,,ii #aagth ,,congress #ast ,session ,s4 #caff ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,november #d1 #bjba,mr4 ,cardin 7for himself and ,ms4 ,stabenow7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend title ,,xix of the ,social ,security ,act to improve coverage of dental and oral health services for adults under ,medicaid1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,medicaid ,dental ,benefit ,act of #bjba4 #b4 ,requiring ,medicaid coverage of dental and oral health services for adults 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 ,medically needy 7,i7 ,in general ,section #aijb7;a77#aj77;,c77iv7 of such ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,c77iv77 is amended by striking and 7#ag7 and inserting 1 7#aj71 and 7#ag7 after 7#e74 7,,ii7 ,rule of construction ,nothing in this section or the amendments made by this section shall be construed to limit the access of an individual residing in an institutional setting to dental and oral health services 7as such term is defined in section #aije7;jj7 of the ,social ,security ,act1 as added by paragraph 7#b77;,b774 7iii7 ,effective date ,the amendments made by clauses 7i7 and 7ii7 shall apply with respect to expenditures for medical assistance in calendar quarters beginning on or after ,january #a1 #bjbc4 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 ,january #a1 #bjbc1 coverage of dental and oral health services 7as such term is defined in section #aije7;jj7744 7,c7 ,optional application to territories ,section #aijb7;j7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7j77 is amended-- 7i7 by striking this title1 the ,secretary and inserting 8this title-- 7#a7 in the case of a ,state other than the #ej ,states and the ,district of ,columbia the requirement under subsection 7a77#aj77;,a7 to provide the care and services listed in paragraph 7#aj7 of section #aije7;a7 shall be optional2 and 7#b7 the ,secretary 2 and 7ii7 by striking the second comma after section #aajh7;f74 7#b7 ,definition of dental and oral health services ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is amended-- 7,a7 in subsection 7a77#aj71 by inserting and dental and oral health services 7as defined in subsection 7jj77 after dental services2 and 7,b7 by adding at the end the following new subsection3 7jj7 ,dental and oral health services ,for purposes of subsection 7a77#aj71 the term dental and oral health services means dentures and denture services1 implants and implant services1 and services necessary to prevent oral disease and promote oral health1 restore oral structures to health and function1 reduce oral pain1 and treat emergency oral conditions1 that are furnished by a provider who is legally authorized to furnish such items and services under ,state law 7or the ,state regulatory mechanism provided by ,state law74 4 7#c7 ,conforming amendment 7,a7 ,in general ,section #aije7;a77#aj7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77#aj771 as amended by paragraph 7#b71 is amended by striking dental services and4 7,b7 ,effective date ,the amendment made by subparagraph 7,a7 shall take effect on ,january #a1 #bjbc4 7b7 ,state option for additional dental and oral health benefits ,section #aije7;a77#ac7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77#ac77 is amended by inserting the following new subparagraph after subparagraph 7,c73 7,d7 at ,state option1 such items and services related to dental and oral health services 7as defined in subsection 7jj77 that are in addition to those identified in such subsection 7jj7 as the ,state may specify2 4 7c7 ,increased ,,fmap 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 7,b7 in subsection 7ff71 by striking and 7ii7 and inserting 1 7ii71 and 7kk72 and 7,c7 by adding at the end the following new subsection3 7kk7 ,increased ,,fmap for expenditures related to dental and oral health services 7#a7 ,in general 7,a7 #ej ,states and ,,dc ,notwithstanding subsection 7b71 in the case of a ,state that is #a of the #ej ,states or the ,district of ,columbia1 during the #ab-quarter period that begins on ,january #a1 #bjbc1 the ,federal medical assistance percentage shall be equal to #ajj percent with respect to amounts expended by the ,state for medical assistance for dental and oral health services authorized under paragraph 7#aj7 of subsection 7a74 ,in no case may the application of this subparagraph result in the ,federal medical assistance percentage determined for a ,state with respect to expenditures described in this subparagraph exceeding #ajj percent4 7,b7 ,territories 7i7 ,in general ,notwithstanding subsection 7b71 in the case of a ,state that is ,puerto ,rico1 the ,virgin ,islands1 ,guam1 the ,northern ,mariana ,islands1 or ,american ,samoa1 during a period described in clause 7ii71 the ,federal medical assistance percentage shall be equal to #ajj percent with respect to amounts expended by the ,state for medical assistance for any item or service that is included in dental and oral health services authorized under paragraph 7#aj7 of subsection 7a74 ,in no case may the application of this clause result in the ,federal medical assistance percentage determined for a ,state with respect to expenditures described in this clause exceeding #ajj percent4 7ii7 ,period described ,a period described in this clause is1 with respect to an item or service described in clause 7i7 and a ,state described in such clause1 the #ab-quarter period that begins with the first quarter beginning on or after ,january #a1 #bjbc1 in which such item or service is first covered under the ,state plan or under a waiver of such plan4 7#b7 ,exclusions ,the ,federal medical assistance percentage specified in paragraph 7#a7 shall not apply to amounts expended for medical assistance during any period for-- 7,a7 additional items and services authorized under paragraph 7#ac77;,d7 of subsection 7a72 or 7,b7 items and services furnished to an individual if1 as of the date of enactment of this subsection1 medical assistance was available to such individual for such items and services or medicare cost-sharing under the ,state plan or a waiver of such plan4 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 additional amount paid to ,puerto ,rico1 the ,virgin ,islands1 ,guam1 the ,northern ,mariana ,islands1 and ,american ,samoa for expenditures for medical assistance that is attributable to an increase in 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 7g74 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