[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1606 Introduced in House (IH)]

112th CONGRESS
  1st Session
                                H. R. 1606

  To amend title XIX of the Social Security Act to require States to 
 provide oral health services to aged, blind, or disabled individuals 
          under the Medicaid Program, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 15, 2011

  Mr. Engel (for himself and Ms. Schakowsky) introduced the following 
    bill; which was referred to the Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
  To amend title XIX of the Social Security Act to require States to 
 provide oral health services to aged, blind, or disabled individuals 
          under the Medicaid Program, and for other purposes.

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

SECTION 1. SHORT TITLE; FINDINGS.

    (a) Short Title.--This Act may be cited as the ``Special Care 
Dentistry Act of 2011''.
    (b) Findings.--Congress finds the following:
            (1) According to the United States Surgeon General's Report 
        on Oral Health in America:
                    (A) No less than a silent epidemic of oral diseases 
                is affecting our most vulnerable citizens, including 
                low income elderly, individuals with disabilities, and 
                many members of racial and ethnic minority groups.
                    (B) Oral diseases and conditions affect health and 
                well-being throughout life. The burden of oral problems 
                is extensive and may be particularly severe in 
                vulnerable populations.
                    (C) Oral diseases and conditions are associated 
                with other health problems. Associations between 
                chronic oral infections and other health problems, 
                including diabetes, heart disease, and adverse 
                pregnancy outcomes have been reported.
            (2) Providing appropriate and necessary oral health 
        benefits under Medicaid to individuals classified as aged, 
        blind, or disabled would prevent unnecessary emergency room 
        visits, hospitalizations, and downstream health care costs, 
        reducing Medicaid spending.
            (3) While 28 percent of the people enrolled in Medicaid are 
        aged, blind, or disabled, the high cost of medical expenditures 
        for these populations consumes 72 percent of the total Medicaid 
        budget. This is not the case with dental benefits.
            (4) For the aged, blind, or disabled, oral health services 
        are deemed ``optional'' by the Federal Government and most 
        States provide little to no Medicaid coverage for these 
        services. Many of these vulnerable citizen's mouths are 
        infected with no hope of receiving access to even basic dental 
        care.
            (5) In 2003, adult aged, blind, and disabled Medicaid 
        recipients received basic oral health services in only 6 States 
        (Connecticut, New Jersey, New York, North Dakota, Pennsylvania, 
        and Wisconsin).
            (6) Appropriate and necessary oral health services for 
        adult aged, blind, and disabled people will help reduce not 
        only Medicaid costs for these populations, but also downstream 
        Medicare expenditures, which together total almost 
        $600,000,000,000 annually.
            (7) Dental office overhead averages over 65 percent. 
        Unfortunately, Medicaid reimbursement rates fall far short of 
        covering these expenses.
            (8) Additional Federal investment for the delivery of oral 
        health services is needed to ensure vulnerable adults receive 
        oral health benefits.
            (9) Investments are needed for an oral health initiative to 
        reduce the profound disparities in oral health by improving the 
        health status of vulnerable populations to the level of health 
        status that is enjoyed by the majority of Americans.

SEC. 2. REQUIREMENT TO PROVIDE AGED, BLIND, OR DISABLED INDIVIDUALS 
              WITH ORAL HEALTH SERVICES UNDER THE MEDICAID PROGRAM.

    (a) In General.--Title XIX of the Social Security Act (42 U.S.C. 
1396 et seq.) is amended by inserting after section 1943 the following 
new section:

