[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 560 Introduced in Senate (IS)]

<DOC>






117th CONGRESS
  1st Session
                                 S. 560

    To improve coverage of maternal oral health care, and for other 
                               purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 3, 2021

 Ms. Stabenow introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
    To improve coverage of maternal oral health care, 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 ``Oral Health for Moms Act''.

SEC. 2. REQUIRING COVERAGE OF ORAL HEALTH SERVICES FOR PREGNANT AND 
              POSTPARTUM INDIVIDUALS.

    (a) In General.--
            (1) Medicaid.--Section 1905 of the Social Security Act (42 
        U.S.C. 1396d) is amended--
                    (A) in subsection (a)(4)--
                            (i) by striking ``; and (D)'' and inserting 
                        ``; (D)''; and
                            (ii) by inserting ``; and (E) beginning 
                        January 1, 2022, oral health services for 
                        pregnant and postpartum individuals (as defined 
                        in subsection (hh))'' after ``subsection 
                        (hh))''; and
                    (B) by adding at the end the following new 
                subsection:
    ``(hh) Oral Health Services for Pregnant and Postpartum 
Individuals.--
            ``(1) In general.--For purposes of this title, the term 
        `oral health services for pregnant and postpartum individuals' 
        means dental services necessary to prevent disease and promote 
        oral health, restore oral structures to health and function, 
        and treat emergency conditions that are furnished to an 
        individual during pregnancy (or during the 60-day period 
        beginning on the last day of the pregnancy or such longer 
        period beginning on the last day of the pregnancy as the State 
        shall elect).
            ``(2) Coverage requirements.--To satisfy the requirement to 
        provide oral health services for pregnant and postpartum 
        individuals, a State shall, at a minimum, provide coverage to 
        prevent disease and promote oral health, restore oral 
        structures to health and function, and treat emergency 
        conditions, consistent with recommendations for perinatal oral 
        health care and dental care during pregnancy from the American 
        Academy of Pediatric Dentistry and the American College of 
        Obstetricians and Gynecologists. Such coverage shall include--
                    ``(A) routine diagnostic and preventive care such 
                as dental cleanings, exams, and X-rays;
                    ``(B) basic dental services such as fillings and 
                extractions;
                    ``(C) major dental services such as root canals, 
                crowns, and dentures;
                    ``(D) emergency dental care; and
                    ``(E) other necessary services related to dental 
                and oral health (as defined by the Secretary).''.
            (2) Coverage of oral health services for pregnant and 
        postpartum individuals regardless of eligibility pathway.--
        Section 1902(a)(10) of the Social Security Act (42 U.S.C. 
        1396a(a)(10)) is amended in the matter following subparagraph 
        (G)--
                    (A) by striking ``and (XVIII)'' and inserting 
                ``(XVIII)''; and
                    (B) by striking the semicolon at the end and 
                inserting ``, and (XIX) beginning January 1, 2022, 
                medical assistance shall be made available for oral 
                health services for pregnant and postpartum individuals 
                for any individual who is eligible for and receiving 
                medical assistance under the State plan or under a 
                waiver of such plan during such individual's pregnancy 
                and during the 60-day period beginning on the last day 
                of the pregnancy (or such longer period beginning on 
                the last day of the pregnancy as the State shall 
                elect), notwithstanding any other provision of law 
                (including another provision of this paragraph) 
                limiting such individual's eligibility for medical 
                assistance under such plan or waiver to coverage for a 
                limited type of benefits and services that would not 
                otherwise include coverage of oral health services for 
                pregnant and postpartum individuals;''.
            (3) CHIP.--
                    (A) In general.--Section 2103(c)(6)(A) of the 
                Social Security Act (42 U.S.C. 1397cc(c)(6)(A)) is 
                amended by inserting ``and, in the case that the State 
