[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[S. 1522 Introduced in Senate (IS)]

113th CONGRESS
  1st Session
                                S. 1522

 To improve access to oral health care for vulnerable and underserved 
                              populations.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           September 18, 2013

Mr. Sanders (for himself and Mr. Schatz) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
 To improve access to oral health care for vulnerable and underserved 
                              populations.

    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 ``Comprehensive Dental Reform Act of 
2013''.

SEC. 2. TABLE OF CONTENTS.

    The table of contents of this Act is as follows:

Sec. 1. Short title.
Sec. 2. Table of contents.
Sec. 3. Findings.
                     TITLE I--MEDICARE AND MEDICAID

                          Subtitle A--Medicare

Sec. 101. Coverage of dental services under the Medicare program.
                          Subtitle B--Medicaid

Sec. 111. Coverage of dental services under the Medicaid program.
                    TITLE II--PUBLIC HEALTH PROGRAMS

               Subtitle A--National Health Service Corps

Sec. 201. National Health Service Corps.
Sec. 202. Community based dental residencies.
                   Subtitle B--Oral Health Education

Sec. 211. Authorization of appropriations for oral health education for 
                            medical providers.
Sec. 212. Oral health education for other non-health professionals.
Sec. 213. Dental education.
Sec. 214. Oral health professional student loans.
                 Subtitle C--Other Oral Health Programs

Sec. 221. Access points.
Sec. 222. Dental clinics in schools.
Sec. 223. Emergency room care coordination.
Sec. 224. Research funding.
Sec. 225. Mobile and portable dental services.
    Subtitle D--Oral Health Services as an Essential Health Benefit

Sec. 231. Oral health services as an essential health benefit.
  TITLE III--DEPARTMENT OF VETERANS AFFAIRS AND DEPARTMENT OF DEFENSE 
                                MATTERS

           Subtitle A--Department of Veterans Affairs Matters

Sec. 301. Requiring the Secretary of Veterans Affairs to furnish dental 
                            care in the same manner as any other 
                            medical service.
Sec. 302. Demonstration program on training and employment of 
                            alternative dental health care providers 
                            for dental health care services for 
                            veterans in rural and other underserved 
                            communities.
               Subtitle B--Department of Defense Matters

Sec. 311. Demonstration program on training and employment of 
                            alternative dental health care providers 
                            for dental health care services for members 
                            of the Armed Forces and dependents lacking 
                            ready access to such services.
                  TITLE IV--FEDERAL BUREAU OF PRISONS

Sec. 401. Demonstration program on training and employment of 
                            alternative dental health care providers 
                            for dental health care services for 
                            prisoners within the custody of the Bureau 
                            of Prisons.
                     TITLE V--INDIAN HEALTH SERVICE

Sec. 501. Demonstration program on training and employment of 
                            alternative dental health care providers 
                            for dental health care services under the 
                            Indian Health Service.
                     TITLE VI--REPORTS TO CONGRESS

Sec. 601. Evaluation of expansion of coverage for dental services.

SEC. 3. FINDINGS.

    Congress makes the following findings:
            (1) The United States must establish a nationwide and 
        comprehensive approach to address the lack of access to needed 
        dental care and reduce oral health disparities.
            (2) Since 2000, when the Surgeon General of the United 
        States called dental disease a ``silent epidemic'', there has 
        been increasing but still insufficient attention given to 
        addressing oral health issues. The Healthy People 2020 
        initiative includes oral health as a leading health indicator 
        for the first time in the history of the Healthy People 
        program, and in 2011, the Institute of Medicine published 2 
        reports, ``Improving Access to Oral Health Care for Vulnerable 
        and Underserved Populations'' and ``Advancing Oral Health in 
        America'', that focused on oral health.
            (3) Dental caries, commonly known as cavities, are the most 
        common chronic disease for children in the United States. 
        Additionally, 25 percent of American adults who have attained 
        65 years of age have lost all of their teeth.
            (4) Untreated oral health problems contribute to an 
        increased risk for serious medical conditions such as diabetes, 
        hospital-acquired pneumonia, and poor birth outcomes.
            (5) According to a report by the Surgeon General of the 
        United States, students miss more than 51,000,000 hours of 
        school and employed adults lose more than 164,000,000 hours of 
        work each year due to dental disease and dental visits.
            (6) While the lack of access to oral health services is a 
        national problem, those who are most likely to remain 
        underserved are individuals with low incomes, racial and ethnic 
        minorities, pregnant women, older adults, individuals with 
        special needs, and individuals living in rural communities.
            (7) More than 1 in 4 Americans do not have dental health 
        insurance which is far greater than the number of individuals 
        who lack general health insurance.
            (8) The Medicare program and the Department of Veterans 
        Affairs do not provide dental coverage to the majority of their 
        beneficiaries, and States can elect whether to provide dental 
        coverage to adults under the Medicaid program.
            (9) Only 20 percent of practicing dentists in the United 
        States provide care to individuals enrolled in Medicaid, and a 
        very small percentage of dentists devote a substantial part of 
        their practice towards caring for individuals who are 
        underserved.
            (10) The United States spends more than $100,000,000,000 on 
        dental care and that number is expected to rise to nearly 
        $170,000,000,000 by 2020. Over $30,000,000,000 dollars was 
        spent out-of-pocket for dental services in 2008.
            (11) The lack of access to oral health services results in 
        higher health care expenditures. In 2009, there were over 
        830,000 visits to emergency rooms across the United States for 
        preventable dental conditions, which is 16 percent higher than 
        in 2006. The treatment of dental conditions in hospital 
        emergency rooms in 2010 cost as much as $2,100,000,000.

