[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5098 Introduced in House (IH)]







107th CONGRESS
  2d Session
                                H. R. 5098

   To provide disadvantaged children with access to dental services.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 11, 2002

  Mr. Dingell (for himself, Mr. Upton, and Mr. Waxman) introduced the 
   following bill; which was referred to the Committee on Energy and 
                                Commerce

_______________________________________________________________________

                                 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 Access 
to Oral Health Act of 2002''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
TITLE I--IMPROVING DELIVERY OF PEDIATRIC DENTAL SERVICES UNDER MEDICAID 
                               AND SCHIP

Sec. 101. Grants to improve the provision of dental services under 
                            medicaid and SCHIP.
Sec. 102. Requiring coverage of substantially equivalent dental 
                            services under SCHIP.
Sec. 103. State option to provide wrap-around SCHIP coverage to 
                            children who have other health coverage.
    TITLE II--IMPROVING DELIVERY OF PEDIATRIC DENTAL SERVICES UNDER 
  COMMUNITY HEALTH CENTERS, PUBLIC HEALTH DEPARTMENTS, AND THE INDIAN 
                             HEALTH SERVICE

Sec. 201. Grants to improve the provision of dental health services 
                            through community health centers and public 
                            health departments.
Sec. 202. Dental officer multiyear retention bonus for the Indian 
                            Health Service.
Sec. 203. Streamline process for designating dental health professional 
                            shortage areas.
Sec. 204. Demonstration projects to increase access to pediatric dental 
                            services in underserved areas.
   TITLE III--IMPROVING ORAL HEALTH PROMOTION AND DISEASE PREVENTION 
                                PROGRAMS

Sec. 301. Oral health initiative.
Sec. 302. CDC reports.
Sec. 303. Early childhood caries.
Sec. 304. School-based dental sealant program.

TITLE I--IMPROVING DELIVERY OF PEDIATRIC DENTAL SERVICES UNDER MEDICAID 
                               AND SCHIP

SEC. 101. GRANTS TO IMPROVE THE PROVISION OF DENTAL SERVICES UNDER 
              MEDICAID AND SCHIP.

    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 IMPROVE THE PROVISION OF DENTAL SERVICES UNDER 
              MEDICAID AND SCHIP.

    ``(a) Authority to Make Grants.--In addition to any other payments 
made under this title to a State, the Secretary shall award grants to 
States that satisfy the requirements of subsection (b) to improve the 
provision of dental services to children who are enrolled in a State 
plan under title XIX or a State child health plan under title XXI (in 
this section, collectively referred to as the `State plans').
    ``(b) Requirements.--In order to be eligible for a grant under this 
section, a State shall provide the Secretary with the following 
assurances:
            ``(1) Improved service delivery.--The State shall have a 
        plan to improve the delivery of dental services to children who 
        are enrolled in the State plans, including providing outreach 
        and administrative case management, improving collection and 
        reporting of claims data, and providing incentives, in addition 
        to raising reimbursement rates, to increase provider 
        participation.
            ``(2) Adequate payment rates.--The State has provided for 
        payment under the State plans for dental services for children 
        at levels consistent with the market-based rates and sufficient 
        enough to enlist providers to treat children in need of dental 
        services.
            ``(3) Ensured access.--The State shall ensure it will make 
        dental services available to children enrolled in the State 
        plans to the same extent as such services are available to the 
        general population of the State.
    ``(c) Use of Funds.--
            ``(1) In general.--Funds provided under this section may be 
        used to provide administrative resources (such as program 
        development, provider training, data collection and analysis, 
        and research-related tasks) to assist States in providing and 
        assessing services which include preventive and therapeutic 
        dental care regimens.
            ``(2) Limitation.--Such funds may not be used for payment 
        of direct dental, medical, or other services or to obtain 
        Federal matching funds under any Federal program.
    ``(d) Application.--A State shall submit an application to the 
Secretary for a grant under this section in such form and manner and 
containing such information as the Secretary may require.
    ``(e) Authorization of Appropriations.--There are authorized to be 
appropriated to make grants under this section $50,000,000 for fiscal 
year 2003 and each fiscal year thereafter.
    ``(f) 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 
        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)(6) (relating to prohibition on 
                payments to excluded individuals and entities).
                    ``(B) Section 504(c) (relating to the use of funds 
                for the purchase of technical assistance).
                    ``(C) Section 504(d) (relating to a limitation on 
                administrative expenditures).
                    ``(D) 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.
                    ``(E) Section 507 (relating to penalties for false 
                statements).
                    ``(F) Section 508 (relating to nondiscrimination).
                    ``(G) Section 509 (relating to the administration 
                of the grant program).''.

