[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[S. 2583 Introduced in Senate (IS)]







105th CONGRESS
  2d Session
                                S. 2583

   To provide disadvantaged children with access to dental services.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

              October 8 (legislative day, October 2), 1998

  Mr. Bingaman (for himself and Mr. Cochran) introduced the following 
 bill; which was read twice and referred to the Committee on Labor and 
                            Human Resources

_______________________________________________________________________

                                 A BILL


 
   To provide disadvantaged children with access to dental services.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Children's Dental 
Health Improvement Act of 1998''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.
 TITLE I--EXPANDED OPPORTUNITIES FOR TRAINING PEDIATRIC DENTAL HEALTH 
                             CARE PROVIDERS

Sec. 101. Children's dental health training and demonstration programs.
Sec. 102. Increase in National Health Service Corps dental training 
                            positions.
Sec. 103. Maternal and child health centers for leadership in pediatric 
                            dentistry education.
Sec. 104. Dental officer multiyear retention bonus for the Indian 
                            Health Service.
Sec. 105. Medicare payments to approved nonhospital dentistry residency 
                            training programs; permanent dental 
                            exemption from voluntary residency 
                            reduction programs.
Sec. 106. Dental health professional shortage areas.
  TITLE II--ENSURING DELIVERY OF PEDIATRIC DENTAL SERVICES UNDER THE 
                      MEDICAID AND SCHIP PROGRAMS

Sec. 201. Increased FMAP and fee schedule for dental services provided 
                            to children under the medicaid program.
Sec. 202. Required minimum medicaid expenditures for dental health 
                            services.
Sec. 203. Requirement to verify sufficient numbers of participating 
                            dentists under the medicaid program.
Sec. 204. Inclusion of recommended age for first dental visit in 
                            definition of EPSDT services.
Sec. 205. Approval of final regulations implementing changes to EPSDT 
                            services.
Sec. 206. Use of SCHIP funds to treat children with special dental 
                            health needs.
Sec. 207. Grants to supplement fees for the treatment of children with 
                            special dental health needs.
Sec. 208. Demonstration projects to increase access to pediatric dental 
                            services in underserved areas.
                  TITLE III--PEDIATRIC DENTAL RESEARCH

Sec. 301. Identification of interventions that reduce transmission of 
                            dental diseases in high risk populations; 
                            development of approaches for pediatric 
                            dental assessment.
Sec. 302. Agency for Health Care Policy and Research.
Sec. 303. Consensus development conference.
               TITLE IV--SURVEILLANCE AND ACCOUNTABILITY

Sec. 401. CDC reports.
Sec. 402. Reporting requirements under the medicaid program.
Sec. 403. Administration on Children, Youth, and Families.
                         TITLE V--MISCELLANEOUS

Sec. 501. Effective date.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) Children's oral health impacts upon and reflects 
        children's general health.
            (2) Tooth decay is the most prevalent preventable chronic 
        disease of childhood and only the common cold, the flu, and 
        otitis media occur more often among young children.
            (3) Despite the design of the medicaid program to reach 
        children and ensure access to routine dental care, in 1996, the 
        Inspector General of the Department of Health and Human 
        Services reported that only 18 percent of children eligible for 
        medicaid received even a single preventive dental service.
            (4) The United States is facing a major dental health care 
        crisis that primarily affects the poor children of our country, 
        with 80 percent of all dental caries in children found in the 
        20 percent of the population.
            (5) Low income children eligible for the medicaid program 
        and the State children's health insurance program experience 
        disproportionately high levels of oral disease.
            (6) The United States is not training enough pediatric 
        dental health care providers to meet the increasing need for 
        pediatric dental services.
            (7) The United States needs to increase access to health 
        promotion and disease prevention activities in the area of oral 
        health for children by increasing access to pediatric dental 
        health providers.

 TITLE I--EXPANDED OPPORTUNITIES FOR TRAINING PEDIATRIC DENTAL HEALTH 
                             CARE PROVIDERS

SEC. 101. CHILDREN'S DENTAL HEALTH TRAINING AND DEMONSTRATION PROGRAMS.

    Part E of title VII of the Public Health Service Act (42 U.S.C. 
294o et seq.) is amended by adding at the end the following:

``SEC. 779. CHILDREN'S DENTAL HEALTH PROGRAMS.