                elects to provide pregnancy-related assistance pursuant 
                to section 2112, the pregnancy-related assistance 
                provided to a targeted low-income pregnant woman'' 
                after ``targeted low-income child''.
                    (B) Effective date.--The amendment made by this 
                section shall take effect on January 1, 2022.
    (b) Enhanced FMAP; Maintenance of Effort.--
            (1) Medicaid.--Section 1905 of the Social Security Act (42 
        U.S.C. 1396d), as amended by subsection (a)(1), is further 
        amended--
                    (A) in subsection (b), by striking ``and (ff)'' and 
                inserting ``(ff), and (ii)''; and
                    (B) by adding at the end the following:
    ``(ii) Increased FMAP for Additional Expenditures for Low-Income 
Pregnant People.--
            ``(1) In general.--Subject to paragraph (2), for calendar 
        quarters beginning on or after January 1, 2022, notwithstanding 
        subsection (b), the Federal medical assistance percentage for a 
        State, with respect to the additional amounts expended by such 
        State for medical assistance under the State plan under this 
        title or a waiver of such plan that are attributable to 
        requirements imposed by the amendments made by the Oral Health 
        for Moms Act (as determined by the Secretary), shall be equal 
        to 100 percent.
            ``(2) Maintenance of effort.--Paragraph (1) shall not apply 
        with respect to a State if, for any calendar quarter during the 
        period beginning with the date of enactment of this subsection 
        and ending with January 1, 2025, the State--
                    ``(A) has in effect under such plan eligibility 
                standards, methodologies, or procedures (including any 
                enrollment cap or other numerical limitation on 
                enrollment, any waiting list, any procedures designed 
                to delay the consideration of applications for 
                enrollment, or similar limitation with respect to 
                enrollment) for individuals described in subsection 
                (l)(1) who are eligible for medical assistance under 
                the State plan or waiver under subsection 
                (a)(10)(A)(ii)(IX) that are more restrictive than the 
                eligibility standards, methodologies, or procedures, 
                respectively, for such individuals under such plan or 
                waiver that are in effect on the date of the enactment 
                of this subsection; or
                    ``(B) provides pregnancy-related assistance to 
                targeted low-income pregnant women under the State plan 
                under title XXI (or a waiver of such a plan) at a level 
                that is less than the level at which the State provides 
                such assistance to such women under such plan on the 
                date of the enactment of this subsection.''.
            (2) CHIP.--Section 2105 of the Social Security Act (42 
        U.S.C. 1397ee) is amended--
                    (A) in subsection (b), by adding at the end the 
                following: ``For calendar quarters beginning on or 
                after January 1, 2022, the enhanced FMAP for a State 
                shall, subject to paragraph (2) of subsection (h), be 
                100 percent with respect to amounts described in 
                paragraph (1) of such subsection.''; and
                    (B) by adding at the end the following new 
                subsection:
    ``(h) Increased eFMAP for Additional Expenditures for Targeted Low-
Income Pregnant Women.--
            ``(1) Amounts described.--For purposes of subsection (b), 
        the amounts described in this paragraph are additional amounts 
        expended by a State for pregnancy-related assistance that is 
        provided under the State plan under this title or a waiver of 
        such plan during a calendar quarter beginning on or after 
        January 1, 2022, that are attributable to the provision of 
        dental coverage to targeted low-income pregnant women (as 
        determined by the Secretary).
            ``(2) Maintenance of effort.--The fourth sentence of 
        subsection (b) shall not apply with respect to a State if, for 
        any calendar quarter during the period beginning with the date 
        of enactment of this subsection and ending with January 1, 
        2025, the State--
                    ``(A) has in effect under the State plan under 
                title XIX (or a waiver of such a plan) eligibility 
                standards, methodologies, or procedures (including any 
                enrollment cap or other numerical limitation on 
                enrollment, any waiting list, any procedures designed 
                to delay the consideration of applications for 
