the ,social ,security ,act 7#db     
,u4,s4,c4 #acif;d7r7771 and a           
description of the use of dental        
services by children and adults enrolled
 in the ,state ,medicaid program4  7,b7 
,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

 7,a74 ,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 program4  7f7          
,effective date  7#a7 ,in general       
,except as provided in paragraph 7#b71  
the amendments made by this section     
shall apply to calendar quarters        
beginning on or after ,january #a1      
#bjad1 without regard to whether or not 
final regulations to carry out such     
amendments have been promulgated by such
 date4  7#b7 ,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 7other than          
legislation appropriating funds7 in     
order for the plan to meet the          

additional requirements imposed by the  
amendments made by this section1 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     
,act4 ,for purposes of the previous     
sentence1 in the case of a ,state that  
has a #b-year legislative session1 each 
year of such session shall be deemed to 
be a separate regular session of the    
,state legislature4  ,,ii ,public       
,health programs  ,a ,national ,health  
,service ,corps  #bja4 ,national ,health
 ,service ,corps  7a7 ,in general       
,section #cca of the ,public ,health    
,service ,act 7#db ,u4,s4,c4 #bed;d7 is 
amended-- 7#a7 in subsection 7a77#c71 by
 adding at the end the following3  7,f7 
,the term dental therapist means1 with  

respect to a ,state that licenses such  
dental therapists1 a mid-level dental   
practitioner who is licensed to practice
 under the law of the ,state and who    
provides preventive and restorative     
services directly to the public1        
commensurate with the scope of the      
practice4  2 and  7#b7 in subsection    
7b7-- 7,a7 in paragraph 7#a71 by        
inserting 1 dental therapy1 after       
dental2 and  7,b7 in paragraph 7#b71 by 
inserting dental therapists1 after      
dentists14  7b7 ,facilitation of        
effective provision of corps services   
,section #ccf7;f77#c7 of the ,public    
,health ,service ,act 7#db ,u4,s4,c4    
#bed;h-#a7;f77#c77 is amended by        
inserting dental therapists after       
midwives14  7c7 ,scholarship program and
 loan repayment program  7#a7           
,scholarship program ,section #cch;,a of
 the ,public ,health ,service ,act 7#db 
,u4,s4,c4 #bedl7 is amended-- 7,a7 in   
subsection 7a77#a71 by inserting dental 
therapists1 after dentists12 and  7,b7  

in subsection 7b77#a71 by inserting     
including dental therapy1 after or other
 health profession14  7#b7 ,loan        
repayment program ,section #cch;,b of   
the ,public ,health ,service ,act 7#db  
,u4,s4,c4 #bedl-#a7 is amended-- 7,a7 in
 subsection 7a77#a71 by inserting dental
 therapists1 after dentists12 and  7,b7 
in subsection 7b77#a7-- 7i7 in          
subparagraph 7,a71 by inserting dental  
therapist1 after nurse practitioner12   
7ii7 in subparagraph 7,b71 by inserting 
dental therapy1 after mental health12   
and  7iii7 in subparagraph 7,c77ii71 by 
inserting 1 including dental therapy1   
after health profession4  7#c7          
,authorization of appropriations        
,section #cch;,h of the ,public ,health 
,service ,act 7#db ,u4,s4,c4 #bedq7 is  
amended-- 7,a7 in subsection 7a71 by    
striking this section and inserting this
 subpart2 and  7,b7 by adding at the end
 the following3  7d7 ,authorization of  
appropriations with respect to oral     
health professionals ,to carry out this 

subpart with respect to dentists1 dental
 therapists1 and dental hygienists1 in  
addition to the amounts authorized under
 subsection 7a71 there is authorized to 
be appropriated such sums as may be     
necessary for fiscal years #bjad through
 #bjag1 which shall be used to provide  
an emergency expansion for scholarships 
to1 and loan repayments on behalf of1   
such oral health professionals4  4      
#bjb4 ,community based dental           
residencies ,section #cdj;,h of the     
,public ,health ,service ,act 7#db      
,u4,s4,c4 #bef;h7 is amended by adding  
at the ending the following3  7k7       
,additional funding ,for the purpose of 
expanding the program under this        
section1 there is authorized to be      
appropriated such sums as may be        
necessary for the #e-year period        
beginning with the fiscal year that     
begins not less than #a year and not    
more than #b years after the date of    
enactment of the ,comprehensive ,dental 
,reform ,act of #bjac  4  ,b ,oral      

