,,ii #aahth ,,congress #b;d ,session ,s4 #dceg ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,may #af1 #bjbd,mr4 ,sanders 7for himself and ,mr4 ,brown7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to improve access to oral health care for vulnerable and underserved populations4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,comprehensive ,dental ,reform ,act of #bjbd4 7b7 ,table of contents ,the table of contents for this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4,,title ,i--,medicare and ,medicaid,subtitle ,a--,medicare,sec4 #aja4 ,coverage of dental services under the ,medicare program4,subtitle ,b--,medicaid,sec4 #aaa4 ,coverage of dental services under the ,medicaid program4,,title ,,ii--,public health programs,subtitle ,a--,national ,health ,service ,corps,sec4 #bja4 ,national ,health ,service ,corps4,sec4 #bjb4 ,community based dental residencies4,sec4 #bjc4 ,community-based training of dental students4,subtitle ,b--,oral health education,sec4 #baa4 ,authorization of appropriations for oral health education for medical providers4,sec4 #bab4 ,oral health education for other non-health professionals4,sec4 #bac4 ,dental education4,sec4 #bad4 ,oral health professional student loans4,subtitle ,c--,other oral health programs,sec4 #bba4 ,access points4,sec4 #bbb4 ,dental clinics in schools4,sec4 #bbc4 ,emergency department care coordination4,sec4 #bbd4 ,research funding4,sec4 #bbe4 ,mobile and portable dental services4,subtitle ,d--,oral health services as an essential health benefit,sec4 #bca4 ,oral health services as an essential health benefit4,,title ,,iii--,department of ,veterans ,affairs ,matters,sec4 #cja4 ,requirement that ,secretary of ,veterans ,affairs furnish dental care in the same manner as any other medical service4,sec4 #cjb4 ,demonstration program on training and employment of alternative dental health care providers for dental health care services for veterans in rural and other underserved communities4,sec4 #cjc4 ,program of education to promote dental health in veterans4,sec4 #cjd4 ,student loan repayment program to incentivize dental training and ensure the dental workforce of the ,department of ,veterans ,affairs4,sec4 #cje4 ,educational and training partnerships for dentists1 dental hygienists1 and oral surgeons4,,title ,,iv--,federal ,bureau of ,prisons,sec4 #dja4 ,demonstration program on training and employment of alternative dental health care providers for dental health care services for prisoners within the custody of the ,bureau of ,prisons4,,title ,v--,indian ,health ,service,sec4 #eja4 ,demonstration program on training and employment of alternative dental health care providers for dental health care services under the ,indian ,health ,service4,,title ,,vi--,reports to ,congress,sec4 #fja4 ,reports on enrollment in coverage for oral health services4 ,i ,medicare and ,medicaid ,a ,medicare #aja4 ,coverage of dental services under the ,medicare program 7a7 ,coverage ,section #ahfa7s77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#b77 is amended-- 7#a7 in subparagraph 7,,jj71 by inserting and after the semicolon at the end2 and 7#b7 by adding at the end the following new subparagraph3 7,,kk7 oral health services 7as defined in subsection 7nnn772 4 7b7 ,oral health services defined ,section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 is amended by adding at the end the following new subsection3 7nnn7 ,oral health services 7#a7 ,the term oral health services means services 7as defined by the ,secretary7 that are necessary to prevent disease and promote oral health1 restore oral structures to health and function1 and treat emergency conditions4 7#b7 ,for purposes of paragraph 7#a71 such term shall include mobile and portable oral health services 7as defined by the ,secretary7 that-- 7,a7 are provided for the purpose of overcoming mobility1 transportation1 and access barriers for individuals2 and 7,b7 satisfy the standards and certification requirements established under section #aijb7;a77#hh77;,c7 for the ,state in which the services are provided4 4 7c7 ,payment and coinsurance ,section #ahcc7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77#a77 is amended-- 7#a7 by striking and before 7,,hh72 and 7#b7 by inserting before the semicolon at the end the following3 1 and 7,,ii7 with respect to oral health services 7as defined in section #ahfa7nnn771 the amount paid shall be 7i7 in the case of such services that are preventive1 #ajj percent of the lesser of the actual charge for the services or the amount determined under the payment basis determined under section #ahdh1 and 7ii7 in the case of all other such services1 #hj percent of the lesser of the actual charge for the services or the amount determined under the payment basis determined under section #ahdh4 7d7 ,payment under physician fee schedule ,section #ahdh7;j77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;j77#c77 is amended by inserting 7#b77,,kk71 after risk assessment714 7e7 ,dentures ,section #ahfa7s77#h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#h77 is amended-- 7#a7 by striking 7other than dental7 and inserting 7including dentures72 and 7#b7 by striking internal body4 7f7 ,repeal of ground for exclusion ,section #ahfb7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciey7 is amended by striking paragraph 7#ab74 7g7 ,effective date ,the amendments made by this section shall apply to services furnished on or after ,january #a1 #bjbe4 ,b ,medicaid #aaa4 ,coverage of dental services under the ,medicaid program 