,,ii  #aagth ,,congress  #ast ,session  
,s4 #cjag  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,october #bj1  
#bjba,mr4 ,sanders 7for himself1 ,mr4   
,blumenthal1 ,mr4 ,menendez1 ,mrs4      
,gillibrand1 ,mr4 ,booker1 and ,ms4     
,hirono7 introduced the following bill2 
which was read twice and referred to the
 ,committee on ,veterans' ,affairs  ,a  
,,bill  ,to expand the provision and    
availability of dental care furnished 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 ,act4  #b4  
,sense of ,congress ,it is the sense of 
,congress that-- 7#a7 the ,department of
 ,veterans ,affairs has pioneered a     
whole health approach to health care1   
which brought mental health and suicide 
prevention under the umbrella of primary
 care and integrated health1 provides   
access to alternative medicines1        
delivers a holistic approach to health  

and well-being1 and repeatedly          
demonstrates better health outcomes than
 the private sector at a low cost to    
taxpayers in the ,united ,states2  7#b7 
the effects of poor dental care are seen
 in patients who are at risk of or      
diagnosed with diabetes1 cardiovascular 
disease1 pulmonary conditions1 kidney   
impairment1 and even dementia2  7#c7 the
 ,department spends countless dollars on
 prescription drugs1 community care1    
urgent care1 and emergency room visits  
on preventable ailments that would be   
reduced or eliminated through           
preventative dental care2 and  7#d7 in  
order to best achieve a whole health    
model for the provision of health care  
to veterans and reduce long-term costs1 
the ,department must furnish veterans   
with preventative and comprehensive     
dental care4  #c4 ,requirement that     
,secretary of ,veterans ,affairs 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 #agja7f77;,b71
 by striking as described in sections   
#agaj and #agab of this title2  7#b7 in 
section #agaj7;c71 by striking the      
second sentence2 and  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 appliances4
  7b7 ,conforming and clerical          
amendments  7#a7 ,conforming amendments 
7,a7 ,protection of health care         
eligibility ,section #aebe7;a7 of such  
title is amended by striking medicines  
under section #agab7;d7 and inserting   

medicines under section #agab7;b74  7,b7
 ,dental insurance plan ,section        
#agab;,c7h7 of such title is amended--  
7i7 by striking section #agab of this   
title and inserting this chapter2 and   
7ii7 by striking such section #agab and 
inserting this chapter4  7#b7 ,heading  
amendment ,the heading for section #agab
 of such title is amended to read as    
follows3  #agab4 ,appliances2 drugs and 
medicines for certain disabled veterans2
 vaccines  4  7#c7 ,clerical amendment  
,the table of sections at the beginning 
of subchapter ,,ii of chapter #ag of    
such title is amended by striking the   
item relating to section #agab and      
inserting the following new item3       
#agab4 ,appliances2 drugs and medicines 
for certain disabled veterans2 vaccines4
  4  7c7 ,effective date ,the amendments
 made by this section shall take effect 
on the date that is one year after the  
date of the enactment of this ,act4  #d4
 ,expansion of furnishing by ,department
 of ,veterans ,affairs of dental care to

 all enrolled veterans  7a7 ,in general 
,the ,secretary of ,veterans ,affairs   
shall furnish dental care to all        
veterans enrolled in the system of      
annual patient enrollment of the        
,department of ,veterans ,affairs       
established and operated under section  
#agje7;a7 of title #ch1 ,united ,states 
,code1 pursuant to the phased approach  
required under this section4  7b7 ,phase
 one required  7#a7 ,commencement  7,a7 
,in general ,commencing not later than  
one year after the date of the enactment
 of this ,act1 the ,secretary of        
,veterans ,affairs shall furnish dental 
care to all covered veterans who are not
 eligible for dental services and       
treatment and related dental appliances 
under the laws administered by the      
,secretary as of the date of the        
enactment of this ,act4  7,b7 ,phase one
 ,in this section1 the furnishing of    
dental care under subparagraph 7,a7     
shall be referred to as phase one4  7#b7
 ,duration of phase one ,phase one shall

