1. Short title; table of contents
(a) This Act may be cited as the Children’s Dental Health Improvement Act of 2004
.
(b) 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. State option to provide wrap-around SCHIP coverage to children who have other health coverage
Title II—Correcting gme payments for dental residency training programs
Sec. 201. Limitation on the application of the 1-year lag in the indirect medical education ratio (IME) changes and the 3-year rolling average for counting interns and residents for IME and direct graduate medical education (D–GME) payments under the medicare program
Title III—Improving delivery of pediatric dental services under community health centers, public health departments, and the Indian Health Service
Sec. 301. Grants to improve the provision of dental health services through community health centers and public health departments
Sec. 302. Dental officer multiyear retention bonus for the Indian Health Service
Sec. 303. Demonstration projects to increase access to pediatric dental services in underserved areas
Sec. 304. Technical correction
Title IV—Improving oral health promotion and disease prevention programs
Sec. 401. Oral health initiative
Sec. 402. CDC reports
Sec. 403. Early childhood caries
Sec. 404. School-based dental sealant program
Sec. 405. Basic oral health promotion
<enum>I</enum> <header>Improving delivery of pediatric dental services under medicaid and SCHIP</header>
<section id="HCDF8B7AFB5984FD4B620E9D90CB8D8D"> <enum>101.</enum> <header>Grants to improve the provision of dental services under medicaid and SCHIP</header> <text display-inline="no-display-inline">Title V of the <act-name parsable-cite="SSA">Social Security Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/701">42 U.S.C. 701 et seq.</external-xref>) is amended by adding at the end the following:</text>
<quoted-block act-name="Social Security Act" id="H4CA0278AEB0445C282DD1E67BAEEAB3F">
<section id="HB189A95B9DF7458B98DED318CF1FCE3"> <enum>511.</enum> <header>Grants to improve the provision of dental services under medicaid and SCHIP</header>
<subsection id="HB779F1541EB543379BED000695F6B1CA"> <enum>(a)</enum> <header>Authority to make grants</header> <text>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 <quote>State plans</quote>).</text> </subsection>
<subsection id="H28F3562C4083490099C817737BB934E"> <enum>(b)</enum> <header>Requirements</header> <text>In order to be eligible for a grant under this section, a State shall provide the Secretary with the following assurances:</text>
<paragraph id="H8DF6332FA02E49D5005DF4542EBD5C8C"> <enum>(1)</enum> <header>Improved service delivery</header> <text>The State shall have a plan to improve the delivery of dental services to children, including children with special health care needs, 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.</text> </paragraph>
<paragraph id="H18A639D6033E4A5FB83753D5AB899D3"> <enum>(2)</enum> <header>Adequate payment rates</header> <text>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.</text> </paragraph>
<paragraph id="H8FD76430BCD04BDFA850F72EA1B09590"> <enum>(3)</enum> <header>Ensured access</header> <text>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.</text> </paragraph> </subsection>
<subsection id="H25063CE3526B426AA7B4A14E129D1E1C"> <enum>(c)</enum> <header>Use of funds</header>
<paragraph id="H8D0AD9AF38C943FC989312A31C2B2CBF"> <enum>(1)</enum> <header>In general</header> <text>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 that include preventive and therapeutic dental care regimens.</text> </paragraph>
<paragraph id="HF4092414AA73415D96C3337ECB206D44"> <enum>(2)</enum> <header>Limitation</header> <text>Funds provided under this section may not be used for payment of direct dental, medical, or other services or to obtain Federal matching funds under any Federal program.</text> </paragraph> </subsection>
<subsection id="HC8C9337FDAA446E700CE8BC2A8FF18BF"> <enum>(d)</enum> <header>Application</header> <text>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.</text> </subsection>
<subsection id="H72FC715DCE3E434F9F003061C03A2E0"> <enum>(e)</enum> <header>Authorization of appropriations</header> <text>There are authorized to be appropriated to make grants under this section $50,000,000 for fiscal year 2005 and each fiscal year thereafter.</text> </subsection>
<subsection id="H16E318B5011A4F9FB18D66900062A8A7"> <enum>(f)</enum> <header>Application of other provisions of title</header>
<paragraph id="HA9ED0488549244D798077588EF61E53"> <enum>(1)</enum> <header>In general</header> <text>Except as provided in paragraph (2), the other provisions of this title shall not apply to a grant made under this section.</text> </paragraph>
<paragraph id="H21ECB3199C0C4222942ED01477107BEE"> <enum>(2)</enum> <header>Exceptions</header> <text>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):</text>
