[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 3313 Introduced in Senate (IS)]

<DOC>






115th CONGRESS
  2d Session
                                S. 3313

   To improve dental care provided to veterans by the Department of 
               Veterans Affairs, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             July 31, 2018

  Mr. Sanders introduced the following bill; which was read twice and 
             referred to the Committee on Veterans' Affairs

_______________________________________________________________________

                                 A BILL


 
   To improve dental care provided to veterans by the Department of 
               Veterans Affairs, 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.

    This Act may be cited as the ``Veterans Dental Care Eligibility 
Expansion and Enhancement Act of 2018''.

SEC. 2. RESTORATIVE DENTAL SERVICES FOR VETERANS.

    (a) In General.--Section 1710(c) of title 38, United States Code, 
is amended--
            (1) in the second sentence--
                    (A) by redesignating subparagraphs (A) and (B) as 
                clauses (i) and (ii), respectively; and
                    (B) by redesignating paragraphs (1) and (2) as 
                subparagraphs (A) and (B), respectively;
            (2) by inserting ``(1)'' after ``(c)'';
            (3) by striking ``The Secretary'' and inserting the 
        following:
    ``(2) The Secretary''; and
            (4) by adding at the end the following new paragraph:
    ``(3) In addition to the dental services, treatment, and appliances 
authorized to be furnished by paragraph (2), the Secretary may furnish 
dental services and treatment, and dental appliances, needed to restore 
functioning in a veteran that is lost as a result of any services or 
treatment furnished under this subsection.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
take effect on the date that is one year after the date of the 
enactment of this Act.

SEC. 3. EXPANSION OF DENTAL SERVICES FOR VETERANS EXPOSED TO TOXIC 
              SUBSTANCES, RADIATION, OR OTHER CONDITIONS.

    Section 1712(a)(1) of title 38, United States Code, is amended--
            (1) by redesignating subparagraphs (G) and (H) as 
        subparagraphs (H) and (I), respectively; and
            (2) by inserting after subparagraph (F) the following new 
        subparagraph (G):
            ``(G) from which a veteran entitled to hospital care and 
        medical services under section 1710(a)(2)(F) is suffering;''.

SEC. 4. PILOT PROGRAM ON EXPANSION OF FURNISHING OF DENTAL SERVICES AND 
              TREATMENT TO ALL ENROLLED VETERANS.

