,i #aag? ,,congress #a/ ,session ,h4 ,r4 #ddci ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,july #af1 #bjba,ms4 ,b>ragn 7= h]self1 ,mr4 ,grijalva1 ,ms4 ,velzquez1 ,mr4 ,payne1 ,mr4 ,soto1 & ,ms4 ,norton7 introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,en]gy & ,comm]ce ,a ,,bill ,to am5d title ,,xix ( ! ,social ,security ,act to improve cov]age ( adult oral heal? c>e "u ! ,m$icaid program1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,m$icaid ,d5tal ,b5efit ,act4 #b4 ,requir+ cov]age ( oral heal? s]vices = adults "u ! ,m$icaid program 7a7 ,9 g5]al 7#a7 ,m&atory cov]age 7,a7 ,9 g5]al 7i7 ,requirem5t ,section #aijb7;a77#aj77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a77 is am5d$ by ins]t+ 7#aj71 aft] 7#e714 7ii7 ,effective date ,! am5dm5t made by clause 7i7 %all apply ) respect to m$ical assi/ance furni%$ 9 cal5d> qu>t]s beg9n+ on or aft] ! date t is #a ye> aft] ! date ( ! enactm5t ( ?is ,act4 7,b7 ,b5*m>k cov]age ,section #aicg7;b77#e7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#g7;b77#e77 is am5d$ by /rik+ ! p]iod & ins]t+ 1 &1 beg9n+ ) ! fir/ qu>t] beg9n+ on or aft] ! date t is #a ye> aft] ! date ( ! enactm5t ( ! ,m$icaid ,d5tal ,b5efit ,act1 cov]age ( d5tal & oral heal? s]vices 7z def9$ 9 section #aije7;jj7744 7#b7 ,def9ition ( s]vices ,section #aije ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is am5d$-- 7,a7 9 subsection 7a77#aj71 by /rik+ d5tal s]vices & ins]t+ d5tal & oral heal? s]vices 7z def9$ 9 subsection 7jj772 & 7,b7 by add+ at ! end ! foll[+ new subsection3 7jj7 ,def9ition ( d5tal & oral heal? s]vices 7#a7 ,9 g5]al ,= purposes ( ?is title1 ! t]m d5tal & oral heal? s]vices means s]vices necess>y to prev5t disease & promote oral heal?1 re/ore oral /ructures to heal? & function1 r$uce oral pa91 & treat em]g5cy oral conditions4 ,su* t]m includes ! s]vices specifi$ 9 p>agraph 7#b74 7#b7 ,specifi$ s]vices ,= purposes ( p>agraph 7#a71 ! s]vices specifi$ 9 ?is p>agraph are ! foll[+3 7,a7 ,r\t9e diagno/ic & prev5tive c>e 7su* z d5tal clean+s1 exams1 & x-rays74 7,b7 ,basic d5tal s]vices 7su* z fill+s & extractions7 & major d5tal s]vices 7su* z root canals1 cr[ns1 & d5tures74 7,c7 ,em]g5cy d5tal c>e4 7,d7 ,temporom&ibul> 7,,tmd7 & or(acial pa9 disord] treatm5t4 7,e7 ,o!r necess>y s]vices relat$ to d5tal & oral heal? 7z specifi$ by ! ,secret>y74 4 7b7 ,enhanc$ ,,fmap2 ma9t5ance ( ef=t 7#a7 ,m$icaid ,section #aije ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d71 z am5d$ by subsection 7a71 is fur!r am5d$-- 7,a7 9 subsection 7b71 by /rik+ & 7ii7 & ins]t+ 7ii71 & 7kk72 & 7,b7 by add+ at ! end ! foll[+ new subsection3 7kk7 ,increas$ ,,fmap = exp5ditures = d5tal & oral heal? s]vices 7#a7 ,9 g5]al ,! ,f$]al m$ical assi/ance p]c5tage ) respect to am\nts exp5d$ by su* ,/ate = m$ical assi/ance consi/+ ( d5tal & oral heal? s]vices 7z def9$ 9 subsection 7jj77 furni%$ dur+ ! fir/ cal5d> qu>t] beg9n+ on or aft] ! date t is #a ye> aft] ! date ( ! enactm5t ( ?is subsection 7or dur+ any subsequ5t qu>t]7 to individuals #ba ye>s ( age or old] %all be equal to1 9 ! case ( su* s]vices furni%$-- 7,a7 dur+ ! #c-ye> p]iod beg9n+ on ! fir/ day ( su* fir/ cal5d> qu>t]1 #ajj p]c5t2 7,b7 dur+ ! #a-ye> p]iod imm$iately foll[+ ! p]iod describ$ 9 subp>agraph 7,a71 #ie p]c5t2 7,c7 dur+ ea* subsequ5t #a-ye> p]iod 7?r\gh ! ?ird su* subsequ5t p]iod71 ! p]c5tage specifi$ "u ?is p>agraph = ! prec$+ #a-ye> p]iod1 r$uc$ by #e p]c5tage po9ts2 & 7,d7 dur+ any qu>t] beg9n+ aft] ! #g-ye> p]iod beg9n+ on ! fir/ day describ$ 9 subp>agraph 7,a71 #hj p]c5t4 7#b7 ,no r$uction 9 ,,fmap ,p>agraph 7#a7 %all n apply ) respect to am\nts exp5d$ by a ,/ate if ! ,f$]al m$ical assi/ance p]c5tage o!rwise applicable to su* am\nts )\t application ( su* p>agraph w\ld be high] ?an su* p]c5tage applicable to su* am\nts ) application ( su* p>agraph4 4 7#b7 ,exclusion ( am\nts attributable to increas$ ,,fmap f t]ritorial caps ,section #aajh ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acjh7 is am5d$-- 7,a7 9 subsection 7f71 9 ! matt] prec$+ p>agraph 7#a71 by /rik+ subsections 7g7 & 7h7 & ins]t+ subsections 7g71 7h71 & 7i72 & 7,b7 by add+ at ! end ! foll[+3 7i7 ,exclusion f caps ( am\nts attributable to increas$ ,,fmap = cov]age ( d5tal & oral heal? s]vices ,any paym5t made to a t]ritory = exp5ditures = m$ical assi/ance t are subject to an increase ! ,f$]al m$ical assi/ance p]c5tage applicable to su* exp5ditures "u section #aije7kk7 %all n be tak5 into acc\nt = purposes ( apply+ paym5t limits "u subsections 7f7 & 7g7 to ! ext5t t su* paym5t exce$s ! am\nt ( ! paym5t t w\ld h be5 made to ! t]ritory = su* exp5ditures )\t reg>d to su* section4 4 #c4 ,adult oral heal? quality & equity measures 7a7 ,9 g5]al ,title ,,xi ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acja et seq47 is am5d$ by ins]t+ aft] section #aaci;,b ! foll[+ new section3 #aaci;,c4 ,adult oral heal? quality & equity measures 7a7 ,developm5t ( core set ( adult oral heal? c>e quality & equity measures 7#a7 ,9 g5]al ,! ,secret>y %all id5tify & publi% a recomm5d$ core set ( heal? quality & equity measures = individuals enroll$ 9 a ,/ate plan 7or waiv] ( su* plan7 "u title ,,xix :o are ov] ! age ( #ba 9 ! same mann] z ! ,secret>y id5tifies & publi%es a core set ( *ild heal? quality measures "u section #aaci;,a1 includ+ ) respect to id5tify+ & publi%+ exi/+ oral heal? quality measures = su* individuals t are 9 use "u public & privately sponsor$ heal? c>e cov]age arrangem5ts1 or t are "p ( report+ sy/ems t measure bo? ! pres5ce & duration ( heal? insurance cov]age ov] "t1 t may be applicable to enroll$ adults4 7#b7 ,alignm5t ) exi/+ core set ,9 id5tify+ & publi%+ ! recomm5d$ core set ( adult oral heal? quality & equity measures requir$ "u p>agraph 7#a71 ! ,secret>y %all ensure t1 to ! ext5t possible1 su* measures align ) & d n duplicate ! core set ( adult heal? quality & equity measures id5tifi$1 publi%$1 & revis$ "u section #aaci;,b4 7#c7 ,process = adult oral heal? quality & equity measures program ,9 id5tify+ gaps 9 exi/+ adult oral heal? quality & equity measures & e/abli%+ priorities = ! developm5t & advancem5t ( su* measures1 ! ,secret>y %all consult )-- 7,a7 ,/ates2 7,b7 heal? c>e provid]s2 7,c7 pati5t repres5tatives2 7,d7 d5tal pr(essionals2 & 7,e7 national organizations ) exp]tise 9 oral heal? quality or equity measurem5t4 7b7 ,deadl9es 7#a7 ,recomm5d$ measures ,n lat] ?an #a ye> aft] enactm5t ( ?is ,act1 ! ,secret>y %all id5tify & publi% = comm5t a recomm5d$ core set ( adult oral heal? quality & equity measures t includes ! foll[+3 7,a7 ,measures ( utilization ( oral heal? & d5tal s]vices across heal? c>e sett+s4 7,b7 ,measures t address ! availability ( oral evaluations dur+ or foll[+ m$ical visits = enroll$ adults4 7,c7 ,measures t address ! incid5ce ( em]g5cy