<subparagraph id="HABD63187997A46BB95392784C87B00B8"> <enum>(A)</enum> <text>Section 504(b)(6) (relating to prohibition on payments to excluded individuals and entities).</text> </subparagraph>
<subparagraph id="H2466ED9834CF4CB2813972DF35F889CC"> <enum>(B)</enum> <text>Section 504(c) (relating to the use of funds for the purchase of technical assistance).</text> </subparagraph>
<subparagraph id="H37AB8384FC524A72A8A56D7E59B934C"> <enum>(C)</enum> <text>Section 504(d) (relating to a limitation on administrative expenditures).</text> </subparagraph>
<subparagraph id="HF5D754B52D6C4D9D8FDDAEE6D7D3FF7"> <enum>(D)</enum> <text>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.</text> </subparagraph>
<subparagraph id="HAF49ECF479124E8998E45E2FB741F58E"> <enum>(E)</enum> <text>Section 507 (relating to penalties for false statements).</text> </subparagraph>
<subparagraph id="H1DD507282DF04632AAE8150361199D72"> <enum>(F)</enum> <text>Section 508 (relating to nondiscrimination).</text> </subparagraph>
<subparagraph id="H6DC62E1251E3428391EE544154748E4"> <enum>(G)</enum> <text>Section 509 (relating to the administration of the grant program).</text> </subparagraph> </paragraph> </subsection> </section> <after-quoted-block>.</after-quoted-block> </quoted-block> </section>
<section id="H32BAC5870E074A7BAB6880393EBABD9"> <enum>102.</enum> <header>State option to provide wrap-around SCHIP coverage to children who have other health coverage</header>
<subsection id="H99D8BC25F4CA45F3B8031764AAD00287"> <enum>(a)</enum> <header>In general</header>
<paragraph id="HB24B52A75DBB4DA99362F7453BDA6455"> <enum>(1)</enum> <header>SCHIP</header>
<subparagraph id="H4390465C04E4429EBCA7B0BFF9F00AE"> <enum>(A)</enum> <header>State option to provide wrap-around coverage</header> <text>Section 2110(b) of the <act-name parsable-cite="SSA">Social Security Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1397jj">42 U.S.C. 1397jj(b)</external-xref>) is amended—</text>
<clause id="H80C9B14CEE674BDB8295EDE98EB4971"> <enum>(i)</enum> <text>in paragraph (1)(C), by inserting <quote>, subject to paragraph (5),</quote> after <quote>under title XIX or</quote>; and</text> </clause>
<clause id="HF3D48AF10DCF40B8B8D51DA055BD2D77"> <enum>(ii)</enum> <text>by adding at the end the following:</text>
<quoted-block id="HBB0757C6D59D4AA08268575615AF97FF">
<paragraph id="H3A08EE0D69E3411888A0F349E9C42DBA"> <enum>(5)</enum> <header>State option to provide wrap-around coverage</header> <text>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—</text>
<subparagraph id="HBD9221572D8945FC93B7B8700AD3DA2"> <enum>(A)</enum> <text>dental services;</text> </subparagraph>
<subparagraph id="H2F784939C622411400BE28384EBCF06E"> <enum>(B)</enum> <text>cost-sharing protection; or</text> </subparagraph>
<subparagraph id="H5138D04833B54D83B2F0009371BEF7A7"> <enum>(C)</enum> <text>all services.</text> </subparagraph> <continuation-text continuation-text-level="paragraph">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.</continuation-text> </paragraph> <after-quoted-block>.</after-quoted-block> </quoted-block> </clause> </subparagraph>
<subparagraph id="H65965E30CB9A40EC888E66D160A4715D"> <enum>(B)</enum> <header>Conditions described</header> <text>Section 2105(c) of the <act-name parsable-cite="SSA">Social Security Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1397ee">42 U.S.C. 1397ee(c)</external-xref>) is amended by adding at the end the following:</text>
<quoted-block act-name="Social Security Act" id="H94550736529C4508B100ABFE15E369DF">
<paragraph id="HECCA206E9CEC4A86A42C3649DBB2FF00"> <enum>(8)</enum> <header>Conditions for provision of wrap-around coverage</header> <text>For purposes of section 2110(b)(5), the conditions described in this paragraph are the following:</text>
<subparagraph id="H49AC29A97DF34E61A2C3A210CF79F1F"> <enum>(A)</enum> <header>Income eligibility</header> <text>The State child health plan (whether implemented under title XIX or this XXI)—</text>
<clause id="HBB6806F4DB4E4977B03654D516DA19"> <enum>(i)</enum> <text>has the highest income eligibility standard permitted under this title as of January 1, 2004;</text> </clause>
<clause id="H68A1BB66C6BB4F5DB6AE6B3CCCCEE328"> <enum>(ii)</enum> <text>subject to subparagraph (B), does not limit the acceptance of applications for children; and</text> </clause>
<clause id="H62E3B0D7A60243B98D67136400F7F88C"> <enum>(iii)</enum> <text>provides benefits to all children in the State who apply for and meet eligibility standards.</text> </clause> </subparagraph>
<subparagraph id="H282BD25A9D69453C8889B9DA67F8E9F6"> <enum>(B)</enum> <header>No waiting list imposed</header> <text>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.</text> </subparagraph>
