,,ii  #aaeth ,,congress  #b;d ,session  
,s4 #ccac  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,july #ca1     
#bjah ,mr4 ,sanders introduced the      
following bill2 which was read twice and
 referred to the ,committee on          
,veterans' ,affairs  ,a ,,bill  ,to     
improve dental care provided to veterans
 by the ,department of ,veterans        
,affairs1 and for other purposes4  #a4  
,short title  ,this ,act may be cited as
 the ,veterans ,dental ,care            
,eligibility ,expansion and ,enhancement
 ,act of #bjah4  #b4 ,restorative dental
 services for veterans  7a7 ,in general 
,section #agaj7;c7 of title #ch1 ,united
 ,states ,code1 is amended-- 7#a7 in the
 second sentence--  7,a7 by             
redesignating subparagraphs 7,a7 and    
7,b7 as clauses 7i7 and 7ii71           
respectively2 and  7,b7 by redesignating
 paragraphs 7#a7 and 7#b7 as            
subparagraphs 7,a7 and 7,b71            
respectively2  7#b7 by inserting 7#a7   
after 7c72  7#c7 by striking ,the       

,secretary and inserting the following3 
7#b7 ,the ,secretary  2 and  7#d7 by    
adding at the end the following new     
paragraph3  7#c7 ,in addition to the    
dental services1 treatment1 and         
appliances authorized to be furnished by
 paragraph 7#b71 the ,secretary may     
furnish dental services and treatment1  
and dental appliances1 needed to restore
 functioning in a veteran that is lost  
as a result of any services or treatment
 furnished under this subsection4  4    
7b7 ,effective date ,the amendments made
 by subsection 7a7 shall take effect on 
the date that is one year after the date
 of the enactment of this ,act4  #c4    
,expansion of dental services for       
veterans exposed to toxic substances1   
radiation1 or other conditions ,section 
#agab7;a77#a7 of title #ch1 ,united     
,states ,code1 is amended-- 7#a7 by     
redesignating subparagraphs 7,g7 and    
7,h7 as subparagraphs 7,h7 and 7,i71    
respectively2 and  7#b7 by inserting    
after subparagraph 7,f7 the following   

new subparagraph 7,g73  7,g7 from which 
a veteran entitled to hospital care and 
medical services under section          
#agaj7;a77#b77;,f7 is suffering2  4  #d4
 ,pilot program on expansion of         
furnishing of dental services and       
treatment to all enrolled veterans  7a7 
,pilot program required ,commencing not 
later than #edj days after the date of  
the enactment of this ,act1 the         
,secretary of ,veterans ,affairs shall  
carry out a pilot program to assess the 
feasibility and advisability of         
furnishing dental services and treatment
 to veterans enrolled in the system of  
patient enrollment of the ,department of
 ,veterans ,affairs under section #agje 
of title #ch1 ,united ,states ,code1 who
 are not eligible for dental services   
and treatment1 and related dental       
appliances1 from the ,department under  
authorities other than this section4    
7b7 ,duration of pilot program ,the     
pilot program shall be carried out      
during the three-year period beginning  

on the date of the commencement of the  
pilot program4  7c7 ,locations  7#a7 ,in
 general ,the ,secretary shall carry out
 the pilot program at not fewer than #af
 locations as follows3 7,a7 ,four       
medical centers of the ,department of   
,veterans ,affairs with an established  
dental clinic4  7,b7 ,four medical      
centers of the ,department with a       
contract for the furnishing of dental   
care4  7,c7 ,four community-based       
outpatient clinics with space available 
for the furnishing of services and      
treatment under the pilot program4  7,d7
 ,four facilities selected from among   
,federally-qualified health centers and 
facilities of the ,indian ,health       
,service with established dental        
clinics1 of which--  7i7 at least one   
facility shall be such a facility of the
 ,indian ,health ,service2 and  7ii7 any
 facility of the ,indian ,health        
,service so selected shall be selected  
in consultation with the ,secretary of  
,health and ,human ,services4  7#b7     