    ``(a) Training Program.--
            ``(1) In general.--The Secretary, acting through the Bureau 
        of Health Professions, shall develop training materials to be 
        used by health professionals to promote oral health through 
        health education.
            ``(2) Design.--The materials developed under paragraph (1) 
        shall be designed to enable health care professionals to--
                    ``(A) provide information to individuals concerning 
                the importance of oral health;
                    ``(B) recognize oral disease in individuals; and
                    ``(C) make appropriate referrals of individuals for 
                dental treatment.
            ``(3) Distribution.--The materials developed under 
        paragraph (1) shall be distributed to--
                    ``(A) accredited schools of the health sciences 
                (including schools for physician assistants, schools of 
                medicine, osteopathic medicine, dental hygiene, public 
                health, nursing, pharmacy, and dentistry), and public 
                or private institutions accredited for the provision of 
                graduate or specialized training programs in all 
                aspects of health; and
                    ``(B) health professionals and community-based 
                health care workers.
    ``(b) Demonstration Program.--
            ``(1) In general.--The Secretary shall make grants to 
        schools that train pediatric dental health providers to meet 
        the costs of projects--
                    ``(A) to plan and develop new training programs and 
                to maintain or improve existing training programs in 
                providing dental health services to children; and
                    ``(B) to assist dental health providers in managing 
                complex dental problems in children.
            ``(2) Administration.--
                    ``(A) Amount.--The amount of any grant under 
                paragraph (1) shall be determined by the Secretary.
                    ``(B) Application.--No grant may be made under 
                paragraph (1) unless an application therefore is 
                submitted to and approved by the Secretary. Such an 
                application shall be in such form, submitted in such 
                manner, and contain such information, as the Secretary 
                shall by regulation prescribe.
                    ``(C) Eligibility.--To be eligible for a grant 
                under subsection (a), the applicant must demonstrate to 
                the Secretary that it has or will have available full-
                time faculty and staff members with training and 
                experience in the field of pediatric dentistry and 
                support from other faculty and staff members trained in 
                pediatric dentistry and other relevant specialties and 
                disciplines such as dental public health and 
                pediatrics, as well as research.
    ``(c) Authorization of Appropriations.--There is authorized to be 
appropriated such sums as may be necessary to carry out this 
section.''.

SEC. 102. INCREASE IN NATIONAL HEALTH SERVICE CORPS DENTAL TRAINING 
              POSITIONS.

    The Secretary of Health and Human Services shall increase the 
number of dental health providers skilled in treating children who 
become members of the National Health Service Corps under subpart II of 
part D of title III of the Public Health Service Act (42 U.S.C. 254d et 
seq.) so that there are at least 100 additional dentists and dental 
hygienists in the Corps by 2000, at least 150 additional dentists and 
dental hygienists in the Corps by 2001, and at least 300 additional 
dentists and dental hygienists in the Corps by 2002. The Secretary 
shall ensure that at least 20 percent of the dentists in the Corps are 
pediatric dentists and that another 20 percent of the dentists in the 
Corps have general practice residency training.

SEC. 103. MATERNAL AND CHILD HEALTH CENTERS FOR LEADERSHIP IN PEDIATRIC 
              DENTISTRY EDUCATION.

    (a) Expansion of Training Programs.--The Secretary of Health and 
Human Services shall, through the Maternal and Child Health Bureau, 
establish not less than 36 additional training positions annually for 
pediatric dentists at centers of excellence. The Secretary shall ensure 
that such training programs are established in geographically diverse 
areas.
    (b) Authorization of Appropriations.--There is authorized to be 
appropriated, such sums as may be necessary to carry out this section.

SEC. 104. DENTAL OFFICER MULTIYEAR RETENTION BONUS FOR THE INDIAN 
              HEALTH SERVICE.