7a7 ,in general ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is amended-- 7#a7 in subsection 7a77#aj71 by striking dental services and inserting oral health services 7as defined in subsection 7kk77#a772 and 7#b7 by adding at the end the following3 7kk7 7#a7 ,subject to paragraphs 7#b7 and 7#c71 for purposes of this title1 the term oral health services means services 7as defined by the ,secretary7 that are necessary to prevent disease and promote oral health1 restore oral structures to health and function1 and treat emergency conditions4 ,these services shall include1 in the case of pregnant or postpartum women1 such services as are necessary to address oral health conditions that exist or are exacerbated by pregnancy or childbirth or which1 if left untreated1 could adversely affect fetal or child development4 7#b7 ,for purposes of paragraph 7#a71 such term shall include-- 7,a7 dentures2 and 7,b7 mobile and portable oral health services 7as defined by the ,secretary7 that-- 7i7 are provided for the purpose of overcoming mobility1 transportation1 and access barriers for individuals2 and 7ii7 satisfy the standards and certification requirements established under section #aijb7;a77#hh77;,c7 for the ,state in which the services are provided4 7#c7 ,for purposes of paragraph 7#a71 such term shall not apply to dental care or services provided to individuals under the age of #ba under subsection 7r77#c74 4 7b7 ,conforming amendments 7#a7 ,state plan requirements ,section #aijb7;a7 of such ,act 7#db ,u4,s4,c4 #acif;a7a77 is amended-- 7,a7 in paragraph 7#aj77;,a71 in the matter preceding clause 7i71 by inserting 7#aj71 after 7#e712 7,b7 in paragraph 7#hf71 by striking and at the end2 7,c7 in paragraph 7#hg71 by striking the period at the end and inserting 2 and2 and 7,d7 by inserting after paragraph 7#hg7 the following3 7#hh7 provide for-- 7,a7 informing1 in writing1 all individuals who have been determined to be eligible for medical assistance of the availability of oral health services 7as defined in section #aije7kk772 7,b7 conducting targeted outreach to pregnant women who have been determined to be eligible for medical assistance about the availability of medical assistance for such dental services and the importance of receiving dental care while pregnant2 and 7,c7 establishing and maintaining standards for and certification of mobile and portable oral health services 7as described in subsections 7r77#c77;,c7 and 7kk77#b77;,b7 of section #aije74 4 7#b7 ,definition of medical assistance ,section #aije7;a77#ab7 of such ,act 7#db ,u4,s4,c4 #acif;d7a77#ab77 is amended by striking 1 dentures14 7c7 ,mobile and portable oral health services under ,,epsdt ,section #aije7r77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7r77#c77 is amended-- 7#a7 in subparagraph 7,a77ii71 by striking 2 and and inserting a semicolon2 7#b7 in subparagraph 7,b71 by striking the period at the end and inserting 2 and2 and 7#c7 by adding at the end the following new subparagraph3 7,c7 which shall include mobile and portable oral health services 7as defined by the ,secretary7 that-- 7i7 are provided for the purpose of overcoming mobility1 transportation1 or access barriers for children2 and 7ii7 satisfy the standards and certification requirements established under section #aijb7;a77#hh77;,c7 for the ,state in which the services are provided4 4 7d7 ,increased federal funding for dental services 7#a7 ,in general ,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 in the first sentence1 by striking and 7ii7 and inserting 7ii71 and 7ll72 and 7,b7 by adding at the end the following new subsection3 7ll7 ,increased ,,fmap for oral health services 7#a7 ,in general ,notwithstanding subsection 7b7 and section #aijc7;a77#g7 and subject to the requirements described in paragraphs 7#c7 and 7#d71 with respect to amounts expended on or after ,january #a1 #bjbe1 for covered oral health expenses 7as described in paragraph 7#b771 the ,federal medical assistance percentage for a ,state that is one of the #ej ,states or the ,district of ,columbia for such expenses shall be equal to the ,federal medical assistance percentage that would otherwise apply to the ,state for the fiscal year1 as determined under subsection 7b7 or section #aijc7;a77#g71 increased by #ae percentage points4 7#b7 ,covered oral health expenses ,for purposes of paragraph 7#a71 the term covered oral health expenses means the amounts expended for medical assistance for oral health services 7as defined in subsection 7kk77 and amounts expended for the proper and efficient administration of the provision of such oral health services under the ,state plan4 7#c7 ,requirements ,for purposes of paragraph 7#a71 the ,federal medical assistance percentage applicable to covered oral health expenses under this subsection shall not apply to a ,state unless-- 7,a7 the ,state plan for medical assistance provides payment for oral health services 7as so defined7 furnished by a health care provider at a rate that is not less than #gj percent of the usual and customary fee for such services in the ,state2 and 7,b7 the ,state satisfies such additional requirements as are established by the ,secretary1 which shall include-- 7i7 streamlining of administrative procedures for purposes of ensuring adequate provider participation and increasing patient utilization of oral health services2 and 7ii7 the provision of technical assistance to health care providers designed to reduce the number of missed patient appointments and reduce other barriers to the delivery of