 be carried out during the two-year     
period beginning on the date of the     
commencement of phase one4  7#c7        
,locations  7,a7 ,in general ,the       
,secretary shall carry out phase one at 
the following locations3 7i7 ,each      
medical center of the ,department with  
an established dental clinic4  7ii7 ,not
 fewer than four military medical       
treatment facilities of the ,department 
of ,defense with the capacity to furnish
 dental care1 which shall be selected in
 consultation with the ,secretary of    
,defense4  7iii7 ,not fewer than four   
community-based outpatient clinics with 
space available for the furnishing of   
dental care under phase one4  7iv7 ,not 
fewer than four ,federally ,qualified   
,health ,centers4  7v7 ,not fewer than  
four facilities of the ,indian ,health  
,service with established dental        
clinics1 which shall be selected in     
consultation with the ,secretary of     
,health and ,human ,services4  7,b7     
,considerations ,in selecting locations 

for phase one1 the ,secretary shall     
consider the feasibility and            
advisability of selecting locations in  
each of the following3 7i7 ,rural areas4
  7ii7 ,areas that are not in close     
proximity to an active duty military    
installation4  7iii7 ,areas representing
 different geographic locations1 such as
 census tracts established by the       
,bureau of the ,census4  7,c7 ,mobile   
dental clinics ,in carrying out phase   
one1 the ,secretary shall test the      
efficacy of mobile dental clinics to    
service rural areas that do not have a  
population base to warrant a full-time  
clinic but where there are covered      
veterans in need of dental care4  7,d7  
,home-based dental care ,in carrying out
 phase one1 the ,secretary shall test   
the efficacy of portable dental care    
units to service rural veteran in their 
homes1 as the ,secretary considers      
medically appropriate4  7#d7 ,scope of  
services ,the dental care furnished to  
covered veterans under phase one 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  7#e7   
,use of telemedicine ,when providing    
dental services via telemedicine under  
phase one1 the ,secretary shall use     
,federal employees to the maximum extent
 possible4  7#f7 ,voluntary             
participation ,the participation of a   
covered veteran in phase one shall be at
 the election of the veteran4  7#g7     
,copayments ,the ,secretary may collect 
copayments for dental care furnished    
under phase one in accordance with      
authorities on the collection of        
copayments for medical care of veterans 
under chapter #ag of title #ch1 ,united 
,states ,code4  7#h7 ,administration    
7,a7 ,notice to covered veterans on     
phase one ,in carrying out phase one1   
the ,secretary shall inform all covered 
veterans of the services and treatment  

available under phase one4  7,b7        
,contracts  7i7 ,in general ,subject to 
clause 7iii71 in carrying out phase one1
 the ,secretary may enter into contracts
 with appropriate entities for the      
provision of dental care under phase    
one4  7ii7 ,performance standards and   
metrics ,each contract entered into     
under clause 7i7 shall specify          
performance standards and metrics and   
processes for ensuring compliance of the
 contractor concerned with such         
performance standards4  7iii7           
,limitation ,the ,secretary may only    
enter into contracts under clause 7i7 if
 the ,secretary determines that the     
,department does not employ1 and cannot 
recruit and retain1 qualified dentists1 
dental hygienists1 and oral surgeons in 
the applicable location4  7#i7          
,definitions ,in this subsection3 7,a7  
,covered veteran ,the term covered      
veteran means a veteran enrolled in the 
system of annual patient enrollment of  
the ,department of ,veterans ,affairs   