SEC. 102. REQUIRING COVERAGE OF SUBSTANTIALLY EQUIVALENT DENTAL 
              SERVICES UNDER SCHIP.

    (a) In General.--Section 2103(c)(2) of the Social Security Act (42 
U.S.C. 1397cc(c)(2)) is amended by adding at the end the following new 
subparagraph:
                    ``(E) Dental services.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect on January 1, 2003.

SEC. 103. STATE OPTION TO PROVIDE WRAP-AROUND SCHIP COVERAGE TO 
              CHILDREN WHO HAVE OTHER HEALTH COVERAGE.

    (a) In General.--
            (1) SCHIP.--
                    (A) State option to provide wrap-around coverage.--
                Section 2110(b) of the Social Security Act (42 U.S.C. 
                1397jj(b)) is amended--
                            (i) in paragraph (1)(C), by inserting ``, 
                        subject to paragraph (5),'' after ``under title 
                        XIX or''; and
                            (ii) by adding at the end the following new 
                        paragraph:
            ``(5) State option to provide wrap-around coverage.--A 
        State may waive the requirement of paragraph (1)(C) that a 
        targeted low-income child may not be covered under a group 
        health plan or under health insurance coverage, if the State 
        satisfies the conditions described in subsection (c)(8). The 
        State may waive such requirement in order to provide--
                    ``(A) dental services;
                    ``(B) cost-sharing protection; or
                    ``(C) all services.
        In waiving such requirement, a State may limit the application 
        of the waiver to children whose family income does not exceed a 
        level specified by the State, so long as the level so specified 
        does not exceed the maximum income level otherwise established 
        for other children under the State child health plan.''; and
                    (B) Conditions described.--Section 2105(c) of such 
                Act (42 U.S.C. 1397ee(c)) is amended by adding at the 
                end the following new paragraph:
            ``(8) Conditions for provision of wrap around coverage.--
        For purposes of section 2110(b)(5), the conditions described in 
        this paragraph are the following:
                    ``(A) Income eligibility.--The State child health 
                plan (whether implemented under title XIX or this 
                XXI)--
                            ``(i) has the highest income eligibility 
                        standard permitted under this title as of 
                        January 1, 2002;
                            ``(ii) subject to subparagraph (B), does 
                        not limit the acceptance of applications for 
                        children; and
                            ``(iii) provides benefits to all children 
                        in the State who apply for and meet eligibility 
                        standards.
                    ``(B) No waiting list imposed.--With respect to 
                children whose family income is at or below 200 percent 
                of the poverty line, the State does not impose any 
                numerical limitation, waiting list, or similar 
                limitation on the eligibility of such children for 
                child health assistance under such State plan.
                    ``(C) No more favorable treatment.--The State child 
                health plan may not provide  more favorable coverage of 
dental services to the children covered under section 2110(b)(5) than 
to children otherwise covered under this title.''.
                    (C) State option to waive waiting period.--Section 
                2102(b)(1)(B) of such Act (42 U.S.C. 1397bb(b)(1)(B)) 
                is amended--
                            (i) in clause (i), by striking ``and'' at 
                        the end;
                            (ii) in clause (ii), by striking the period 
                        and inserting ``; and''; and
                            (iii) by adding at the end the following 
                        new clause:
                            ``(iii) at State option, may not apply a 
                        waiting period in the case of child described 
                        in section 2110(b)(5), if the State satisfies 
                        the requirements of section 2105(c)(8).''.
            (2) Application of enhanced match under medicaid.--Section 
        1905 of such Act (42 U.S.C. 1396d) is amended--
                    (A) in subsection (b), in the fourth sentence, by 
                striking ``or subsection (u)(3)'' and inserting 
                ``(u)(3), or (u)(4)''; and
                    (B) in subsection (u)--
                            (i) by redesignating paragraph (4) as 
                        paragraph (5); and
                            (ii) by inserting after paragraph (3) the 
                        following new paragraph:
    ``(4) For purposes of subsection (b), the expenditures described in 
this paragraph are expenditures for items and services for children 
described in section 2110(b)(5), but only in the case of a State that 
satisfies the requirements of section 2105(c)(8).''.
            (3) Application of secondary payor provisions.--Section 
        2107(e)(1) of such Act (42 U.S.C. 1397gg(e)(1)) is amended--
                    (A) by redesignating subparagraphs (B) through (D) 
                as subparagraphs (C) through (E), respectively; and
                    (B) by inserting after subparagraph (A) the 
                following new subparagraph:
                    ``(B) Section 1902(a)(25) (relating to coordination 
                of benefits and secondary payor provisions) with 
                respect to children covered under a waiver described in 
                section 2110(b)(5).''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
take effect on January 1, 2003, and shall apply to child health 
assistance and medical assistance provided on or after that date.