oral health services4 7#d7 ,limitation ,for purposes of amounts expended for covered oral health services1 in no case shall any increase under this subsection result in a ,federal medical assistance percentage that exceeds #ajj percent4 4 7#b7 ,conforming amendment ,section #aijc7;a77#g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7a77#g77 is amended by striking section #aiai7;g77#c77;,b7 and inserting sections #aije7ll7 and #aiai7;g77#c77;,b74 7e7 ,secretarial responsibilities 7#a7 ,technical assistance and outreach ,the ,secretary of ,health and ,human ,services1 acting through the ,administrator of the ,centers for ,medicare ,medicaid ,services1 shall provide technical assistance to ,states and conduct outreach to ,states for purposes of educating and encouraging ,states to utilize and provide payment under each ,state ,medicaid program for telehealth-enabled dental services in order to provide dental services to traditionally underserved populations in need of such services4 7#b7 ,database and annual report on dental benefits for adult ,medicaid enrollees 7,a7 ,medicaid dental benefits database ,the ,secretary of ,health and ,human ,services1 acting through the ,administrator of the ,centers for ,medicare ,medicaid ,services1 shall maintain1 as accurately and up-to-date as possible1 a database that contains with respect to each ,state 7as defined for purposes of title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq477 information regarding the dental benefits available for adults enrolled in the ,state ,medicaid program1 including any limits on such benefits and the amount of reimbursement provided under the ,state ,medicaid program for such benefits4 ,the database also shall include a separate description of the dental benefits1 benefit limits1 and amount of reimbursement provided under each ,state ,medicaid program for pregnant women1 if such benefits are not provided to the woman as part of early and periodic screening1 diagnostic1 and treatment services 7as defined in section #aije7r7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7r7771 and a description of the use of dental services by children and adults enrolled in the ,state ,medicaid program4 7,b7 ,annual report ,the ,secretary of ,health and ,human ,services shall make available to the public an annual report regarding the information collected in the database required under subparagraph 7,a74 ,each annual report under this subparagraph shall include for each ,state ,medicaid program and with respect to the most recent year for which data are available the yearly dental service utilization rates for children and adults enrolled in the ,state ,medicaid program4 7f7 ,effective date 7#a7 ,in general ,except as provided in paragraph 7#b71 the amendments made by this section shall apply to calendar quarters beginning on or after ,january #a1 #bjbe1 without regard to whether or not final regulations to carry out such amendments have been promulgated by such date4 7#b7 ,delay permitted for ,state plan amendment ,in the case of a ,state plan for medical assistance under title ,,xix of the ,social ,security ,act which the ,secretary of ,health and ,human ,services determines requires ,state legislation 7other than legislation appropriating funds7 in order for the plan to meet the additional requirements imposed by the amendments made by this section1 the ,state plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the ,state legislature that begins after the date of enactment of this ,act4 ,for purposes of the previous sentence1 in the case of a ,state that has a #b-year legislative session1 each year of such session shall be deemed to be a separate regular session of the ,state legislature4 ,,ii ,public health programs ,a ,national ,health ,service ,corps #bja4 ,national ,health ,service ,corps 7a7 ,in general ,section #cca of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;d7 is amended-- 7#a7 in subsection 7a77#c71 by adding at the end the following3 7,f7 ,the term dental therapist means1 with respect to a ,state or ,tribal government that licenses or certifies such dental therapists1 a mid-level dental practitioner who-- 7i7 7,i7 is licensed to practice under the law of the ,state2 or 7,,ii7 is certified to practice under the ,community ,health ,aide ,program of the ,indian ,health ,service under section #aai of the ,indian ,health ,care ,improvement ,act2 and 7ii7 provides preventive and restorative services directly to the public1 commensurate with the scope of the practice4 2 and 7#b7 in subsection 7b7-- 7,a7 in paragraph 7#a71 by inserting dental therapy programs and after schools at which2 and 7,b7 in paragraph 7#b71 by inserting dental therapists1 after dentists14 7b7 ,facilitation of effective provision of corps services ,section #ccf7;f77#c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;h-#a7;f77#c77 is amended by inserting dental therapists1 after midwives14 7c7 ,scholarship program and loan repayment program 7#a7 ,scholarship program ,section #cch;,a of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bedl7 is amended-- 7,a7 in subsection 7a77#a71 by inserting dental therapists1 after dentists12 and 7,b7 in subsection 7b77#a71 by inserting including dental therapy1 after or other health profession14 7#b7 ,loan repayment program ,section #cch;,b of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bedl-#a7 is amended-- 7,a7 in subsection 7a77#a71 by inserting dental therapists1 after dentists12 and 7,b7 in subsection 7b77#a7-- 7i7 in subparagraph 7,a71 by inserting