,,ii #aagth ,,congress #ast ,session ,s4 #efj ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,march #c1 #bjba,ms4 ,stabenow introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to improve coverage of maternal oral health care1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,oral ,health for ,moms ,act4 #b4 ,requiring coverage of oral health services for pregnant and postpartum individuals 7a7 ,in general 7#a7 ,medicaid ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is amended-- 7,a7 in subsection 7a77#d7-- 7i7 by striking 2 and 7,d7 and inserting 2 7,d72 and 7ii7 by inserting 2 and 7,e7 beginning ,january #a1 #bjbb1 oral health services for pregnant and postpartum individuals 7as defined in subsection 7hh77 after subsection 7hh772 and 7,b7 by adding at the end the following new subsection3 7hh7 ,oral health services for pregnant and postpartum individuals 7#a7 ,in general ,for purposes of this title1 the term oral health services for pregnant and postpartum individuals means dental services necessary to prevent disease and promote oral health1 restore oral structures to health and function1 and treat emergency conditions that are furnished to an individual during pregnancy 7or during the #fj-;day period beginning on the last day of the pregnancy or such longer period beginning on the last day of the pregnancy as the ,state shall elect74 7#b7 ,coverage requirements ,to satisfy the requirement to provide oral health services for pregnant and postpartum individuals1 a ,state shall1 at a minimum1 provide coverage to prevent disease and promote oral health1 restore oral structures to health and function1 and treat emergency conditions1 consistent with recommendations for perinatal oral health care and dental care during pregnancy from the ,american ,academy of ,pediatric ,dentistry and the ,american ,college of ,obstetricians and ,gynecologists4 ,such coverage shall include-- 7,a7 routine diagnostic and preventive care such as dental cleanings1 exams1 and ,x-rays2 7,b7 basic dental services such as fillings and extractions2 7,c7 major dental services such as root canals1 crowns1 and dentures2 7,d7 emergency dental care2 and 7,e7 other necessary services related to dental and oral health 7as defined by the ,secretary74 4 7#b7 ,coverage of oral health services for pregnant and postpartum individuals regardless of eligibility pathway ,section #aijb7;a77#aj7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77 is amended in the matter following subparagraph 7,g7-- 7,a7 by striking and 7,,xviii7 and inserting 7,,xviii72 and 7,b7 by striking the semicolon at the end and inserting 1 and 7,,xix7 beginning ,january #a1 #bjbb1 medical assistance shall be made available for oral health services for pregnant and postpartum individuals for any individual who is eligible for and receiving medical assistance under the ,state plan or under a waiver of such plan during such individual's pregnancy and during the #fj-;day period beginning on the last day of the pregnancy 7or such longer period beginning on the last day of the pregnancy as the ,state shall elect71 notwithstanding any other provision of law 7including another provision of this paragraph7 limiting such individual's eligibility for medical assistance under such plan or waiver to coverage for a limited type of benefits and services that would not otherwise include coverage of oral health services for pregnant and postpartum individuals24 7#c7 ,,chip 7,a7 ,in general ,section #bajc7;c77#f77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;cc7c77#f77;,a77 is amended by inserting and1 in the case that the ,state elects to provide pregnancy-related assistance pursuant to section #baab1 the pregnancy-related assistance provided to a targeted low-income pregnant woman after targeted low-income child4 7,b7 ,effective date ,the amendment made by this section shall take effect on ,january #a1 #bjbb4 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 7a77#a71 is further amended-- 7,a7 in subsection 7b71 by striking and 7ff7 and inserting 7ff71 and 7ii72 and 7,b7 by adding at the end the following3 7ii7 ,increased ,,fmap for additional expenditures for low-,income pregnant people 7#a7 ,in general ,subject to paragraph 7#b71 for calendar quarters beginning on or after ,january #a1 #bjbb1 notwithstanding subsection 7b71 the ,federal medical assistance percentage for a ,state1 with respect to the additional amounts expended by such ,state for medical assistance under the ,state plan under this title or a waiver of such plan that are attributable to requirements imposed by the amendments made by the ,oral ,health for ,moms ,act 7as determined by the ,secretary71 shall be equal to #ajj percent4 7#b7 ,maintenance of effort ,paragraph 7#a7 shall not apply with respect to a ,state if1 for any calendar quarter during the period beginning with the date of enactment of this subsection and ending with ,january #a1 #bjbe1 the ,state-- 7,a7 has in effect under such plan eligibility standards1 methodologies1 or procedures 7including any enrollment cap or other numerical limitation on enrollment1 any waiting list1 any procedures designed to delay the consideration of applications for enrollment1 or similar limitation with respect to enrollment7 for individuals described in subsection 7l77#a7 who are eligible for medical assistance under the ,state plan or waiver under subsection 7a77#aj77;,a77ii77,,ix7 that are more restrictive than the eligibility standards1 methodologies1 or procedures1 respectively1 for such individuals under such plan or waiver that are in effect on the date of the enactment