health education  #baa4 ,authorization  
of appropriations for oral health       
education for medical providers ,section
 #gdg7;c7 of the ,public ,health        
,service ,act 7#db ,u4,s4,c4 #bick7c77  
is amended by adding at the end the     
following3  7#d7 ,oral health education 
,in addition to other amounts authorized
 under this subsection for purposes of  
carrying out this section1 there is     
authorized to be appropriated such sums 
as may be necessary for fiscal years    
#bjad through #bjag for the purpose of  
educating nondental medical             
professionals1 including physicians1    
nurses1 nurse practitioners1 physician  
assistants1 and pharmacists1 about oral 
health1 including issues such as oral   
hygiene instruction1 topical application
 of fluoride1 and oral health           
screenings1 with the goal of integrating
 oral health care into overall health   
care4  4  #bab4 ,oral health education  
for other non-health professionals      
,subpart ,i of part ,c of title ,,vii of

 the ,public ,health ,service ,act 7#db 
,u4,s4,c4 #bick et seq47 is amended by  
inserting after section #gdh the        
following3  #gdh;,a4 ,oral health       
education for other non-oral health     
professionals  7a7 ,in general ,the     
,secretary may make grants to1 or enter 
into contracts with1 an accredited      
public or nonprofit private hospital1 an
 educational institution1 or a public or
 private nonprofit entity which the     
,secretary has determined is capable of 
carrying out such grant or contract to  
educate individuals1 such as community  
health workers1 social workers1         
nutritionists1 health educators1        
occupational therapists1 and            
psychologists1 to promote oral health   
education and literacy and to provide   
support for behavior change and         
assistance with care coordination with  
respect to oral health4  7b7            
,authorization of appropriations ,to    
carry out this section1 there is        
authorized to be appropriated such sums 

as may be necessary for fiscal years    
#bjad through #bjag4  4  #bac4 ,dental  
education ,section #gdh of the ,public  
,health ,service ,act 7#db ,u4,s4,c4    
#bick-#b7 is amended-- 7#a7 in          
subsection 7a77#a77;,h71 by striking    
pediatric training programs and         
inserting pediatric dental training     
programs2 and  7#b7 in subsection 7c7-- 
7,a7 by striking the subsection heading 
and inserting ,requirements for         
award4--2  7,b7 by amending the matter  
preceding paragraph 7#a7 to read as     
follows3 ,with respect to training      
provided for under this section1 the    
,secretary shall award grants or        
contracts only to eligible entities that
 meet at least #g of the following      
criteria32  7,c7 in paragraph 7#b71 by  
striking have a record of training the  
greatest percentage of providers1 or    
that have demonstrated significant      
improvements in the percentage of       
providers1 who enter and and inserting  
train significant numbers of providers  

who2  7,d7 in paragraph 7#c7-- 7i7 by   
striking have a record of training and  
inserting intent to train2 and  7ii7 by 
striking the period at the end and      
inserting and have faculty with         
experience in treating underserved      
populations42  7,e7 in paragraph 7#h71  
by inserting or have established after  
establish2 and  7,f7 by adding at the   
end the following3  7#i7 ,qualified     
applicants that require not less than   
#bjj hours of community-based education 
rotations4  4  #bad4 ,oral health       
professional student loans ,part ,f of  
title ,,vii of the ,public ,health      
,service ,act 7#db ,u4,s4,c4 #bie;j7 is 
amended by adding at the end the        
following3  #gii;,c4 ,oral health       
professional student loans  7a7 ,in     
general ,the ,secretary shall establish 
and operate a student loan fund for oral
 health professional students1 including
 dental hygienists1 dental therapists1  
and dentists4  7b7 ,content ,the        
,secretary shall establish and operate  