dental therapist1 after nurse practitioner12 7ii7 in subparagraph 7,b71 by inserting dental therapy1 after mental health12 and 7iii7 in subparagraph 7,c77ii71 by inserting 1 including dental therapy after health profession4 7#c7 ,authorization of appropriations ,section #cch;,h of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bedq7 is amended-- 7,a7 in subsection 7a71 by striking this section and inserting this subpart2 and 7,b7 by adding at the end the following3 7d7 ,authorization of appropriations with respect to oral health professionals ,to carry out this subpart with respect to dentists1 dental therapists1 and dental hygienists1 in addition to the amounts authorized under subsection 7a71 there is authorized to be appropriated such sums as may be necessary for fiscal years #bjbe through #bjbh1 which shall be used to provide an emergency expansion for scholarships to1 and loan repayments on behalf of1 such oral health professionals4 4 #bjb4 ,community based dental residencies ,section #cdj;,h of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bef;h7 is amended by adding at the ending the following3 7k7 ,additional funding ,for the purpose of expanding dental residencies at teaching health centers that operate graduate medical education programs1 there is authorized to be appropriated such sums as may be necessary for each of fiscal years #bjbe through #bjbh 4 #bjc4 ,community-based training of dental students 7a7 ,in general ,the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary7 shall establish a pilot program under which the ,secretary awards grants to eligible entities for the purpose of supporting the community-based training of dental students4 ,such grants shall be for a #e-year period1 beginning in fiscal year #bjbe4 7b7 ,eligible entities ,to be eligible to receive a grant under this section1 an entity shall-- 7#a7 be a ,federally-qualified health center1 rural health center1 or ,tribal health facility2 and 7#b7 submit an application to the ,secretary at such time1 in such manner1 and containing such information as the ,secretary may require4 7c7 ,selection of awardees 7#a7 ,in general ,the ,secretary shall award #f grants under this section to eligible entities described in subsection 7b74 ,in making such awards1 the ,secretary shall ensure that each entity receiving a grant operates in a different ,state 7including each of the several ,states and the ,district of ,columbia71 territory1 or ,tribal territory4 7#b7 ,priority ,in awarding grants under this section1 the ,secretary shall give priority to eligible entities that-- 7,a7 have a focus on training students in rural and underserved areas2 7,b7 partner with dental professional schools and programs associated with a historically ,black college or university 7as defined by the term part ,b institution in section #cbb of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajfa77 or minority-serving institutions 7as described in section #cga of such ,act 7#bj ,u4,s4,c4 #ajfgq772 or 7,c7 are located in a ,state or geographic area without a dental school4 7d7 ,use of funds ,an eligible entity receiving a grant under this section-- 7#a7 shall use such funds to establish a training program for dental1 dental hygienist1 dental therapy1 and dental assistant students in a community-based1 outpatient setting2 7#b7 may use such funds-- 7,a7 to support faculty and preceptor wages and living stipends for trainees2 7,b7 to purchase equipment1 education tools1 and make renovations or alterations to a training site2 and 7,c7 to provide supportive services such as child care1 transportation1 and food assistance to enable students to persist in and complete a training program2 and 7#c7 may use up to #e percent of the grant amount for planning and development1 data collection and reporting1 other administrative purposes4 7e7 ,reporting 7#a7 ,reports from eligible entities ,each eligible entity receiving a grant under this section shall submit such reports on the program supported by the grant as the ,secretary may require4 7#b7 ,reports to ,congress ,not later than #a year after the date on which the program under this section terminates under subsection 7f71 the ,secretary shall submit to the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and the ,committee on ,energy and ,commerce of the ,house of ,representatives a report on the program4 7f7 ,sunset ,the grant program under this section shall terminate on ,september #cj1 #bjbi4 7g7 ,appropriations ,to carry out this section1 there is appropriated1 out of amounts in the ,treasury not otherwise appropriated1 #d1ejj1jjj for fiscal year #bjbe1 to remain available through the end of fiscal year #bjbi4 ,b ,oral health education #baa4 ,authorization of appropriations for oral health education for medical providers ,section #gdg7;c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bick7c77 is amended by adding at the end the following3 7#d7 ,oral health education ,in addition to other amounts authorized under this subsection for purposes of carrying out this section1 there is authorized to be appropriated such sums as may be necessary for fiscal years #bjbe through #bjbh for the purpose of educating nondental medical professionals 7including physicians1 nurses1 nurse practitioners1 physician assistants1 and pharmacists and particularly such professionals who provide care to children and pregnant and postpartum women7 about oral health1 including issues such as oral hygiene instruction1 topical application of fluoride1 and oral health screenings1 with the