    (a) Terms and Definitions.--In this section:
            (1) Dental officer.--The term ``dental officer'' means an 
        officer of the Indian Health Service designated as a dental 
        officer.
            (2) Director.--The term ``Director'' means the Director of 
        the Indian Health Service.
            (3) Creditable service.--The term ``creditable service'' 
        includes all periods that a dental officer spent in graduate 
        dental educational (GDE) training programs while not on active 
        duty in the Indian Health Service and all periods of active 
        duty in the Indian Health Service as a dental officer.
            (4) Residency.--The term ``residency'' means a graduate 
        dental educational (GDE) training program of at least 12 
        months, excluding general practice residency (GPR) or a 12-
        month advanced education general dentistry (AEGD).
            (5) Specialty.--The term ``specialty'' means a dental 
        specialty for which there is an Indian Health Service specialty 
        code number.
    (b) Requirements for Bonus.--
            (1) In general.--An eligible dental officer of the Indian 
        Health Service who executes a written agreement to remain on 
        active duty for 2, 3, or 4 years after the completion of any 
        other active duty service commitment to the Indian Health 
        Service may, upon acceptance of the written agreement by the 
        Director, be authorized to receive a dental officer multiyear 
        retention bonus under this section. The Director may, based on 
        requirements of the Indian Health Service, decline to offer 
        such a retention bonus to any specialty that is otherwise 
        eligible, or to restrict the length of such a retention bonus 
        contract for a specialty to less than 4 years.
            (2) Limitations.--Each annual dental officer multiyear 
        retention bonus authorized under this section shall not exceed 
        the following:
                    (A) $14,000 for a 4-year written agreement.
                    (B) $8,000 for a 3-year written agreement.
                    (C) $4,000 for a 2-year written agreement.
    (c) Eligibility.--
            (1) In general.--In order to be eligible to receive a 
        dental officer multiyear retention bonus under the section, a 
        dental officer shall--
                    (A) be at or below such grade as the Director shall 
                determine;
                    (B) have at least 8 years of creditable service, or 
                have completed any active duty service commitment of 
                the Indian Health Service incurred for dental education 
                and training;
                    (C) have completed initial residency training, or 
                be scheduled to complete initial residency training 
                before September 30 of the fiscal year in which the 
                officer enters into a dental officer multiyear 
                retention bonus written service agreement under this 
                section; and
                    (D) have a dental specialty in pediatric dentistry 
                or oral and maxillofacial surgery.
            (2) Extension to other officers.--The Director may extend 
        the retention bonus to dental officers other than officers with 
        a dental specialty in pediatric dentistry based on demonstrated 
        need. The criteria used as the basis for such an extension 
        shall be equitably determined and consistently applied.
    (d) Termination of Entitlement to Special Pay.--The Director may 
terminate at any time a dental officer's multiyear retention bonus 
contract under this section. If such a contract is terminated, the 
unserved portion of the retention bonus contract shall be recouped on a 
pro rata basis. The Director shall establish regulations that specify 
the conditions and procedures under which termination may take place. 
The regulations and conditions for termination shall be included in the 
written service contract for a dental officer multiyear retention bonus 
under this section.
    (e) Refunds.--
            (1) In general.--Prorated refunds shall be required for 
        sums paid under a retention bonus contract under this section 
        if a dental officer who has received the retention bonus fails 
        to complete the total period of service specified in the 
        contract, as conditions and circumstances warrant.
            (2) Debt to united states.--An obligation to reimburse the 
        United States imposed under paragraph (1) is a debt owed to the 
        United States.
            (3) No discharge in bankruptcy.--Notwithstanding any other 
        provision of law, a discharge in bankruptcy under title 11, 
        United States Code, that is entered less than 5 years after the 
        termination of a retention bonus contract under this section 
        does not discharge the dental officer who signed such a 
        contract from a debt arising under the contract or paragraph 
        (1).

SEC. 105. MEDICARE PAYMENTS TO APPROVED NONHOSPITAL DENTISTRY RESIDENCY 
              TRAINING PROGRAMS; PERMANENT DENTAL EXEMPTION FROM 
              VOLUNTARY RESIDENCY REDUCTION PROGRAMS.