the student loan fund program under     
subsection 7a7 in the same manner and   
subject to the same terms as the loan   
fund program established with schools of
 nursing under section #hce4  7c7       
,authorization of appropriations ,to    
carry out this section1 there are       
authorized to be appropriated such sums 
as may be necessary for fiscal years    
#bjad through #bjag4  4  ,c ,other oral 
health programs  #bba4 ,access points   
,subpart ,x of part ,d of title ,,iii of
 the ,public ,health ,service ,act 7#db 
,u4,s4,c4 #bef;f et seq47 is amended by 
adding at the end the following3        
#cdj;,g-#b4 ,funding for oral health    
services  7a7 ,in general ,the          
,secretary1 acting through the          
,administrator of the ,health ,resources
 and ,services ,administration1 shall   
establish a program to award grants to  
eligible entities to provide oral health
 services1 or to contract with private  
dental practices to provide             
comprehensive oral health services1 to  

low income individuals and individuals  
who are underserved with respect to oral
 health care4  7b7 ,technical assistance
 ,the ,secretary shall provide technical
 assistance to entities receiving grants
 under subsection 7a7 to provide        
technical assistance to such entities in
 order to-- 7#a7 with respect to oral   
health care services1 increase          
utilization and efficiency and minimize 
missed appointments1 contract with      
offsite providers1 recruit providers    
7including oral health specialists71 and
 operate programs outside the physical  
facilities to take advantage of new     
systems to improve access to oral health
 services2  7#b7 address barriers to    
access to such services and conduct     
targeted outreach to special populations
 such as pregnant women1 individuals    
with disabilities1 individuals with     
chronic conditions such as diabetes1 and
 individuals residing in long-term care 
facilities2 or  7#c7 contract with      
private dental practices that will      

provide oral health services other than 
preventive oral health care1 including  
restoration and maintenance of oral     
health1 in order to meet the need for   
oral health services in the community4  
7c7 ,eligible entities ,to be eligible  
to receive a grant under subsection 7a71
 an entity shall-- 7#a7 be-- 7,a7 a     
,federally qualified health center 7as  
defined in section #ahfa7;aa7 of the    
,social ,security ,act72  7,b7 a safety 
net clinic or a free clinic 7as defined 
by the ,secretary72  7,c7 a health care 
clinic that provides services to tribal 
organizations or urban ,indian          
organizations 7as such terms are defined
 in section #d of the ,indian ,health   
,care ,improvement ,act72 or  7,d7 any  
other interested public or private      
sector health care provider or          
organization that the ,secretary        
determines has a demonstrated history in
 serving a high number of uninsured and 
or low-income individuals or those who  
lack ready access to oral health        

services2 and  7#b7 demonstrate a clear 
need to expand oral health care services
 beyond preventive oral health care4    
7d7 ,allocation for hiring oral health  
care specialists ,a portion of the funds
 available under this section shall be  
allocated toward hiring oral health care
 specialists1 such as oral surgeons and 
endodontists1 at entities receiving     
grants under this section4  7e7         
,authorization of appropriations ,to    
carry out this section1 there is        
authorized to be appropriated such sums 
as may be necessary for each of fiscal  
years #bjad through #bjag4  4  #bbb4    
,dental clinics in schools ,part ,q of  
title ,,iii of the ,public ,health      
,service ,act 7#db ,u4,s4,c4 #bhj;h et  
seq47 is amended by adding at the end   
the following3  #cii,z-#b4 ,dental      
clinics in schools  7a7 ,in general ,the
 ,secretary shall award grants to       
qualified entities for the purpose of   
funding the building1 operation1 or     
expansion of dental clinics in schools4 