dep>tm5t visits = non-traumatic d5tal conditions4 7,d7 ,measures t address ! availability & receipt ( foll[-up d5tal c>e aft] em]g5cy dep>tm5t visits = non-traumatic d5tal conditions dur+ pregnancy4 7,e7 ,measures t address ! availability ( c\nsel+ ( enroll$ adults aim$ at improv+ oral heal? outcomes4 7,f7 ,measures t address ! availability & receipt ( c>e = b5efici>ies :o meet ! m$ical necessity crit]ia = g5]al ane/hesia & intrav5\s s$ation4 7,g7 ,measures t address scre5+ & evaluation = c>ies risk & p]iodontitis & treatm5t = c>ies risk & p]iodontitis1 includ+ ! foll[+3 7i7 ,! p]c5tage ( enroll$ adults :o h c>ies risk docum5t$ 9 ! report+ ye> involv$4 7ii7 ,! p]c5tage ( enroll$ adults :o receiv$ a topical fluoride application or sealants bas$ on an oral heal? risk assessm5t demon/rat+ ! ne$ = su* application or sealants dur+ ! report+ ye> involv$4 7iii7 ,! p]c5tage ( enroll$ adults :o receiv$ a compreh5sive or p]iodic oral evaluation or a compreh5sive p]iodontal evaluation dur+ ! report+ ye> involv$4 7iv7 ,! p]c5tage ( enroll$ adults ) a hi/ory ( p]iodontitis :o receiv$ an oral prophylaxis1 scal+ or root plan+1 or p]iodontal ma9t5ance visit at lea/ #b times dur+ ! report+ ye> involv$4 7v7 ,! p]c5tage ( enroll$ adults ) diabetes :o receive a compreh5sive or p]iodic evaluation or a compreh5sive p]iodontal evaluation dur+ ! report+ ye> involv$4 7vi7 ,! p]c5tage ( enroll$ adults :o require too? extraction dur+ ! report+ ye> involv$4 7vii7 ,! p]c5tage ( enroll$ adults :o require p>tial or full d5tures dur+ ! report+ ye> involv$4 7#b7 ,dissem9ation ,n lat] ?an #a ye> aft] enactm5t ( ?is ,act1 ! ,secret>y %all publi% an initial core set ( oral heal? quality & equity measures t are applicable to enroll$ adults4 7#c7 ,/&>diz$ report+ ,n lat] ?an #b ye>s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y1 9 consultation ) ,/ates1 %all develop a /&>diz$ =mat = ! collection & report+ ( in=mation bas$ on ! initial core set ( adult oral heal? quality & equity measures 7/ratifi$ by race1 e?nicity1 prim>y language1 disability /atus1 sexual ori5tation & g5d] id5tity7 & create guidel9es1 proc$ures1 & inc5tives to ,/ates to use su* measures & to collect & report in=mation reg>d+ ! quality & equity ( oral heal? c>e = enroll$ adults4 7#d7 ,reports to ,congress ,n lat] ?an #c ye>s aft] enactm5t ( ?is act1 & e #c ye>s !reaft]1 ! ,secret>y %all include 9 ! report to ,congress requir$ "u section #aaci;,a7a77#f7 in=mation simil> to ! in=mation requir$ "u t section ) respect to ! measures e/abli%$ "u ?is section4 7c7 ,annual /ate reports reg>d+ /ate-,specific oral heal? quality & equity measures appli$ "u m$icaid 7#a7 ,9 g5]al ,ea* ,/ate ) a plan approv$ "u title ,,xix 7or ) a waiv] ( su* plan 9 effect7 %all annually report 7sep>ately or z "p ( ! annual report requir$ "u section #aaci;,a7c77 to ! ,secret>y on-- 7,a7 ! ,/ate-specific adult oral heal? quality & equity measures appli$ by ! ,/ate "u su* a plan or waiv]1 includ+ measures describ$ 9 subsection 7b77#a72 7,b7 ! ,/ate-specific in=mation on ! quality & equity ( oral heal? c>e furni%$ to enroll$ adults "u su* a plan or waiv]1 includ+ in=mation collect$ ?r\gh ext]nal quality reviews ( manag$ c>e organizations "u section #aicb & b5*m>k plans "u section #aicg1 disaggregat$ by race1 e?nicity1 prim>y language1 disability /atus1 sexual ori5tation1 & g5d] id5tity2 7,c7 ! ,/ate-specific in=mation