of this subsection2 or 7,b7 provides pregnancy-related assistance to targeted low-income pregnant women under the ,state plan under title ,,xxi 7or a waiver of such a plan7 at a level that is less than the level at which the ,state provides such assistance to such women under such plan on the date of the enactment of this subsection4 4 7#b7 ,,chip ,section #baje of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7 is amended-- 7,a7 in subsection 7b71 by adding at the end the following3 ,for calendar quarters beginning on or after ,january #a1 #bjbb1 the enhanced ,,fmap for a ,state shall1 subject to paragraph 7#b7 of subsection 7h71 be #ajj percent with respect to amounts described in paragraph 7#a7 of such subsection42 and 7,b7 by adding at the end the following new subsection3 7h7 ,increased e,f,m,a,p for additional expenditures for targeted low-,income pregnant women 7#a7 ,amounts described ,for purposes of subsection 7b71 the amounts described in this paragraph are additional amounts expended by a ,state for pregnancy-related assistance that is provided under the ,state plan under this title or a waiver of such plan during a calendar quarter beginning on or after ,january #a1 #bjbb1 that are attributable to the provision of dental coverage to targeted low-income pregnant women 7as determined by the ,secretary74 7#b7 ,maintenance of effort ,the fourth sentence of subsection 7b7 shall not apply with respect to a ,state if1 for any calendar quarter during the period beginning with the date of enactment of this subsection and ending with ,january #a1 #bjbe1 the ,state-- 7,a7 has in effect under the ,state plan under title ,,xix 7or a waiver of such a plan7 eligibility standards1 methodologies1 or procedures 7including any enrollment cap or other numerical limitation on enrollment1 any waiting list1 any procedures designed to delay the consideration of applications for enrollment1 or similar limitation with respect to enrollment7 for individuals described in subsection 7l77#a7 of section #aijb who are eligible for medical assistance under such ,state plan or waiver under subsection 7a77#aj77;,a77ii77,,ix7 of such section that are more restrictive than the eligibility standards1 methodologies1 or procedures1 respectively1 for such individuals under such plan or waiver that are in effect on the date of the enactment of this subsection2 or 7,b7 provides pregnancy-related assistance to targeted low-income pregnant women under the ,state plan under this title 7or a waiver of such a plan7 at a level that is less than the level at which the ,state provides such assistance to such women under such plan or waiver on the date of the enactment of this subsection4 4 7#c7 ,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 oral health services for pregnant and postpartum individuals ,any payment made to a territory for expenditures on medical assistance that are subject to the ,federal medical assistance percentage specified under section #aije7;ii7 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 7#d7 ,adjustment of ,,chip allotments to account for increased e,f,m,a,p ,section #bajd of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;dd7 is amended-- 7,a7 in subsection 7c7-- 7i7 in paragraph 7#a71 by inserting paragraph 7#e7 and before subsections 7d7 and 7m77#e72 and 7ii7 by adding at the end the following new paragraph3 7#e7 ,adjusting allotments to account for increased ,federal payments for coverage of dental services for pregnant people ,if a commonwealth or territory described in paragraph 7#c7 receives payment for a fiscal year under subsection 7a7 of section #baje for expenditures that are subject to the enhanced ,,fmap specified under subsection 7h7 of such section1 the amount of the allotment determined for such commonwealth or territory under this subsection shall be increased by the amount by which-- 7,a7 the amount of the payment received by the commonwealth or territory for such expenditures for the fiscal year2 exceeds 7,b7 the amount of the payment that the commonwealth or territory would have received for such expenditures for the fiscal year without regard to such subsection 7h74 2 and 7,b7 in subsection 7m7-- 7i7 in paragraph 7#b77;,b71 in the matter preceding clause 7i71 by striking paragraphs 7#e7 and 7#g7 and inserting paragraphs 7#e71 7#g71 and 7#ab72 and 7ii7 by adding at the end the following new paragraph3 7#ab7 ,adjusting allotments to account for increased ,federal payments for coverage of dental services for pregnant people ,if a ,state receives payment for a fiscal year under subsection 7a7 of section #baje for expenditures that are subject to the enhanced ,,fmap specified under subsection 7h7 of such section1 the amount of the allotment determined for the ,state and fiscal year under this subsection shall be increased by the amount by which-- 7,a7 the amount of the payment received by the ,state for such expenditures for the fiscal year2 exceeds 7,b7 the amount of the payment that the ,state would have received for such expenditures for the fiscal year without regard to such subsection 7h74 4 #c4 ,maternal oral health quality measures ,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 ,maternal oral health quality measures 7a7 ,development of core set of maternal oral health care quality measures 7#a7 ,in general ,the ,secretary shall identify and publish a recommended core set of health quality measures for enrolled pregnant individuals 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 maternal 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 pregnant individuals4 7#b7 ,alignment with