[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 4357 Introduced in Senate (IS)]

<DOC>






118th CONGRESS
  2d Session
                                S. 4357

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


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 16, 2024

Mr. Sanders (for himself and Mr. Brown) introduced the following bill; 
     which was read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

_______________________________________________________________________

                                 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; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Comprehensive 
Dental Reform Act of 2024''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
                     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.
Sec. 203. Community-based training of dental students.
                   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 department 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 MATTERS

Sec. 301. Requirement that Secretary of Veterans Affairs 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.
Sec. 303. Program of education to promote dental health in veterans.
Sec. 304. Student loan repayment program to incentivize dental training 
                            and ensure the dental workforce of the 
                            Department of Veterans Affairs.
Sec. 305. Educational and training partnerships for dentists, dental 
                            hygienists, and oral surgeons.
                  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. Reports on enrollment in coverage for oral health services.

                     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 (JJ), by inserting ``and'' after the 
        semicolon at the end; and
            (2) by adding at the end the following new subparagraph:
            ``(KK) oral health services (as defined in subsection 
        (nnn));''.
    (b) Oral Health Services Defined.--Section 1861 of the Social 
Security Act (42 U.S.C. 1395x) is amended by adding at the end the 
following new subsection:

                         ``Oral Health Services

    ``(nnn)(1) The term `oral health services' means services (as 
defined by the Secretary) 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)(88)(C) 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 ``(HH)''; and
            (2) by inserting before the semicolon at the end the 
        following: ``, and (II) with respect to oral health services 
        (as defined in section 1861(nnn)), the amount paid shall be (i) 
        in the case of such services that are preventive, 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)(KK),'' 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, 2025.

                          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 striking ``dental services'' 
        and inserting ``oral health services (as defined in subsection 
        (kk)(1))''; and
            (2) by adding at the end the following:
    ``(kk)(1) Subject to paragraphs (2) and (3), for purposes of this 
title, the term `oral health services' means services (as defined by 
the Secretary) that are necessary to prevent disease and promote oral 
health, restore oral structures to health and function, and treat 
emergency conditions. These services shall include, in the case of 
pregnant or postpartum women, such services as are necessary to address 
oral health conditions that exist or are exacerbated by pregnancy or 
childbirth or which, if left untreated, could adversely affect fetal or 
child development.
    ``(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)(88)(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 (86), by striking ``and'' at the 
                end;
                    (C) in paragraph (87), by striking the period at 
                the end and inserting ``; and''; and
                    (D) by inserting after paragraph (87) the 
                following:
            ``(88) provide for--
                    ``(A) informing, in writing, all individuals who 
                have been determined to be eligible for medical 
                assistance of the availability of oral health services 
                (as defined in section 1905(kk));
                    ``(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 
                (kk)(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)(88)(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 further 
        amended--
                    (A) in subsection (b), in the first sentence, by 
                striking ``and (ii)'' and inserting ``(ii), and (ll)''; 
                and
                    (B) by adding at the end the following new 
                subsection:
    ``(ll) Increased FMAP for Oral Health 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, 2025, for covered oral health 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 oral health expenses.--For purposes of 
        paragraph (1), the term `covered oral health expenses' means 
        the amounts expended for medical assistance for oral health 
        services (as defined in subsection (kk)) and amounts expended 
        for the proper and efficient administration of the provision of 
        such oral health services under the State plan.
            ``(3) Requirements.--For purposes of paragraph (1), the 
        Federal medical assistance percentage applicable to covered 
        oral health expenses under this subsection shall not apply to a 
        State unless--
                    ``(A) the State plan for medical assistance 
                provides payment for oral health services (as so 
                defined) furnished by a health care 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 oral health services; and
                            ``(ii) the provision of technical 
                        assistance to health care 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 oral health 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(ll) 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 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, 2025, 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 or Tribal government that licenses 
                or certifies such dental therapists, a mid-level dental 
                practitioner who--
                            ``(i)(I) is licensed to practice under the 
                        law of the State; or
                            ``(II) is certified to practice under the 
                        Community Health Aide Program of the Indian 
                        Health Service under section 119 of the Indian 
                        Health Care Improvement Act; and
                            ``(ii) 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 
                programs and'' after ``schools at which''; 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 2025 through 2028, 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 dental 
residencies at teaching health centers that operate graduate medical 
education programs, there is authorized to be appropriated such sums as 
may be necessary for each of fiscal years 2025 through 2028''.