<subparagraph id="H027D60EFF8F44A6A98999D62B369FFFA"> <enum>(C)</enum> <header>No more favorable treatment</header> <text>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.</text> </subparagraph> </paragraph> <after-quoted-block>.</after-quoted-block> </quoted-block> </subparagraph>
<subparagraph id="HB010526BD52E44259D729B875C00FC8D"> <enum>(C)</enum> <header>State option to waive waiting period</header> <text>Section 2102(b)(1)(B) of the <act-name parsable-cite="SSA">Social Security Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1397bb">42 U.S.C. 1397bb(b)(1)(B)</external-xref>) is amended—</text>
<clause id="HFADFD5073C3C4A19A9191EBACFFBCB26"> <enum>(i)</enum> <text>in clause (i), by striking <quote>and</quote> at the end;</text> </clause>
<clause id="H2E9161C599474C169151774F21554461"> <enum>(ii)</enum> <text>in clause (ii), by striking the period and inserting <quote>; and</quote>; and</text> </clause>
<clause id="HF160505F64B84380B0397BA9F7818FB"> <enum>(iii)</enum> <text>by adding at the end the following:</text>
<quoted-block id="H5EE125268A32474283B173C2BCD31D08">
<clause id="H3745F75AF0274B388EFDBFDD1B055FEB"> <enum>(iii)</enum> <text>at State option, may not apply a waiting period in the case of a child described in section 2110(b)(5), if the State satisfies the requirements of section 2105(c)(8).</text> </clause> <after-quoted-block>.</after-quoted-block> </quoted-block> </clause> </subparagraph> </paragraph>
<paragraph id="HD3E26A12B0704471B563597E2C067262"> <enum>(2)</enum> <header>Application of enhanced match under medicaid</header> <text>Section 1905 of the <act-name parsable-cite="SSA">Social Security Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1396d">42 U.S.C. 1396d</external-xref>) is amended—</text>
<subparagraph id="H1C42300C40B14E259747F9EBC68E88DB"> <enum>(A)</enum> <text>in subsection (b), in the fourth sentence, by striking <quote>or subsection (u)(3)</quote> and inserting <quote>(u)(3), or (u)(4)</quote>; and</text> </subparagraph>
<subparagraph id="H720DD57430AB452DBB24500008AE1E21"> <enum>(B)</enum> <text>in subsection (u)—</text>
<clause id="HA8B28C4D34AA4425A6886016B3C4B53B"> <enum>(i)</enum> <text>by redesignating paragraph (4) as paragraph (5); and</text> </clause>
<clause id="H63F06DB29B204D55B1F4682E53C3B27D"> <enum>(ii)</enum> <text>by inserting after paragraph (3) the following:</text>
<quoted-block id="H1C7543D99DEA42D6A0F89C50F16F2EBA">
<paragraph id="HFA54FD347D9F425D80DFB19BFFE1491E"> <enum>(4)</enum> <text>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).</text> </paragraph> <after-quoted-block>.</after-quoted-block> </quoted-block> </clause> </subparagraph> </paragraph>
<paragraph id="H0D1530406B1947849D3895FAE78AA6D"> <enum>(3)</enum> <header>Application of secondary payor provisions</header> <text>Section 2107(e)(1) of the <act-name parsable-cite="SSA">Social Security Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1397gg">42 U.S.C. 1397gg(e)(1)</external-xref>) is amended—</text>
<subparagraph id="HADD31032811D44E885B95074718CAA48"> <enum>(A)</enum> <text>by redesignating subparagraphs (B) through (D) as subparagraphs (C) through (E), respectively; and</text> </subparagraph>
<subparagraph id="H85A3A3C13A984FEEB7FBC7D8DA0406FC"> <enum>(B)</enum> <text>by inserting after subparagraph (A) the following:</text>
<quoted-block id="HDB3BAF25D3F346ECB3CA35364973B529">
<subparagraph id="H3D6E672F4F4D4880AC4656E3748F95E1"> <enum>(B)</enum> <text>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).</text> </subparagraph> <after-quoted-block>.</after-quoted-block> </quoted-block> </subparagraph> </paragraph> </subsection>
<subsection id="H0329085EB56540FFB2F451E563C6E7DC"> <enum>(b)</enum> <header>Effective date</header> <text>The amendments made by subsection (a) shall take effect on January 1, 2004, and shall apply to child health assistance and medical assistance provided on or after that date.</text> </subsection> </section>
<enum>II</enum> <header>Correcting GME payments for dental residency training programs</header>
<section id="H78CAD8678AC04576BA3F2097AEBA84"> <enum>201.</enum> <header>Limitation on the application of the 1-year lag in the indirect medical education ratio (IME) changes and the 3-year rolling average for counting interns and residents for IME and direct graduate medical education (D–GME) payments under the medicare program</header>
<subsection id="H15627505722E4E3D9FE4E4BCB03CCDFC"> <enum>(a)</enum> <header>IME ratio and rolling average</header> <text>Section 1886(d)(5)(B)(vi) of the <act-name parsable-cite="SSA">Social Security Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww(d)(5)(B)(vi)</external-xref>) is amended by adding at the end the following new sentence: <quote>For cost reporting periods beginning during fiscal years beginning on or after October 1, 2004, subclauses (I) and (II) shall be applied only with respect to a hospital’s approved medical residency training program in the fields of allopathic medicine and osteopathic medicine.</quote>.</text> </subsection>
