,i #aagth ,,congress #ast ,session ,h4 ,r4 #ddci ,,in ,,the ,,house ,,of ,,representatives ,july #af1 #bjba,ms4 ,barragn 7for herself1 ,mr4 ,grijalva1 ,ms4 ,velzquez1 ,mr4 ,payne1 ,mr4 ,soto1 and ,ms4 ,norton7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce ,a ,,bill ,to amend title ,,xix of the ,social ,security ,act to improve coverage of adult oral health care under the ,medicaid program1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,medicaid ,dental ,benefit ,act4 #b4 ,requiring coverage of oral health services for adults under the ,medicaid program 7a7 ,in general 7#a7 ,mandatory coverage 7,a7 ,in general 7i7 ,requirement ,section #aijb7;a77#aj77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a77 is amended by inserting 7#aj71 after 7#e714 7ii7 ,effective date ,the amendment made by clause 7i7 shall apply with respect to medical assistance furnished in calendar quarters beginning on or after the date that is #a year after the date of the enactment of this ,act4 7,b7 ,benchmark coverage ,section #aicg7;b77#e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#g7;b77#e77 is amended by striking the period and inserting 1 and1 beginning with the first quarter beginning on or after the date that is #a year after the date of the enactment of the ,medicaid ,dental ,benefit ,act1 coverage of dental and oral health services 7as defined in section #aije7;jj7744 7#b7 ,definition of services ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is amended-- 7,a7 in subsection 7a77#aj71 by striking dental services and inserting dental and oral health services 7as defined in subsection 7jj772 and 7,b7 by adding at the end the following new subsection3 7jj7 ,definition of dental and oral health services 7#a7 ,in general ,for purposes of this title1 the term dental and oral health services means services necessary to prevent disease and promote oral health1 restore oral structures to health and function1 reduce oral pain1 and treat emergency oral conditions4 ,such term includes the services specified in paragraph 7#b74 7#b7 ,specified services ,for purposes of paragraph 7#a71 the services specified in this paragraph are the following3 7,a7 ,routine diagnostic and preventive care 7such as dental cleanings1 exams1 and x-rays74 7,b7 ,basic dental services 7such as fillings and extractions7 and major dental services 7such as root canals1 crowns1 and dentures74 7,c7 ,emergency dental care4 7,d7 ,temporomandibular 7,,tmd7 and orofacial pain disorder treatment4 7,e7 ,other necessary services related to dental and oral health 7as specified by the ,secretary74 4 7b7 ,enhanced ,,fmap2 maintenance of effort 7#a7 ,medicaid ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d71 as amended by subsection 7a71 is further amended-- 7,a7 in subsection 7b71 by striking and 7ii7 and inserting 7ii71 and 7kk72 and 7,b7 by adding at the end the following new subsection3 7kk7 ,increased ,,fmap for expenditures for dental and oral health services 7#a7 ,in general ,the ,federal medical assistance percentage with respect to amounts expended by such ,state for medical assistance consisting of dental and oral health services 7as defined in subsection 7jj77 furnished during the first calendar quarter beginning on or after the date that is #a year after the date of the enactment of this subsection 7or during any subsequent quarter7 to individuals #ba years of age or older shall be equal to1 in the case of such services furnished-- 7,a7 during the #c-year period beginning on the first day of such first calendar quarter1 #ajj percent2 7,b7 during the #a-year period immediately following the period described in subparagraph 7,a71 #ie percent2 7,c7 during each subsequent #a-year period 7through the third such subsequent period71 the percentage specified under this paragraph for the preceding #a-year period1 reduced by #e percentage points2 and 7,d7 during any quarter beginning after the #g-year period beginning on the first day described in subparagraph 7,a71 #hj percent4 7#b7 ,no reduction in ,,fmap ,paragraph 7#a7 shall not apply with respect to amounts expended by a ,state if the ,federal medical assistance percentage otherwise applicable to such amounts without application of such paragraph would be higher than such percentage applicable to such amounts with application of such paragraph4 4 7#b7 ,exclusion of amounts attributable to increased ,,fmap from territorial caps ,section #aajh of the ,social ,security ,act 7#db ,u4,s4,c4 #acjh7 is amended-- 7,a7 in subsection 7f71 in the matter preceding paragraph 7#a71 by striking subsections 7g7 and 7h7 and inserting subsections 7g71 7h71 and 7i72 and 7,b7 by adding at the end the following3 7i7 ,exclusion from caps of amounts attributable to increased ,,fmap for coverage of dental and oral health services ,any payment made to a territory for expenditures for medical assistance that are subject to an increase the ,federal medical assistance percentage applicable to such expenditures under section #aije7kk7 shall not be taken into account for purposes of applying payment limits under subsections 7f7 and 7g7 to the extent that such payment exceeds the amount of the payment