goal of integrating oral health care into overall health care4 4 #bab4 ,oral health education for other non-health professionals ,subpart ,i of part ,c of title ,,vii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bick et seq47 is amended by inserting after section #gdh the following3 #gdh;,a4 ,oral health education for other non-oral health professionals 7a7 ,in general ,the ,secretary may make grants to1 or enter into contracts with1 an accredited public or nonprofit private hospital1 educational institutions1 or public or private nonprofit entities that the ,secretary has determined to be capable of carrying out such grant or contract to educate individuals1 such as community health workers1 social workers1 nutritionists1 health educators1 occupational therapists1 and psychologists1 to promote oral health education and literacy and to provide support for behavior change and assistance with care coordination with respect to oral health4 7b7 ,authorization of appropriations ,to carry out this section1 there is authorized to be appropriated such sums as may be necessary for fiscal years #bjbe through #bjbh4 4 #bac4 ,dental education ,section #gdh of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bick-#b7 is amended-- 7#a7 in subsection 7a77#a77;,h71 by striking pediatric training programs and inserting pediatric dental training programs2 and 7#b7 in subsection 7c7-- 7,a7 by striking the subsection heading and inserting ,requirements for award4--2 7,b7 by amending the matter preceding paragraph 7#a7 to read as follows3 ,with respect to training provided for under this section1 the ,secretary shall award grants or contracts only to eligible entities that meet at least #g of the following criteria32 7,c7 in paragraph 7#b71 by striking have a record of training the greatest percentage of providers1 or that have demonstrated significant improvements in the percentage of providers1 who enter and and inserting train significant numbers of providers who2 7,d7 in paragraph 7#c7-- 7i7 by striking have a record of training and inserting intend to train2 and 7ii7 by striking the period at the end and inserting and have faculty with experience in treating underserved populations42 7,e7 in paragraph 7#h71 by inserting or have established after establish2 and 7,f7 by adding at the end the following3 7#i7 ,qualified applicants that require not less than #bjj hours of community-based education rotations4 4 #bad4 ,oral health professional student loans ,subpart #c of part ,e of title ,,vii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bie;f et seq47 is amended by adding at the end the following3 #ggi4 ,oral health professional student loans 7a7 ,in general ,the ,secretary shall establish and operate a student loan fund for oral health professional students1 including dental hygienists1 dental therapists1 and dentists4 7b7 ,content ,the ,secretary shall establish and operate the student loan fund program under subsection 7a7 in the same manner and subject to the same terms as the loan fund program established with schools of nursing under section #hce4 7c7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated such sums as may be necessary for fiscal years #bjbe through #bjbh4 4 ,c ,other oral health programs #bba4 ,access points ,subpart ,x of part ,d of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bef;f et seq47 is amended by adding at the end the following3 #cdj;,g-#b4 ,funding for oral health services 7a7 ,in general ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 shall establish a program to award grants to eligible entities to provide oral health services1 or to contract with private dental practices to provide comprehensive oral health services1 to low-income individuals and individuals who are underserved with respect to oral health care4 7b7 ,technical assistance ,the ,secretary shall provide technical assistance to entities receiving grants under subsection 7a7 to provide technical assistance to such entities in order to-- 7#a7 with respect to oral health care services1 increase utilization and efficiency and minimize missed appointments1 contract with offsite providers1 recruit providers 7including oral health specialists71 and operate programs outside the physical facilities to take advantage of new systems to improve access to oral health services2 7#b7 address barriers to access to such services and conduct targeted outreach to special populations such as pregnant women1 individuals with disabilities1 individuals with chronic conditions such as diabetes1 and individuals residing in long-term care facilities2 or 7#c7 contract with private dental practices that will provide oral health services other than preventive oral health care1 including restoration and maintenance of oral health1 in order to meet the need for oral health services in the community4 7c7 ,eligible entities ,to be eligible to receive a grant under subsection 7a71 an entity shall-- 7#a7 be-- 7,a7 a ,federally qualified health center 7as defined in section #ahfa7;aa7 of the ,social ,security ,act72 7,b7 a safety net clinic or a free clinic 7as defined by the ,secretary72 7,c7 a health care clinic that provides services to ,tribal organizations or urban ,indian organizations 7as such terms are defined in section #d of the ,indian ,health ,care ,improvement ,act72 or 7,d7 any other interested public or private sector health care provider or organization that the ,secretary determines has a demonstrated history of serving a high number of uninsured and or low-income individuals or