reg>d+ ! d5tal b5efits available to enroll$ adults "u su* a plan or waiv]1 includ+ any limits on su* b5efits & ! am\nt ( reimbursem5t provid$ "u su* plan or waiv] = su* b5efits2 & 7,d7 ! ,/ate-specific plan to id5tify1 evaluate1 & r$uce 9 mean+ful & measurable ways1 to ! ext5t practicable1 heal? disp>ities bas$ on age1 sex1 race1 e?nicity1 prim>y language1 sexual ori5tation & g5d] id5tity1 & disability /atus4 7#b7 ,publication ,n lat] ?an #b ye>s aft] ! date ( enactm5t ( ?is ,act1 & annually !reaft]1 ! ,secret>y %all collect1 analyze1 & make publicly available ! in=mation report$ by ,/ates "u p>agraph 7#a74 7d7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ #aj1jjj1jjj to c>ry out ?is section4 ,funds appropriat$ "u ?is subsection %all rema9 available until exp5d$4 4 7b7 ,requir$ report+ 7#a7 ,m$icaid ,section #aijb7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77 is am5d$-- 7,a7 9 p>agraph 7#hf71 by /rik+ & at ! end2 7,b7 9 p>agraph 7#hg77;,d71 by /rik+ ! p]iod & ins]t+ 2 &2 & 7,c7 by ins]t+ aft] p>agraph 7#hg7 ! foll[+ new p>agraph3 7#hh7 provide = ! report+ requir$ "u section #aaci;,c7c74 4 7#b7 ,,*ip ,section #bajb ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;bb7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7d7 ,report+ requirem5ts ,a ,/ate *ild heal? plan %all provide = ! report+ requir$ "u section #aaci;,c7c74 4 #d4 ,adult oral heal? c>e report ,n lat] ?an #b ye>s aft] ! date ( enactm5t ( ?is ,act1 ! ,m$icaid & ,,*ip ,paym5t & ,access ,commission %all submit to ,congress a report on issues relat$ to adult oral heal? across ! #ej ,/ates1 tribes1 & ! t]ritories1 includ+-- 7#a7 ! availability ( adult oral heal? cov]age1 & enrollm5t 9 su* cov]age2 7#b7 a survey ( adult oral heal? /atus among l[-income wom5 ( *ildbe>+ age2 7#c7 b>ri]s to access+ adult oral heal? c>e1 includ+ = racially div]se1 e?nically div]se1 & limit$ ,engli% pr(ici5t communities2 7#d7 innovations & pot5tial solutions to problems ( access 7includ+ disp>ities 9 access7 to adult oral heal? c>e1 includ+ innovations t w\ld exp& access to su* c>e beyond d5tal (fices2 & 7#e7 ! impact ( ! am5dm5ts made by section #b & recomm5dations = improv+ reimbursem5t rates = su* provid] ( d5tal & oral heal? s]vices "u ! ,m$icaid program4 #e4 ,oral heal? outrea* & education ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y %all develop a program1 to be implem5t$ ?r\gh contracts ) entities t fund or provide oral heal? c>e1 to provide-- 7#a7 culturally compet5t & l+ui/ically appropriate in=mation on ! availability & scope ( oral heal? & d5tal cov]age = adults :o are eligible = or enroll$ "u a ,/ate plan 7or waiv] ( su* plan7 "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq472 7#b7 assi/ance 9 connect+ adults & und]s]v$ populations enroll$ 9 su* a plan 7or waiv]7 to oral heal? c>e2 7#c7 education to d5tal1 oral heal?1 & m$ical pr(essionals to /r5g!n core compet5cies 9 deliv]+ culturally compet5t oral heal? c>e to adults enroll$ 9 su* a plan 7or waiv]71 includ+3 individuals ) physical & intellectual disabilities1 pregnant & po/p>tum individuals1 ,alaskan ,native & ,am]ican ,indian populations1 & p liv+ 9 urban1 rural &1 o!r und]s]v$ communities2 & 7#d7 culturally compet5t & l+ui/ically appropriate int]active oral heal? education aim$ at promot+ good oral heal? practices = adults1 includ+ racially & e?nically div]se ,m$icaid b5efici>ies4