    (a) Pilot Program Required.--Commencing not later than 540 days 
after the date of the enactment of this Act, the Secretary of Veterans 
Affairs shall carry out a pilot program to assess the feasibility and 
advisability of furnishing dental services and treatment to veterans 
enrolled in the system of patient enrollment of the Department of 
Veterans Affairs under section 1705 of title 38, United States Code, 
who are not eligible for dental services and treatment, and related 
dental appliances, from the Department under authorities other than 
this section.
    (b) Duration of Pilot Program.--The pilot program shall be carried 
out during the three-year period beginning on the date of the 
commencement of the pilot program.
    (c) Locations.--
            (1) In general.--The Secretary shall carry out the pilot 
        program at not fewer than 16 locations as follows:
                    (A) Four medical centers of the Department of 
                Veterans Affairs with an established dental clinic.
                    (B) Four medical centers of the Department with a 
                contract for the furnishing of dental care.
                    (C) Four community-based outpatient clinics with 
                space available for the furnishing of services and 
                treatment under the pilot program.
                    (D) Four facilities selected from among Federally-
                qualified health centers and facilities of the Indian 
                Health Service with established dental clinics, of 
                which--
                            (i) at least one facility shall be such a 
                        facility of the Indian Health Service; and
                            (ii) any facility of the Indian Health 
                        Service so selected shall be selected in 
                        consultation with the Secretary of Health and 
                        Human Services.
            (2) Considerations.--In selecting locations for the pilot 
        program, the Secretary shall consider the feasibility and 
        advisability of selecting locations in each of the following:
                    (A) Rural areas.
                    (B) Areas that are not in close proximity to an 
                active duty military installation.
                    (C) Areas representing different geographic 
                locations, such as census tracts established by the 
                Bureau of the Census.
    (d) Limitation on Number of Participating Veterans.--
            (1) In general.--The total number of veterans who may 
        participate in the pilot program may not exceed 100,000.
            (2) Distribution of limitation.--In applying the limitation 
        in paragraph (1) to the pilot program, the Secretary shall 
        distribute the limitation across and among locations selected 
        for the pilot program in a manner that takes appropriate 
        account of the size and need of veterans for dental services at 
        each such location.
    (e) Scope of Services.--The dental services and treatment furnished 
to veterans under the pilot program shall be consistent with the dental 
services and treatment furnished by the Secretary to veterans with 
service-connected disabilities rated 100 percent disabling under the 
laws administered by the Secretary.
    (f) Voluntary Participation.--The participation of a veteran in the 
pilot program shall be at the election of the veteran.
    (g) Copayments.--
            (1) In general.--The Secretary may collect copayments for 
        dental services and treatment furnished under the pilot program 
        in accordance with authorities on the collection of copayments 
        for medical care of veterans under chapter 17 of title 38, 
        United States Code.
            (2) Limitation.--The amounts of copayments authorized under 
        paragraph (1) may not exceed the amounts allowed for medical 
        care under such chapter.
    (h) Program Administration.--
            (1) Notice to eligible veterans on pilot program.--In 
        carrying out the pilot program, the Secretary shall inform all 
        veterans eligible to participate in the pilot program of the 
        services and treatment available under the pilot program.
            (2) Contracts.--
                    (A) In general.--In carrying out the pilot program, 
                the Secretary may enter into contracts with appropriate 
                entities for the provision of dental services and 
                treatment under the pilot program.
                    (B) Performance standards and metrics.--Each 
                contract entered into under subparagraph (A) shall 
                specify performance standards and metrics and processes 
                for ensuring compliance of the contractor concerned 
                with such performance standards.
    (i) Reports.--
            (1) Preliminary reports.--
                    (A) In general.--Not later than each of 540 days 
                and three years after the date of the commencement of 
                the pilot program, the Secretary shall submit to the 
                Committee on Veterans' Affairs of the Senate and the 
                Committee on Veterans' Affairs of the House of 
                Representatives a report on the pilot program.
                    (B) Contents.--Each report under subparagraph (A) 
                shall include the following:
                            (i) A description of the implementation and 
                        operation of the pilot program.
                            (ii) The number of veterans receiving 
                        services and treatment under the pilot program, 
                        and a description of the dental services and 
                        treatment furnished to such veterans.
                            (iii) An analysis of the costs and benefits 
                        of the pilot program, including a comparison of 
                        costs and benefits by location type.
                            (iv) An assessment of the impact of the 
                        pilot program on medical care, wellness, 
                        employability, and perceived quality of life of 
                        veterans.
                            (v) The current findings and conclusions of 
                        the Secretary with respect to the pilot 
                        program.
                            (vi) Such recommendations for the 
                        continuation or expansion of the pilot program 
                        as the Secretary considers appropriate.
            (2) Final report.--
                    (A) In general.--Not later than 180 days after the 
                completion of the pilot program, the Secretary shall 
                submit to the Committee on Veterans' Affairs of the 
                Senate and the Committee on Veterans' Affairs of the 
                House of Representatives a report on the pilot program.
                    (B) Contents.--The report under subparagraph (A) 
                shall include the following:
                            (i) The findings and conclusions of the 
                        Secretary with respect to the pilot program.
                            (ii) Such recommendations for the 
                        continuation or expansion of the pilot program 
                        as the Secretary considers appropriate.
    (j) Federally-Qualified Health Center Defined.--In this section the 
term ``Federally-qualified health center'' has the meaning given that 
term in section 1905(l)(2)(B) of the Social Security Act (42 U.S.C. 
1396d(l)(2)(B)).
    (k) Effective Date.--This section shall take effect on the date 
that is one year after the date of the enactment of this Act.

SEC. 5. CONSTRUCTION OR LEASE OF DENTAL CLINICS OF DEPARTMENT OF 
              VETERANS AFFAIRS.

    (a) In General.--The Secretary of Veterans Affairs shall construct 
or lease a dental clinic of the Department of Veterans Affairs in any 
State that does not have a facility of the Department that offers 
onsite dental services.
    (b) Submittal of Plan.--Not later than 180 days after the date of 
the enactment of this Act, the Secretary shall submit to Congress a 
plan for construction or lease of a dental clinic in each of the States 
described in subsection (a) and shall beginning construction of any 
such clinic indicated for construction in such plan not later than one 
year after such date of enactment.
    (c) Appropriation of Amounts.--There is authorized to be 
appropriated and is appropriated to the Secretary of Veterans Affairs 
$10,000,000 to carry out this section, which shall be available until 
expended.
    (d) Facility of the Department Defined.--In this section, the term 
``facility of the Department'' has the meaning given the term 
``facilities of the Department'' in section 1701 of title 38, United 
States Code.
    (e) Emergency Designation.--
            (1) Statutory paygo.--This section is designated as an 
        emergency requirement pursuant to section 4(g) of the Statutory 
        Pay-As-You-Go Act of 2010 (2 U.S.C. 933(g)).
            (2) Senate designation.--In the Senate, this section is 
        designated as an emergency requirement pursuant to section 
        4112(a) of H. Con. Res. 71 (115th Congress), the concurrent 
        resolution on the budget for fiscal year 2018.

SEC. 6. PROGRAM ON EDUCATION TO PROMOTE DENTAL HEALTH IN VETERANS.

