[Congressional Record Volume 144, Number 140 (Thursday, October 8, 1998)]
[Senate]
[Pages S11976-S11980]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BINGAMAN (for himself and Mr. Cochran):
  S. 2583. A bill to provide disadvantaged children with access to 
dental services; to the Committee on Labor and Human Resources.
 Mr. Bingaman. Mr. President today I introduce with my friend 
and colleague, Senator Thad Cochran, the Childrens Dental Health 
Improvement Act of 1998. The bill is designed to increase access to 
dental services for our disadvantaged children.
  Medicaid's Early and Periodic Screening Diagnosis and Treatment or 
``EPSDT'' program requires states to not only pay for a comprehensive 
set of child health services, including dental services, but to assure 
delivery of those services. Unfortunately, low income children do not 
get the dental service they need. Despite the design of the Medicaid 
program to reach children and ensure access to routine dental care, the 
Inspector General of the Department of Health and Human Services 
reported in 1996 that only 18 percent of children eligible for Medicaid 
received even a single preventive dental service. The same report shows 
that no state provides preventive services to more than 50% of eligible 
children. Dentist participation is too low to assure access. We are 
falling short of our obligation to these children.
  In the past few months, I have had the opportunity to speak to many 
of New Mexico's rural health providers and have learned that for New 
Mexico, the problem is of crisis proportions. Less than 1% of New 
Mexico's Medicaid dollars are used for children's oral health care 
needs. My state alone projects a shortage of 157 dentists and 229 
dental hygienists. Children in New Mexico and elsewhere are showing up 
in emergency rooms for treatment of tooth abscesses instead of getting 
their cavities filled early on or having dental decay prevented in the 
first place.
  Some will say: ``Why care about a few cavities in kids?'' In reality, 
this is a complex children's health issue. Chronically poor oral health 
is associated with growth and development problems in toddlers and 
compromises children's nutritional status. These children suffer from 
pain and cannot play or learn. Their personal suffering is real. In 
reality, untreated dental problems get progressively worse and 
ultimately require more expensive interventions. Many of these children 
come to emergency rooms and ultimately must be treated in the operating 
room.
  Tooth decay remains the single most common chronic disease of 
childhood and according to the Children's Dental Health Project, it 
affects more than half of all children by second grade. Tooth decay in 
children six year olds is 5 to 8 more common than asthma which is often 
cited as the most common chronic disease of childhood.
  National data confirm that pediatric oral health in the U.S. is 
backsliding. Healthy People 2000 goals for dental needs of children 
will not be met. As this chart shows:
  52% of our 6 to 8 year olds have dental caries, or cavities compared 
to 54% in 1986. Our goal was to decrease this to 35% by the year 2000; 
we have only succeeded in a 2% change in this area.
  Additionally, we have slid backwards in some areas. The Healthy 
People 2000 oral health indicators show an increase in the percentage 
of children with untreated cavities. In 1986, 28% of our 6 to 8 year 
olds had untreated cavities compared to now where we find 31% of these 
children have untreated cavities.
  Tooth decay is increasingly a disease of low and modest income 
children. A substantial portion of decay in young children goes 
untreated. In fact, forty seven percent of decay in children aged 2 
through 9 is untreated.
  The Children's Dental Health Improvement Act is designed to attack 
the problem from many fronts. First, our bill addresses the issue of 
provider shortage by expanding opportunities for training pediatric 
dental health care providers. Next, we will work toward increasing the 
actual care provided under the Medicaid program. Additionally, we have 
looked at the need for pediatric dental research to facilitate better 
approaches for care. Finally, we have put into place greater measures 
for surveillance of the problem and have looked at the need to increase 
accountability in the area of actual treatment once a problem is 
identified.
  I am committed to solving the problem of adequate access to dental 
care for our children and view this as a public health issue that has 
gone unnoticed for too long. I will welcome my colleagues to work with 
me to ensure that these children have healthy smiles vs. chronic pain 
from untreated problems.
  Mr. President, I ask unanimous consent to have the text of the 
Children's Dental Health Improvement Act of 1998 printed in the Record.

