[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5191 Introduced in House (IH)]







107th CONGRESS
  2d Session
                                H. R. 5191

 To amend titles XIX and XXI of the Social Security Act to provide for 
  expanded dental coverage under Medicaid and State children's health 
 insurance programs and to provide for funding for expanded community 
                         oral health services.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 23, 2002

     Mr. Sanders (for himself, Ms. Lee, Mr. Hinchey, Mr. Larson of 
 Connecticut, and Mr. Frank) introduced the following bill; which was 
            referred to the Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
 To amend titles XIX and XXI of the Social Security Act to provide for 
  expanded dental coverage under Medicaid and State children's health 
 insurance programs and to provide for funding for expanded community 
                         oral health services.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Oral Health Promotion Act of 2002''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Oral and general health are inseparable, and good 
        dental care is critical to our overall physical health and 
        well-being, yet 108 million Americans have no public or private 
        dental insurance.
            (2) Although oral health in America has improved 
        dramatically over the last 50 years, dental caries (cavities) 
        are presently the single most common chronic childhood disease, 
        five times more likely than asthma and seven times more common 
        than hay fever.
            (3) According to the Surgeon General, low-income, minority 
        children experience significant disparities in oral health 
        status and access to basic dental care. In a year-long study, 
        the Surgeon General found that fewer than one in five Medicaid-
        covered children received a single dental visit during that 
        period and that 25 percent of poor and minority children never 
        visit a dentist before entering kindergarten.
            (4) Poor children are more than twice as likely than their 
        more affluent peers to have dental caries, which cause a 
        significant amount of pain to children and cause difficulty 
        eating, playing and learning, as well as many missed days of 
        school, and which are more likely to go untreated. Surveys have 
        shown that children miss nearly 52 million hours of school each 
        year because of dental problems.
            (5) Low-income adults face similar problems with pain and 
        limitations on daily activities and are more likely than those 
        with higher incomes to lose permanent teeth and have untreated 
        dental disease. Among adult workers, more than 164 million work 
        hours are lost annually because of dental problems.

SEC. 3. REQUIREMENT FOR DENTAL BENEFITS 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 amendments made by subsection (a) shall 
take effect on January 1, 2003.

SEC. 4. AUTHORITY TO PROVIDE DENTAL COVERAGE UNDER SCHIP AS A 
              SUPPLEMENT TO OTHER HEALTH COVERAGE.

    (a) Authority To Provide Coverage.--
            (1) SCHIP.--
                    (A) In general.--Section 2105(a)(1)(C) of the 
                Social Security Act (42 U.S.C. 1397ee(a)(1)(C)) is 
                amended--
                            (i) by inserting ``(i)'' after ``(C)''; and
                            (ii) by adding at the end the following:
                    ``(ii) notwithstanding clause (i), in the case of a 
                State that satisfies the conditions described in 
                subsection (c)(8) and at the option of a State, for 
                child health assistance that consists only of coverage 
                of dental services for a child who would be considered 
                a targeted low-income child if--
                            ``(I) that portion of subparagraph (C) of 
                        section 2110(b)(1) relating to coverage of the 
                        child under a group health plan or under health 
                        insurance coverage did not apply, and such 
                        child has such coverage that does not include 
                        coverage of dental services; or
                            ``(II) such child meets the requirements 
                        (other than income-related requirements) to be 
                        a targeted low-income child; 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:
            ``(8) Conditions for provision of dental services only 
        coverage.--For purposes of subsection (a)(1)(C)(ii), the 
        conditions described in this paragraph are the following:
                    ``(A) Income eligibility.--The State child health 
                plan (whether implemented under title XIX or this 
                title)--
                            ``(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) Authorization of appropriations.--In addition 
                to any funds otherwise authorized to be appropriated, 
                there are authorized to be appropriated such additional 
                funds as may be necessary to carry out the amendments 
                made by subparagraphs (A) and (B).
                    (D) 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 choose not to 
                        apply a waiting period in the case of a child 
                        described in section 2105(a)(1)(C)(ii), if the 
                        State satisfies the requirements of section 
                        2105(c)(8) and provides such child with child 
                        health assistance that consists only of 
                        coverage of dental services.''.
                    (E) Optional application to adults covered under 
                waivers.--The amendments made by this paragraph shall 
                also apply under title XXI of the Social Security Act 
                at a State's  option to adults receiving assistance 
under such title in a manner comparable to the manner in which such 
amendments apply to child health assistance furnished to a child 
covered under such title.
            (2) Application of enhanced match under medicaid.--Section 
        1905 of the Social Security 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 dental services for children 
described in section 2105(a)(1)(C)(ii), but only in the case of a State 
that satisfies the requirements of section 2105(c)(8).''.
    (b) Effective Date.--The amendments made by subsection (a) take 
effect on the date of the enactment of this Act, and apply to child 
health assistance and medical assistance provided on or after that 
date.