    (a) Medicare Payments To Approved Nonhospital Dentistry Training 
Programs.--Section 1886 of the Social Security Act (42 U.S.C. 1395ww) 
is amended by adding at the end the following:
    ``(l) Payments For Nonhospital Based Dental Residency Training 
Programs.--
            ``(1) In general.--Beginning January 1, 1999, the Secretary 
        shall make payments under this paragraph to approved 
        nonhospital based dentistry residency training programs 
        providing oral health care to children for the direct and 
        indirect expenses associated with operating such training 
        programs.
            ``(2) Payment amount.--
                    ``(A) Methodology.--The Secretary shall establish 
                procedures for making payments under this subsection.
                    ``(B) Total amount of payments.--In making payments 
                to approved non-hospital based dentistry residency 
                training programs under this subsection, the Secretary 
                shall ensure that the total amount of such 
payments will not result in a reduction of payments that would 
otherwise be made under subsection (h) or (k) to hospitals for dental 
residency training programs.
                    ``(C) Approved programs.--The Secretary shall 
                establish procedures for the approval of nonhospital 
                based dentistry residency training programs under this 
                subsection.''.
    (b) Permanent Dental Exemption From Voluntary Residency Reduction 
Programs.--
            (1) In general.--Section 1886(h)(6)(C) of the Social 
        Security Act (42 U.S.C. 1395ww(h)(6)(C)) is amended--
                    (A) by redesignating clauses (i) through (iii) as 
                subclauses (I) through (III), respectively, and 
                indenting such subclauses (as so redesignated) 
                appropriately;
                    (B) by striking ``For purposes'' and inserting the 
                following:
                            ``(i) In general.--Subject to clause (ii), 
                        for purposes''; and
                    (C) by adding at the end the following:
                            ``(ii) Definition of `approved medical 
                        residency training program'.--In this 
                        subparagraph, the term `approved medical 
                        residency training program' means only such 
                        programs in allopathic or osteopathic 
                        medicine.''.
            (2) Application to demonstration projects and authority.--
        Section 4626(b)(3) of the Balanced Budget Act of 1997 (42 
        U.S.C. 1395ww note) is amended by inserting ``in allopathic or 
        osteopathic medicine'' before the period.
    (c) Effective Date.--
            (1) Subsection (a).--The amendment made by subsection (a) 
        takes effect on the date of enactment of this Act.
            (2) Subsection (b).--The amendments made by subsection (b) 
        shall take effect as if included in the enactment of the 
        Balanced Budget Act of 1997.

SEC. 106. DENTAL HEALTH PROFESSIONAL SHORTAGE AREAS.

    (a) Designation.--Section 332(a) of the Public Health Service Act 
(42 U.S.C. 254e(a)) is amended by adding at the end the following:
    ``(4)(A) In designating health professional shortage areas under 
this section, the Secretary may designate certain areas as dental 
health professional shortage areas if the Secretary determines that 
such areas have a severe shortage of dental health professionals. The 
Secretary shall develop, publish and periodically update criteria to be 
used in designating dental health professional shortage areas.
    ``(B) For purposes of this title, a dental health professional 
shortage area shall be considered to be a health professional shortage 
area.''.
    (b) Loan Repayment Program.--Section 338B(b)(1)(A) of the Public 
Health Service Act (42 U.S.C. 254l-1(b)(1)(A)) is amended by inserting 
``(including dental hygienists)'' after ``profession''.
    (c) Technical Amendment.--Section 331(a)(2) of the Public Health 
Service Act (42 U.S.C. 254d(a)(2)) is amended by inserting ``(including 
dental health services)'' after ``services''.

  TITLE II--ENSURING DELIVERY OF PEDIATRIC DENTAL SERVICES UNDER THE 
                      MEDICAID AND SCHIP PROGRAMS

SEC. 201. INCREASED FMAP AND FEE SCHEDULE FOR DENTAL SERVICES PROVIDED 
              TO CHILDREN UNDER THE MEDICAID PROGRAM.

    (a) Increased FMAP.--Section 1903(a)(5) of the Social Security Act 
(42 U.S.C. 1396b(a)(5)) is amended--
            (1) by striking ``equal to 90 per centum'' and inserting 
        ``equal to--
                    ``(A) 90 per centum'';
            (2) by inserting ``and'' after the semicolon; and
            (3) by adding at the end the following:
                    ``(B) the greater of the Federal medical assistance 
                percentage or 75 per centum of the sums expended during 
                such quarter which are attributable to dental services 
                for children;''.
    (b) Fee Schedule.--Section 1902(a) of the Social Security Act (42 
U.S.C. 1396a(a)) is amended--
            (1) in paragraph (65), by striking the period and inserting 
        ``; and''; and
            (2) by inserting after paragraph (65) the following:
            ``(66) provide for payment under the State plan for dental 
        services for children at a rate that is designed to create an 
        incentive for providers of such services to treat children in 
        need of dental services (but that does not result in a 
        reduction or other adverse impact on the extent to which the 
        State provides dental services to adults).''.