    ``oral health services for aged, blind, or disabled individuals

    ``Sec. 1944.  (a) Services Under a State Adult Dental Program for 
Aged, Blind, or Disabled Individuals.--A State shall provide oral 
health coverage for aged, blind, or disabled individuals described in 
subsection (b) through a separate State adult dental program. The State 
shall demonstrate that the services and fees provided and program 
requirements under this section are at least equivalent to the 
services, fees, and requirements that are provided to children under 
this title and include age-appropriate services for such individuals, 
and that the services are provided at intervals to determine the 
existence of a suspected illness or condition consistent with 
reasonable standards of dental practice (taking into account the 
increased needs and oral health complexities of the population) as 
determined by the Secretary after consultation with national 
professional dental organizations.
    ``(b) Aged, Blind, or Disabled Individuals Described.--For purposes 
of subsection (a), an aged, blind, or disabled individual described in 
this subsection is an individual--
            ``(1) who is eligible for medical assistance under 
        subclause (I) or (II) of section 1902(a)(10)(A)(i) (but only, 
        in the case of subclause (I), with respect to an individual who 
        is so eligible on the basis of receiving aid or assistance 
        under any plan of the State approved under title I, X, XIV, or 
        XVI); and
            ``(2) who would be considered an aged, blind, or disabled 
        individual under section 1614 (without regard to whether the 
        individual satisfies the income and resource requirements for 
        receiving supplemental security income benefits under title 
        XVI) and is otherwise eligible for medical assistance under the 
        State plan or under a waiver of such plan.
    ``(c) Transportation.--The State shall provide transportation for 
aged, blind, or disabled individuals described in subsection (b) to 
dental offices, hospitals, clinics, or other treatment centers for the 
provision of oral health services to the same extent that 
transportation is provided under the State plan for children eligible 
for medical assistance.''.
    (b) Definition of Oral Health Services.--
            (1) In general.--Section 1905 of the Social Security Act 
        (42 U.S.C. 1396d) is amended--
                    (A) in subsection (a), by amending paragraph (10) 
                to read as follows:
            ``(10) oral health services (as defined in subsection 
        (ee)); and''; and
                    (B) by adding at the end the following:
    ``(ee)(1) For purposes of this title, the term `oral health 
services' means--
            ``(A) relief of pain and infections;
            ``(B) restoration or replacement of teeth;
            ``(C) periodontal treatment;
            ``(D) dental health preventive services, including adult 
        fluoride application;
            ``(E) in-patient and out-patient dental surgical, 
        evaluation, and examination services;
            ``(F) dentures or partial denture care;
            ``(G) per patient house call and long term care facility 
        visits;
            ``(H) sedation and anesthesia; and
            ``(I) behavior management services.
    ``(2) For the purpose of this subsection:
            ``(A) The term `long term care facility' means--
                    ``(i) a nursing facility;
                    ``(ii) an assisted living facility or a resident 
                care program facility (as such terms are defined by the 
                Secretary);
                    ``(iii) a board and care facility (as defined in 
                section 1903(q)(4)(B), including a mental retardation 
                group home);
                    ``(iv) an intermediate care facility for the 
                mentally retarded; and
                    ``(v) any other facility that is licensed or 
                certified by the State and is determined appropriate by 
                the Secretary, such as a community mental health center 
                that meets the requirements of section 1913(c) of the 
                Public Health Service Act, a psychiatric health 
                facility, and a mental health rehabilitation center.
            ``(B) The term `house call' means the delivery of dental 
        services in long term care facilities needed to overcome 
        mobility impairments and transportation barriers.
            ``(C) The term `behavior management' means services needed 
        to accommodate physical or behavioral impairment.''.
    (c) Conforming Amendments.--
            (1) Terminology.--Section 1902(a)(43)(D)(iii) of the Social 
        Security Act (42 U.S.C. 1396a(a)(43)(D)(iii)) is amended by 
        striking ``dental'' and inserting ``oral health'' each place it 
        appears.
            (2) State plan.--Section 1902(a) of such Act (42 U.S.C. 
        1396a(a)) is amended--
                    (A) in paragraph (82), by striking ``and'' at the 
                end;
                    (B) in paragraph (83), by striking the period at 
                the end and inserting ``; and''; and
                    (C) by inserting after paragraph (83) the 
                following:
            ``(84) provide for--
                    ``(A) making oral health services available to 