                     TITLE I--MEDICARE AND MEDICAID

                          Subtitle A--Medicare

SEC. 101. COVERAGE OF DENTAL SERVICES UNDER THE MEDICARE PROGRAM.

    (a) Coverage.--Section 1861(s)(2) of the Social Security Act (42 
U.S.C. 1395x(s)(2)) is amended--
            (1) in subparagraph (EE), by striking ``and'' after the 
        semicolon at the end;
            (2) in subparagraph (FF), by adding ``and'' after the 
        semicolon at the end; and
            (3) by adding at the end the following new subparagraph:
            ``(GG) dental services (as defined in subsection (iii));''.
    (b) Dental Services Defined.--Section 1861(s) of the Social 
Security Act (42 U.S.C. 1395x(s)) is amended by adding at the end the 
following new subsection:

                           ``Dental Services

    ``(iii)(1) The term `dental services' means oral health services 
(as defined by the Secretary) provided by a licensed oral health care 
provider that are necessary to prevent disease and promote oral health, 
restore oral structures to health and function, and treat emergency 
conditions.
    ``(2) For purposes of paragraph (1), such term shall include mobile 
and portable oral health services (as defined by the Secretary) that--
            ``(A) are provided for the purpose of overcoming mobility, 
        transportation, and access barriers for individuals; and
            ``(B) satisfy the standards and certification requirements 
        established under section 1902(a)(84)(B) for the State in which 
        the services are provided.''.
    (c) Payment and Coinsurance.--Section 1833(a)(1) of the Social 
Security Act (42 U.S.C. 1395l(a)(1)) is amended--
            (1) by striking ``and'' before ``(Z)''; and
            (2) by inserting before the semicolon at the end the 
        following: ``, and (AA) with respect to dental services (as 
        defined in section 1861(iii)), the amount paid shall be (i) in 
        the case of such services that are dental health preventive 
        services described in paragraph (1)(D) of such section, 100 
        percent of the lesser of the actual charge for the services or 
        the amount determined under the payment basis determined under 
        section 1848, and (ii) in the case of all other such services, 
        80 percent of the lesser of the actual charge for the services 
        or the amount determined under the payment basis determined 
        under section 1848''.
    (d) Payment Under Physician Fee Schedule.--Section 1848(j)(3) of 
the Social Security Act (42 U.S.C. 1395w-4(j)(3)) is amended by 
inserting ``(2)(GG),'' after ``risk assessment),''.
    (e) Dentures.--Section 1861(s)(8) of the Social Security Act (42 
U.S.C. 1395x(s)(8)) is amended--
            (1) by striking ``(other than dental)'' and inserting 
        ``(including dentures)''; and
            (2) by striking ``internal body''.
    (f) Repeal of Ground for Exclusion.--Section 1862(a) of the Social 
Security Act (42 U.S.C. 1395y) is amended by striking paragraph (12).
    (g) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after January 1, 2014.

                          Subtitle B--Medicaid

SEC. 111. COVERAGE OF DENTAL SERVICES UNDER THE MEDICAID PROGRAM.