SEC. 203. COMMUNITY-BASED TRAINING OF DENTAL STUDENTS.

    (a) In General.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary'') shall establish a 
pilot program under which the Secretary awards grants to eligible 
entities for the purpose of supporting the community-based training of 
dental students. Such grants shall be for a 5-year period, beginning in 
fiscal year 2025.
    (b) Eligible Entities.--To be eligible to receive a grant under 
this section, an entity shall--
            (1) be a Federally-qualified health center, rural health 
        center, or Tribal health facility; and
            (2) submit an application to the Secretary at such time, in 
        such manner, and containing such information as the Secretary 
        may require.
    (c) Selection of Awardees.--
            (1) In general.--The Secretary shall award 6 grants under 
        this section to eligible entities described in subsection (b). 
        In making such awards, the Secretary shall ensure that each 
        entity receiving a grant operates in a different State 
        (including each of the several States and the District of 
        Columbia), territory, or Tribal territory.
            (2) Priority.--In awarding grants under this section, the 
        Secretary shall give priority to eligible entities that--
                    (A) have a focus on training students in rural and 
                underserved areas;
                    (B) partner with dental professional schools and 
                programs associated with a historically Black college 
                or university (as defined by the term ``part B 
                institution'' in section 322 of the Higher Education 
                Act of 1965 (20 U.S.C. 1061)) or minority-serving 
                institutions (as described in section 371 of such Act 
                (20 U.S.C. 1067q)); or
                    (C) are located in a State or geographic area 
                without a dental school.
    (d) Use of Funds.--An eligible entity receiving a grant under this 
section--
            (1) shall use such funds to establish a training program 
        for dental, dental hygienist, dental therapy, and dental 
        assistant students in a community-based, outpatient setting;
            (2) may use such funds--
                    (A) to support faculty and preceptor wages and 
                living stipends for trainees;
                    (B) to purchase equipment, education tools, and 
                make renovations or alterations to a training site; and
                    (C) to provide supportive services such as child 
                care, transportation, and food assistance to enable 
                students to persist in and complete a training program; 
                and
            (3) may use up to 5 percent of the grant amount for 
        planning and development, data collection and reporting, other 
        administrative purposes.
    (e) Reporting.--
            (1) Reports from eligible entities.--Each eligible entity 
        receiving a grant under this section shall submit such reports 
        on the program supported by the grant as the Secretary may 
        require.
            (2) Reports to congress.--Not later than 1 year after the 
        date on which the program under this section terminates under 
        subsection (f), the Secretary shall submit to the Committee on 
        Health, Education, Labor, and Pensions of the Senate and the 
        Committee on Energy and Commerce of the House of 
        Representatives a report on the program.
    (f) Sunset.--The grant program under this section shall terminate 
on September 30, 2029.
    (g) Appropriations.--To carry out this section, there is 
appropriated, out of amounts in the Treasury not otherwise 
appropriated, $4,500,000 for fiscal year 2025, to remain available 
through the end of fiscal year 2029.

                   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 2025 through 2028 for the 
        purpose of educating nondental medical professionals (including 
        physicians, nurses, nurse practitioners, physician assistants, 
        and pharmacists and particularly such professionals who provide 
        care to children and pregnant and postpartum women) 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, 
educational institutions, or public or private nonprofit entities that 
the Secretary has determined to be 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 2025 through 2028.''.

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 ``intend 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.

    Subpart 3 of part E of title VII of the Public Health Service Act 
(42 U.S.C. 295f et seq.) is amended by adding at the end the following:

``SEC. 779. 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 2025 through 2028.''.

                 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 of 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 2025 through 2028.''.

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-3. 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 2025 through 2028.''.

SEC. 223. EMERGENCY DEPARTMENT CARE COORDINATION.

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

``SEC. 399V-8. EMERGENCY DEPARTMENT CARE COORDINATION WITH RESPECT TO 
              DENTAL CARE.