SEC. 202. REQUIRED MINIMUM MEDICAID EXPENDITURES FOR DENTAL HEALTH 
              SERVICES.

    Section 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)), as 
amended by section 201(b), is amended--
            (1) in paragraph (65), by striking ``and'' at the end;
            (2) in paragraph (66), by striking the period and inserting 
        ``; and''; and
            (3) by inserting after paragraph (66) the following:
            ``(67) provide that, beginning with fiscal year 1999--
                    ``(A) not less than an amount equal to 7 percent of 
                the total annual expenditures under the State plan for 
                medical assistance provided to children will be 
                expended during each fiscal year for dental services 
                for children (including the prevention, screening, 
                diagnosis, and treatment of dental conditions); and
                    ``(B) the State will not reduce or otherwise 
                adversely impact the extent to which the State provides 
                dental services to adults in order to meet the 
                requirement of subparagraph (A).''.

SEC. 203. REQUIREMENT TO VERIFY SUFFICIENT NUMBERS OF PARTICIPATING 
              DENTISTS UNDER THE MEDICAID PROGRAM.

    Section 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)), as 
amended by section 202, is amended--
            (1) in paragraph (66), by striking ``and'' at the end;
            (2) in paragraph (67), by striking the period and inserting 
        ``; and''; and
            (3) by inserting after paragraph (67) the following:
            ``(68) provide that the State will annually verify that the 
        number of dentists participating under the State plan--
                    ``(A) satisfies the minimum established degree of 
                participation of dentists to the population of children 
                in the State, as determined by the Secretary in 
                accordance with the criteria used by the Secretary 
                under section 332(a)(4) of the Public Health Service 
                Act (42 U.S.C. 254e(a)(4)) to designate a dental health 
                professional shortage area; and
                    ``(B) is sufficient to ensure that children 
                enrolled in the State plan have the same level of 
                access to dental services as the children residing in 
                the State who are not eligible for medical assistance 
                under the State plan.''.

SEC. 204. INCLUSION OF RECOMMENDED AGE FOR FIRST DENTAL VISIT IN 
              DEFINITION OF EPSDT SERVICES.

    Section 1905(r)(1)(A)(i) of the Social Security Act (42 U.S.C. 
1396d(r)(1)(A)(i)) is amended by inserting ``and, with respect to 
dental services under paragraph (3), in accordance with guidelines for 
the age of a first dental visit that are consistent with guidelines of 
the American Dental Association, the American Academy of Pediatric 
Dentistry, and the Bright Futures program of the Health Resources and 
Services Administration of the Department of Health and Human 
Services,'' after ``vaccines,''.

SEC. 205. APPROVAL OF FINAL REGULATIONS IMPLEMENTING CHANGES TO EPSDT 
              SERVICES.

    Not later than 30 days after the date of enactment of this Act, the 
Secretary of Health and Human Services shall issue final regulations 
implementing the proposed regulations based on section 6403 of the 
Omnibus Budget Reconciliation Act of 1989 (Public Law 101-239; 103 
Stat. 2262) that were contained in the Federal Register issued for 
October 1, 1993.

SEC. 206. USE OF SCHIP FUNDS TO TREAT CHILDREN WITH SPECIAL DENTAL 
              HEALTH NEEDS.

    (a) In General.--Section 1905 of the Social Security Act (42 U.S.C. 
1396d) is amended--
            (1) in subsection (b), by striking ``or subsection (u)(3)'' 
        and inserting ``subsection (u)(3), or subsection (u)(4)''; and
            (2) in subsection (u)--
                    (A) by redesignating paragraph (4) as paragraph 
                (5); and
                    (B) by inserting after paragraph (3) the following 
                new paragraph:
    ``(4)(A) For purposes of subsection (b), the expenditures described 
in this paragraph are expenditures for medical assistance described in 
subparagraph (B) for a low-income child described in subparagraph (C), 
but only in the case of such a child who resides in a State described 
in subparagraph (D).
    ``(B) For purposes of subparagraph (A), the medical assistance 
described in this subparagraph consists of the following:
            ``(i) Dental services provided to children with special 
        oral health needs, including advanced oral, dental, and 
        craniofacial diseases and conditions.
            ``(ii) Outreach conducted to identify and treat children 
        with such special dental health needs.
    ``(C) For purposes of subparagraph (A), a low-income child 
described in this subparagraph is a child whose family income does not 
exceed 50 percentage points above the medicaid applicable income level 
(as defined in section 2110(b)(4)).
    ``(D) A State described in this subparagraph is a State that, as of 
August 5, 1997, has under a waiver authorized by the Secretary or under 
section 1902(r)(2), established a medicaid applicable income level (as 
defined in section 2110(b)(4)) for children under 19 years of age 
residing in the State that is at or above 185 percent of the poverty 
line (as defined in section 673(2) of the Community Services Block 
Grant Act (42 U.S.C. 9902(2), including any revision required by such 
section for a family of the size involved).''.
    (b) Effective Date.--The amendments made by this section shall take 
effect as if included in the enactment of section 4911 of the Balanced 
Budget Act of 1997 (Public Law 105-33; 111 Stat. 570).