,considerations ,in selecting locations 
for the pilot program1 the ,secretary   
shall consider the feasibility and      
advisability of selecting locations in  
each of the following3  7,a7 ,rural     
areas4  7,b7 ,areas that are not in     
close proximity to an active duty       
military installation4  7,c7 ,areas     
representing different geographic       
locations1 such as census tracts        
established by the ,bureau of the       
,census4  7d7 ,limitation on number of  
participating veterans  7#a7 ,in general
 ,the total number of veterans who may  
participate in the pilot program may not
 exceed #ajj1jjj4  7#b7 ,distribution of
 limitation ,in applying the limitation 
in paragraph 7#a7 to the pilot program1 
the ,secretary shall distribute the     
limitation across and among locations   
selected for the pilot program in a     
manner that takes appropriate account of
 the size and need of veterans for      
dental services at each such location4  
7e7 ,scope of services ,the dental      

services and treatment furnished to     
veterans under the pilot program shall  
be consistent with the dental services  
and treatment furnished by the          
,secretary to veterans with             
service-connected disabilities rated    
#ajj percent disabling under the laws   
administered by the ,secretary4  7f7    
,voluntary participation ,the           
participation of a veteran in the pilot 
program shall be at the election of the 
veteran4  7g7 ,copayments  7#a7 ,in     
general ,the ,secretary may collect     
copayments for dental services and      
treatment furnished under the pilot     
program in accordance with authorities  
on the collection of copayments for     
medical care of veterans under chapter  
#ag of title #ch1 ,united ,states ,code4
  7#b7 ,limitation ,the amounts of      
copayments authorized under paragraph   
7#a7 may not exceed the amounts allowed 
for medical care under such chapter4    
7h7 ,program administration  7#a7       
,notice to eligible veterans on pilot   

program ,in carrying out the pilot      
program1 the ,secretary shall inform all
 veterans eligible to participate in the
 pilot program of the services and      
treatment available under the pilot     
program4  7#b7 ,contracts  7,a7 ,in     
general ,in carrying out the pilot      
program1 the ,secretary may enter into  
contracts with appropriate entities for 
the provision of dental services and    
treatment under the pilot program4  7,b7
 ,performance standards and metrics     
,each contract entered into under       
subparagraph 7,a7 shall specify         
performance standards and metrics and   
processes for ensuring compliance of the
 contractor concerned with such         
performance standards4  7i7 ,reports    
7#a7 ,preliminary reports  7,a7 ,in     
general ,not later than each of #edj    
days and three years after the date of  
the commencement of the pilot program1  
the ,secretary shall submit to the      
,committee on ,veterans' ,affairs of the
 ,senate and the ,committee on          

,veterans' ,affairs of the ,house of    
,representatives a report on the pilot  
program4  7,b7 ,contents ,each report   
under subparagraph 7,a7 shall include   
the following3 7i7 ,a description of the
 implementation and operation of the    
pilot program4  7ii7 ,the number of     
veterans receiving services and         
treatment under the pilot program1 and a
 description of the dental services and 
treatment furnished to such veterans4   
7iii7 ,an analysis of the costs and     
benefits of the pilot program1 including
 a comparison of costs and benefits by  
location type4  7iv7 ,an assessment of  
the impact of the pilot program on      
medical care1 wellness1 employability1  
and perceived quality of life of        
veterans4  7v7 ,the current findings and
 conclusions of the ,secretary with     
respect to the pilot program4  7vi7     
,such recommendations for the           
continuation or expansion of the pilot  
program as the ,secretary considers     
appropriate4  7#b7 ,final report  7,a7  

,in general ,not later than #ahj days   
after the completion of the pilot       
program1 the ,secretary shall submit to 
the ,committee on ,veterans' ,affairs of
 the ,senate and the ,committee on      
,veterans' ,affairs of the ,house of    
,representatives a report on the pilot  
program4  7,b7 ,contents ,the report    
under subparagraph 7,a7 shall include   
the following3 7i7 ,the findings and    
conclusions of the ,secretary with      
respect to the pilot program4  7ii7     
,such recommendations for the           
continuation or expansion of the pilot  
program as the ,secretary considers     
appropriate4  7j7 ,federally-,qualified 
health center defined ,in this section  
the term ,federally-qualified health    
center has the meaning given that term  
in section #aije7l77#b77;,b7 of the     
,social ,security ,act 7#db ,u4,s4,c4   
#acif;d7l77#b77;,b774  7k7 ,effective   
date ,this section shall take effect on 
the date that is one year after the date
 of the enactment of this ,act4  #e4    