existing core set ,in identifying and publishing the recommended core set of maternal oral health quality 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 measures identified1 published1 and revised under section #aaci;,b4 7#c7 ,process for maternal oral health quality measures program ,in identifying gaps in existing maternal oral health quality measures and establishing priorities for the development and advancement of such measures1 the ,secretary shall consult with-- 7,a7 ,states2 7,b7 health care providers1 including physicians in the fields of general obstetrics1 maternal-fetal medicine1 family medicine1 neonatology1 and pediatrics2 7,c7 dental professionals2 and 7,d7 national organizations with expertise in maternal oral health quality measurement4 7#d7 ,definition of enrolled pregnant individual ,the term enrolled pregnant individual means an individual who-- 7,a7 is pregnant or is in the #fj-;day period beginning on the last day of the individual's pregnancy2 and 7,b7 is enrolled for medical assistance1 child health assistance1 or pregnancy-related assistance 7as applicable7 under a ,state plan under title ,,xix or ,,xxi 7or a waiver of such a plan74 7b7 ,deadlines 7#a7 ,recommended measures ,not later than ,january #a1 #bjbc1 the ,secretary shall identify and publish for comment a recommended core set of maternal oral health quality measures that includes the following3 7,a7 ,measures of utilization of oral health and dental services during pregnancy across health care settings4 7,b7 ,measures that address the availability of oral evaluations during or following medical visits for enrolled pregnant individuals4 7,c7 ,measures that address the incidence of emergency department visits for non-traumatic dental conditions during pregnancy4 7,d7 ,measures that address the availability 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 pregnant individuals and postpartum individuals aimed at improving the oral health of enrolled pregnant individuals and infants4 7,f7 ,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 pregnant individuals who have caries risk documented in the reporting year involved4 7ii7 ,the percentage of enrolled pregnant individuals 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 pregnant individuals who received a comprehensive or periodic oral evaluation or a comprehensive periodontal evaluation during the reporting year involved4 7iv7 ,the percentage of enrolled pregnant individuals 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 7#b7 ,dissemination ,not later than ,january #a1 #bjbd1 the ,secretary shall publish an initial core set of maternal oral health quality measures that are applicable to enrolled pregnant individuals4 7#c7 ,standardized reporting ,not later than ,january #a1 #bjbe1 the ,secretary1 in consultation with ,states1 shall develop a standardized format for reporting information based on the initial core set of maternal oral health quality measures 7stratified by race1 ethnicity1 primary language1 and disability status7 and create procedures to encourage ,states to use such measures to voluntarily report information regarding the quality of oral health care for enrolled pregnant individuals4 7#d7 ,reports to ,congress ,not later than ,january #a1 #bjbf1 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 maternal oral health quality measures applied under ,medicaid or ,,chip 7#a7 ,in general ,each ,state with a plan or waiver approved under title ,,xix or ,,xxi 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 maternal oral health quality 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 of oral health care furnished to enrolled pregnant individuals 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 #aicg2 and 7,c7 the ,state-specific information regarding the dental benefits available to enrolled pregnant individuals 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 benefits4 7#b7 ,publication ,not later than ,september #cj1 #bjbf1 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 #d4 ,inclusion of oral health services for pregnant and postpartum individuals as an essential health benefit 7a7 ,in general ,section #acjb7;b7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjbb7;b77 is amended-- 7#a7 in paragraph 7#a71 by adding at the end the following3 7,k7 ,oral health services for pregnant and postpartum individuals4 2 and 7#b7 in paragraph 7#d77;,f7-- 7,a7 by striking section #acaa7;b77#b77;,b77ii7 and inserting section #acaa7;d77#b77;,b77ii72 and 7,b7 by inserting or 7#a77,k7 after paragraph 7#a77;,j74 7b7 ,state ,exchange requirements ,section #acaa7;d77#b77;,b77ii7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;d77#b77;,b77ii77 is amended by inserting or oral health benefits meeting the requirements of section #acjb7;d77#a77,k7 before the period4 7c7 ,premium assistance credit amount ,section #cf;,b7b77#c77;,e7 of the ,internal ,revenue ,code of #aihf is amended-- 7#a7 by striking section #acaa7;d77#b77;,b77ii77,i7 and inserting section #acaa7;d77#b77;,b77ii72 and 7#b7 by striking section #acjb7;b77#a77;,j7 and inserting subparagraph 7,j7 or 7,k7 of section #acjb7;b77#a74 7d7 ,conforming amendment ,section #bgae7;b77#c77;,b77i7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ae7;b77#c77;,b77i77 is amended by striking through 7,j7 and inserting through 7,k74 #e4 ,federally qualified health center grant program 7a7 ,in general ,not later than #a year after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services 7in this ,act referred to as the ,secretary7 shall establish a grant program under which the ,secretary shall