    (a) In General.--Section 1905 of the Social Security Act (42 U.S.C. 
1396d) is amended--
            (1) in subsection (a)(10), by adding ``(as described in 
        subsection (ee)(1))'' after ``dental services''; and
            (2) by adding at the end the following:
    ``(ee)(1) Subject to paragraphs (2) and (3), for purposes of this 
title, the term `dental services' means oral health services (as 
defined by the Secretary) provided by a licensed oral health care 
provider that are necessary to prevent disease and promote oral health, 
restore oral structures to health and function, and treat emergency 
conditions.
    ``(2) For purposes of paragraph (1), such term shall include--
            ``(A) dentures; and
            ``(B) mobile and portable oral health services (as defined 
        by the Secretary) that--
                    ``(i) are provided for the purpose of overcoming 
                mobility, transportation, and access barriers for 
                individuals; and
                    ``(ii) satisfy the standards and certification 
                requirements established under section 1902(a)(82)(C) 
                for the State in which the services are provided.
    ``(3) For purposes of paragraph (1), such term shall not apply to 
dental care or services provided to individuals under the age of 21 
under subsection (r)(3).''.
    (b) Conforming Amendments.--
            (1) State plan requirements.--Section 1902(a) of such Act 
        (42 U.S.C. 1396a(a)) is amended--
                    (A) in paragraph (10)(A), in the matter preceding 
                clause (i), by inserting ``(10),'' after ``(5),'';
                    (B) in paragraph (80), by striking ``and'' at the 
                end;
                    (C) in paragraph (81), by striking the period at 
                the end and inserting ``; and''; and
                    (D) by inserting after paragraph (81) the 
                following:
            ``(82) provide for--
                    ``(A) informing, in writing, all individuals who 
                have been determined to be eligible for medical 
                assistance of the availability of dental services (as 
                defined in section 1905(ee));
                    ``(B) conducting targeted outreach to pregnant 
                women who have been determined to be eligible for 
                medical assistance about the availability of medical 
                assistance for such dental services and the importance 
                of receiving dental care while pregnant; and
                    ``(C) establishing and maintaining standards for 
                and certification of mobile and portable oral health 
                services (as described in subsections (r)(3)(C) and 
                (ee)(2)(B) of section 1905).''.
            (2) Definition of medical assistance.--Section 1905(a)(12) 
        of such Act (42 U.S.C. 1396d(a)(12)) is amended by striking ``, 
        dentures,''.
    (c) Mobile and Portable Oral Health Services Under EPSDT.--Section 
1905(r)(3) of the Social Security Act (42 U.S.C. 1396d(r)(3)) is 
amended--
            (1) in subparagraph (A)(ii), by striking ``; and'' and 
        inserting a semicolon;
            (2) in subparagraph (B), by striking the period at the end 
        and inserting ``; and''; and
            (3) by adding at the end the following new subparagraph:
            ``(C) which shall include mobile and portable oral health 
        services (as defined by the Secretary) that--
                    ``(i) are provided for the purpose of overcoming 
                mobility, transportation, or access barriers for 
                children; and
                    ``(ii) satisfy the standards and certification 
                requirements established under section 1902(a)(82)(C) 
                for the State in which the services are provided.''.
    (d) Increased Federal Funding for Dental Services.--
            (1) In general.--Section 1905 of the Social Security Act 
        (42 U.S.C. 1396d), as amended by subsection (a), is amended--
                    (A) in subsection (b), in the first sentence, by 
                striking ``and (aa)'' and inserting ``(aa), and (ff)''; 
                and
                    (B) by adding at the end the following new 
                subsection:
    ``(ff) Increased FMAP for Dental Services.--
            ``(1) In general.--Notwithstanding subsection (b) and 
        section 1903(a)(7) and subject to the requirements described in 
        paragraphs (3) and (4), with respect to amounts expended on or 
        after January 1, 2014, for covered dental expenses (as 
        described in paragraph (2)), the Federal medical assistance 
        percentage for a State that is one of the 50 States or the 
        District of Columbia for such expenses shall be equal to the 
        Federal medical assistance percentage that would otherwise 
        apply to the State for the fiscal year, as determined under 
        subsection (b) or section 1903(a)(7), increased by 15 
        percentage points.
            ``(2) Covered dental expenses.--For purposes of paragraph 
        (1), the term `covered dental expenses' means the amounts 
        expended for medical assistance for dental services (as 
        described in subsection (ee)) and amounts expended for the 
        proper and efficient administration of the provision of such 
        dental services under the State plan.
            ``(3) Requirements.--For purposes of paragraph (1), the 
        Federal medical assistance percentage applicable to covered 
        dental expenses under this subsection shall not apply to a 
        State unless--
                    ``(A) the State plan for medical assistance 
                provides payment for dental services (as so defined) 
                furnished by a dental provider at a rate that is not 
                less than 70 percent of the usual and customary fee for 
                such services in the State; and
                    ``(B) the State satisfies such additional 
                requirements as are established by the Secretary, which 
                shall include--
                            ``(i) streamlining of administrative 
                        procedures for purposes of ensuring adequate 
                        provider participation and increasing patient 
                        utilization of dental services; and
                            ``(ii) the provision of technical 
                        assistance to dental providers designed to 
                        reduce the number of missed patient 
                        appointments and reduce other barriers to the 
                        delivery of oral health services.
            ``(4) Limitation.--For purposes of amounts expended for 
        covered dental services, in no case shall any increase under 
        this subsection result in a Federal medical assistance 
        percentage that exceeds 100 percent.''.
            (2) Conforming amendment.--Section 1903(a)(7) of the Social 
        Security Act (42 U.S.C. 1396b(a)(7)) is amended by striking 
        ``section 1919(g)(3)(B)'' and inserting ``sections 1905(ff) and 
        1919(g)(3)(B)''.
    (e) Secretarial Responsibilities.--
            (1) Technical assistance and outreach.--The Secretary of 
        Health and Human Services, acting through the Administrator of 
        the Centers for Medicare & Medicaid Services, shall provide 
        technical assistance to States and conduct outreach to States 
        for purposes of educating and encouraging States to utilize and 
        provide payment under each State Medicaid program for 
        telehealth-enabled dental services in order to provide dental 
        services to traditionally underserved populations in need of 
        such services.
            (2) Database and annual report on dental benefits for adult 
        medicaid enrollees.--
                    (A) Medicaid dental benefits database.--The 
                Secretary of Health and Human Services, acting through 
                the Administrator of the Centers for Medicare & 
                Medicaid Services, shall maintain, as accurately and 
                up-to-date as possible, a database that contains with 
                respect to the each State (as defined for purposes of 
                title XIX of the Social Security Act (42 U.S.C. 1396 et 
                seq.)) information regarding the dental benefits 
                available for adults enrolled in the State Medicaid 
                program, including any limits on such benefits and the 
                amount of reimbursement provided under the State 
                Medicaid program for such benefits. The database also 
                shall include a separate description of the dental 
                benefits, benefit limits, and amount of reimbursement 
                provided under each State Medicaid program for pregnant 
                women, if such benefits are not provided to the woman 
                as part of early and periodic screening, diagnostic, 
                and treatment services (as defined in section 1905(r) 
                of the Social Security Act (42 U.S.C. 1396d(r))), and a 
                description of the use of dental services by children 
                and adults enrolled in the State Medicaid program.
                    (B) Annual report.--The Secretary of Health and 
                Human Services shall make available to the public an 
                annual report regarding the information collected in 
                the database required under subparagraph (A). Each 
                annual report under this subparagraph shall include for 
                each State Medicaid program and with respect to the 
                most recent year for which data are available the 
                yearly dental service utilization rates for children 
                and adults enrolled in the State Medicaid program.
    (f) 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 January 1, 2014, 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.