those who lack ready access to oral health services2 and 7#b7 demonstrate a clear need to expand oral health care services beyond preventive oral health care4 7d7 ,allocation for hiring oral health care specialists ,a portion of the funds available under this section shall be allocated toward hiring oral health care specialists1 such as oral surgeons and endodontists1 at entities receiving grants under this section4 7e7 ,authorization of appropriations ,to carry out this section1 there is authorized to be appropriated such sums as may be necessary for each of fiscal years #bjbe through #bjbh4 4 #bbb4 ,dental clinics in schools ,part ,q of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;h et seq47 is amended by adding at the end the following3 #cii,z-#c4 ,dental clinics in schools 7a7 ,in general ,the ,secretary shall award grants to qualified entities for the purpose of funding the building1 operation1 or expansion of dental clinics in schools4 7b7 ,qualified entities ,to receive a grant under this section1 a qualified entity shall submit an application to the ,secretary at such time1 in such manner1 and containing such information as the ,secretary may require4 7c7 ,requirements ,an entity receiving a grant under this section shall-- 7#a7 provide comprehensive oral health services at a dental clinic based at a school1 including oral health education1 oral screening1 fluoride application1 prophylaxis1 sealants1 and basic restorative services2 7#b7 develop a coordinated system of care by referring patients to an available qualified oral health provider in the community for any required oral health services not provided in the dental clinic in the school1 including restorative services1 to ensure that all the oral health needs of students are met2 and 7#c7 maintain clinic hours that extend beyond school hours4 7d7 ,authorization of appropriations ,for purposes of carrying out this section1 there is authorized to be appropriated such sums as may be necessary for fiscal years #bjbe through #bjbh4 4 #bbc4 ,emergency department care coordination ,part ,p of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;g et seq47 is amended by adding at the end the following3 #cii,v-#h4 ,emergency department care coordination with respect to dental care 7a7 ,in general ,the ,secretary shall establish a grant program to facilitate individuals receiving dental care at facilities other than hospital emergency departments1 under which the ,secretary awards grants to eligible entities to cover costs related to construction and renovation1 equipment1 staff1 outreach and education1 and any other allowable uses1 with respect to the entity's facilities1 as the ,secretary determines appropriate4 7b7 ,eligible entities ,to be eligible to receive a grant under this section an entity shall-- 7#a7 be-- 7,a7 a ,federally qualified health center 7as defined in paragraph 7#d7 of section #ahfa7;aa7 of the ,social ,security ,act7 or rural health clinic 7as defined in paragraph 7#b7 of such section72 7,b7 a private dental practice2 or 7,c7 any other interested public or private sector health care provider or organization1 such as a dental school1 that the ,secretary determines has the capacity to serve in a coordinated1 cost-effective manner1 a high number of individuals who lack access to oral health services2 and 7#b7 partner with a hospital or urgent care center4 7c7 ,oral health education for primary care and ,,ed health care providers ,the ,secretary shall allocate a portion of the amounts appropriated under subsection 7e7 toward medical education for primary care and emergency department physicians1 nurses1 nurse practitioners1 and physician assistants to be trained in oral health4 7d7 ,report ,not later than ,january #a1 #bjbh1 the ,secretary shall submit to ,congress a report on the best practices determined by the program established under this section to address oral health needs of individuals who go to emergency departments in need of oral health care4 7e7 ,authorization of appropriations ,to carry out this section1 there is authorized to be appropriated such sums as may be necessary for fiscal years #bjbe through #bjbh4 4 #bbd4 ,research funding 7a7 ,in general ,for the period of fiscal years #bjbe through #bjbg1 there is authorized to be appropriated for the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary7 such sums as may be necessary to conduct1 in consultation with the heads of agencies and offices of the ,department of ,health and ,human ,services1 including the ,director of the ,centers for ,disease ,control and ,prevention1 the ,director of the ,agency for ,healthcare ,research and ,quality1 the ,director of the ,national ,institutes of ,health1 and the ,administrator of the ,health ,resources and ,services ,administration-- 7#a7 research on-- 7,a7 the prevention of oral disease2 7,b7 oral disease management2 7,c7 evidence-based strategies to prevent tooth decay2 7,d7 rigorous1 multidisciplinary research-based approaches to overcome disparities in oral health2 7,e7 perinatal1 postnatal1 and childhood oral health issues1 including the integration of dental providers in settings where pediatricians practice2 7,f7 access1 quality1 and outcomes with respect to oral health services2 and 7,g7 other topics as the ,secretary determines appropriate2 and 7#b7 an evaluation of oral health service delivery to underserved and vulnerable populations1 including an evaluation of workforce models to enhance oral health service delivery4 7b7 ,supplement not supplant ,funds appropriated