established and operated under section  
#agje7;a7 of title #ch1 ,united ,states 
,code1 pursuant to paragraph 7#a7 or    
7#b7 of such section4  7,b7 ,federally  
qualified health center ,the term       
,federally ,qualified ,health ,center   
means a ,federally-qualified health     
center as defined in section            
#aije7l77#b77;,b7 of the ,social        
,security ,act 7#db ,u4,s4,c4           
#acif;d7l77#b77;,b774  7c7 ,expansion   
7#a7 ,in general ,after the completion  
of phase one1 the ,secretary shall      
expand the provision of dental care     
under this section to all veterans1     
including through the use of the        
recommendations of the ,secretary under 
subsection 7d77#b77;,f71 as follows3    
7,a7 ,in phase two1 which shall-- 7i7   
commence not later than #ij days after  
the completion of phase one2 and  7ii7  
consist of the provision of dental care 
to all veterans enrolled in the system  
of annual patient enrollment of the     
,department of ,veterans ,affairs       

established and operated under section  
#agje7;a7 of title #ch1 ,united ,states 
,code1 pursuant to paragraph 7#a71 7#b71
 7#c71 or 7#d7 of such section4  7,b7   
,in phase three1 which shall-- 7i7      
commence not later than #ij days after  
the completion of phase two2 and  7ii7  
consist of the provision of dental care 
to all veterans enrolled in such system 
pursuant to paragraph 7#a71 7#b71 7#c71 
7#d71 7#e71 or 7#f7 of such section4    
7,c7 ,in phase four1 which shall-- 7i7  
commence not later than #ij days after  
the completion of phase three2 and  7ii7
 consist of the provision of dental care
 to all veterans enrolled in such       
system4  7#b7 ,facility expansion ,under
 each phase specified in paragraph 7#a71
 the ,secretary shall expand the number 
of facilities described in subsection   
7b77#c7 furnishing dental care under    
this section commensurate to the number 
of new veterans furnished care under    
such phase1 including through the use of
 any other facilities to which veterans 

have access4  7#c7 ,duration ,each phase
 specified in paragraph 7#a7 shall be   
carried out during a period not to      
exceed two years and all such phases1   
including phase one1 shall be carried   
out for a period not to exceed eight    
years4  7#d7 ,conclusion ,upon the      
conclusion of phase four specified under
 paragraph 7#a77;,c71 all veterans      
enrolled in the system of annual patient
 enrollment of the ,department of       
,veterans ,affairs established and      
operated under section #agje7;a7 of     
title #ch1 ,united ,states ,code1 shall 
be eligible for dental care from the    
,department4  7d7 ,reports  7#a7 ,in    
general ,not later than #ij days before 
the completion of phase one1 and not    
later than #ahj days after the          
completion of each subsequent phase     
under subsection 7c77#a71 the ,secretary
 shall submit to the ,committee on      
,veterans' ,affairs and the ,committee  
on ,armed ,services of the ,senate and  
the ,committee on ,veterans' ,affairs   

and the ,committee on ,armed ,services  
of the ,house of ,representatives a     
report on the phase about to be         
completed and the plans of the          
,secretary for implementation of        
expansion of the provision of dental    
care pursuant to subsection 7c74  7#b7  
,contents ,each report under paragraph  
7#a7 shall include the following3 7,a7  
,a description of the implementation and
 operation of the phase covered by the  
report4  7,b7 ,the number of veterans   
receiving dental care under such phase  
and a description of the dental care    
furnished to such veterans4  7,c7 ,an   
analysis of the costs and benefits of   
such phase1 including a comparison of   
costs and benefits by location type4    
7,d7 ,an assessment of the impact of    
such phase on appointments for care1    
prescriptions1 hospitalizations1        
emergency room visits1 wellness1        
employability1 and satisfaction of      
patients1 and perceived quality of life 
of veterans4  7,e7 ,an analysis and     

assessment of the efficacy of mobile    
clinics and home-based dental care to   
service the dental needs of veterans    
during such phase4  7,f7 ,the findings  
and conclusions of the ,secretary with  
respect to such phase4  7,g7 ,a         
comparison of the costs for private     
sector dental care with cost of         
furnishing dental care from the         
,department1 broken down by each        
locality included in such phase4  7,h7  
,such recommendations for the expansion 
of dental care pursuant to subsection   
7c7 as the ,secretary considers         
appropriate4  #e4 ,requirement of dental
 clinic of ,department of ,veterans     
,affairs in each ,state  7a7 ,in general
 ,the ,secretary of ,veterans ,affairs  
shall ensure that each ,state has a     
dental clinic of the ,department of     
,veterans ,affairs to service the needs 
of the veterans within that ,state4  7b7
 ,effective date ,this section shall    
take effect on the date that is one year
 after the date of the enactment of this