[[Page S11977]]

  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2583

       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 ``Children's 
     Dental Health Improvement Act of 1998''.
       (b) Table of Contents.--The table of contents for this Act 
     is as follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.

 TITLE I--EXPANDED OPPORTUNITIES FOR TRAINING PEDIATRIC DENTAL HEALTH 
                             CARE PROVIDERS

Sec. 101. Children's dental health training and demonstration programs.
Sec. 102. Increase in National Health Service Corps dental training 
              positions.
Sec. 103. Maternal and child health centers for leadership in pediatric 
              dentistry education.
Sec. 104. Dental officer multiyear retention bonus for the Indian 
              Health Service.
Sec. 105. Medicare payments to approved nonhospital dentistry residency 
              training programs; permanent dental exemption from 
              voluntary residency reduction programs.
Sec. 106. Dental health professional shortage areas.

  TITLE II--ENSURING DELIVERY OF PEDIATRIC DENTAL SERVICES UNDER THE 
                      MEDICAID AND SCHIP PROGRAMS

Sec. 201. Increased FMAP and fee schedule for dental services provided 
              to children under the medicaid program.
Sec. 202. Required minimum medicaid expenditures for dental health 
              services.
Sec. 203. Requirement to verify sufficient numbers of participating 
              dentists under the medicaid program.
Sec. 204. Inclusion of recommended age for first dental visit in 
              definition of EPSDT services.
Sec. 205. Approval of final regulations implementing changes to EPSDT 
              services.
Sec. 206. Use of SCHIP funds to treat children with special dental 
              health needs.
Sec. 207. Grants to supplement fees for the treatment of children with 
              special dental health needs.
Sec. 208. Demonstration projects to increase access to pediatric dental 
              services in underserved areas.

                  TITLE III--PEDIATRIC DENTAL RESEARCH

Sec. 301. Identification of interventions that reduce transmission of 
              dental diseases in high risk populations; development of 
              approaches for pediatric dental assessment.
Sec. 302. Agency for Health Care Policy and Research.
Sec. 303. Consensus development conference.

               TITLE IV--SURVEILLANCE AND ACCOUNTABILITY

Sec. 401. CDC reports.
Sec. 402. Reporting requirements under the medicaid program.
Sec. 403. Administration on Children, Youth, and Families.

                         TITLE V--MISCELLANEOUS

Sec. 501. Effective date.

     SEC. 2. FINDINGS.

       Congress makes the following findings:
       (1) Children's oral health impacts upon and reflects 
     children's general health.
       (2) Tooth decay is the most prevalent preventable chronic 
     disease of childhood and only the common cold, the flu, and 
     otitis media occur more often among young children.
       (3) Despite the design of the medicaid program to reach 
     children and ensure access to routine dental care, in 1996, 
     the Inspector General of the Department of Health and Human 
     Services reported that only 18 percent of children eligible 
     for medicaid received even a single preventive dental 
     service.
       (4) The United States is facing a major dental health care 
     crisis that primarily affects the poor children of our 
     country, with 80 percent of all dental caries in children 
     found in the 20 percent of the population.
       (5) Low income children eligible for the medicaid program 
     and the State children's health insurance program experience 
     disproportionately high levels of oral disease.
       (6) The United States is not training enough pediatric 
     dental health care providers to meet the increasing need for 
     pediatric dental services.
       (7) The United States needs to increase access to health 
     promotion and disease prevention activities in the area of 
     oral health for children by increasing access to pediatric 
     dental health providers.
 TITLE I--EXPANDED OPPORTUNITIES FOR TRAINING PEDIATRIC DENTAL HEALTH 
                             CARE PROVIDERS

     SEC. 101. CHILDREN'S DENTAL HEALTH TRAINING AND DEMONSTRATION 
                   PROGRAMS.

       Part E of title VII of the Public Health Service Act (42 
     U.S.C. 294o et seq.) is amended by adding at the end the 
     following:

     ``SEC. 779. CHILDREN'S DENTAL HEALTH PROGRAMS.