that would have been made to the territory for such expenditures without regard to such section4 4 #c4 ,adult oral health quality and equity measures 7a7 ,in general ,title ,,xi of the ,social ,security ,act 7#db ,u4,s4,c4 #acja et seq47 is amended by inserting after section #aaci;,b the following new section3 #aaci;,c4 ,adult oral health quality and equity measures 7a7 ,development of core set of adult oral health care quality and equity measures 7#a7 ,in general ,the ,secretary shall identify and publish a recommended core set of health quality and equity measures for individuals enrolled in a ,state plan 7or waiver of such plan7 under title ,,xix who are over the age of #ba in the same manner as the ,secretary identifies and publishes a core set of child health quality measures under section #aaci;,a1 including with respect to identifying and publishing existing oral health quality measures for such individuals that are in use under public and privately sponsored health care coverage arrangements1 or that are part of reporting systems that measure both the presence and duration of health insurance coverage over time1 that may be applicable to enrolled adults4 7#b7 ,alignment with existing core set ,in identifying and publishing the recommended core set of adult oral health quality and equity measures required under paragraph 7#a71 the ,secretary shall ensure that1 to the extent possible1 such measures align with and do not duplicate the core set of adult health quality and equity measures identified1 published1 and revised under section #aaci;,b4 7#c7 ,process for adult oral health quality and equity measures program ,in identifying gaps in existing adult oral health quality and equity measures and establishing priorities for the development and advancement of such measures1 the ,secretary shall consult with-- 7,a7 ,states2 7,b7 health care providers2 7,c7 patient representatives2 7,d7 dental professionals2 and 7,e7 national organizations with expertise in oral health quality or equity measurement4 7b7 ,deadlines 7#a7 ,recommended measures ,not later than #a year after enactment of this ,act1 the ,secretary shall identify and publish for comment a recommended core set of adult oral health quality and equity measures that includes the following3 7,a7 ,measures of utilization of oral health and dental services across health care settings4 7,b7 ,measures that address the availability of oral evaluations during or following medical visits for enrolled adults4 7,c7 ,measures that address the incidence of emergency department visits for non-traumatic dental conditions4 7,d7 ,measures that address the availability and receipt of follow-up dental care after emergency department visits for non-traumatic dental conditions during pregnancy4 7,e7 ,measures that address the availability of counseling of enrolled adults aimed at improving oral health outcomes4 7,f7 ,measures that address the availability and receipt of care for beneficiaries who meet the medical necessity criteria for general anesthesia and intravenous sedation4 7,g7 ,measures that address screening and evaluation for caries risk and periodontitis and treatment for caries risk and periodontitis1 including the following3 7i7 ,the percentage of enrolled adults who have caries risk documented in the reporting year involved4 7ii7 ,the percentage of enrolled adults who received a topical fluoride application or sealants based on an oral health risk assessment demonstrating the need for such application or sealants during the reporting year involved4 7iii7 ,the percentage of enrolled adults who received a comprehensive or periodic oral evaluation or a comprehensive periodontal evaluation during the reporting year involved4 7iv7 ,the percentage of enrolled adults with a history of periodontitis who received an oral prophylaxis1 scaling or root planing1 or periodontal maintenance visit at least #b times during the reporting year involved4 7v7 ,the percentage of enrolled adults with diabetes who receive a comprehensive or periodic evaluation or a comprehensive periodontal evaluation during the reporting year involved4 7vi7 ,the percentage of enrolled adults who require tooth extraction during the reporting year involved4 7vii7 ,the percentage of enrolled adults who require partial or full dentures during the reporting year involved4 7#b7 ,dissemination ,not later than #a year after enactment of this ,act1 the ,secretary shall publish an initial core set of oral health quality and equity measures that are applicable to enrolled adults4 7#c7 ,standardized reporting ,not later than #b years after the date of the enactment of this ,act1 the ,secretary1 in consultation with ,states1 shall develop a standardized format for the collection and reporting of information based on the initial core set of adult oral health quality and equity measures 7stratified by race1 ethnicity1 primary language1 disability status1 sexual orientation and gender identity7 and create guidelines1 procedures1 and incentives to ,states to use such measures and to collect and report information regarding the quality and equity of oral health care for enrolled adults4 7#d7 ,reports