                    TITLE II--PUBLIC HEALTH PROGRAMS

               Subtitle A--National Health Service Corps

SEC. 201. NATIONAL HEALTH SERVICE CORPS.

    (a) In General.--Section 331 of the Public Health Service Act (42 
U.S.C. 254d) is amended--
            (1) in subsection (a)(3), by adding at the end the 
        following:
                    ``(F) The term `dental therapist' means, with 
                respect to a State that licenses such dental 
                therapists, a mid-level dental practitioner who is 
                licensed to practice under the law of the State and who 
                provides preventive and restorative services directly 
                to the public, commensurate with the scope of the 
                practice.''; and
            (2) in subsection (b)--
                    (A) in paragraph (1), by inserting ``, dental 
                therapy,'' after ``dental''; and
                    (B) in paragraph (2), by inserting ``dental 
                therapists,'' after ``dentists,''.
    (b) Facilitation of Effective Provision of Corps Services.--Section 
336(f)(3) of the Public Health Service Act (42 U.S.C. 254h-1(f)(3)) is 
amended by inserting ``dental therapists'' after ``midwives,''.
    (c) Scholarship Program and Loan Repayment Program.--
            (1) Scholarship program.--Section 338A of the Public Health 
        Service Act (42 U.S.C. 254l) is amended--
                    (A) in subsection (a)(1), by inserting ``dental 
                therapists,'' after ``dentists,''; and
                    (B) in subsection (b)(1), by inserting ``including 
                dental therapy,'' after ``or other health 
                profession,''.
            (2) Loan repayment program.--Section 338B of the Public 
        Health Service Act (42 U.S.C. 254l-1) is amended--
                    (A) in subsection (a)(1), by inserting ``dental 
                therapists,'' after ``dentists,''; and
                    (B) in subsection (b)(1)--
                            (i) in subparagraph (A), by inserting 
                        ``dental therapist,'' after ``nurse 
                        practitioner,'';
                            (ii) in subparagraph (B), by inserting 
                        ``dental therapy,'' after ``mental health,''; 
                        and
                            (iii) in subparagraph (C)(ii), by inserting 
                        ``, including dental therapy,'' after ``health 
                        profession''.
            (3) Authorization of appropriations.--Section 338H of the 
        Public Health Service Act (42 U.S.C. 254q) is amended--
                    (A) in subsection (a), by striking ``this section'' 
                and inserting ``this subpart''; and
                    (B) by adding at the end the following:
    ``(d) Authorization of Appropriations With Respect to Oral Health 
Professionals.--To carry out this subpart with respect to dentists, 
dental therapists, and dental hygienists, in addition to the amounts 
authorized under subsection (a), there is authorized to be appropriated 
such sums as may be necessary for fiscal years 2014 through 2017, which 
shall be used to provide an emergency expansion for scholarships to, 
and loan repayments on behalf of, such oral health professionals.''.

SEC. 202. COMMUNITY BASED DENTAL RESIDENCIES.

    Section 340H of the Public Health Service Act (42 U.S.C. 256h) is 
amended by adding at the ending the following:
    ``(k) Additional Funding.--For the purpose of expanding the program 
under this section, there is authorized to be appropriated such sums as 
may be necessary for the 5-year period beginning with the fiscal year 
that begins not less than 1 year and not more than 2 years after the 
date of enactment of the Comprehensive Dental Reform Act of 2013''.

                   Subtitle B--Oral Health Education

SEC. 211. AUTHORIZATION OF APPROPRIATIONS FOR ORAL HEALTH EDUCATION FOR 
              MEDICAL PROVIDERS.

    Section 747(c) of the Public Health Service Act (42 U.S.C. 293k(c)) 
is amended by adding at the end the following:
            ``(4) Oral health education.--In addition to other amounts 
        authorized under this subsection for purposes of carrying out 
        this section, there is authorized to be appropriated such sums 
        as may be necessary for fiscal years 2014 through 2017 for the 
        purpose of educating nondental medical professionals, including 
        physicians, nurses, nurse practitioners, physician assistants, 
        and pharmacists, about oral health, including issues such as 
        oral hygiene instruction, topical application of fluoride, and 
        oral health screenings, with the goal of integrating oral 
        health care into overall health care.''.