       ``(a) Training Program.--
       ``(1) In general.--The Secretary, acting through the Bureau 
     of Health Professions, shall develop training materials to be 
     used by health professionals to promote oral health through 
     health education.
       ``(2) Design.--The materials developed under paragraph (1) 
     shall be designed to enable health care professionals to--
       ``(A) provide information to individuals concerning the 
     importance of oral health;
       ``(B) recognize oral disease in individuals; and
       ``(C) make appropriate referrals of individuals for dental 
     treatment.
       ``(3) Distribution.--The materials developed under 
     paragraph (1) shall be distributed to--
       ``(A) accredited schools of the health sciences (including 
     schools for physician assistants, schools of medicine, 
     osteopathic medicine, dental hygiene, public health, nursing, 
     pharmacy, and dentistry), and public or private institutions 
     accredited for the provision of graduate or specialized 
     training programs in all aspects of health; and
       ``(B) health professionals and community-based health care 
     workers.
       ``(b) Demonstration Program.--
       ``(1) In general.--The Secretary shall make grants to 
     schools that train pediatric dental health providers to meet 
     the costs of projects--
       ``(A) to plan and develop new training programs and to 
     maintain or improve existing training programs in providing 
     dental health services to children; and
       ``(B) to assist dental health providers in managing complex 
     dental problems in children.
       ``(2) Administration.--
       ``(A) Amount.--The amount of any grant under paragraph (1) 
     shall be determined by the Secretary.
       ``(B) Application.--No grant may be made under paragraph 
     (1) unless an application therefore is submitted to and 
     approved by the Secretary. Such an application shall be in 
     such form, submitted in such manner, and contain such 
     information, as the Secretary shall by regulation prescribe.
       ``(C) Eligibility.--To be eligible for a grant under 
     subsection (a), the applicant must demonstrate to the 
     Secretary that it has or will have available full-time 
     faculty and staff members with training and experience in the 
     field of pediatric dentistry and support from other faculty 
     and staff members trained in pediatric dentistry and other 
     relevant specialties and disciplines such as dental public 
     health and pediatrics, as well as research.
       ``(c) Authorization of Appropriations.--There is authorized 
     to be appropriated such sums as may be necessary to carry out 
     this section.''.

     SEC. 102. INCREASE IN NATIONAL HEALTH SERVICE CORPS DENTAL 
                   TRAINING POSITIONS.

       The Secretary of Health and Human Services shall increase 
     the number of dental health providers skilled in treating 
     children who become members of the National Health Service 
     Corps under subpart II of part D of title III of the Public 
     Health Service Act (42 U.S.C. 254d et seq.) so that there are 
     at least 100 additional dentists and dental hygienists in the 
     Corps by 2000, at least 150 additional dentists and dental 
     hygienists in the Corps by 2001, and at least 300 additional 
     dentists and dental hygienists in the Corps by 2002. The 
     Secretary shall ensure that at least 20 percent of the 
     dentists in the Corps are pediatric dentists and that another 
     20 percent of the dentists in the Corps have general practice 
     residency training.

     SEC. 103. MATERNAL AND CHILD HEALTH CENTERS FOR LEADERSHIP IN 
                   PEDIATRIC DENTISTRY EDUCATION.

       (a) Expansion of Training Programs.--The Secretary of 
     Health and Human Services shall, through the Maternal and 
     Child Health Bureau, establish not less than 36 additional 
     training positions annually for pediatric dentists at centers 
     of excellence. The Secretary shall ensure that such training 
     programs are established in geographically diverse areas.
       (b) Authorization of Appropriations.--There is authorized 
     to be appropriated, such sums as may be necessary to carry 
     out this section.

     SEC. 104. DENTAL OFFICER MULTIYEAR RETENTION BONUS FOR THE 
                   INDIAN HEALTH SERVICE.