    TITLE II--IMPROVING DELIVERY OF PEDIATRIC DENTAL SERVICES UNDER 
  COMMUNITY HEALTH CENTERS, PUBLIC HEALTH DEPARTMENTS, AND THE INDIAN 
                             HEALTH SERVICE

SEC. 201. GRANTS TO IMPROVE THE PROVISION OF DENTAL HEALTH SERVICES 
              THROUGH COMMUNITY HEALTH CENTERS AND PUBLIC HEALTH 
              DEPARTMENTS.

    Part D of title III of the Public Health Service Act (42 U.S.C. 
254b et seq.) is amended by insert before section 330, the following:

``SEC. 329. GRANT PROGRAM TO EXPAND THE AVAILABILITY OF SERVICES.

    ``(a) In General.--The Secretary, acting through the Health 
Resources and Services Administration, shall establish a program under 
which the Secretary may award grants to eligible entities and eligible 
individuals to expand the availability of primary dental care services 
in dental health professional shortage areas or medically underserved 
areas.
    ``(b) Eligibility.--
            ``(1) Entities.--To be eligible to receive a grant under 
        this section an entity--
                    ``(A) shall be--
                            ``(i) a health center receiving funds under 
                        section 330 or designated as a Federally 
                        qualified health center;
                            ``(ii) a county or local public health 
                        department, if located in a federally-
                        designated dental health professional shortage 
                        area;
                            ``(iii) an Indian tribe or tribal 
                        organization (as defined in section 4 of the 
                        Indian Self-Determination and Education 
                        Assistance Act (25 U.S.C. 450b)); or
                            ``(iv) a dental education program 
                        accredited by the Commission on Dental 
                        Accreditation; and
                    ``(B) shall prepare and submit to the Secretary an 
                application at such time, in such manner, and 
                containing such information as the Secretary may 
                require.
            ``(2) Individuals.--To be eligible to receive a grant under 
        this section an individual shall--
                    ``(A) be a dental health professional licensed or 
                certified in accordance with the laws  of State in 
which such individual provides dental services;
                    ``(B) prepare and submit to the Secretary an 
                application at such time, in such manner, and 
                containing such information as the Secretary may 
                require; and
                    ``(C) provide assurances that--
                            ``(i) the individual will practice in a 
                        federally-designated dental health professional 
                        shortage area; and
                            ``(ii) not less than 33 percent of the 
                        patients of such individual are--
                                    ``(I) receiving assistance under a 
                                State plan under title XIX of the 
                                Social Security Act (42 U.S.C. 1396 et 
                                seq.);
                                    ``(II) receiving assistance under a 
                                State plan under title XXI of the 
                                Social Security Act (42 U.S.C. 1397aa 
                                et seq.); or
                                    ``(III) uninsured.
    ``(c) Use of Funds.--
            ``(1) Entities.--An entity shall use amounts received under 