SEC. 212. ORAL HEALTH EDUCATION FOR OTHER NON-HEALTH PROFESSIONALS.

    Subpart I of part C of title VII of the Public Health Service Act 
(42 U.S.C. 293k et seq.) is amended by inserting after section 748 the 
following:

``SEC. 748A. ORAL HEALTH EDUCATION FOR OTHER NON-ORAL HEALTH 
              PROFESSIONALS.

    ``(a) In General.--The Secretary may make grants to, or enter into 
contracts with, an accredited public or nonprofit private hospital, an 
educational institution, or a public or private nonprofit entity which 
the Secretary has determined is capable of carrying out such grant or 
contract to educate individuals, such as community health workers, 
social workers, nutritionists, health educators, occupational 
therapists, and psychologists, to promote oral health education and 
literacy and to provide support for behavior change and assistance with 
care coordination with respect to oral health.
    ``(b) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated such sums as may be necessary 
for fiscal years 2014 through 2017.''.

SEC. 213. DENTAL EDUCATION.

    Section 748 of the Public Health Service Act (42 U.S.C. 293k-2) is 
amended--
            (1) in subsection (a)(1)(H), by striking ``pediatric 
        training programs'' and inserting ``pediatric dental training 
        programs''; and
            (2) in subsection (c)--
                    (A) by striking the subsection heading and 
                inserting ``Requirements for Award.--'';
                    (B) by amending the matter preceding paragraph (1) 
                to read as follows: ``With respect to training provided 
                for under this section, the Secretary shall award 
                grants or contracts only to eligible entities that meet 
                at least 7 of the following criteria:'';
                    (C) in paragraph (2), by striking ``have a record 
                of training the greatest percentage of providers, or 
                that have demonstrated significant improvements in the 
                percentage of providers, who enter and'' and inserting 
                ``train significant numbers of providers who'';
                    (D) in paragraph (3)--
                            (i) by striking ``have a record of 
                        training'' and inserting ``intent to train''; 
                        and
                            (ii) by striking the period at the end and 
                        inserting ``and have faculty with experience in 
                        treating underserved populations.'';
                    (E) in paragraph (8), by inserting ``or have 
                established'' after ``establish''; and
                    (F) by adding at the end the following:
            ``(9) Qualified applicants that require not less than 200 
        hours of community-based education rotations.''.

SEC. 214. ORAL HEALTH PROFESSIONAL STUDENT LOANS.

    Part F of title VII of the Public Health Service Act (42 U.S.C. 
295j) is amended by adding at the end the following:

``SEC. 799C. ORAL HEALTH PROFESSIONAL STUDENT LOANS.

    ``(a) In General.--The Secretary shall establish and operate a 
student loan fund for oral health professional students, including 
dental hygienists, dental therapists, and dentists.
    ``(b) Content.--The Secretary shall establish and operate the 
student loan fund program under subsection (a) in the same manner and 
subject to the same terms as the loan fund program established with 
schools of nursing under section 835.
    ``(c) Authorization of Appropriations.--To carry out this section, 
there are authorized to be appropriated such sums as may be necessary 
for fiscal years 2014 through 2017.''.

                 Subtitle C--Other Oral Health Programs

SEC. 221. ACCESS POINTS.

    Subpart X of part D of title III of the Public Health Service Act 
(42 U.S.C. 256f et seq.) is amended by adding at the end the following:

``SEC. 340G-2. FUNDING FOR ORAL HEALTH SERVICES.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration, shall establish a 
program to award grants to eligible entities to provide oral health 
services, or to contract with private dental practices to provide 
comprehensive oral health services, to low income individuals and 
individuals who are underserved with respect to oral health care.
    ``(b) Technical Assistance.--The Secretary shall provide technical 
assistance to entities receiving grants under subsection (a) to provide 
technical assistance to such entities in order to--
            ``(1) with respect to oral health care services, increase 
        utilization and efficiency and minimize missed appointments, 
        contract with offsite providers, recruit providers (including 
        oral health specialists), and operate programs outside the 
        physical facilities to take advantage of new systems to improve 
        access to oral health services;
            ``(2) address barriers to access to such services and 
        conduct targeted outreach to special populations such as 
        pregnant women, individuals with disabilities, individuals with 
        chronic conditions such as diabetes, and individuals residing 
        in long-term care facilities; or
            ``(3) contract with private dental practices that will 
        provide oral health services other than preventive oral health 
        care, including restoration and maintenance of oral health, in 
        order to meet the need for oral health services in the 
        community.
    ``(c) Eligible Entities.--To be eligible to receive a grant under 
subsection (a), an entity shall--
            ``(1) be--
                    ``(A) a Federally qualified health center (as 
                defined in section 1861(aa) of the Social Security 
                Act);
                    ``(B) a safety net clinic or a free clinic (as 
                defined by the Secretary);
                    ``(C) a health care clinic that provides services 
                to tribal organizations or urban Indian organizations 
                (as such terms are defined in section 4 of the Indian 
                Health Care Improvement Act); or
                    ``(D) any other interested public or private sector 
                health care provider or organization that the Secretary 
                determines has a demonstrated history in serving a high 
                number of uninsured and or low-income individuals or 
                those who lack ready access to oral health services; 
                and
            ``(2) demonstrate a clear need to expand oral health care 
        services beyond preventive oral health care.
    ``(d) Allocation for Hiring Oral Health Care Specialists.--A 
portion of the funds available under this section shall be allocated 
toward hiring oral health care specialists, such as oral surgeons and 
endodontists, at entities receiving grants under this section.
    ``(e) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated such sums as may be necessary 
for each of fiscal years 2014 through 2017.''.