7b7 ,qualified entities ,to receive a   
grant under this section1 a qualified   
entity shall submit an application to   
the ,secretary at such time1 in such    
manner1 and containing such information 
as the ,secretary may require4  7c7     
,requirements ,an entity receiving a    
grant under this section shall-- 7#a7   
provide comprehensive oral health       
services at a dental clinic based at a  
school1 including oral health education1
 oral screening1 fluoride application1  
prophylaxis1 sealants1 and basic        
restorative services2  7#b7 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    
school1 including restorative services1 
to ensure that all the oral health needs
 of students are met2 and  7#c7 maintain
 clinic hours that extend beyond school 
hours4  7d7 ,authorization of           
appropriations ,for purposes of carrying

 out this section1 there is authorized  
to be appropriated such sums as may be  
necessary for fiscal years #bjad through
 #bjag4  4  #bbc4 ,emergency room care  
coordination ,part ,b of title ,,iii of 
the ,public ,health ,service ,act 7#db  
,u4,s4,c4 #bdc et seq47 is amended by   
adding at the end the following3        
#cbj;,b4 ,emergency room care           
coordination with respect to dental care
  7a7 ,in general ,the ,secretary1      
acting through the ,administrator of the
 ,health ,resources and ,services       
,administration1 shall establish a grant
 program to enable individuals to       
receive dental care at a facility       
operated by a grant recipient rather    
than at a hospital emergency room4  7b7 
,eligible entities ,to be eligible to   
receive a grant under this section an   
entity shall-- 7#a7 be-- 7,a7 a         
,federally qualified health center 7as  
defined in paragraph 7#d7 of section    
#ahfa7;aa7 of the ,social ,security     
,act7 or rural health clinic 7as defined

 in paragraph 7#b7 of such section72    
7,b7 a private dental practice2 or  7,c7
 any other interested public or private 
sector health care provider or          
organization1 such as a dental school1  
that the ,secretary determines has the  
capacity to serve in a coordinated1     
cost-effective manner1 a high number of 
individuals who lack access to oral     
health services2 and  7#b7 partner with 
a hospital or urgent care center4  7c7  
,oral health education for primary care 
and ,,er health care providers ,the     
,secretary shall allocate a portion of  
the amounts appropriated under          
subsection 7e7 toward medical education 
for primary care and emergency room     
physicians1 nurses1 nurse practitioners1
 physician assistants1 and nurse        
practitioners to be trained in oral     
health4  7d7 ,report ,not later than    
,january #a1 #bjag1 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 rooms in need of   
oral health care4  7e7 ,authorization of
 appropriations ,to carry out this      
section1 there is authorized to be      
appropriated such sums as may be        
necessary for fiscal years #bjad through
 #bjag4  4  #bbd4 ,research funding ,for
 fiscal years #bjad through #bjag1 there
 is authorized to be appropriated such  
sums as may be necessary to each of--   
7#a7 the ,centers for ,disease ,control 
and ,prevention1 for the purpose of     
conducting research on-- 7,a7 the       
prevention of oral disease2  7,b7 oral  
disease management2 and  7,c7           
evidence-based strategies to prevent    
tooth decay2  7#b7 the ,agency for      
,healthcare ,research and ,quality1 for 
the purpose of conducting-- 7,a7        
research with respect to oral health    
services and the delivery of oral health
 services2 and  7,b7 an evaluation of   
oral health service delivery to         
underserved and vulnerable populations2 

7#c7 the ,national ,institute of ,dental
 and ,craniofacial ,research for the    
purpose of conducting research on oral  
health disease management including     
pharmaceutical-behavioral intervention2 
and  7#d7 the ,maternal and ,child      
,health ,bureau for the purpose of      
conducting research on perinatal1       
postnatal1 and childhood oral health    
issues4  #bbe4 ,mobile and portable     
dental services ,subpart ,x of part ,d  
of title ,,iii of the ,public ,health   
,service ,act 7#db ,u4,s4,c4 #bef;f et  
seq471 as amended by section #bba1 is   
further amended by adding at the end the
 following3  #cdj;,g-#c4 ,mobile and    
portable dental services  7a7 ,in       
general ,the ,secretary shall award     
grants to ,federally qualified health   
centers 7as defined in paragraph 7#d7 of
 section #ahfa7;aa7 of the ,social      
,security ,act71 rural health clinics   
7as defined in paragraph 7#b7 of such   
section71 nonprofit dental clinics1 and 
dental schools to provide mobile and    