under this section shall be used to supplement1 and not supplant1 other ,federal1 ,state1 and local public funds provided for activities described in subsection 7a74 #bbe4 ,mobile and portable dental services ,subpart ,x of part ,d of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bef;f et seq471 as amended by section #bba1 is further amended by adding at the end the following3 #cdj;,g-#c4 ,mobile and portable dental services 7a7 ,in general ,the ,secretary shall award grants to ,federally qualified health centers 7as defined in paragraph 7#d7 of section #ahfa7;aa7 of the ,social ,security ,act71 rural health clinics 7as defined in paragraph 7#b7 of such section71 nonprofit dental clinics1 and dental schools to provide mobile and portable1 comprehensive dental services that provide for the restoration or maintenance of oral health and function 7including dental services provided by licensed providers through telehealth-enabled collaboration and supervision7 and outreach for dental services to underserved populations4 7b7 ,eligible entities ,to be eligible to receive a grant under this section1 an eligible entity shall submit an application to the ,secretary at such time1 in such manner1 and containing such information as the ,secretary may require1 including information to demonstrate that the entity is capable of providing coordinated care and continuity of care to patients4 7c7 ,use of funds ,eligible entities receiving a grant under this section shall deliver the dental services described in subsection 7a7 at locations such as senior centers1 nursing homes1 assisted living facilities1 schools1 licensed child care centers that serve eligible individuals who receive benefits under the ,state ,children's ,health ,insurance ,program under title ,,xxi of the ,social ,security ,act or the ,medicaid program under title ,,xix of the ,social ,security ,act1 and facilities that provide services under the ,special ,supplemental ,nutrition ,program for ,women1 ,infants1 and ,children established by section #ag of the ,child ,nutrition ,act of #aiff or under the ,head ,start ,act4 7d7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated such sums as may be necessary4 4 ,d ,oral health services as an essential health benefit #bca4 ,oral health services as an essential health benefit ,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#a7-- 7,a7 in subparagraph 7,j71 by striking oral and2 and 7,b7 by adding at the end the following3 7,k7 ,oral health services for children and adults4 2 and 7#b7 by adding at the end the following3 7#f7 ,oral health services ,for purposes of paragraph 7#a77,k71 the term oral health services means services 7as defined by the ,secretary71 that are necessary to prevent disease and promote oral health1 restore oral structures to health and function1 and treat emergency conditions4 4 ,,iii ,department of ,veterans ,affairs ,matters #cja4 ,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 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 appliances2 7#d7 in section #agab;,c7h7-- 7,a7 by striking section #agab of this title and inserting this chapter2 and 7,b7 by striking outpatient dental services and treatment1 and related dental appliances1 under such section #agab and inserting dental services and appliances under this chapter2 and 7#e7 by striking section #bjfb4 7b7 ,conforming amendment ,section #aebe7;a7 of such title is amended by striking medicines under section #agab7;d7 and inserting medicines under section #agab7;b74 7c7 ,clerical amendments ,such title is further amended-- 7#a7 in section #agab1 in the heading for such section1 by striking ,dental care and inserting ,appliances2 7#b7 in the table of sections at the beginning of chapter #ag1 by striking the item relating to section #agab and inserting the following new item3 #agab4 ,appliances2 drugs and medicines for certain disabled veterans2 vaccines4 2 and 7#c7 in the table of sections at the beginning of chapter #bj1 by striking the item relating to section #bjfb4 #cjb4 ,demonstration program on training and employment of alternative dental health care providers for dental health care services for veterans in rural and other underserved communities 7a7 ,demonstration program authorized ,the ,secretary of ,veterans ,affairs may carry out a demonstration program to establish programs to train and employ alternative dental health care providers in order to increase access to dental health care services for veterans who are entitled to such services from the ,department of ,veterans ,affairs and reside in rural and other underserved communities4 7b7 ,telehealth ,for purposes of alternative dental health care providers and other dental care providers who are licensed to provide clinical care1 dental services provided under the demonstration program under this section may be administered by such providers through telehealth-enabled collaboration and supervision when appropriate and feasible4 7c7 ,alternative dental health care providers defined ,in this section1 the term alternative dental health care providers has the meaning given that term in section #cdj;,g-#a7;a77#b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bef;g-#a7;a77#b774 7d7 ,authorization of appropriations ,there are authorized to be appropriated such sums as are necessary to carry out the demonstration program under this section4 #cjc4 ,program of 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 section3 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 #cjd4 ,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 