       (a) Terms and Definitions.--In this section:
       (1) Dental officer.--The term ``dental officer'' means an 
     officer of the Indian Health Service designated as a dental 
     officer.
       (2) Director.--The term ``Director'' means the Director of 
     the Indian Health Service.
       (3) Creditable service.--The term ``creditable service'' 
     includes all periods that a dental officer spent in graduate 
     dental educational (GDE) training programs while not on 
     active duty in the Indian Health Service and all periods of 
     active duty in the Indian Health Service as a dental officer.
       (4) Residency.--The term ``residency'' means a graduate 
     dental educational (GDE) training program of at least 12 
     months, excluding general practice residency (GPR) or a 12-
     month advanced education general dentistry (AEGD).
       (5) Specialty.--The term ``specialty'' means a dental 
     specialty for which there is an Indian Health Service 
     specialty code number.
       (b) Requirements for Bonus.--

[[Page S11978]]

       (1) In general.--An eligible dental officer of the Indian 
     Health Service who executes a written agreement to remain on 
     active duty for 2, 3, or 4 years after the completion of any 
     other active duty service commitment to the Indian Health 
     Service may, upon acceptance of the written agreement by the 
     Director, be authorized to receive a dental officer multiyear 
     retention bonus under this section. The Director may, based 
     on requirements of the Indian Health Service, decline to 
     offer a such a retention bonus to any specialty that is 
     otherwise eligible, or to restrict the length of a such a 
     retention bonus contract for a specialty to less than 4 
     years.
       (2) Limitations.--Each annual dental officer multiyear 
     retention bonus authorized under this section shall not 
     exceed the following:
       (A) $14,000 for a 4-year written agreement.
       (B) $8,000 for a 3-year written agreement.
       (C) $4,000 for a 2-year written agreement.
       (c) Eligibility.--
       (1) In general.--In order to be eligible to receive a 
     dental officer multiyear retention bonus under the section, a 
     dental officer shall--
       (A) be at or below such grade as the Director shall 
     determine;
       (B) have at least 8 years of creditable service, or have 
     completed any active duty service commitment of the Indian 
     Health Service incurred for dental education and training;
       (C) have completed initial residency training, or be 
     scheduled to complete initial residency training before 
     September 30 of the fiscal year in which the officer enters 
     into a dental officer multiyear retention bonus written 
     service agreement under this section; and
       (D) have a dental specialty in pediatric dentistry or oral 
     and maxillofacial surgery.
       (2) Extension to other officers.--The Director may extend 
     the retention bonus to dental officers other than officers 
     with a dental specialty in pediatric dentistry based on 
     demonstrated need. The criteria used as the basis for such an 
     extension shall be equitably determined and consistently 
     applied.
       (d) Termination of Entitlement to Special Pay.--The 
     Director may terminate at any time a dental officer's 
     multiyear retention bonus contract under this section. If 
     such a contract is terminated, the unserved portion of the 
     retention bonus contract shall be recouped on a pro rata 
     basis. The Director shall establish regulations that specify 
     the conditions and procedures under which termination may 
     take place. The regulations and conditions for termination 
     shall be included in the written service contract for a 
     dental officer multiyear retention bonus under this section.
       (e) Refunds.--
       (1) In general.--Prorated refunds shall be required for 
     sums paid under a retention bonus contract under this section 
     if a dental officer who has received the retention bonus 
     fails to complete the total period of service specified in 
     the contract, as conditions and circumstances warrant.
       (2) Debt to united states.--An obligation to reimburse the 
     United States imposed under paragraph (1) is a debt owed to 
     the United States.
       (3) No discharge in bankruptcy.--Notwithstanding any other 
     provision of law, a discharge in bankruptcy under title 11, 
     United States Code, that is entered less than 5 years after 
     the termination of a retention bonus contract under this 
     section does not discharge the dental officer who signed such 
     a contract from a debt arising under the contract or 
     paragraph (1).

     SEC. 105. MEDICARE PAYMENTS TO APPROVED NONHOSPITAL DENTISTRY 
                   RESIDENCY TRAINING PROGRAMS; PERMANENT DENTAL 
                   EXEMPTION FROM VOLUNTARY RESIDENCY REDUCTION 
                   PROGRAMS.