portable1 comprehensive dental services 
that provide for the restoration or     
maintenance of oral health and function 
7including dental services provided by  
licensed providers through              
telehealth-enabled collaboration and    
supervision7 and outreach for dental    
services to underserved populations4    
,eligible entities shall deliver such   
services at locations such as senior    
centers1 nursing homes1 assisted living 
facilities1 schools1 licensed day 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 7#db ,u4,s4,c4 #acig;aa  
et seq47 or the ,medicaid program under 
title ,,xix of the ,social ,security    
,act 7#db ,u4,s4,c4 #acif et seq471 and 
facilities that provide services under  
the ,special ,supplemental ,nutrition   
,program for ,women1 ,infants1 and      
,children 7the ,,wic program7 or the    
,head ,start ,act 7#db ,u4,s4,c4 #ihca  

et seq474 ,the ,secretary shall award   
the grants to entities that can provide 
coordinated care and continuity of care4
  7b7 ,authorization of appropriations  
,to carry out this section1 there are   
authorized to be appropriated such sums 
as may be necessary4  4  ,d ,oral health
 services as an essential health benefit
  #bca4 ,oral health services as an     
essential health benefit ,section       
#acjb7;b77#a7 of the ,patient           
,protection and ,affordable ,care ,act  
7#db ,u4,s4,c4 #ahjbb7;b77#a77 is       
amended by adding at the end the        
following3  7,k7 ,oral health services4 
4  ,,iii ,department of ,veterans       
,affairs and ,department of ,defense    
,matters  ,a ,department of ,veterans   
,affairs ,matters  #cja4 ,requiring the 
,secretary of ,veterans ,affairs to     
furnish dental care in the same manner  
as any other medical service  7a7 ,in   
general ,title #ch1 ,united ,states     
,code1 is amended-- 7#a7 in section     
#agja7f71 by striking as described in   

sections #agaj and #agab of this title2 
7#b7 in section #agaj7;c71 by striking  
the second sentence2  7#c7 in section   
#agab-- 7,a7 by striking subsections 7a7
 and 7b72  7,b7 by redesignating        
subsections 7c71 7d71 and 7e7 as        
subsections 7a71 7b71 and 7c71          
respectively2 and  7,c7 in subsection   
7a71 as redesignated by subparagraph    
7,b7-- 7i7 by striking ,dental          
appliances and inserting ,the ,secretary
 may furnish dentures1 dental           
appliances2 and  7ii7 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 appliances2
 and  7#d7 by striking section #bjfb4   
7b7 ,conforming amendments ,such title  
is further amended-- 7#a7 in section    
#aebe7;a71 by striking medicines under  
section #agab7;d7 and inserting         
medicines under section #agab7;b72 and  
7#b7 in section #agjc7;a77#g71 by       
striking 1 for a veteran described in   

section #agab7;a77#a77;,f7 of this      
title4  7c7 ,clerical amendments ,such  
title is further amended-- 7#a7 in      
section #agab1 in the heading for such  
section1 by striking ,dental care and   
inserting ,appliances2  7#b7 in the     
table of sections at the beginning of   
chapter #ag1 by striking the item       
relating to section #agab and inserting 
the following new item3  #agab4         
,appliances2 drugs and medicines for    
certain disabled veterans2 vaccines4  2 
and  7#c7 in the table of sections at   
the beginning of chapter #bj1 by        
striking the item relating to section   
#bjfb4  #cjb4 ,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 
7a7 ,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       
entitled to such services who reside in 
rural and other underserved communities4
  7b7 ,telehealth ,for purposes of      
alternative dental health care providers
 and any other dental care providers who
 are licensed to provide clinical care1 
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 feasible4  7c7 ,alternative dental 
health care providers defined ,in this  
section1 the term alternative dental    
health care providers has the meaning   
given that term in section              
#cdj;,g-#a7;a77#b7 of the ,public       
,health ,service ,act 7#db ,u4,s4,c4    
#bef;g-#a7;a77#b774  7d7 ,authorization 
of appropriations ,there are authorized 
to be appropriated such sums as are     
necessary to carry out the demonstration
 program under this section4  ,b        