 ,act4  #f4 ,program on education to    
promote dental health in veterans  7a7  
,program required ,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 annual patient enrollment 
of the ,department of ,veterans ,affairs
 established and operated under section 
#agje7;a7 of title #ch1 ,united ,states 
,code4  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 eligibility for
 dental care through the ,department4   
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 webinars1 ,my ,healthe,vet1 and 
,,va4gov4  7,c7 ,presentations by the   
dental program office of the ,department
 of information1 including both small   
group and large group presentations1 and

 distribution of such information to all
 locations in which the program is being
 carried out4  7#b7 ,selection of       
mechanisms ,in selecting mechanisms     
under paragraph 7#a71 the ,secretary    
shall select mechanisms designed to     
maximize the number of veterans who     
receive education under the program4    
7d7 ,construction ,nothing in this      
section shall be construed to alter or  
revise the eligibility of any veteran   
for dental care under the laws          
administered by the ,secretary4  7e7    
,definitions ,in this section-- 7#a7    
,federally qualified health center ,the 
term ,federally ,qualified ,health      
,center means a ,federally-qualified    
health center as defined 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    
7f7 ,effective date ,this section shall 

take effect on the date that is one year
 after the date of the enactment of this
 ,act4  #g4 ,student loan repayment     
program to incentivize dental training  
and ensure the dental workforce of the  
,department of ,veterans ,affairs  7a7  
,program required ,the ,secretary of    
,veterans ,affairs1 to ensure that the  
,department of ,veterans ,affairs has   
sufficient staff to provide dental      
service to veterans1 shall implement a  
loan reimbursement program for qualified
 dentists1 dental hygienists1 and oral  
surgeons who agree-- 7#a7 to be         
appointed by the ,secretary as a        
dentist1 dental hygienist1 or oral      
surgeon1 as the case may be1 under      
section #gdja of title #ch1 ,united     
,states ,code2 and  7#b7 to serve as a  
dentist1 dental hygienist1 or oral      
surgeon1 as the case may be1 of the     
,department pursuant to such appointment
 at a dental clinic of the ,department  
for a period of not less than five      
years4  7b7 ,maximum amount ,the        

,secretary may reimburse not more than--
 7#a7 #ge1jjj for each dentist          
participating in the program under      
subsection 7a72  7#b7 #aj1jjj for each  
dental hygienist participating in such  
program2 and  7#c7 #bj1jjj for each oral
 surgeon participating in such program4 
7c7 ,selection of locations ,the        
,secretary shall monitor demand among   
veterans for dental care and require    
participants in the program under       
subsection 7a7 to choose from dental    
clinics of the ,department with the     
greatest need for dentists1 dental      
hygienists1 or oral surgeons1 as the    
case may be1 according to facility      
enrollment and patient demand4  #h4     
,educational and training partnerships  
for dentists1 dental hygienists1 and    
oral surgeons ,the ,secretary of        
,veterans ,affairs shall enter into     
educational and training partnerships   
with dental schools to provide training 
and employment opportunities for        
dentists1 dental hygienists1 and oral   

surgeons4  #i4 ,authorization of        
appropriations  7a7 ,in general ,there  
is authorized to be appropriated for the
 ,department of ,veterans ,affairs for  
fiscal year #bjba such sums as may be   
necessary to carry out this ,act and the
 amendments made by this ,act4  7b7     
,availability ,the amount authorized to 
be appropriated under subsection 7a7    
shall be available for obligation for   
the eight-year period beginning on the  
date that is one year after the date of 
the enactment of this ,act4