SEC. 222. DENTAL CLINICS IN SCHOOLS.

    Part Q of title III of the Public Health Service Act (42 U.S.C. 
280h et seq.) is amended by adding at the end the following:

``SEC. 399Z-2. DENTAL CLINICS IN SCHOOLS.

    ``(a) In General.--The Secretary shall award grants to qualified 
entities for the purpose of funding the building, operation, or 
expansion of dental clinics in schools.
    ``(b) Qualified Entities.--To receive a grant under this section, a 
qualified entity shall submit an application to the Secretary at such 
time, in such manner, and containing such information as the Secretary 
may require.
    ``(c) Requirements.--An entity receiving a grant under this section 
shall--
            ``(1) provide comprehensive oral health services at a 
        dental clinic based at a school, including oral health 
        education, oral screening, fluoride application, prophylaxis, 
        sealants, and basic restorative services;
            ``(2) develop a coordinated system of care by referring 
        patients to an available qualified oral health provider in the 
        community for any required oral health services not provided in 
        the dental clinic in the school, including restorative 
        services, to ensure that all the oral health needs of students 
        are met; and
            ``(3) maintain clinic hours that extend beyond school 
        hours.
    ``(d) Authorization of Appropriations.--For purposes of carrying 
out this section, there is authorized to be appropriated such sums as 
may be necessary for fiscal years 2014 through 2017.''.

SEC. 223. EMERGENCY ROOM CARE COORDINATION.

    Part B of title III of the Public Health Service Act (42 U.S.C. 243 
et seq.) is amended by adding at the end the following:

``SEC. 320B. EMERGENCY ROOM CARE COORDINATION WITH RESPECT TO DENTAL 
              CARE.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration, shall establish a 
grant program to enable individuals to receive dental care at a 
facility operated by a grant recipient rather than at a hospital 
emergency room.
    ``(b) Eligible Entities.--To be eligible to receive a grant under 
this section an entity shall--
            ``(1) be--
                    ``(A) a Federally qualified health center (as 
                defined in paragraph (4) of section 1861(aa) of the 
                Social Security Act) or rural health clinic (as defined 
                in paragraph (2) of such section);
                    ``(B) a private dental practice; or
                    ``(C) any other interested public or private sector 
                health care provider or organization, such as a dental 
                school, that the Secretary determines has the capacity 
                to serve in a coordinated, cost-effective manner, a 
                high number of individuals who lack access to oral 
                health services; and
            ``(2) partner with a hospital or urgent care center.
    ``(c) Oral Health Education for Primary Care and ER Health Care 
Providers.--The Secretary shall allocate a portion of the amounts 
appropriated under subsection (e) toward medical education for primary 
care and emergency room physicians, nurses, nurse practitioners, 
physician assistants, and nurse practitioners to be trained in oral 
health.
    ``(d) Report.--Not later than January 1, 2017, the Secretary shall 
submit to Congress a report on the best practices determined by the 
program established under this section to address oral health needs of 
individuals who go to emergency rooms in need of oral health care.
    ``(e) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated such sums as may be necessary 
for fiscal years 2014 through 2017.''.

SEC. 224. RESEARCH FUNDING.

    For fiscal years 2014 through 2017, there is authorized to be 
appropriated such sums as may be necessary to each of--
            (1) the Centers for Disease Control and Prevention, for the 
        purpose of conducting research on--
                    (A) the prevention of oral disease;
                    (B) oral disease management; and
                    (C) evidence-based strategies to prevent tooth 
                decay;
            (2) the Agency for Healthcare Research and Quality, for the 
        purpose of conducting--
                    (A) research with respect to oral health services 
                and the delivery of oral health services; and
                    (B) an evaluation of oral health service delivery 
                to underserved and vulnerable populations;
            (3) the National Institute of Dental and Craniofacial 
        Research for the purpose of conducting research on oral health 
        disease management including pharmaceutical-behavioral 
        intervention; and
            (4) the Maternal and Child Health Bureau for the purpose of 
        conducting research on perinatal, postnatal, and childhood oral 
        health issues.

SEC. 225. MOBILE AND PORTABLE DENTAL SERVICES.

    Subpart X of part D of title III of the Public Health Service Act 
(42 U.S.C. 256f et seq.), as amended by section 221, is further amended 
by adding at the end the following:

``SEC. 340G-3. MOBILE AND PORTABLE DENTAL SERVICES.