        a grant under this section to provide for the increased 
        availability of primary dental services in the areas described 
        in subsection (a). Such amounts may be used to supplement the 
        salaries offered for individuals accepting employment as 
        dentists in such areas.
            ``(2) Individuals.--A grant to an individual under 
        subsection (a) shall be in the form of a $1,000 bonus payment 
        for each month in which such individual is in compliance with 
        the eligibility requirements of subsection (b)(2)(C).
    ``(d) Authorization of Appropriations.--
            ``(1) In general.--Notwithstanding any other amounts 
        appropriated under section 330 for health centers, there is 
        authorized to be appropriated $40,000,000 for each of fiscal 
        years 2003 through 2007 to hire and retain dental health care 
        providers under this section.
            ``(2) Use of funds.--Of the amount appropriated for a 
        fiscal year under paragraph (1), the Secretary shall use--
                    ``(A) not less than 75 percent of such amount to 
                make grants to eligible entities; and
                    ``(B) not more than 25 percent of such amount to 
                make grants to eligible individuals.''.

SEC. 202. DENTAL OFFICER MULTIYEAR RETENTION BONUS FOR THE INDIAN 
              HEALTH SERVICE.

    (a) Terms and Definitions.--In this section:
            (1) 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.
            (2) Dental officer.--The term ``dental officer'' means an 
        officer of the Indian Health Service designated as a dental 
        officer.
            (3) Director.--The term ``Director'' means the Director of 
        the Indian Health Service.
            (4) Residency.--The term ``residency'' means a graduate 
        dental educational (GDE) training program of at least 12 months 
        leading to a specialty, including general practice residency 
        (GPR) or an 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 this section, a 
        dental officer shall--
                    (A) be at or below such grade as the Director shall 
                determine;
                    (B) have completed any active duty service 
                commitment of the Indian Health Service incurred for 
                dental education and training or have 8 years of 
                creditable service;
                    (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, as well as to other 
        dental hygienists with a minimum of a baccalaureate degree, 
        based on demonstrated need.
    (d) Termination of Entitlement to Special Pay.--The Director may 
terminate, with cause, 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 under 
        paragraph (1).

SEC. 203. STREAMLINE PROCESS FOR DESIGNATING DENTAL HEALTH PROFESSIONAL 
              SHORTAGE AREAS.

    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) 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, in consultation with State and local dental societies and tribal 
health organizations, streamline the process to develop, publish and 
periodically update criteria to be used in designating dental health 
professional shortage areas.''.

SEC. 204. 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 Resources and 
Services Administration and the Director of the Indian Health Service, 
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--IMPROVING ORAL HEALTH PROMOTION AND DISEASE PREVENTION 
                                PROGRAMS

SEC. 301. ORAL HEALTH INITIATIVE.