    ``(a) In General.--The Secretary shall establish a grant program to 
facilitate individuals receiving dental care at facilities other than 
hospital emergency departments, under which the Secretary awards grants 
to eligible entities to cover costs related to construction and 
renovation, equipment, staff, outreach and education, and any other 
allowable uses, with respect to the entity's facilities, as the 
Secretary determines appropriate.
    ``(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 ED Health Care 
Providers.--The Secretary shall allocate a portion of the amounts 
appropriated under subsection (e) toward medical education for primary 
care and emergency department physicians, nurses, nurse practitioners, 
and physician assistants to be trained in oral health.
    ``(d) Report.--Not later than January 1, 2028, 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 departments 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 2025 through 2028.''.

SEC. 224. RESEARCH FUNDING.

    (a) In General.--For the period of fiscal years 2025 through 2027, 
there is authorized to be appropriated for the Secretary of Health and 
Human Services (referred to in this section as the ``Secretary'') such 
sums as may be necessary to conduct, in consultation with the heads of 
agencies and offices of the Department of Health and Human Services, 
including the Director of the Centers for Disease Control and 
Prevention, the Director of the Agency for Healthcare Research and 
Quality, the Director of the National Institutes of Health, and the 
Administrator of the Health Resources and Services Administration--
            (1) research on--
                    (A) the prevention of oral disease;
                    (B) oral disease management;
                    (C) evidence-based strategies to prevent tooth 
                decay;
                    (D) rigorous, multidisciplinary research-based 
                approaches to overcome disparities in oral health;
                    (E) perinatal, postnatal, and childhood oral health 
                issues, including the integration of dental providers 
                in settings where pediatricians practice;
                    (F) access, quality, and outcomes with respect to 
                oral health services; and
                    (G) other topics as the Secretary determines 
                appropriate; and
            (2) an evaluation of oral health service delivery to 
        underserved and vulnerable populations, including an evaluation 
        of workforce models to enhance oral health service delivery.
    (b) Supplement Not Supplant.--Funds appropriated under this section 
shall be used to supplement, and not supplant, other Federal, State, 
and local public funds provided for activities described in subsection 
(a).

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.
    ``(b) Eligible Entities.--To be eligible to receive a grant under 
this section, an eligible entity shall submit an application to the 
Secretary at such time, in such manner, and containing such information 
as the Secretary may require, including information to demonstrate that 
the entity is capable of providing coordinated care and continuity of 
care to patients.
    ``(c) Use of Funds.--Eligible entities receiving a grant under this 
section shall deliver the dental services described in subsection (a) 
at locations such as senior centers, nursing homes, assisted living 
facilities, schools, licensed child 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 or the 
Medicaid program under title XIX of the Social Security Act, and 
facilities that provide services under the Special Supplemental 
Nutrition Program for Women, Infants, and Children established by 
section 17 of the Child Nutrition Act of 1966 or under the Head Start 
Act.
    ``(d) 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) of the Patient Protection and Affordable Care Act 
(42 U.S.C. 18022(b)) is amended--
            (1) in paragraph (1)--
                    (A) in subparagraph (J), by striking ``oral and''; 
                and
                    (B) by adding at the end the following:
                    ``(K) Oral health services for children and 
                adults.''; and
            (2) by adding at the end the following:
            ``(6) Oral health services.--For purposes of paragraph 
        (1)(K), the term `oral health services' means services (as 
        defined by the Secretary), that are necessary to prevent 
        disease and promote oral health, restore oral structures to 
        health and function, and treat emergency conditions.''.

           TITLE III--DEPARTMENT OF VETERANS AFFAIRS MATTERS

SEC. 301. REQUIREMENT THAT SECRETARY OF VETERANS AFFAIRS 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)(B), 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'';
            (4) in section 1712C(h)--
                    (A) by striking ``section 1712 of this title'' and 
                inserting ``this chapter''; and
                    (B) by striking ``outpatient dental services and 
                treatment, and related dental appliances, under such 
                section 1712'' and inserting ``dental services and 
                appliances under this chapter''; and
            (5) by striking section 2062.
    (b) Conforming Amendment.--Section 1525(a) of such title is amended 
by striking ``medicines under section 1712(d)'' and inserting 
``medicines under section 1712(b)''.
    (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 who are 
entitled to such services from the Department of Veterans Affairs and 
reside in rural and other underserved communities.
    (b) 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.
    (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.

SEC. 303. PROGRAM OF EDUCATION TO PROMOTE DENTAL HEALTH IN VETERANS.