                enrollment, or similar limitation with respect to 
                enrollment) for individuals described in subsection 
                (l)(1) of section 1902 who are eligible for medical 
                assistance under such State plan or waiver under 
                subsection (a)(10)(A)(ii)(IX) of such section that are 
                more restrictive than the eligibility standards, 
                methodologies, or procedures, respectively, for such 
                individuals under such plan or waiver that are in 
                effect on the date of the enactment of this subsection; 
                or
                    ``(B) provides pregnancy-related assistance to 
                targeted low-income pregnant women under the State plan 
                under this title (or a waiver of such a plan) at a 
                level that is less than the level at which the State 
                provides such assistance to such women under such plan 
                or waiver on the date of the enactment of this 
                subsection.''.
            (3) Exclusion of amounts attributable to increased fmap 
        from territorial caps.--Section 1108 of the Social Security Act 
        (42 U.S.C. 1308) is amended--
                    (A) in subsection (f), in the matter preceding 
                paragraph (1), by striking ``subsections (g) and (h)'' 
                and inserting ``subsections (g), (h), and (i)''; and
                    (B) by adding at the end the following:
    ``(i) Exclusion From Caps of Amounts Attributable to Increased FMAP 
for Coverage of Oral Health Services for Pregnant and Postpartum 
Individuals.--Any payment made to a territory for expenditures on 
medical assistance that are subject to the Federal medical assistance 
percentage specified under section 1905(ii) shall not be taken into 
account for purposes of applying payment limits under subsections (f) 
and (g) to the extent that such payment exceeds the amount of the 
payment that would have been made to the territory for such 
expenditures without regard to such section.''.
            (4) Adjustment of chip allotments to account for increased 
        efmap.--Section 2104 of the Social Security Act (42 U.S.C. 
        1397dd) is amended--
                    (A) in subsection (c)--
                            (i) in paragraph (1), by inserting 
                        ``paragraph (5) and'' before ``subsections (d) 
                        and (m)(5)''; and
                            (ii) by adding at the end the following new 
                        paragraph:
            ``(5) Adjusting allotments to account for increased federal 
        payments for coverage of dental services for pregnant people.--
        If a commonwealth or territory described in paragraph (3) 
        receives payment for a fiscal year under subsection (a) of 
        section 2105 for expenditures that are subject to the enhanced 
        FMAP specified under subsection (h) of such section, the amount 
        of the allotment determined for such commonwealth or territory 
        under this subsection shall be increased by the amount by 
        which--
                    ``(A) the amount of the payment received by the 
                commonwealth or territory for such expenditures for the 
                fiscal year; exceeds
                    ``(B) the amount of the payment that the 
                commonwealth or territory would have received for such 
                expenditures for the fiscal year without regard to such 
                subsection (h).''; and
                    (B) in subsection (m)--
                            (i) in paragraph (2)(B), in the matter 
                        preceding clause (i), by striking ``paragraphs 
                        (5) and (7)'' and inserting ``paragraphs (5), 
                        (7), and (12)''; and
                            (ii) by adding at the end the following new 
                        paragraph:
            ``(12) Adjusting allotments to account for increased 
        federal payments for coverage of dental services for pregnant 
        people.--If a State receives payment for a fiscal year under 
        subsection (a) of section 2105 for expenditures that are 
        subject to the enhanced FMAP specified under subsection (h) of 
        such section, the amount of the allotment determined for the 
        State and fiscal year under this subsection shall be increased 
        by the amount by which--
                    ``(A) the amount of the payment received by the 
                State for such expenditures for the fiscal year; 
                exceeds
                    ``(B) the amount of the payment that the State 
                would have received for such expenditures for the 
                fiscal year without regard to such subsection (h).''.