    (a) Program Required.--
            (1) In general.--The Secretary of Veterans Affairs shall 
        carry out a program of education to promote dental health for 
        veterans who are enrolled in the system of patient enrollment 
        of the Department of Veterans Affairs under section 1705 of 
        title 38, United States Code.
            (2) Construction.--Nothing in the program shall be deemed 
        to alter or revise the eligibility of any veteran for dental 
        care under the laws administered by the Secretary.
    (b) Elements.--The program required by subsection (a) shall provide 
education for veterans on the following:
            (1) The association between dental health and overall 
        health and well-being.
            (2) Proper techniques for dental care.
            (3) Signs and symptoms of commonly occurring dental 
        conditions.
            (4) Treatment options for commonly occurring dental issues.
            (5) Options for obtaining access to dental care, including 
        information on--
                    (A) eligibility for dental care through the 
                Department;
                    (B) options available through State and local 
                governments or nonprofit organizations; and
                    (C) purchasing private dental insurance.
            (6) Available and accessible options for obtaining low- or 
        no-cost dental care, including through dental schools and 
        Federally-qualified health centers.
            (7) Such other matters relating to dental health as the 
        Secretary considers appropriate.
    (c) Delivery of Educational Materials.--
            (1) In general.--The Secretary shall provide educational 
        materials to veterans under the program required by subsection 
        (a) through a variety of mechanisms, including the following:
                    (A) The availability and distribution of print 
                materials at facilities of the Department (including at 
                medical centers, clinics, Vet Centers, and readjustment 
                counseling centers) and to providers (including members 
                of patient aligned care teams).
                    (B) The availability and distribution of materials 
                over the internet, including through webinars and My 
                HealtheVet.
                    (C) Presentations of information, including both 
                small group and large group presentations.
            (2) Selection of mechanisms.--In selecting mechanisms for 
        purposes of this subsection, the Secretary shall select 
        mechanisms designed to maximize the number of veterans who 
        receive education under the program.
            (3) Inclusion of materials for blind and visually 
        impaired.--The Secretary shall ensure that educational 
        materials are available under this subsection in a format for 
        the blind and visually impaired.
    (d) Definitions.--In this section:
            (1) Federally-qualified health center defined.--The term 
        ``Federally-qualified health center'' has the meaning given 
        that term in section 1905(l)(2)(B) of the Social Security Act 
        (42 U.S.C. 1396d(l)(2)(B)).
            (2) Vet center.--The term ``Vet Center'' has the meaning 
        given that term in section 1712A(h) of title 38, United States 
        Code.
    (e) Effective Date.--This section shall take effect on the date 
that is one year after the date of the enactment of this Act.

SEC. 7. INFORMATION ON DENTAL SERVICES FOR INCLUSION IN ELECTRONIC 
              MEDICAL RECORDS UNDER DENTAL INSURANCE PILOT PROGRAM.

    (a) In General.--Commencing not later than 540 days after the date 
of the enactment of this Act, the Secretary of Veterans Affairs shall 
expand the dental insurance pilot program established by section 17.169 
of title 38, Code of Federal Regulations (as in effect on the date of 
the enactment of this Act), to establish a mechanism by which private 
sector dental care providers shall forward to the Department of 
Veterans Affairs information on dental care furnished to individuals 
under the pilot program for inclusion in the electronic medical records 
of the Department with respect to such individuals.
    (b) Construction With Current Pilot Program Requirements.--
            (1) In general.--Nothing in this section shall be construed 
        to revise eligibility for participation in, or the locations 
        of, the pilot program referred to in subsection (a).
            (2) Duration.--The Secretary may continue the pilot program 
        for two years in addition to the duration otherwise provided 
        for the pilot program in section 17.169 of title 38, Code of 
        Federal Regulations (as in effect on the date of the enactment 
        of this Act), if the Secretary determines that the continuation 
        is needed to assess the mechanism required by subsection (a).
            (3) Voluntary participation in mechanism.--The 
        participation in the mechanism required by subsection (a) of an 
        individual otherwise participating in the pilot program shall 
        be at the election of the individual.
    (c) Inclusion of Information on Mechanism in Reports.--Each report 
to Congress on the pilot program after the date of the commencement of 
the mechanism required by subsection (a) shall include information on 
the mechanism, including a current assessment of the feasibility and 
advisability of using the mechanism to include information on dental 
care furnished to individuals in the electronic medical records of the 
Department with respect to such individuals.
    (d) Effective Date.--This section shall take effect on the date 
that is one year after the date of the enactment of this Act.

SEC. 8. 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 who are 
entitled to such services from the Department of Veterans Affairs and 
reside in rural and other underserved communities.
    (b) Priority.--The Secretary shall give priority for participation 
in the demonstration program under this section to medical centers or 
health systems of the Department of Veterans Affairs in States with a 
technical college within the State college system of that State that 
has established a degree or certificate level program for the training 
of alternative dental health care providers.
    (c) Telehealth.--For purposes of alternative dental health care 
providers and 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 appropriate and 
feasible.
    (d) 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)).

SEC. 9. AUTHORIZATION OF APPROPRIATIONS.

    (a) In General.--There is authorized to be appropriated for the 
Department of Veterans Affairs for fiscal year 2020 $500,000,000 to 
carry out this Act and the amendments made by this Act, other than 
section 4.
    (b) Availability.--The amount authorized to be appropriated under 
subsection (a) shall be available for obligation for the five-year 
period beginning on the date that is one year after the date of the 
enactment of this Act.
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