<subsection id="HB3DA7DD466324EFA833105F5C257DEE"> <enum>(b)</enum> <header>D–GME rolling average</header> <text>Section 1886(h)(4)(G) of the <act-name parsable-cite="SSA">Social Security Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww(h)(4)(G)</external-xref>) is amended by adding at the end the following new clause:</text>
<quoted-block act-name="Social Security Act" id="HA1549A1999564640BF04A9DB2D8800FA">
<clause id="HCBC7C0A05BBB4BC29C79415DE8EFE4E1"> <enum>(iv)</enum> <header>Application for fy 2005 and subsequent years</header> <text>For cost reporting periods beginning during fiscal years beginning on or after October 1, 2004, clauses (i) through (iii) shall be applied only with respect to a hospital’s approved medical residency training program in the fields of allopathic medicine and osteopathic medicine.</text> </clause> <after-quoted-block>.</after-quoted-block> </quoted-block> </subsection> </section>
<enum>III</enum> <header>Improving delivery of pediatric dental services under community health centers, public health departments, and the Indian Health Service</header>
<section id="HE612E759AC1046D6A4D794301839D264"> <enum>301.</enum> <header>Grants to improve the provision of dental health services through community health centers and public health departments</header> <text display-inline="no-display-inline">Subpart I of part D of title III of the <act-name parsable-cite="PHSA">Public Health Service Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/254b">42 U.S.C. 254b et seq.</external-xref>) is amended by insert before section 330, the following:</text>
<quoted-block act-name="Public Health Service Act" id="HFD4156E55CEC48BDA2FFA9D81F90ECCB">
<section id="H670A09F1BE0D481280B700326C00FEA9"> <enum>329.</enum> <header>Grant program to expand the availability of services</header>
<subsection id="H8C8234E7E1EC4C43BFD85800083D01B3"> <enum>(a)</enum> <header>In general</header> <text>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.</text> </subsection>
<subsection id="HD752037ECC914DD79BE6F84DD90110A6"> <enum>(b)</enum> <header>Eligibility</header>
<paragraph id="H51B189A8614E4A22947709EFF599938"> <enum>(1)</enum> <header>Entities</header> <text>To be eligible to receive a grant under this section an entity—</text>
<subparagraph id="H9B1BEAB9E7084E528582BEE3DE58496C"> <enum>(A)</enum> <text>shall be—</text>
<clause id="H1571B1533F3545D100D5260079547C66"> <enum>(i)</enum> <text>a health center receiving funds under section 330 or designated as a Federally qualified health center;</text> </clause>
<clause id="H8BB3B6597D214074A134BBEB00281218"> <enum>(ii)</enum> <text>a county or local public health department, if located in a federally-designated dental health professional shortage area;</text> </clause>
<clause id="H05F7141D4CFD41DCA27BC39B7C51698"> <enum>(iii)</enum> <text>an Indian tribe or tribal organization (as defined in section 4 of the <act-name parsable-cite="ISDA">Indian Self-Determination and Education Assistance Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/25/450b">25 U.S.C. 450b</external-xref>));</text> </clause>
<clause id="H97E0F34B75684739B2DC45B0E700DF20"> <enum>(iv)</enum> <text>a dental education program accredited by the Commission on Dental Accreditation; or</text> </clause>
<clause id="HE32E23015B974C3CBC47D0A7CD6E4C1D"> <enum>(v)</enum> <text>a community-based program whose child service population is made up of at least 33 percent of children who are eligible children, including at least 25 percent of such children being children with mental retardation or related developmental disabilities, unless specific documentation of a lack of need for access by this sub-population is established; and</text> </clause> </subparagraph>
<subparagraph id="HD2A2D553AB4945119D1FCA64FB5153C"> <enum>(B)</enum> <text>shall prepare and submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require, including information concerning dental provider capacity to serve individuals with developmental disabilities.</text> </subparagraph> </paragraph>
<paragraph id="H46DD9259C986446AA225ACAF3F044CA2"> <enum>(2)</enum> <header>Individuals</header> <text>To be eligible to receive a grant under this section an individual shall—</text>
<subparagraph id="H3FEF734AF34740438FD716D88FE9DAE5"> <enum>(A)</enum> <text>be a dental health professional licensed or certified in accordance with the laws of State in which such individual provides dental services;</text> </subparagraph>
<subparagraph id="H1A321C49A17D4172B0CA6001FD5E55"> <enum>(B)</enum> <text>prepare and submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require; and</text> </subparagraph>
<subparagraph id="HE429A4348EBC4F75B9BE2D4056D336DD"> <enum>(C)</enum> <text>provide assurances that—</text>
