,i  #aah? ,,congress  #a/ ,session  ,h4 
,r4 #adbb  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,m>* #g1 #bjbc,mr4    
,simpson 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 oral heal? c>e & d5tal b5efits  
"u ! ,m$icaid program1 & = o!r purposes4
  #a4 ,%ort title ,?is ,act may be cit$ 
z ! ,/r5g!n+ ,m$icaid ,inc5tives =      
,lic5sees ,enroll$ 9 ,d5tal ,act or !   
,,smil$ ,act4  #b4 ,support = ensur+    
individuals enroll$ 9 ,m$icaid h d5tal  
s]vices access equal to ! population ( !
 ,/ate ,section #aijc ( ! ,social       
,security ,act 7#db ,u4,s4,c4 #acif;b7  
is am5d$ by add+ at ! end ! foll[+ new  
subsection3  7cc7 ,equal access to oral 
heal? c>e plan  7#a7 ,provid]           
p>ticipation & access requirem5ts ,n    
lat] ?an #a ye> aft] ! date ( enactm5t (
 ?is p>agraph1 a ,/ate %all provide !   
,secret>y ) assurances t adm9i/rative   
b>ri]s to ! p>ticipation ( lic5s$ d5ti/s

 "u ?is title w be address$1 by-- 7,a7  
improv+ eligibility v]ification2  7,b7  
ensur+ t any su* d5ti/ may p>ticipate 9 
a publicly fund$ plan )\t also hav+ to  
p>ticipate 9 any o!r plan2  7,c7        
simplify+ claims =ms process+2 &  7,d7  
assign+ a s+le plan adm9i/rator = !     
d5tal program4  7#b7 ,/udy on d5ti/     
p>ticipation ,n lat] ?an #c ye>s aft] ! 
date on :i* ! assurance "u p>agraph 7#a7
 is submitt$1 ea* ,/ate %all conduct a  
/udy to det]m9e :e!r ! p>ticipation (   
lic5s$ d5ti/s h increas$ foll[+ !       
assurance provid$ "u p>agraph 7#a74  4  
#c4 ,d5tal & oral heal? s]vices def9$2  
audit requirem5t  7a7 ,d5tal & oral     
heal? s]vices def9$ ,section #aije ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#acif;d7 is am5d$-- 7#a7 9 subsection   
7a77#aj71 by ins]t+ & d5tal & oral heal?
 s]vices 7z def9$ 9 subsection 7jj77    
aft] d5tal s]vices2 &  7#b7 by add+ at !
 end ! foll[+ new subsection3  7jj7     
,d5tal & oral heal? s]vices  7#a7 ,9    
g5]al ,= purposes ( subsection 7a77#aj71

 ! t]m d5tal & oral heal? s]vices means 
d5tures & d5ture s]vices1 implants &    
implant s]vices1 & s]vices necess>y to  
prev5t oral disease & promote oral      
heal?1 re/ore oral /ructures to heal? & 
function1 r$uce oral pa91 & treat       
em]g5cy oral conditions1 t are furni%$  
by a provid] :o-- 7,a7 is legally       
au?oriz$ to furni% su* items & s]vices  
"u ,/ate law 7or ! ,/ate regulatory     
me*anism provid$ by ,/ate law72  7,b7 is
 initially cr$5tial$ by a ,/ate ,m$icaid
 program 7or ! designat$ entity ( su*   
program7 ?r\gh an integrat$ data        
collection sy/em1 z describ$ 9 p>agraph 
7#c72 &  7,c7 is1 z applicable1         
re-cr$5tial$ ?r\gh su* integrat$ data   
collection sy/em by a ,/ate ,m$icaid    
program 7or ! designat$ entity ( su*    
program74  7#b7 ,selection ( data       
collection sy/em ,n lat] ?an "o ye> aft]
 ! date ( enactm5t ( ?is subsection1 !  
,/ate ,m$icaid ,director %all select an 
integrat$ data collection sy/em 7z def9$
 9 p>agraph 7#c7 t-- 7,a7 m9imizes      

provid] pap]work burd52 &  7,b7         
communicates f9al cr$5tial+ decisions to
 provid]s )9 #ij days ( receipt ( a     
complet$ application4  7#c7 ,integrat$  
data collection sy/em def9$ ,= purposes 
( ?is subsection1 ! t]m integrat$ data  
collection sy/em means an electronic    
sy/em ma9ta9$ by a ,/ate & us$ =        
purposes ( enroll+1 scre5+1 & cr$5tial+ 
d5ti/s "u a ,/ate ,m$icaid program4  4  
7b7 ,d5tal & oral heal? s]vices audit   
requirem5t ,n lat] ?an #ij days aft] !  
date ( enactm5t ( ?is ,act1 a ,/ate     
,m$icaid program1 includ+ a program (f]$
 by a sponsor ( a ,m$icaid manag$ c>e   
plan1 t (f]s d5tal & oral heal? s]vices 
audits a claim = su* d5tal & oral heal? 
s]vices %all-- 7#a7 utilize a lic5s$    
heal? c>e pr(essional f ! d5tal         
specialty area ( practice be+ audit$ to 
e/abli% relevant audit me?odology       
consi/5t )-- 7,a7 e/abli%$ practice     
guidel9es1 /&>ds ( c>e1 & ,/ate-issu$   
d5tal ,m$icaid provid] h&books2 &  7,b7 
e/abli%$ cl9ical practice guidel9es &   

acceptable /&>ds ( c>e e/abli%$ by !    
d5tal pr(essional or specialty          
organizations responsible = sett+ su*   
/&>ds ( c>e2  7#b7 develop & implem5t1 9
 consultation ) ! ,c5t]s = ,m$ic>e      
,m$icaid ,s]vices1 a proc$ure 9 :i* an  
improp] paym5t id5tifi$ by an audit may 
be resubmitt$ z a claims adju/m5t1      
includ+ ! resubmission (-- 7,a7 claims  
d5i$ z a result ( an int]pretation (    
scope ( s]vices n previ\sly held by !   
,c5t]s = ,m$ic>e  ,m$icaid ,s]vices2    
7,b7 docum5tation :5 ! docum5t provid$  
is incomplete1 illegible1 or uncle>2 &  
7,c7 docum5tation :5 cl]ical errors     
result$ 9 a d5ial ( claims = s]vices    
actually provid$2 &  7#c7 disall[ !     
diff]5ce betwe5 ! paym5t = ! s]vice t 0 
provid$ & ! paym5t = ! s]vice t %\ld h  
be5 provid$ if a s]vice 0 provid$ &     
suffici5tly docum5t$1 b d5i$ because x 0
 det]m9$ t a diff]5t s]vice %\ld h be5  
bill$4