SEC. 5. ENHANCED MATCHING RATE UNDER MEDICAID FOR COVERAGE OF FULL 
              ADULT DENTAL BENEFITS.

    (a) In General.--Section 1905(a)(4) of the Social Security Act (42 
U.S.C. 1396d(a)(4)) is amended--
            (1) by inserting ``(A)'' after ``with respect to''; and
            (2) by inserting before the period at the end the 
        following: ``and (B) with respect to medical assistance 
        provided for dental benefits for adults but only if such 
        benefits cover the full range of dental benefits (including 
        orthodontia and dentures)''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to medical assistance for items and services furnished on or 
after the date of the enactment of this Act, regardless of whether the 
State medicaid plan provided for full adult dental benefits before such 
date.

SEC. 6. ESTABLISHMENT OF FUND FOR ORAL HEALTH SERVICES THROUGH 
              COMMUNITY-BASED HEALTH CENTERS.

    (a) In General.--There is established in the Treasury of the United 
States a fund to be known as Community Oral Health Expansion Fund 
(referred to in this section as the ``Fund''). The Fund shall consist 
of such amounts as may be appropriated under subsection (b) to the 
Fund. Amounts appropriated for the Fund shall remain available until 
expended.
    (b) Authorization of Appropriations to Fund.--For each fiscal year 
beginning with fiscal year 2003, there is authorized to be appropriated 
to the Fund $140,000,000.
    (c) Use of Fund.--
            (1) In general.--Amounts in the Fund and available pursuant 
        to appropriations Act shall be used by the Secretary of Health 
        and Human Services to make grants to the States for the purpose 
        of establishing or expanding the availability of oral health 
        services through Federally-qualified health centers (as defined 
        in section 1905(l)(2)(B) of the Social Security Act) or through 
        other nonprofit private or public community-based providers of 
        health services.
            (2) Certain uses.--The purposes for which a grant under 
        paragraph (1) may be expended include, with respect to oral 
        health services--
                    (A) recruiting and compensating staff;
                    (B) purchasing equipment; and
                    (C) constructing, modernizing, or renovating 
                facilities.
            (3) Use for demonstration projects.--In conjunction with 
        any of the uses specified under paragraph (2), grants under 
        paragraph (1) also may be used by health centers and other 
        community-based providers described in paragraph (1) for 
        demonstration projects and demonstration partnerships with Head 
        Start programs for identifying children at risk of dental 
        disease and providing early intervention and prevention of such 
        disease.
    (d) Requirement of Matching Funds.--
            (1) In general.--With respect to the costs of the program 
        to be carried out under subsection (c) by a State, a grant 
        under such subsection may be made only if the State agrees to 
        make available (directly or through donations from public or 
        private entities) non-Federal contributions toward such costs 
        in an amount that is not less than 10 percent of such costs ($1 
        for each $9 of Federal funds provided in the grant).
            (2) Determination of amount contributed.--Non-Federal 
        contributions required in paragraph (1) may be in cash or in 
        kind, fairly evaluated, including plant, equipment, or 
        services. Amounts provided by the Federal Government, or 
        services assisted or subsidized to any significant extent by 
        the Federal Government, may not be included in determining the 
        amount of such non-Federal contributions.
    (e) Priority for States Covering Medicaid Level of Dental Benefits 
Under SCHIP and Preference for States With Market-Based Payment Rates 
for Dental Services Under Medicaid and SCHIP.--In awarding grants to 
States under this section, the Secretary of Health and Human Services 
shall--
            (1) give priority to those States that provide, under its 
        State child health insurance plan under title XXI of the Social 
        Security Act, for the coverage of dental benefits in an amount, 
        duration, and scope equivalent to that provided under its State 
        medicaid plan under title XIX of such Act; and
            (2) give preference to States that provide for 
        reimbursement under its State medicaid plan and its State child 
        health insurance plan under titles XIX and XXI of such Act for 
        dental services at levels consistent with market-based rates.
    (f) State Defined.--For purposes of this section, the term 
``State'' has the meaning given such term for purposes of title XIX of 
the Social Security Act.
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