,department of ,defense ,matters  #caa4 
,demonstration program on training and  
employment of alternative dental health 
care providers for dental health care   
services for members of the ,armed      
,forces and dependents lacking ready    
access to such services  7a7            
,demonstration program authorized ,the  
,secretary of ,defense 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 members of the ,armed     
,forces and their dependents who lack   
ready access to such services1 including
 the following3 7#a7 ,members and       
dependents who reside in rural areas or 
areas otherwise underserved by dental   
health care providers4  7#b7 ,members of
 the ,national ,guard and ,reserves in  
active status who are potentially       
deployable4  7b7 ,telehealth ,for       
purposes of alternative dental health   
care providers and any other dental care

 providers who are licensed to provide  
clinical care1 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 feasible4  7c7   
,alternative dental health care         
providers defined ,in this section1 the 
term alternative dental health care     
providers has the meaning given that    
term in section #cdj;,g-#a7;a77#b7 of   
the ,public ,health ,service ,act 7#db  
,u4,s4,c4 #bef;g-#a7;a77#b774  7d7      
,authorization of appropriations ,there 
are authorized to be appropriated such  
sums as are necessary to carry out the  
demonstration program under this        
section4  ,,iv ,federal ,bureau of      
,prisons  #dja4 ,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  7a7 ,demonstration 

program authorized ,the ,attorney       
,general1 acting through the ,director  
of the ,bureau of ,prisons1 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 ,prisons4    
7b7 ,telehealth ,for purposes of        
alternative dental health care providers
 and any other dental care providers who
 are licensed to provide clinical care1 
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 feasible4  7c7 ,alternative dental 
health care providers defined ,in this  
section1 the term alternative dental    
health care providers has the meaning   
given that term in section              
#cdj;,g-#a7;a77#b7 of the ,public       
,health ,service ,act 7#db ,u4,s4,c4    

#bef;g-#a7;a77#b774  7d7 ,authorization 
of appropriations ,there are authorized 
to be appropriated such sums as are     
necessary to carry out the demonstration
 program under this section4  ,v ,indian
 ,health ,service  #eja4 ,demonstration 
program on training and employment of   
alternative dental health care providers
 for dental health care services under  
the ,indian ,health ,service  7a7       
,demonstration program authorized ,the  
,secretary of ,health and ,human        
,services1 acting through the ,indian   
,health ,service1 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         
,service1 ,indian tribes1 tribal        
organizations1 and ,urban ,indian       
organizations 7as those terms are       
defined in section #d of the ,indian    

,health ,care ,improvement ,act 7#be    
,u4,s4,c4 #afjc774  7b7 ,telehealth ,for
 purposes of alternative dental health  
care providers and any other dental care
 providers who are licensed to provide  
clinical care1 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 feasible4  7c7   
,alternative dental health care         
providers defined ,in this section1 the 
term alternative dental health care     
providers has the meaning given that    
term in section #cdj;,g-#a7;a77#b7 of   
the ,public ,health ,service ,act 7#db  
,u4,s4,c4 #bef;g-#a7;a77#b774  7d7      
,authorization of appropriations ,there 
are authorized to be appropriated such  
sums as are necessary to carry out the  
demonstration program under this        
section4  ,,vi ,reports to ,congress    
#fja4 ,evaluation of expansion of       
coverage for dental services  7a7       

,secretary of ,health and ,human        
,services ,not later than ,october #a1  
#bjag1 the ,secretary of ,health and    
,human ,services shall submit to        
,congress a report that provides a      
comprehensive cost-benefit analysis     
regarding the expansion of coverage for 
dental services pursuant to this ,act1  
including whether the provision of such 
services resulted in a reduction in     
total health care costs for individuals 
under the ,medicare and ,medicaid       
programs4  7b7 ,comptroller ,general    
7#a7 ,medicaid and ,medicare ,not later 
than ,january #a1 #bjag1 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 
programs4  7#b7 ,demonstration programs 
,not later than ,january #a1 #bjag1 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 #cjb1 #caa1 #dja1 and #eja1    
including-- 7,a7 the extent to which the
 programs improved access to oral health
 care and increased utilization of oral 
health services2 and  7,b7 an           
examination of the training provided    
under the programs to alternative dental
 health care providers and the quality  
of care provided by such providers4