services 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 #cje4 ,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 schools1 including dental programs within a community college1 to provide training and employment opportunities for dentists1 dental hygienists1 and oral surgeons4 ,,iv ,federal ,bureau of ,prisons #dja4 ,demonstration program on training and employment of alternative dental health care providers for dental health care services for prisoners within the custody of the ,bureau of ,prisons 7a7 ,demonstration program authorized ,the ,attorney ,general1 acting through the ,director of the ,bureau of ,prisons1 may carry out a demonstration program to establish programs to train and employ alternative dental health care providers in order to increase access to dental health services for prisoners within the custody of the ,bureau of ,prisons4 7b7 ,telehealth ,for purposes of alternative dental health care providers and any other dental care providers who are licensed to provide clinical care1 dental services provided under the demonstration program under this section may be administered by such providers through telehealth-enabled collaboration and supervision when deemed appropriate and feasible4 7c7 ,alternative ,dental ,health ,care ,providers ,defined ,in this section1 the term alternative dental health care providers has the meaning given that term in section #cdj;,g-#a of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bef;g-#a74 7d7 ,authorization ,of ,appropriations ,there are authorized to be appropriated such sums as are necessary to carry out the demonstration program under this section4 ,v ,indian ,health ,service #eja4 ,demonstration program on training and employment of alternative dental health care providers for dental health care services under the ,indian ,health ,service 7a7 ,demonstration program authorized ,the ,secretary of ,health and ,human ,services1 acting through the ,indian ,health ,service1 may carry out a demonstration program to establish programs to train and employ alternative dental health care providers in order to help eliminate oral health disparities and increase access to dental services through health programs operated by the ,indian ,health ,service1 ,indian tribes1 tribal organizations1 and urban ,indian organizations 7as those terms are defined in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc774 7b7 ,telehealth ,for purposes of alternative dental health care providers and any other dental care providers who are licensed to provide clinical care1 dental services provided under the demonstration program under this section may be administered by such providers through telehealth-enabled collaboration and supervision when deemed appropriate and feasible4 7c7 ,alternative dental health care providers defined ,in this section1 the term alternative dental health care providers has the meaning given that term in section #cdj;,g-#a7;a77#b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bef;g-#a7;a77#b774 7d7 ,authorization of appropriations ,there are authorized to be appropriated such sums as are necessary to carry out the demonstration program under this section4 ,,vi ,reports to ,congress #fja4 ,reports on enrollment in coverage for oral health services 7a7 ,secretary of ,health and ,human ,services ,the ,secretary of ,health and ,human ,services shall submit to ,congress the following reports3 7#a7 ,cost-benefit analysis ,not later than ,october #a1 #bjbh1 a report that provides a comprehensive cost-benefit analysis regarding the expansion of coverage for dental services pursuant to this ,act1 including whether the provision of such services resulted in a reduction in total health care costs for individuals under the ,medicare and ,medicaid programs4 7#b7 ,annual report on enrollment1 utilization1 and expenditures in dental insurance plans ,not later than #a year after the date of the enactment of this ,act1 and annually thereafter1 an annual report containing detailed information on-- 7,a7 enrollment in private insurance plans providing pediatric and adult dental coverage1 whether such coverage is provided through a qualified health plan 7as defined in section #acja7;a7 of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh77 or a stand-alone dental plan2 7,b7 the utilization of oral health services by children and adults who receive dental coverage under a qualified health plan or a stand-alone dental plan2 and 7,c7 expenditures related to oral health services by individuals and families who receive dental coverage in a qualified health plan or stand-alone dental plan4 7b7 ,comptroller ,general 7#a7 ,medicaid and ,medicare ,not later than ,january #a1 #bjbh1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report that provides a comprehensive analysis and evaluation of the implementation and utilization of the expanded coverage for dental services pursuant to this ,act for individuals enrolled in the ,medicare and ,medicaid programs4 7#b7 ,demonstration programs ,not later than ,january #a1 #bjbh1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report that provides a comprehensive analysis and evaluation of the demonstration programs described in sections #cjb1 #dja1 and #eja1 including-- 7,a7 the extent to which the programs improved access to oral health care and increased utilization of oral health services2 and 7,b7 an examination of the training provided under the programs to alternative dental health care providers and the quality of care provided by such providers4