    (a) Program Required.--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 annual patient enrollment of the 
Department of Veterans Affairs established and operated under section 
1705(a) of title 38, United States Code.
    (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 eligibility for dental care through the 
        Department.
            (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, My 
                HealtheVet, and VA.gov.
                    (C) Presentations by the dental program office of 
                the Department of information, including both small 
                group and large group presentations, and distribution 
                of such information to all locations in which the 
                program is being carried out.
            (2) Selection of mechanisms.--In selecting mechanisms under 
        paragraph (1), the Secretary shall select mechanisms designed 
        to maximize the number of veterans who receive education under 
        the program.
    (d) Construction.--Nothing in this section shall be construed to 
alter or revise the eligibility of any veteran for dental care under 
the laws administered by the Secretary.
    (e) Definitions.--In this section:
            (1) Federally qualified health center.--The term 
        ``Federally Qualified Health Center'' means a Federally-
        qualified health center as defined 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.
    (f) Effective Date.--This section shall take effect on the date 
that is one year after the date of the enactment of this Act.

SEC. 304. STUDENT LOAN REPAYMENT PROGRAM TO INCENTIVIZE DENTAL TRAINING 
              AND ENSURE THE DENTAL WORKFORCE OF THE DEPARTMENT OF 
              VETERANS AFFAIRS.

    (a) Program Required.--The Secretary of Veterans Affairs, to ensure 
that the Department of Veterans Affairs has sufficient staff to provide 
dental services to veterans, shall implement a loan reimbursement 
program for qualified dentists, dental hygienists, and oral surgeons 
who agree--
            (1) to be appointed by the Secretary as a dentist, dental 
        hygienist, or oral surgeon, as the case may be, under section 
        7401 of title 38, United States Code; and
            (2) to serve as a dentist, dental hygienist, or oral 
        surgeon, as the case may be, of the Department pursuant to such 
        appointment at a dental clinic of the Department for a period 
        of not less than five years.
    (b) Maximum Amount.--The Secretary may reimburse not more than--
            (1) $75,000 for each dentist participating in the program 
        under subsection (a);
            (2) $10,000 for each dental hygienist participating in such 
        program; and
            (3) $20,000 for each oral surgeon participating in such 
        program.
    (c) Selection of Locations.--The Secretary shall monitor demand 
among veterans for dental care and require participants in the program 
under subsection (a) to choose from dental clinics of the Department 
with the greatest need for dentists, dental hygienists, or oral 
surgeons, as the case may be, according to facility enrollment and 
patient demand.

SEC. 305. EDUCATIONAL AND TRAINING PARTNERSHIPS FOR DENTISTS, DENTAL 
              HYGIENISTS, AND ORAL SURGEONS.

    The Secretary of Veterans Affairs shall enter into educational and 
training partnerships with dental schools, including dental programs 
within a community college, to provide training and employment 
opportunities for dentists, dental hygienists, and oral surgeons.

                  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 of the Public Health Service 
Act (42 U.S.C. 256g-1).
    (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. REPORTS ON ENROLLMENT IN COVERAGE FOR ORAL HEALTH SERVICES.

    (a) Secretary of Health and Human Services.--The Secretary of 
Health and Human Services shall submit to Congress the following 
reports:
            (1) Cost-benefit analysis.--Not later than October 1, 2028, 
        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.
            (2) Annual report on enrollment, utilization, and 
        expenditures in dental insurance plans.--Not later than 1 year 
        after the date of the enactment of this Act, and annually 
        thereafter, an annual report containing detailed information 
        on--
                    (A) enrollment in private insurance plans providing 
                pediatric and adult dental coverage, whether such 
                coverage is provided through a qualified health plan 
                (as defined in section 1301(a) of the Patient 
                Protection and Affordable Care Act (Public Law 111-
                148)) or a stand-alone dental plan;
                    (B) the utilization of oral health services by 
                children and adults who receive dental coverage under a 
                qualified health plan or a stand-alone dental plan; and
                    (C) expenditures related to oral health services by 
                individuals and families who receive dental coverage in 
                a qualified health plan or stand-alone dental plan.
    (b) Comptroller General.--
            (1) Medicaid and medicare.--Not later than January 1, 2028, 
        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, 
        2028, 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, 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>