    ``(a) In General.--The Secretary shall award grants to Federally 
qualified health centers (as defined in paragraph (4) of section 
1861(aa) of the Social Security Act), rural health clinics (as defined 
in paragraph (2) of such section), nonprofit dental clinics, and dental 
schools to provide mobile and portable, comprehensive dental services 
that provide for the restoration or maintenance of oral health and 
function (including dental services provided by licensed providers 
through telehealth-enabled collaboration and supervision) and outreach 
for dental services to underserved populations. Eligible entities shall 
deliver such services at locations such as senior centers, nursing 
homes, assisted living facilities, schools, licensed day care centers 
that serve eligible individuals who receive benefits under the State 
Children's Health Insurance Program under title XXI of the Social 
Security Act (42 U.S.C. 1397aa et seq.) or the Medicaid program under 
title XIX of the Social Security Act (42 U.S.C. 1396 et seq.), and 
facilities that provide services under the Special Supplemental 
Nutrition Program for Women, Infants, and Children (the WIC program) or 
the Head Start Act (42 U.S.C. 9831 et seq.). The Secretary shall award 
the grants to entities that can provide coordinated care and continuity 
of care.
    ``(b) Authorization of Appropriations.--To carry out this section, 
there are authorized to be appropriated such sums as may be 
necessary.''.

    Subtitle D--Oral Health Services as an Essential Health Benefit

SEC. 231. ORAL HEALTH SERVICES AS AN ESSENTIAL HEALTH BENEFIT.

    Section 1302(b)(1) of the Patient Protection and Affordable Care 
Act (42 U.S.C. 18022(b)(1)) is amended by adding at the end the 
following:
                    ``(K) Oral health services.''.

  TITLE III--DEPARTMENT OF VETERANS AFFAIRS AND DEPARTMENT OF DEFENSE 
                                MATTERS

           Subtitle A--Department of Veterans Affairs Matters

SEC. 301. REQUIRING THE SECRETARY OF VETERANS AFFAIRS TO FURNISH DENTAL 
              CARE IN THE SAME MANNER AS ANY OTHER MEDICAL SERVICE.

    (a) In General.--Title 38, United States Code, is amended--
            (1) in section 1701(6), by striking ``as described in 
        sections 1710 and 1712 of this title'';
            (2) in section 1710(c), by striking the second sentence;
            (3) in section 1712--
                    (A) by striking subsections (a) and (b);
                    (B) by redesignating subsections (c), (d), and (e) 
                as subsections (a), (b), and (c), respectively; and
                    (C) in subsection (a), as redesignated by 
                subparagraph (B)--
                            (i) by striking ``Dental appliances'' and 
                        inserting ``The Secretary may furnish dentures, 
                        dental appliances''; and
                            (ii) by striking ``to be furnished by the 
                        Secretary under this section may be procured by 
                        the Secretary'' and inserting ``under this 
                        section and may procure such appliances''; and
            (4) by striking section 2062.
    (b) Conforming Amendments.--Such title is further amended--
            (1) in section 1525(a), by striking ``medicines under 
        section 1712(d)'' and inserting ``medicines under section 
        1712(b)''; and
            (2) in section 1703(a)(7), by striking ``, for a veteran 
        described in section 1712(a)(1)(F) of this title''.
    (c) Clerical Amendments.--Such title is further amended--
            (1) in section 1712, in the heading for such section, by 
        striking ``Dental care'' and inserting ``Appliances'';
            (2) in the table of sections at the beginning of chapter 
        17, by striking the item relating to section 1712 and inserting 
        the following new item:

``1712. Appliances; drugs and medicines for certain disabled veterans; 
                            vaccines.'';
        and
            (3) in the table of sections at the beginning of chapter 
        20, by striking the item relating to section 2062.

SEC. 302. DEMONSTRATION PROGRAM ON TRAINING AND EMPLOYMENT OF 
              ALTERNATIVE DENTAL HEALTH CARE PROVIDERS FOR DENTAL 
              HEALTH CARE SERVICES FOR VETERANS IN RURAL AND OTHER 
              UNDERSERVED COMMUNITIES.

    (a) Demonstration Program Authorized.--The Secretary of Veterans 
Affairs may carry out a demonstration program to establish programs to 
train and employ alternative dental health care providers in order to 
increase access to dental health care services for veterans entitled to 
such services who reside in rural and other underserved communities.
    (b) Telehealth.--For purposes of alternative dental health care 
providers and any other dental care providers who are licensed to 
provide clinical care, dental services provided under the demonstration 
program under this section may be administered by such providers 
through telehealth-enabled collaboration and supervision when deemed 
appropriate and feasible.
    (c) Alternative Dental Health Care Providers Defined.--In this 
section, the term ``alternative dental health care providers'' has the 
meaning given that term in section 340G-1(a)(2) of the Public Health 
Service Act (42 U.S.C. 256g-1(a)(2)).
    (d) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as are necessary to carry out the demonstration 
program under this section.

               Subtitle B--Department of Defense Matters

SEC. 311. DEMONSTRATION PROGRAM ON TRAINING AND EMPLOYMENT OF 
              ALTERNATIVE DENTAL HEALTH CARE PROVIDERS FOR DENTAL 
              HEALTH CARE SERVICES FOR MEMBERS OF THE ARMED FORCES AND 
              DEPENDENTS LACKING READY ACCESS TO SUCH SERVICES.