SEC. 3. MATERNAL ORAL HEALTH QUALITY MEASURES.

    Title XI of the Social Security Act (42 U.S.C. 1301 et seq.) is 
amended by inserting after section 1139B the following new section:

``SEC. 1139C. MATERNAL ORAL HEALTH QUALITY MEASURES.

    ``(a) Development of Core Set of Maternal Oral Health Care Quality 
Measures.--
            ``(1) In general.--The Secretary shall identify and publish 
        a recommended core set of health quality measures for enrolled 
        pregnant individuals in the same manner as the Secretary 
        identifies and publishes a core set of child health quality 
        measures under section 1139A, including with respect to 
        identifying and publishing existing maternal oral health 
        quality measures for such individuals that are in use under 
        public and privately sponsored health care coverage 
        arrangements, or that are part of reporting systems that 
        measure both the presence and duration of health insurance 
        coverage over time, that may be applicable to enrolled pregnant 
        individuals.
            ``(2) Alignment with existing core set.--In identifying and 
        publishing the recommended core set of maternal oral health 
        quality measures required under paragraph (1), the Secretary 
        shall ensure that, to the extent possible, such measures align 
        with and do not duplicate the core set of adult health quality 
        measures identified, published, and revised under section 
        1139B.
            ``(3) Process for maternal oral health quality measures 
        program.--In identifying gaps in existing maternal oral health 
        quality measures and establishing priorities for the 
        development and advancement of such measures, the Secretary 
        shall consult with--
                    ``(A) States;
                    ``(B) health care providers, including physicians 
                in the fields of general obstetrics, maternal-fetal 
                medicine, family medicine, neonatology, and pediatrics;
                    ``(C) dental professionals; and
                    ``(D) national organizations with expertise in 
                maternal oral health quality measurement.
            ``(4) Definition of enrolled pregnant individual.--The term 
        `enrolled pregnant individual' means an individual who--
                    ``(A) is pregnant or is in the 60-day period 
                beginning on the last day of the individual's 
                pregnancy; and
                    ``(B) is enrolled for medical assistance, child 
                health assistance, or pregnancy-related assistance (as 
                applicable) under a State plan under title XIX or XXI 
                (or a waiver of such a plan).
    ``(b) Deadlines.--
            ``(1) Recommended measures.--Not later than January 1, 
        2023, the Secretary shall identify and publish for comment a 
        recommended core set of maternal oral health quality measures 
        that includes the following:
                    ``(A) Measures of utilization of oral health and 
                dental services during pregnancy across health care 
                settings.
                    ``(B) Measures that address the availability of 
                oral evaluations during or following medical visits for 
                enrolled pregnant individuals.
                    ``(C) Measures that address the incidence of 
                emergency department visits for non-traumatic dental 
                conditions during pregnancy.
                    ``(D) Measures that address the availability of 
                follow-up dental care after emergency department visits 
                for non-traumatic dental conditions during pregnancy.
                    ``(E) Measures that address the availability of 
                counseling of enrolled pregnant individuals and 
                postpartum individuals aimed at improving the oral 
                health of enrolled pregnant individuals and infants.
                    ``(F) Measures that address screening and 
                evaluation for caries risk and periodontitis and 
                treatment for caries risk and periodontitis, including 
                the following:
                            ``(i) The percentage of enrolled pregnant 
                        individuals who have caries risk documented in 
                        the reporting year involved.
                            ``(ii) The percentage of enrolled pregnant 
                        individuals who received a topical fluoride 
                        application or sealants based on an oral health 
                        risk assessment demonstrating the need for such 
                        application or sealants during the reporting 
                        year involved.
                            ``(iii) The percentage of enrolled pregnant 
                        individuals who received a comprehensive or 
                        periodic oral evaluation or a comprehensive 
                        periodontal evaluation during the reporting 
                        year involved.
                            ``(iv) The percentage of enrolled pregnant 
                        individuals with a history of periodontitis who 
                        received an oral prophylaxis, scaling or root 
                        planing, or periodontal maintenance visit at 
                        least 2 times during the reporting year 
                        involved.
            ``(2) Dissemination.--Not later than January 1, 2024, the 
        Secretary shall publish an initial core set of maternal oral 
        health quality measures that are applicable to enrolled 
        pregnant individuals.
            ``(3) Standardized reporting.--Not later than January 1, 
        2025, the Secretary, in consultation with States, shall develop 
        a standardized format for reporting information based on the 
        initial core set of maternal oral health quality measures 
        (stratified by race, ethnicity, primary language, and 
        disability status) and create procedures to encourage States to 
        use such measures to voluntarily report information regarding 
        the quality of oral health care for enrolled pregnant 
        individuals.
            ``(4) Reports to congress.--Not later than January 1, 2026, 
        and every 3 years thereafter, the Secretary shall include in 
        the report to Congress required under section 1139A(a)(6) 
        information similar to the information required under that 
        section with respect to the measures established under this 
        section.
    ``(c) Annual State Reports Regarding State-Specific Maternal Oral 
Health Quality Measures Applied Under Medicaid or CHIP.--
            ``(1) In general.--Each State with a plan or waiver 
        approved under title XIX or XXI shall annually report 
        (separately or as part of the annual report required under 
        section 1139A(c)) to the Secretary on--
                    ``(A) the State-specific maternal oral health 
                quality measures applied by the State under such a plan 
                or waiver, including measures described in subsection 
                (b)(1);
                    ``(B) the State-specific information on the quality 
                of oral health care furnished to enrolled pregnant 
                individuals under such a plan or waiver, including 
                information collected through external quality reviews 
                of managed care organizations under section 1932 and 
                benchmark plans under section 1937; and
                    ``(C) the State-specific information regarding the 
                dental benefits available to enrolled pregnant 
                individuals under such a plan or waiver, including any 
                limits on such benefits and the amount of reimbursement 
                provided under such plan or waiver for such benefits.
            ``(2) Publication.--Not later than September 30, 2026, and 
        annually thereafter, the Secretary shall collect, analyze, and 
        make publicly available the information reported by States 
        under paragraph (1).
    ``(d) Authorization of Appropriations.--There are authorized to be 
appropriated $10,000,000 to carry out this section. Funds appropriated 
under this subsection shall remain available until expended.''.