<clause id="H57C78E615AFE4236B49F7BFBF32268CC"> <enum>(i)</enum> <text>the individual will practice in a federally-designated dental health professional shortage area; or</text> </clause>
<clause id="H964C1F4569734B91A9C98F775277F0B0"> <enum>(ii)</enum> <text>not less than 25 percent of the patients of such individual are—</text>
<subclause id="H1799A35BAA1B44B1978C777E6C3D952E"> <enum>(I)</enum> <text>receiving assistance under a State plan under title XIX of the <act-name parsable-cite="SSA">Social Security Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396 et seq.</external-xref>);</text> </subclause>
<subclause id="HBC479803A162423285006E5F2118E6F5"> <enum>(II)</enum> <text>receiving assistance under a State plan under title XXI of the <act-name parsable-cite="SSA">Social Security Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1397aa">42 U.S.C. 1397aa et seq.</external-xref>); or</text> </subclause>
<subclause id="H6D525967EF59468097145B82BB7925B6"> <enum>(III)</enum> <text>uninsured.</text> </subclause> </clause> </subparagraph> </paragraph> </subsection>
<subsection id="H9AF37F7698C745D9B8DEEB8F80E58133"> <enum>(c)</enum> <header>Use of funds</header>
<paragraph id="H0B28CFF4B4DC4CD8BF17A2EEAC1CDB79"> <enum>(1)</enum> <header>Entities</header> <text>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.</text> </paragraph>
<paragraph id="HCADB07705A8146D4939DA00FF8FEF04"> <enum>(2)</enum> <header>Individuals</header> <text>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).</text> </paragraph> </subsection>
<subsection id="HB48406D126F8453E841B77A9C78008D"> <enum>(d)</enum> <header>Authorization of appropriations</header>
<paragraph id="HD1BA1018E06644A59BB1D04E5000AE8"> <enum>(1)</enum> <header>In general</header> <text>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 2005 through 2009 to hire and retain dental health care providers under this section.</text> </paragraph>
<paragraph id="HF6AA73B12DD745508F10D8A2B87E48CB"> <enum>(2)</enum> <header>Use of funds</header> <text>Of the amount appropriated for a fiscal year under paragraph (1), the Secretary shall use—</text>
<subparagraph id="H472D33DC673D4C2AA296038C49283E18"> <enum>(A)</enum> <text>not less than 65 percent of such amount to make grants to eligible entities; and</text> </subparagraph>
<subparagraph id="H2ACA8DFB7A9342BCAE28297F68733142"> <enum>(B)</enum> <text>not more than 35 percent of such amount to make grants to eligible individuals.</text> </subparagraph> </paragraph> </subsection> </section> <after-quoted-block>.</after-quoted-block> </quoted-block> </section>
<section id="HB490676FABCD4B6FB479BCE7385E73C0"> <enum>302.</enum> <header>Dental officer multiyear retention bonus for the Indian Health Service</header>
<subsection id="H3F26803DE3094804AC8EB2841BF3CD45"> <enum>(a)</enum> <header>Terms and definitions</header> <text>In this section:</text>
<paragraph id="H259EF2347049457789073E16ED71EB00"> <enum>(1)</enum> <header>Creditable service</header> <text>The term <term>creditable service</term> 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.</text> </paragraph>
<paragraph id="HC3B6DE8394E04DCA8F04844DE7F41E6B"> <enum>(2)</enum> <header>Dental officer</header> <text>The term <term>dental officer</term> means an officer of the Indian Health Service designated as a dental officer.</text> </paragraph>
<paragraph id="H34D83842CCC24CA4B50030A8473C290"> <enum>(3)</enum> <header>Director</header> <text>The term <term>Director</term> means the Director of the Indian Health Service.</text> </paragraph>
<paragraph id="H9CC209B4E87C45B9984130902C64F964"> <enum>(4)</enum> <header>Residency</header> <text>The term <term>residency</term> 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).</text> </paragraph>
<paragraph id="H5B73679FE107409DB54EF21DD43ACD1"> <enum>(5)</enum> <header>Specialty</header> <text>The term <term>specialty</term> means a dental specialty for which there is an Indian Health Service specialty code number.</text> </paragraph> </subsection>
<subsection id="H57C211D3627A448AA2A05B8D2E1443A4"> <enum>(b)</enum> <header>Requirements for bonus</header>
<paragraph id="H263070F624564E96BC767D61BAC301BB"> <enum>(1)</enum> <header>In general</header> <text>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.</text> </paragraph>
<paragraph id="H7D050227F56347C289CD3F07DCA339E9"> <enum>(2)</enum> <header>Limitations</header> <text>Each annual dental officer multiyear retention bonus authorized under this section shall not exceed the following:</text>
<subparagraph id="HA864703685924B8CB8A570ADEF115885"> <enum>(A)</enum> <text>$14,000 for a 4-year written agreement.</text> </subparagraph>
<subparagraph id="HDBC798FD2A9343D28CF6DC207DECAE43"> <enum>(B)</enum> <text>$8,000 for a 3-year written agreement.</text> </subparagraph>
<subparagraph id="H7E9CA9BE415C4A0AA090F449408D541E"> <enum>(C)</enum> <text>$4,000 for a 2-year written agreement.</text> </subparagraph> </paragraph> </subsection>