    (a) Demonstration Program Authorized.--The Secretary of Defense may 
carry out a demonstration program to establish programs to train and 
employ alternative dental health care providers in order to increase 
access to dental health care services for members of the Armed Forces 
and their dependents who lack ready access to such services, including 
the following:
            (1) Members and dependents who reside in rural areas or 
        areas otherwise underserved by dental health care providers.
            (2) Members of the National Guard and Reserves in active 
        status who are potentially deployable.
    (b) Telehealth.--For purposes of alternative dental health care 
providers and any other dental care providers who are licensed to 
provide clinical care, dental services provided under the demonstration 
program under this section may be administered by such providers 
through telehealth-enabled collaboration and supervision when deemed 
appropriate and feasible.
    (c) Alternative Dental Health Care Providers Defined.--In this 
section, the term ``alternative dental health care providers'' has the 
meaning given that term in section 340G-1(a)(2) of the Public Health 
Service Act (42 U.S.C. 256g-1(a)(2)).
    (d) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as are necessary to carry out the demonstration 
program under this section.

                  TITLE IV--FEDERAL BUREAU OF PRISONS

SEC. 401. DEMONSTRATION PROGRAM ON TRAINING AND EMPLOYMENT OF 
              ALTERNATIVE DENTAL HEALTH CARE PROVIDERS FOR DENTAL 
              HEALTH CARE SERVICES FOR PRISONERS WITHIN THE CUSTODY OF 
              THE BUREAU OF PRISONS.

    (a) Demonstration Program Authorized.--The Attorney General, acting 
through the Director of the Bureau of Prisons, may carry out a 
demonstration program to establish programs to train and employ 
alternative dental health care providers in order to increase access to 
dental health services for prisoners within the custody of the Bureau 
of Prisons.
    (b) Telehealth.--For purposes of alternative dental health care 
providers and any other dental care providers who are licensed to 
provide clinical care, dental services provided under the demonstration 
program under this section may be administered by such providers 
through telehealth-enabled collaboration and supervision when deemed 
appropriate and feasible.
    (c) Alternative Dental Health Care Providers Defined.--In this 
section, the term ``alternative dental health care providers'' has the 
meaning given that term in section 340G-1(a)(2) of the Public Health 
Service Act (42 U.S.C. 256g-1(a)(2)).
    (d) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as are necessary to carry out the demonstration 
program under this section.

                     TITLE V--INDIAN HEALTH SERVICE

SEC. 501. DEMONSTRATION PROGRAM ON TRAINING AND EMPLOYMENT OF 
              ALTERNATIVE DENTAL HEALTH CARE PROVIDERS FOR DENTAL 
              HEALTH CARE SERVICES UNDER THE INDIAN HEALTH SERVICE.

    (a) Demonstration Program Authorized.--The Secretary of Health and 
Human Services, acting through the Indian Health Service, may carry out 
a demonstration program to establish programs to train and employ 
alternative dental health care providers in order to help eliminate 
oral health disparities and increase access to dental services through 
health programs operated by the Indian Health Service, Indian tribes, 
tribal organizations, and Urban Indian organizations (as those terms 
are defined in section 4 of the Indian Health Care Improvement Act (25 
U.S.C. 1603)).
    (b) Telehealth.--For purposes of alternative dental health care 
providers and any other dental care providers who are licensed to 
provide clinical care, dental services provided under the demonstration 
program under this section may be administered by such providers 
through telehealth-enabled collaboration and supervision when deemed 
appropriate and feasible.
    (c) Alternative Dental Health Care Providers Defined.--In this 
section, the term ``alternative dental health care providers'' has the 
meaning given that term in section 340G-1(a)(2) of the Public Health 
Service Act (42 U.S.C. 256g-1(a)(2)).
    (d) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as are necessary to carry out the demonstration 
program under this section.

                     TITLE VI--REPORTS TO CONGRESS

SEC. 601. EVALUATION OF EXPANSION OF COVERAGE FOR DENTAL SERVICES.

    (a) Secretary of Health and Human Services.--Not later than October 
1, 2017, the Secretary of Health and Human Services shall submit to 
Congress a report that provides a comprehensive cost-benefit analysis 
regarding the expansion of coverage for dental services pursuant to 
this Act, including whether the provision of such services resulted in 
a reduction in total health care costs for individuals under the 
Medicare and Medicaid programs.
    (b) Comptroller General.--
            (1) Medicaid and medicare.--Not later than January 1, 2017, 
        the Comptroller General of the United States shall submit to 
        Congress a report that provides a comprehensive analysis and 
        evaluation of the implementation and utilization of the 
        expanded coverage for dental services pursuant to this Act for 
        individuals enrolled in the Medicare and Medicaid programs.
            (2) Demonstration programs.--Not later than January 1, 
        2017, the Comptroller General of the United States shall submit 
        to Congress a report that provides a comprehensive analysis and 
        evaluation of the demonstration programs described in sections 
        302, 311, 401, and 501, including--
                    (A) the extent to which the programs improved 
                access to oral health care and increased utilization of 
                oral health services; and
                    (B) an examination of the training provided under 
                the programs to alternative dental health care 
                providers and the quality of care provided by such 
                providers.
                                 <all>