SEC. 4. INCLUSION OF ORAL HEALTH SERVICES FOR PREGNANT AND POSTPARTUM 
              INDIVIDUALS AS AN ESSENTIAL HEALTH BENEFIT.

    (a) In General.--Section 1302(b) of the Patient Protection and 
Affordable Care Act (42 U.S.C. 18022(b)) is amended--
            (1) in paragraph (1), by adding at the end the following:
                    ``(K) Oral health services for pregnant and 
                postpartum individuals.''; and
            (2) in paragraph (4)(F)--
                    (A) by striking ``section 1311(b)(2)(B)(ii)'' and 
                inserting ``section 1311(d)(2)(B)(ii)''; and
                    (B) by inserting ``or (1)(K)'' after ``paragraph 
                (1)(J)''.
    (b) State Exchange Requirements.--Section 1311(d)(2)(B)(ii) of the 
Patient Protection and Affordable Care Act (42 U.S.C. 
18031(d)(2)(B)(ii)) is amended by inserting ``or oral health benefits 
meeting the requirements of section 1302(d)(1)(K)'' before the period.
    (c) Premium Assistance Credit Amount.--Section 36B(b)(3)(E) of the 
Internal Revenue Code of 1986 is amended--
            (1) by striking ``section 1311(d)(2)(B)(ii)(I)'' and 
        inserting ``section 1311(d)(2)(B)(ii)''; and
            (2) by striking ``section 1302(b)(1)(J)'' and inserting 
        ``subparagraph (J) or (K) of section 1302(b)(1)''.
    (d) Conforming Amendment.--Section 2715(b)(3)(B)(i) of the Public 
Health Service Act (42 U.S.C. 300gg-15(b)(3)(B)(i)) is amended by 
striking ``through (J)'' and inserting ``through (K)''.

SEC. 5. FEDERALLY QUALIFIED HEALTH CENTER GRANT PROGRAM.

    (a) In General.--Not later than 1 year after the date of enactment 
of this Act, the Secretary of Health and Human Services (in this Act 
referred to as the ``Secretary'') shall establish a grant program under 
which the Secretary shall award grants to Federally qualified health 
centers (as defined in section 1861(aa)(4) of the Social Security Act 
(42 U.S.C. 1395x(aa)(4))) to enter into arrangements with private 
dental providers to provide dental services to eligible individuals.
    (b) Authorization of Appropriations.--There are authorized to be 
appropriated to the Secretary such sums as are necessary to carry out 
this section.

SEC. 6. MATERNAL ORAL HEALTH CARE REPORT.

    Not later than 2 years after the date of enactment of this Act, the 
Medicaid and CHIP Payment and Access Commission shall issue a report on 
issues related to maternal oral health across the 50 States and the 
territories, including--
            (1) the availability of maternal oral health coverage, and 
        enrollment in such coverage;
            (2) a survey of oral health status among low-income women 
        of childbearing age;
            (3) barriers to accessing maternal oral health care;
            (4) innovations and potential solutions to problems of 
        access to maternal oral health care, including innovations that 
        would expand access to such care beyond dental offices; and
            (5) the impact of the requirement (imposed by the 
        amendments made by section 2) that State Medicaid programs 
        cover oral health services for pregnant and postpartum 
        individuals on providers of maternal health care services, and 
        such recommendations for improving reimbursement rates for such 
        providers as the Commission deems appropriate.