<subsection id="H529C207F14C64715A6D32D194F8C5787"> <enum>(c)</enum> <header>Eligibility</header>
<paragraph id="H5D25692A3B8F4D3199419731B4335FD"> <enum>(1)</enum> <header>In general</header> <text>In order to be eligible to receive a dental officer multiyear retention bonus under this section, a dental officer shall—</text>
<subparagraph id="H927CC82D40EA41319DDF7DE04DB16FC"> <enum>(A)</enum> <text>be at or below such grade as the Director shall determine;</text> </subparagraph>
<subparagraph id="H67AF205340FE4DD8A4D6CFE4DEE44E3C"> <enum>(B)</enum> <text>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;</text> </subparagraph>
<subparagraph id="HAA8D0711EF7B49E3B702BD910719C052"> <enum>(C)</enum> <text>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</text> </subparagraph>
<subparagraph id="HB58B028496D34944A0B447D1C1A95C6C"> <enum>(D)</enum> <text>have a dental specialty in pediatric dentistry or oral and maxillofacial surgery.</text> </subparagraph> </paragraph>
<paragraph id="H6C5A972140CC4F6491B4EA7824C473D9"> <enum>(2)</enum> <header>Extension to other officers</header> <text>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.</text> </paragraph> </subsection>
<subsection id="H1F1A4F6777614F80B536A643DFDE9EB9"> <enum>(d)</enum> <header>Termination of entitlement to special pay</header> <text>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.</text> </subsection>
<subsection id="HCAB3795E4D8849E4952D91090016D419"> <enum>(e)</enum> <header>Refunds</header>
<paragraph id="HF3CDAA8EE196446195FCD06FCD989E7"> <enum>(1)</enum> <header>In general</header> <text>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.</text> </paragraph>
<paragraph id="H5C4D583B25E0446A8C3B364F6C41A269"> <enum>(2)</enum> <header>Debt to United States</header> <text>An obligation to reimburse the United States imposed under paragraph (1) is a debt owed to the United States.</text> </paragraph>
<paragraph id="H6257D1626ABF4A69BD35B7B18001537"> <enum>(3)</enum> <header>No discharge in bankruptcy</header> <text>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).</text> </paragraph> </subsection> </section>
<section id="H3C7A62C68F014C9586FC6B94E3B91F44"> <enum>303.</enum> <header>Demonstration projects to increase access to pediatric dental services in underserved areas</header>
<subsection id="H27C1410E9E1A41679C92C8CB89C2CDFF"> <enum>(a)</enum> <header>Authority to conduct projects</header> <text>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.</text> </subsection>
<subsection id="HA4CB9B1CF7334462B0A3199E39BA00E5"> <enum>(b)</enum> <header>Authorization of appropriations</header> <text>There is authorized to be appropriated such sums as may be necessary to carry out this section.</text> </subsection> </section>
<section id="H68D6694F13304765AF92D4EAAB8B0E3"> <enum>304.</enum> <header>Technical correction</header> <text display-inline="no-display-inline">Section 340G(b)(1)(B) of the <act-name parsable-cite="PHSA">Public Health Service Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/256g">42 U.S.C. 256g(b)(1)(B)</external-xref>) is amended by striking <quote>and</quote> at the end and inserting <quote>or</quote>.</text> </section>
<enum>IV</enum> <header>Improving oral health promotion and disease prevention programs</header>
<section id="H1A9978157FB6437900DC3DF11FE33C6B"> <enum>401.</enum> <header>Oral health initiative</header>
<subsection id="H6643CE468FCC4642ADE0A8712628001E"> <enum>(a)</enum> <header>Establishment</header> <text>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 and children with developmental disabilities, to the level of health status that is enjoyed by the majority of Americans.</text> </subsection>
<subsection id="H1ED53488D4B746E9B89200C700486441"> <enum>(b)</enum> <header>Activities</header> <text>The Secretary of Health and Human Services shall, through the oral health initiative—</text>
<paragraph id="H551395BA6A0049CC876C7F3EA4C86E32"> <enum>(1)</enum> <text>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;</text> </paragraph>
<paragraph id="H47836604E7DE479B8D001300F039D43C"> <enum>(2)</enum> <text>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;</text> </paragraph>
<paragraph id="HAFA035CF2F79495CA7A3474DAF20BBF6"> <enum>(3)</enum> <text>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; and</text> </paragraph>
<paragraph id="H385287A2F0944025830182689F4D7E09"> <enum>(4)</enum> <text>carry out activities to improve the oral health literacy of the public through school-based education programs.</text> </paragraph> </subsection>
<subsection id="HAAF4F688D52446B3A1982F8C401CBD45"> <enum>(c)</enum> <header>Coordination</header> <text>The Secretary of Health and Human Services shall—</text>