to ,congress ,not later than #c years after enactment of this act1 and every #c years thereafter1 the ,secretary shall include in the report to ,congress required under section #aaci;,a7a77#f7 information similar to the information required under that section with respect to the measures established under this section4 7c7 ,annual state reports regarding state-,specific oral health quality and equity measures applied under medicaid 7#a7 ,in general ,each ,state with a plan approved under title ,,xix 7or with a waiver of such plan in effect7 shall annually report 7separately or as part of the annual report required under section #aaci;,a7c77 to the ,secretary on-- 7,a7 the ,state-specific adult oral health quality and equity measures applied by the ,state under such a plan or waiver1 including measures described in subsection 7b77#a72 7,b7 the ,state-specific information on the quality and equity of oral health care furnished to enrolled adults under such a plan or waiver1 including information collected through external quality reviews of managed care organizations under section #aicb and benchmark plans under section #aicg1 disaggregated by race1 ethnicity1 primary language1 disability status1 sexual orientation1 and gender identity2 7,c7 the ,state-specific information regarding the dental benefits available to enrolled adults under such a plan or waiver1 including any limits on such benefits and the amount of reimbursement provided under such plan or waiver for such benefits2 and 7,d7 the ,state-specific plan to identify1 evaluate1 and reduce in meaningful and measurable ways1 to the extent practicable1 health disparities based on age1 sex1 race1 ethnicity1 primary language1 sexual orientation and gender identity1 and disability status4 7#b7 ,publication ,not later than #b years after the date of enactment of this ,act1 and annually thereafter1 the ,secretary shall collect1 analyze1 and make publicly available the information reported by ,states under paragraph 7#a74 7d7 ,authorization of appropriations ,there are authorized to be appropriated #aj1jjj1jjj to carry out this section4 ,funds appropriated under this subsection shall remain available until expended4 4 7b7 ,required reporting 7#a7 ,medicaid ,section #aijb7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77 is amended-- 7,a7 in paragraph 7#hf71 by striking and at the end2 7,b7 in paragraph 7#hg77;,d71 by striking the period and inserting 2 and2 and 7,c7 by inserting after paragraph 7#hg7 the following new paragraph3 7#hh7 provide for the reporting required under section #aaci;,c7c74 4 7#b7 ,,chip ,section #bajb of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;bb7 is amended by adding at the end the following new subsection3 7d7 ,reporting requirements ,a ,state child health plan shall provide for the reporting required under section #aaci;,c7c74 4 #d4 ,adult oral health care report ,not later than #b years after the date of enactment of this ,act1 the ,medicaid and ,,chip ,payment and ,access ,commission shall submit to ,congress a report on issues related to adult oral health across the #ej ,states1 tribes1 and the territories1 including-- 7#a7 the availability of adult oral health coverage1 and enrollment in such coverage2 7#b7 a survey of adult oral health status among low-income women of childbearing age2 7#c7 barriers to accessing adult oral health care1 including for racially diverse1 ethnically diverse1 and limited ,english proficient communities2 7#d7 innovations and potential solutions to problems of access 7including disparities in access7 to adult oral health care1 including innovations that would expand access to such care beyond dental offices2 and 7#e7 the impact of the amendments made by section #b and recommendations for improving reimbursement rates for such provider of dental and oral health services under the ,medicaid program4 #e4 ,oral health outreach and education ,not later than #a year after the date of enactment of this ,act1 the ,secretary shall develop a program1 to be implemented through contracts with entities that fund or provide oral health care1 to provide-- 7#a7 culturally competent and linguistically appropriate information on the availability and scope of oral health and dental coverage for adults who are eligible for or enrolled under a ,state plan 7or waiver of such plan7 under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq472 7#b7 assistance in connecting adults and underserved populations enrolled in such a plan 7or waiver7 to oral health care2 7#c7 education to dental1 oral health1 and medical professionals to strengthen core competencies in delivering culturally competent oral health care to adults enrolled in such a plan 7or waiver71 including3 individuals with physical and intellectual disabilities1 pregnant and postpartum individuals1 ,alaskan ,native and ,american ,indian populations1 and people living in urban1 rural and1 other underserved communities2 and 7#d7 culturally competent and linguistically appropriate interactive oral health education aimed at promoting good oral health practices for adults1 including racially and ethnically diverse ,medicaid beneficiaries4