SEC. 7. INDIAN HEALTH SERVICE MATERNAL ORAL HEALTH INITIATIVE.

    (a) In General.--Not later than 1 year after the date of enactment 
of this Act, the Secretary shall develop and implement, in consultation 
with Indian tribes and tribal organizations (as those terms are defined 
in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 
1603)), a formal initiative to improve the oral health status of 
pregnant individuals, postpartum individuals, and infants and address 
barriers to oral health care during pregnancy for American Indian and 
Alaska Native populations. This initiative shall include strategies 
to--
            (1) reduce the prevalence and severity of oral disease 
        among pregnant individuals, postpartum individuals, and their 
        infants;
            (2) improve access to oral health care during pregnancy and 
        the postpartum period;
            (3) establish a data collection system to monitor 
        prevalence of oral disease and access to care;
            (4) educate health and dental providers on the importance 
        of oral health care during pregnancy and the postpartum period 
        and build competencies in the delivery of such care;
            (5) increase rates of patient referral to oral health care 
        by non-dental providers; and
            (6) establish mechanisms for outreach and education of 
        pregnant individuals and postpartum individuals for the 
        purposes of improving oral health practices and access to care.
    (b) Authorization of Appropriations.--There are authorized to be 
appropriated to the Secretary such sums as are necessary to carry out 
this section.

SEC. 8. PERINATAL ORAL HEALTH OUTREACH AND EDUCATION.

    Not later than 1 year after the date of enactment of this Act, the 
Secretary shall develop a program, to be implemented by entities that 
fund or provide maternal health care, oral health care, and maternal 
and infant support services, to provide--
            (1) interactive oral health education aimed at promoting 
        good oral health practices for pregnant individuals and 
        postpartum individuals who are eligible for or enrolled in the 
        Medicaid program under title XIX of the Social Security Act or 
        the Children's Health Insurance Program under title XXI of the 
        Social Security Act (42 U.S.C. 1396 et seq., 1397aa et seq.);
            (2) information on oral health and dental coverage for 
        pregnant individuals, postpartum individuals, and children; and
            (3) assistance in connecting pregnant individuals, 
        postpartum individuals, and children to oral health care.

SEC. 9. MATERNAL ORAL HEALTH TRAINING.

    (a) In General.--Not later than 1 year after the date of enactment 
of this Act, the Secretary, acting through the Associate Administrator 
of the Maternal and Child Health Bureau of the Health Resources and 
Services Administration, shall establish a grant program under which 
the Secretary shall award grants to eligible entities for the purpose 
of--
            (1) integrating oral health care into maternal health care 
        settings;
            (2) improving oral health outcomes during pregnancy and the 
        postpartum period;
            (3) developing core competencies in oral health among 
        maternal health providers, including obstetrician-gynecologists 
        and certified nurse-midwives, and non-clinical perinatal health 
        workers, including community health workers and doulas; and
            (4) improving access to oral health care during pregnancy 
        and closing referral gaps.
    (b) Eligible Entities.--The Secretary may make grants under this 
section to, or enter into contracts with State health departments or 
other State health agencies, academic institutions, schools of medicine 
or dentistry, nonprofit hospitals, nonprofit accredited birth centers, 
or public or private nonprofit entities which the Secretary has 
determined are capable of carrying out such a grant or contract to--
            (1) plan, develop, and provide training of maternal health 
        providers to establish core competencies in oral health during 
        pregnancy and the postpartum period;
            (2) provide information to maternal health providers, 
        including information on periodontal disease, dental caries, 
        oral health screening and risk assessment, beneficial oral 
        health practices for pregnant individuals and infants; and
            (3) provide tools and resources aimed at facilitating the 
        integration of oral health care and referral to dental care 
        into maternity care settings.
    (c) Authorization of Appropriations.--There are authorized to be 
appropriated to the Secretary such sums as are necessary to carry out 
this section.
                                 <all>