SEC. 207. GRANTS TO SUPPLEMENT FEES FOR THE TREATMENT OF CHILDREN WITH 
              SPECIAL DENTAL HEALTH NEEDS.

    Title V of the Social Security Act (42 U.S.C. 701 et seq.) is 
amended by adding at the end the following:

``SEC. 511. GRANTS TO SUPPLEMENT FEES FOR THE TREATMENT OF CHILDREN 
              WITH SPECIAL DENTAL HEALTH NEEDS.

    ``(a) Authority to Make Grants.--
            ``(1) In general.--In addition to any other payments made 
        under this title to a State, the Secretary shall award grants 
        to States to supplement payments made under the State programs 
        established under titles XIX and XXI for the treatment of 
        children with special oral health care needs.
            ``(2) Definition of children with special oral, dental, and 
        craniofacial health care needs.--In this section the term 
        `children with special oral health care needs' means children 
        with advanced oral, dental and craniofacial conditions or 
        disorders, and other chronic medical, genetic, and behavioral 
        disorders with dental manifestations.
    ``(b) Application of Other Provisions of Title.--
            ``(1) In general.--Except as provided in paragraph (2), the 
        other provisions of this title shall not apply to a grant made, 
        or activities of the Secretary, under this section.
            ``(2) Exceptions.--The following provisions of this title 
        shall apply to a grant made under subsection (a) to the same 
        extent and in the same manner as such provisions apply to 
        allotments made under section 502(c):
                    ``(A) Section 504(b)(4) (relating to expenditures 
                of funds as a condition of receipt of Federal funds).
                    ``(B) Section 504(b)(6) (relating to prohibition on 
                payments to excluded individuals and entities).
                    ``(C) Section 506 (relating to reports and audits, 
                but only to the extent determined by the Secretary to 
                be appropriate for grants made under this section).
                    ``(D) Section 508 (relating to nondiscrimination).
    ``(c) Authorization of Appropriations.--There is authorized to be 
appropriated such sums as may be necessary to carry out this 
section.''.

SEC. 208. DEMONSTRATION PROJECTS TO INCREASE ACCESS TO PEDIATRIC DENTAL 
              SERVICES IN UNDERSERVED AREAS.

    (a) Authority To Conduct Projects.--The Secretary of Health and 
Human Services, through the Administrator of the Health Care Financing 
Administration, the Administrator of the Health Resources and Services 
Administration, the Director of the Indian Health Service, and the 
Director of the Centers for Disease Control and Prevention shall 
establish demonstration projects that are designed to increase access 
to dental services for children in underserved areas, as determined by 
the Secretary.
    (b) Authorization of Appropriations.--There is authorized to be 
appropriated such sums as may be necessary to carry out this section.

                  TITLE III--PEDIATRIC DENTAL RESEARCH

SEC. 301. IDENTIFICATION OF INTERVENTIONS THAT REDUCE THE BURDEN AND 
              TRANSMISSION OF ORAL, DENTAL, AND CRANIOFACIAL DISEASES 
              IN HIGH RISK POPULATIONS; DEVELOPMENT OF APPROACHES FOR 
              PEDIATRIC ORAL AND CRANIOFACIAL ASSESSMENT.