                aged, blind, or disabled individuals described in 
                subsection (b) of section 1944 in accordance with the 
                requirements of that section;
                    ``(B) informing all persons in the State who are 
                aged, blind, or disabled and have been determined to be 
                eligible for medical assistance including oral health 
                services (as defined in section 1905(ee)), of the 
                availability of such services;
                    ``(C) providing or arranging for the provision of 
                such services in all cases where they are requested;
                    ``(D) arranging for (directly or through referral 
                to appropriate agencies, organizations, or individuals) 
                corrective treatment the need for which is disclosed by 
                such services; and
                    ``(E) reporting to the Secretary (in a uniform form 
                and manner established by the Secretary, by aged, 
                blind, or disabled group and by basis of eligibility 
                for medical assistance, and by not later than April 1 
                after the end of each fiscal year, beginning with 
                fiscal year 2012) the information relating to oral 
                health services provided under the plan during each 
                fiscal year consisting of--
                            ``(i) the number of aged, blind, or 
                        disabled individuals who reside in the State;
                            ``(ii) the number of aged, blind, or 
                        disabled individuals provided oral health 
                        services;
                            ``(iii) the number of such individuals 
                        referred for corrective treatment (the need for 
                        which is disclosed by such services);
                            ``(iv) the amount of, and type of, 
                        preventive oral health services needed and 
                        provided;
                            ``(v) the amount of, and type of, surgical 
                        restorative oral health services needed and 
                        provided; and
                            ``(vi) the amount of, and type of, other 
                        oral health services needed and provided, 
                        disaggregated into whether the services were--
                                    ``(I) emergency;
                                    ``(II) preventive;
                                    ``(III) surgical;
                                    ``(IV) restorative;
                                    ``(V) periodontal;
                                    ``(VI) endodontic; or
                                    ``(VII) prosthodontic.''.
            (3) Nursing facilities.--Section 1919(b)(4)(A)(vi) of such 
        Act (42 U.S.C. 1396r(b)(4)(A)(vi)) is amended by inserting, 
        ``oral health services (as defined in section 1905(ee)) for an 
        aged, blind, or disabled individual described in section 
        1944(b) who is a resident of the nursing facility,'' after 
        ``plan)''.
    (d) Federal Funding for Cost of Covering Aged, Blind, or 
Disabled.--Section 1905 of the Social Security Act (42 U.S.C. 1396d), 
as amended by subsection (b)(1), is amended--
            (1) in subsection (b), in the first sentence, by inserting 
        ``subsection (ee) and'' before ``section 1933(d)''; and
            (2) by adding at the end the following new subsection:
    ``(ff) Increased FMAP for Medical Assistance for Aged, Blind, and 
Disabled Individuals.--The Federal medical assistance percentage 
determined for a State that is one of the 50 States or the District of 
Columbia for each fiscal year with respect to amounts expended for 
medical assistance for aged, blind and disabled individuals described 
in section 1944(b) shall be equal to 100 percent.''.
    (e) Effective Date.--
            (1) In general.--Except as provided in paragraph (2), the 
        amendments made by this section shall apply to calendar 
        quarters beginning on or after October 1, 2011, without regard 
        to whether or not final regulations to carry out such 
        amendments have been promulgated by such date.
            (2) Delay permitted for state plan amendment.--In the case 
        of a State plan for medical assistance under title XIX of the 
        Social Security Act which the Secretary of Health and Human 
        Services determines requires State legislation (other than 
        legislation appropriating funds) in order for the plan to meet 
        the additional requirements imposed by the amendments made by 
        this section, the State plan shall not be regarded as failing 
        to comply with the requirements of such title solely on the 
        basis of its failure to meet these additional requirements 
        before the first day of the first calendar quarter beginning 
        after the close of the first regular session of the State 
        legislature that begins after the date of enactment of this 
        Act. For purposes of the previous sentence, in the case of a 
        State that has a 2-year legislative session, each year of such 
        session shall be deemed to be a separate regular session of the 
        State legislature.
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