<paragraph id="HC637AA533B8A4A74BD385BFB00DC7268"> <enum>(1)</enum> <text>through the Administrator of the Centers for Medicare <short-title></short-title> & Medicaid Services, establish the Chief Dental Officer for the medicaid and State children’s health insurance programs established under titles XIX and XXI, respectively, of the <act-name parsable-cite="SSA">Social Security Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396 et seq.</external-xref> 1397aa et seq.);</text> </paragraph>
<paragraph id="HFE47661B0BA442898396DDCAAF15A644"> <enum>(2)</enum> <text>through the Administrator of the Health Resources and Services Administration, establish the Chief Dental Office for all oral health programs within the Health Resources and Services Administration;</text> </paragraph>
<paragraph id="H47D01192F7BE44CEB7A1D4CBECEABAB1"> <enum>(3)</enum> <text>through the Director of the Centers for Disease Control and Prevention, establish the Chief Dental Officer for all oral health programs within such Centers; and</text> </paragraph>
<paragraph id="H63CAB72DA935414EBD558B2D41FBDDD5"> <enum>(4)</enum> <text>carry out this section in collaboration with the Administrators and Chief Dental Officers described in paragraphs (1), (2), and (3).</text> </paragraph> </subsection>
<subsection id="H98383AC7254C4CA1B709A77682D29D4E"> <enum>(d)</enum> <header>Authorization of appropriations</header> <text>There is authorized to be appropriated to carry out this section, $25,000,000 for fiscal year 2005, and such sums as may be necessary for each subsequent fiscal year.</text> </subsection> </section>
<section id="H8B1FA9C8824F43EEB700F6AB2689695C"> <enum>402.</enum> <header>CDC reports</header>
<subsection id="HA17AA602D3FD4EC881EC3DD784BBEE48"> <enum>(a)</enum> <header>Collection of data</header> <text>The Director of the Centers for Disease Control and Prevention, in collaboration with other organizations and agencies, shall collect data through State-based oral health surveillance systems describing the dental, craniofacial, and oral health of residents of all 50 States and certain Indian tribes.</text> </subsection>
<subsection id="HE25C2D0E3B2741D196208C193F2E20F8"> <enum>(b)</enum> <header>Reports</header> <text>The Director of the Centers for Disease Control and Prevention shall compile and analyze data collection under subsection (a) and annually prepare and submit to the appropriate committees of Congress a report concerning the oral health of States and Indian tribes.</text> </subsection> </section>
<section id="HDEE90A3DAD364C089F9C4E69BAA129CB"> <enum>403.</enum> <header>Early childhood caries</header>
<subsection id="HEB3CABCBE0904304AE24D55844062FD3"> <enum>(a)</enum> <header>In general</header> <text>The Secretary of Health and Human Services, acting through the Director of the Centers for Disease Control and Prevention, shall—</text>
<paragraph id="H4F954E2C2AF7402EA42C489609FB72E7"> <enum>(1)</enum> <text>expand existing surveillance activities to include the identification of children at high risk of early childhood caries, including sub-populations such as children with developmental disabilities;</text> </paragraph>
<paragraph id="HA1EFCE1BF9DA4B0B9BF2C5ECC4E4700"> <enum>(2)</enum> <text>assist State, local, and tribal health agencies and departments in collecting, analyzing and disseminating data on early childhood caries; and</text> </paragraph>
<paragraph id="H742EBCEE20C24F3088DEA5FF1747153B"> <enum>(3)</enum> <text>provide for the development of public health nursing programs and public health education programs on early childhood caries prevention.</text> </paragraph> </subsection>
<subsection id="HA4BDB4A6A0CC431000FD7502788BBED9"> <enum>(b)</enum> <header>Appropriateness of activities</header> <text>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.</text> </subsection>
<subsection id="HB15580F011C14885BF6848BAED34B96"> <enum>(c)</enum> <header>Authorization of appropriations</header> <text>There is authorized to be appropriated to carry out this section, such sums as may be necessary for each fiscal year.</text> </subsection> </section>
<section id="H0CD643FFD01440BA8B67821F1F8244B7"> <enum>404.</enum> <header>School-based dental sealant program</header> <text display-inline="no-display-inline">Section 317M(c) of the <act-name parsable-cite="PHSA">Public Health Service Act</act-name> (as added by section 1602 of <external-xref legal-doc="public-law" parsable-cite="pl/106/310">Public Law 106–310</external-xref>) is amended—</text>
<paragraph id="H394186F5CACF47859213416E1CFBEEED"> <enum>(1)</enum> <text>in paragraph (1), by inserting <quote>and school-linked</quote> after <quote>school-based</quote>;</text> </paragraph>
<paragraph id="H2EC9A344C6BB4440BB8C9C9259329BF6"> <enum>(2)</enum> <text>in the first sentence of paragraph (2)—</text>
<subparagraph id="HE4CE084AB9DD444CA4DE323EF49F006C"> <enum>(A)</enum> <text>by inserting <quote>and school-linked</quote> after <quote>school-based</quote>; and</text> </subparagraph>