    (a) In General.--The Secretary of Health and Human Services, 
through the Maternal and Child Health Bureau, the Indian Health 
Service, and in consultation with the Agency for Health Care Policy and 
Research and the National Institutes of Health, shall--
            (1) support community based research that is designed to 
        improve our understanding of the etiology, pathogenesis, 
        diagnosis, prevention, and treatment of pediatric oral, dental, 
        craniofacial diseases and conditions and their sequelae in high 
        risk populations; and
            (2) develop clinical approaches for pediatric dental 
        disease risk assessment.
    (b) Authorization of Appropriations.--There is authorized to be 
appropriated, such sums as may be necessary to carry out this section.

SEC. 302. AGENCY FOR HEALTH CARE POLICY AND RESEARCH.

    Section 902(a) of the Public Health Service Act (42 U.S.C. 299a(a)) 
is amended--
            (1) in paragraph (7), by striking ``and'' at the end;
            (2) in paragraph (8), by striking the period and inserting 
        ``; and''; and
            (3) by adding at the end the following:
            ``(9) the barriers that exist to dental care for children 
        and the establishment of measures of oral health quality, 
        including access to oral health care for children.''.

SEC. 303. CONSENSUS DEVELOPMENT CONFERENCE.

    (a) In General.--Not later than January 1, 2000, the Secretary of 
Health and Human Services, acting through the National Institute of 
Child Health and Human Development and the National Institute of Dental 
Research, shall convene a conference (to be known as the ``Consensus 
Development Conference'') to examine the management of early childhood 
caries and to support the design and conduct of research on the biology 
and physiologic dynamics of infectious transmission of dental caries. 
The Secretary shall ensure that representatives of interested consumers 
and other professional organizations participate in the Consensus 
Development Conference.
    (b) Experts.--In administering the conference under subsection (a), 
the Secretary of Health and Human Services shall solicit the 
participation of experts in dentistry, including pediatric dentistry, 
public health, and other appropriate medical and child health 
professionals.
    (c) Authorization of Appropriations.--There is authorized to be 
appropriated such sums as may be necessary to carry out this section.

               TITLE IV--SURVEILLANCE AND ACCOUNTABILITY

SEC. 401. CDC REPORTS.

    (a) Collection of Data.--The Director of the Centers for Disease 
Control and Prevention in collaboration with other organizations and 
agencies shall annually collect data describing the dental, 
craniofacial, and oral health of residents of at least 1 State from 
each region of the Department of Health and Human Services.
    (b) Reports.--The Director shall compile and analyze data collected 
under subsection (a) and annually prepare and submit to the appropriate 
committees of Congress a report concerning the oral health of certain 
States.

SEC. 402. REPORTING REQUIREMENTS UNDER THE MEDICAID PROGRAM.

    Section 1902(a)(43)(D) of the Social Security Act (42 U.S.C. 
1396a(43)(D)) is amended--
            (1) in clause (iii), by striking ``and'' and inserting 
        ``with the specific dental condition and treatment provided 
        identified,'';
            (2) in clause (iv), by striking the semicolon and inserting 
        a comma; and
            (3) by adding at the end the following:
                            ``(v) the percentage of expenditures for 
                        such services that were for dental services, 
                        and
                            ``(vi) the percentage of general and 
                        pediatric dentists who are licensed in the 
                        State and provide services commensurate with 
                        eligibility under the State plan;''.

SEC. 403. ADMINISTRATION ON CHILDREN, YOUTH, AND FAMILIES.

    The Administrator of the Administration on Children, Youth, and 
Families shall annually prepare and submit to the appropriate 
committees of Congress a report concerning the percentage of children 
enrolled in a Head Start or Early Start program who have access to and 
who obtain dental care, including children with special oral, dental, 
and craniofacial health needs.

                         TITLE V--MISCELLANEOUS

SEC. 501. EFFECTIVE DATE.

    (a) In General.--Except as otherwise provided in this Act, this Act 
and the amendments made by this Act take effect on the date of 
enactment of this Act.
    (b) Extension of effective date for state law amendment.--In the 
case of a State plan under title XIX of the Social Security Act which 
the Secretary of Health and Human Services determines requires State 
legislation in order for the plan to meet the additional requirements 
imposed by the amendments made by this Act, the State plan shall not be 
regarded as failing to comply with the requirements of such amendments 
solely on the basis of its failure to meet the 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 the enactment of this Act. For purposes of the 
previous sentence, in the case of a State that has a 2-year legislative 
session, each year of the session is considered to be a separate 
regular session of the State legislature.
                                 <all>