award grants to ,federally qualified health centers 7as defined in section #ahfa7;aa77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7aa77#d777 to enter into arrangements with private dental providers to provide dental services to eligible individuals4 7b7 ,authorization of appropriations ,there are authorized to be appropriated to the ,secretary such sums as are necessary to carry out this section4 #f4 ,maternal 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 issue a report on issues related to maternal oral health across the #ej ,states and the territories1 including-- 7#a7 the availability of maternal oral health coverage1 and enrollment in such coverage2 7#b7 a survey of oral health status among low-income women of childbearing age2 7#c7 barriers to accessing maternal oral health care2 7#d7 innovations and potential solutions to problems of access to maternal oral health care1 including innovations that would expand access to such care beyond dental offices2 and 7#e7 the impact of the requirement 7imposed by the amendments made by section #b7 that ,state ,medicaid programs cover oral health services for pregnant and postpartum individuals on providers of maternal health care services1 and such recommendations for improving reimbursement rates for such providers as the ,commission deems appropriate4 #g4 ,indian ,health ,service maternal oral health initiative 7a7 ,in general ,not later than #a year after the date of enactment of this ,act1 the ,secretary shall develop and implement1 in consultation with ,indian tribes and tribal organizations 7as those terms are defined in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc771 a formal initiative to improve the oral health status of pregnant individuals1 postpartum individuals1 and infants and address barriers to oral health care during pregnancy for ,american ,indian and ,alaska ,native populations4 ,this initiative shall include strategies to-- 7#a7 reduce the prevalence and severity of oral disease among pregnant individuals1 postpartum individuals1 and their infants2 7#b7 improve access to oral health care during pregnancy and the postpartum period2 7#c7 establish a data collection system to monitor prevalence of oral disease and access to care2 7#d7 educate health and dental providers on the importance of oral health care during pregnancy and the postpartum period and build competencies in the delivery of such care2 7#e7 increase rates of patient referral to oral health care by non-dental providers2 and 7#f7 establish mechanisms for outreach and education of pregnant individuals and postpartum individuals for the purposes of improving oral health practices and access to care4 7b7 ,authorization of appropriations ,there are authorized to be appropriated to the ,secretary such sums as are necessary to carry out this section4 #h4 ,perinatal 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 by entities that fund or provide maternal health care1 oral health care1 and maternal and infant support services1 to provide-- 7#a7 interactive oral health education aimed at promoting good oral health practices for pregnant individuals and postpartum individuals who are eligible for or enrolled in the ,medicaid program under title ,,xix of the ,social ,security ,act or the ,children's ,health ,insurance ,program under title ,,xxi of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq41 #acig;aa et seq472 7#b7 information on oral health and dental coverage for pregnant individuals1 postpartum individuals1 and children2 and 7#c7 assistance in connecting pregnant individuals1 postpartum individuals1 and children to oral health care4 #i4 ,maternal oral health training 7a7 ,in general ,not later than #a year after the date of enactment of this ,act1 the ,secretary1 acting through the ,associate ,administrator of the ,maternal and ,child ,health ,bureau of the ,health ,resources and ,services ,administration1 shall establish a grant program under which the ,secretary shall award grants to eligible entities for the purpose of-- 7#a7 integrating oral health care into maternal health care settings2 7#b7 improving oral health outcomes during pregnancy and the postpartum period2 7#c7 developing core competencies in oral health among maternal health providers1 including obstetrician-gynecologists and certified nurse-midwives1 and non-clinical perinatal health workers1 including community health workers and doulas2 and 7#d7 improving access to oral health care during pregnancy and closing referral gaps4 7b7 ,eligible entities ,the ,secretary may make grants under this section to1 or enter into contracts with ,state health departments or other ,state health agencies1 academic institutions1 schools of medicine or dentistry1 nonprofit hospitals1 nonprofit accredited birth centers1 or public or private nonprofit entities which the ,secretary has determined are capable of carrying out such a grant or contract to-- 7#a7 plan1 develop1 and provide training of maternal health providers to establish core competencies in oral health during pregnancy and the postpartum period2 7#b7 provide information to maternal health providers1 including information on periodontal disease1 dental caries1 oral health screening and risk assessment1 beneficial oral health practices for pregnant individuals and infants2 and 7#c7 provide tools and resources aimed at facilitating the integration of oral health care and referral to dental care into maternity care settings4 7c7 ,authorization of appropriations ,there are authorized to be appropriated to the ,secretary such sums as are necessary to carry out this section4