    (a) Establishment.--The Secretary of Health and Human Services 
shall establish an oral health initiative to reduce the profound 
disparities in oral health by improving the health status of vulnerable 
populations, particularly low-income children, to the level of health 
status that is enjoyed by the majority of Americans.
    (b) Activities.--The Secretary of Health and Human Services shall, 
through the oral health initiative--
            (1) carry out activities to improve intra- and inter-agency 
        collaborations, including activities to identify, engage, and 
        encourage existing Federal and State programs to maximize their 
        potential to address oral health;
            (2) carry out activities to encourage public-private 
        partnerships to engage private sector communities of interest 
        (including health professionals, educators, State policymakers, 
        foundations, business, and the public) in partnerships that 
        promote oral health and dental care; and
            (3) carry out activities to reduce the disease burden in 
        high risk populations through the application of best-science 
        in oral health, including programs such as community water 
        fluoridation and dental sealants.
    (c) Coordination.--The Secretary of Health and Human Services 
shall--
            (1) through the Administrator of the Centers for Medicare & 
        Medicaid Services (formerly known as the Health Care Financing 
        Administration) establish a Chief Dental Officer for the 
        medicaid and State children's health insurance programs 
        established under titles XIX and XXI, respectively, of the 
        Social Security Act (42 U.S.C. 1396 et seq. 1397aa et seq.); 
        and
            (2) carry out this section in collaboration with such 
        Administrator and Chief Dental Officer and the Administrator 
        and Chief Dental Officer of the Health Resources and Services 
        Administration.
    (d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $25,000,000 for fiscal year 
2003, and such sums as may be necessary for each subsequent fiscal 
year.

SEC. 302. 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 and 1 
Indian tribe from each region of the Department of Health and Human 
Services.
    (b) Reports.--The Director of the Centers for Disease Control and 
Prevention 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 and 
tribes.
    (c) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section such sums as may be necessary 
for each fiscla year 2003 and each subsequent fiscal year.

SEC. 303. EARLY CHILDHOOD CARIES.

    (a) In General.--The Secretary of Health and Human Services, acting 
through the Director of the Centers for Disease Control and Prevention, 
shall--
            (1) expand existing surveillance activities to include the 
        identification of children at high risk of early childhood 
        caries;
            (2) assist State, local, and tribal health agencies and 
        departments in collecting, analyzing and disseminating data on 
        early childhood caries; and
            (3) provide for the development of public health nursing 
        programs and public health education programs on early 
        childhood caries prevention.
    (b) Appropriateness of Activities.--The Secretary of Health and 
Human Services shall carry out programs and activities under subsection 
(a) in a culturally appropriate manner with respect to populations at 
risk of early childhood caries.
    (c) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each fiscal year.

SEC. 304. SCHOOL-BASED DENTAL SEALANT PROGRAM.

    Section 317M(c) of the Public Health Service Act (as added by 
section 1602 of Public Law 106-310)) is amended--
            (1) in paragraph (1), by inserting ``and school-linked'' 
        after ``school-based'';
            (2) in the first sentence of paragraph (2)--
                    (A) by inserting ``and school-linked'' after 
                ``school-based''; and
                    (B) by inserting ``or Indian tribe'' after 
                ``State''; and
            (3) by striking paragraph (3) and inserting the following:
            ``(3) Eligibility.--To be eligible to receive funds under 
        paragraph (1), an entity shall--
                    ``(A) prepare and submit to the State or Indian 
                tribe an application at such time, in such manner and 
                containing such information as the State or Indian 
                tribe may require; and
                    ``(B) be a--
                            ``(i) public elementary or secondary 
                        school--
                                    ``(I) that is located in an urban 
                                area in which and more than 50 percent 
                                of the student population is 
                                participating in Federal or State free 
                                or reduced meal programs; or
                                    ``(II) that is located in a rural 
                                area and, with respect to the school 
                                district in which the school is 
                                located, the district involved has a 
                                median income that is at or below 235 
                                percent of the poverty line, as defined 
                                in section 673(2) of the Community 
                                Services Block Grant Act (42 U.S.C. 
                                9902(2)); or
                            ``(ii) public or non-profit health 
                        organization, including a grantee under section 
                        330, that is under contract with an elementary 
                        or secondary school described in subparagraph 
                        (B) to provide dental services to school-age 
                        children.''.
                                 <all>