<subparagraph id="HA2E692715ECC4F9684EBA5473BE88352"> <enum>(B)</enum> <text>by inserting <quote>or Indian tribe</quote> after <quote>State</quote>; and</text> </subparagraph> </paragraph>
<paragraph id="H2F7ABB5C21B64553AAA44B25B14BDB2C"> <enum>(3)</enum> <text>by striking paragraph (3) and inserting the following:</text>
<quoted-block id="H78148D0C981D4830B357C15E56AA6224">
<paragraph id="H738F415109AA4D2F949CF9F58CF8B515"> <enum>(3)</enum> <header>Eligibility</header> <text>To be eligible to receive funds under paragraph (1), an entity shall—</text>
<subparagraph id="H9453FA82DF7E4F1DA897F246724B312B"> <enum>(A)</enum> <text>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</text> </subparagraph>
<subparagraph id="HD6B069CC62C84016A71896905DDE6683"> <enum>(B)</enum> <text>be a—</text>
<clause id="HC875EA625D774E71AACB86B69B8245A6"> <enum>(i)</enum> <text>public elementary or secondary school—</text>
<subclause id="H6D923F9B43FD4A72A3F558633532E209"> <enum>(I)</enum> <text>that is located in an urban area in which more than 50 percent of the student population is participating in Federal or State free or reduced meal programs; or</text> </subclause>
<subclause id="H7B303FDF4D67496FBBF3005CD0AF6735"> <enum>(II)</enum> <text>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 (<external-xref legal-doc="usc" parsable-cite="usc/42/9902">42 U.S.C. 9902(2)</external-xref>); or</text> </subclause> </clause>
<clause id="H4F7FE95787524008AD00D564AD8BF8B0"> <enum>(ii)</enum> <text>public or non-profit organization, including a grantee under section 330 and urban Indian clinics under title V of the <act-name parsable-cite="IHCIA">Indian Health Care Improvement Act</act-name>, that is under contract with an elementary or secondary school described in subparagraph (B) to provide dental services to school-age children.</text> </clause> </subparagraph> </paragraph> <after-quoted-block>.</after-quoted-block> </quoted-block> </paragraph> </section>
<section id="H09504E4BCA074C9A87D6EF9978E7B648"> <enum>405.</enum> <header>Basic oral health promotion</header>
<subsection id="HF7BCF6B93F2745D39EB8F2619C853E6F"> <enum>(a)</enum> <header>In general</header> <text>The Secretary of Health and Human Services, acting through the Director of the Centers for Disease Control and Prevention and in consultation with dental organizations (including organizations having expertise in the prevention and treatment of oral disease in underserved pediatric populations), shall award grants to States and Indian tribes to improve the basic capacity of such States and tribes to improve the oral health of children and their families.</text> </subsection>
<subsection id="H0497D534DB924426B07BD165DA6B18F1"> <enum>(b)</enum> <header>Requirements</header> <text>A State or Indian tribe shall use amounts received under a grant under this section to conduct one or more of the following activities:</text>
<paragraph id="H09565216576C4D2B90465C5CDFB600C4"> <enum>(1)</enum> <text>Establish an oral health plan, policies, effective prevention programs, and accountability measures and systems.</text> </paragraph>
<paragraph id="H7FC1877011364908B1EEE216EC9EC366"> <enum>(2)</enum> <text>Establish and guide coalitions, partnerships, and alliances to accomplish the establishment of the plan, policies, programs and systems under paragraph (1).</text> </paragraph>
<paragraph id="H91355557BCD14117AB4ED3C1BDFBF6C3"> <enum>(3)</enum> <text>Monitor changes in oral disease burden, disparities, and the utilization of preventive services by high-risk populations.</text> </paragraph>
<paragraph id="HC6B3620C77BD43D68920E1757E1150E8"> <enum>(4)</enum> <text>Identify, test, establish, support, and evaluate prevention interventions to reduce oral health disparities.</text> </paragraph>
<paragraph id="H7E4EC800956E4512AAAD2C95FD3FBA95"> <enum>(5)</enum> <text>Promote public awareness and education in support of improvements of oral health.</text> </paragraph>
<paragraph id="HA97DA486B17B46DB8C40798B919DD49C"> <enum>(6)</enum> <text>Support training programs for dental and other health professions needed to strengthen oral health prevention programs.</text> </paragraph>
<paragraph id="HD0877A7FDCAE4648843C35FF19AB2738"> <enum>(7)</enum> <text>Establish, enhance, or expand oral disease prevention and disparity reduction programs.</text> </paragraph>
<paragraph id="H89D718FF15EE45599C59380358BA52A4"> <enum>(8)</enum> <text>Evaluate the progress and effectiveness of the State’s oral disease prevention and disparity reduction program.</text> </paragraph> </subsection>
<subsection id="H3DA68E23D925452F8931DA1EBA4D4081"> <enum>(c)</enum> <header>Authorization of appropriations</header> <text>There is authorized to be appropriated to carry out this section, such sums as may be necessary for fiscal year 2005 and each subsequent fiscal year.</text> </subsection> </section>