,construction or lease of dental clinics
 of ,department of ,veterans ,affairs   
7a7 ,in general ,the ,secretary of      
,veterans ,affairs shall construct or   
lease a dental clinic of the ,department
 of ,veterans ,affairs in any ,state    
that does not have a facility of the    
,department that offers onsite dental   
services4  7b7 ,submittal of plan ,not  
later than #ahj days after the date of  
the enactment of this ,act1 the         
,secretary shall submit to ,congress a  
plan for construction or lease of a     
dental clinic in each of the ,states    
described in subsection 7a7 and shall   
beginning construction of any such      
clinic indicated for construction in    
such plan not later than one year after 
such date of enactment4  7c7            
,appropriation of amounts ,there is     
authorized to be appropriated and is    
appropriated to the ,secretary of       
,veterans ,affairs #aj1jjj1jjj to carry 
out this section1 which shall be        
available until expended4  7d7 ,facility

 of the ,department defined ,in this    
section1 the term facility of the       
,department has the meaning given the   
term facilities of the ,department in   
section #agja of title #ch1 ,united     
,states ,code4  7e7 ,emergency          
designation  7#a7 ,statutory paygo ,this
 section is designated as an emergency  
requirement pursuant to section #d7;g7  
of the ,statutory ,pay-,as-,you-,go ,act
 of #bjaj 7#b ,u4,s4,c4 #icc7;g774  7#b7
 ,senate designation ,in the ,senate1   
this section is designated as an        
emergency requirement pursuant to       
section #daab7;a7 of ,h4 ,con4 ,res4 #ga
 7#aaeth ,congress71 the concurrent     
resolution on the budget for fiscal year
 #bjah4  #f4 ,program on education to   
promote dental health in veterans  7a7  
,program required  7#a7 ,in general ,the
 ,secretary of ,veterans ,affairs shall 
carry out a program of education to     
promote dental health for veterans who  
are enrolled in the system of patient   
enrollment of the ,department of        

,veterans ,affairs under section #agje  
of title #ch1 ,united ,states ,code4    
7#b7 ,construction ,nothing in the      
program shall be deemed to alter or     
revise the eligibility of any veteran   
for dental care under the laws          
administered by the ,secretary4  7b7    
,elements ,the program required by      
subsection 7a7 shall provide education  
for veterans on the following3 7#a7 ,the
 association between dental health and  
overall health and well-being4  7#b7    
,proper techniques for dental care4     
7#c7 ,signs and symptoms of commonly    
occurring dental conditions4  7#d7      
,treatment options for commonly         
occurring dental issues4  7#e7 ,options 
for obtaining access to dental care1    
including information on--  7,a7        
eligibility for dental care through the 
,department2  7,b7 options available    
through ,state and local governments or 
nonprofit organizations2 and  7,c7      
purchasing private dental insurance4    
7#f7 ,available and accessible options  

for obtaining low- or no-cost dental    
care1 including through dental schools  
and ,federally-qualified health centers4
  7#g7 ,such other matters relating to  
dental health as the ,secretary         
considers appropriate4  7c7 ,delivery of
 educational materials  7#a7 ,in general
 ,the ,secretary shall provide          
educational materials to veterans under 
the program required by subsection 7a7  
through a variety of mechanisms1        
including the following3  7,a7 ,the     
availability and distribution of print  
materials at facilities of the          
,department 7including at medical       
centers1 clinics1 ,vet ,centers1 and    
readjustment counseling centers7 and to 
providers 7including members of patient 
aligned care teams74  7,b7 ,the         
availability and distribution of        
materials over the internet1 including  
through webinars and ,my ,healthe,vet4  
7,c7 ,presentations of information1     
including both small group and large    
group presentations4  7#b7 ,selection of

 mechanisms ,in selecting mechanisms for
 purposes of this subsection1 the       
,secretary shall select mechanisms      
designed to maximize the number of      
veterans who receive education under the
 program4  7#c7 ,inclusion of materials 
for blind and visually impaired ,the    
,secretary shall ensure that educational
 materials are available under this     
subsection in a format for the blind and
 visually impaired4  7d7 ,definitions   
,in this section3 7#a7                  
,federally-qualified health center      
defined ,the term ,federally-qualified  
health center has the meaning given that
 term in section #aije7l77#b77;,b7 of   
the ,social ,security ,act 7#db         
,u4,s4,c4 #acif;d7l77#b77;,b774  7#b7   
,vet ,center ,the term ,vet ,center has 
the meaning given that term in section  
#agab;,a7h7 of title #ch1 ,united       
,states ,code4  7e7 ,effective date     
,this section shall take effect on the  
date that is one year after the date of 
the enactment of this ,act4  #g4        

,information on dental services for     
inclusion in electronic medical records 
under dental insurance pilot program    
7a7 ,in general ,commencing not later   
than #edj days after the date of the    
enactment of this ,act1 the ,secretary  
of ,veterans ,affairs shall expand the  
dental insurance pilot program          
established by section #ag4afi of title 
#ch1 ,code of ,federal ,regulations 7as 
in effect on the date of the enactment  
of this ,act71 to establish a mechanism 
by which private sector dental care     
providers shall forward to the          
,department of ,veterans ,affairs       
information on dental care furnished to 
individuals under the pilot program for 
inclusion in the electronic medical     
records of the ,department with respect 
to such individuals4  7b7 ,construction 
with current pilot program requirements 
7#a7 ,in general ,nothing in this       
section shall be construed to revise    
eligibility for participation in1 or the
 locations of1 the pilot program        

referred to in subsection 7a74  7#b7    
,duration ,the ,secretary may continue  
the pilot program for two years in      
addition to the duration otherwise      
provided for the pilot program in       
section #ag4afi of title #ch1 ,code of  
,federal ,regulations 7as in effect on  
the date of the enactment of this ,act71
 if the ,secretary determines that the  
continuation is needed to assess the    
mechanism required by subsection 7a74   
7#c7 ,voluntary participation in        
mechanism ,the participation in the     
mechanism required by subsection 7a7 of 
an individual otherwise participating in
 the pilot program shall be at the      
election of the individual4  7c7        
,inclusion of information on mechanism  
in reports ,each report to ,congress on 
the pilot program after the date of the 
commencement of the mechanism required  
by subsection 7a7 shall include         
information on the mechanism1 including 
a current assessment of the feasibility 
and advisability of using the mechanism 

to include information on dental care   
furnished to individuals in the         
electronic medical records of the       
,department with respect to such        
individuals4  7d7 ,effective date ,this 
section shall take effect on the date   
that is one year after the date of the  
enactment of this ,act4  #h4            
,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 who   
are entitled to such services from the  
,department of ,veterans ,affairs and   
reside in rural and other underserved   
communities4  7b7 ,priority ,the        
,secretary shall give priority for      

participation in the demonstration      
program under this section to medical   
centers or health systems of the        
,department of ,veterans ,affairs in    
,states with a technical college within 
the ,state college system of that ,state
 that has established a degree or       
certificate level program for the       
training of alternative dental health   
care providers4  7c7 ,telehealth ,for   
purposes of alternative dental health   
care providers and 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      
appropriate and feasible4  7d7          
,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  #i4      
,authorization of appropriations  7a7   
,in general ,there is authorized to be  
appropriated for the ,department of     
,veterans ,affairs for fiscal year #bjbj
 #ejj1jjj1jjj to carry out this ,act and
 the amendments made by this ,act1 other
 than section #d4  7b7 ,availability    
,the amount authorized to be            
appropriated under subsection 7a7 shall 
be available for obligation for the     
five-year period beginning on the date  
that is one year after the date of the  
enactment of this ,act4