       (a) Medicare Payments To Approved Nonhospital Dentistry 
     Training Programs.--Section 1886 of the Social Security Act 
     (42 U.S.C. 1395ww) is amended by adding at the end the 
     following:
       ``(l) Payments For Nonhospital Based Dental Residency 
     Training Programs.--
       ``(1) In general.--Beginning January 1, 1999, the Secretary 
     shall make payments under this paragraph to approved 
     nonhospital based dentistry residency training programs 
     providing oral health care to children for the direct and 
     indirect expenses associated with operating such training 
     programs.
       ``(2) Payment amount.--
       ``(A) Methodology.--The Secretary shall establish 
     procedures for making payments under this subsection.
       ``(B) Total amount of payments.--In making payments to 
     approved non-hospital based dentistry residency training 
     programs under this subsection, the Secretary shall ensure 
     that the total amount of such payments will not result in a 
     reduction of payments that would otherwise be made under 
     subsection (h) or (k) to hospitals for dental residency 
     training programs.
       ``(C) Approved programs.--The Secretary shall establish 
     procedures for the approval of nonhospital based dentistry 
     residency training programs under this subsection.''.
       (b) Permanent Dental Exemption From Voluntary Residency 
     Reduction Programs.--
       (1) In general.--Section 1886(h)(6)(C) of the Social 
     Security Act (42 U.S.C. 1395ww(h)(6)(C)) is amended--
       (A) by redesignating clauses (i) through (iii) as 
     subclauses (I) through (III), respectively, and indenting 
     such subclauses (as so redesignated) appropriately;
       (B) by striking ``For purposes'' and inserting the 
     following:
       ``(i) In general.--Subject to clause (ii), for purposes''; 
     and
       (C) by adding at the end the following:
       ``(ii) Definition of `approved medical residency training 
     program'.--In this subparagraph, the term `approved medical 
     residency training program' means only such programs in 
     allopathic or osteopathic medicine.''.
       (2) Application to demonstration projects and authority.--
     Section 4626(b)(3) of the Balanced Budget Act of 1997 (42 
     U.S.C. 1395ww note) is amended by inserting ``in allopathic 
     or osteopathic medicine'' before the period.
       (c) Effective Date.--
       (1) Subsection (a).--The amendment made by subsection (a) 
     takes effect on the date of enactment of this Act.
       (2) Subsection (b).--The amendments made by subsection (b) 
     shall take effect as if included in the enactment of the 
     Balanced Budget Act of 1997.

     SEC. 106. DENTAL HEALTH PROFESSIONAL SHORTAGE AREAS.

       (a) Designation.--Section 332(a) of the Public Health 
     Service Act (42 U.S.C. 254e(a)) is amended by adding at the 
     end the following:
       ``(4)(A) In designating health professional shortage areas 
     under this section, the Secretary may designate certain areas 
     as dental health professional shortage areas if the Secretary 
     determines that such areas have a severe shortage of dental 
     health professionals. The Secretary shall develop, publish 
     and periodically update criteria to be used in designating 
     dental health professional shortage areas.
       ``(B) For purposes of this title, a dental health 
     professional shortage area shall be considered to be a health 
     professional shortage area.''.
       (b) Loan Repayment Program.--Section 338B(b)(1)(A) of the 
     Public Health Service Act (42 U.S.C. 254l-1(b)(1)(A)) is 
     amended by inserting ``(including dental hygienists)'' after 
     ``profession''.
       (c) Technical Amendment.--Section 331(a)(2) of the Public 
     Health Service Act (42 U.S.C. 254d(a)(2)) is amended by 
     inserting ``(including dental health services)'' after 
     ``services''.
  TITLE II--ENSURING DELIVERY OF PEDIATRIC DENTAL SERVICES UNDER THE 
                      MEDICAID AND SCHIP PROGRAMS

     SEC. 201. INCREASED FMAP AND FEE SCHEDULE FOR DENTAL SERVICES 
                   PROVIDED TO CHILDREN UNDER THE MEDICAID 
                   PROGRAM.

       (a) Increased FMAP.--Section 1903(a)(5) of the Social 
     Security Act (42 U.S.C. 1396b(a)(5)) is amended--
       (1) by striking ``equal to 90 per centum'' and inserting 
     ``equal to--
       ``(A) 90 per centum'';
       (2) by inserting ``and'' after the semicolon; and
       (3) by adding at the end the following:
       ``(B) the greater of the Federal medical assistance 
     percentage or 75 per centum of the sums expended during such 
     quarter which are attributable to dental services for 
     children;''.
       (b) Fee Schedule.--Section 1902(a) of the Social Security 
     Act (42 U.S.C. 1396a(a)) is amended--
       (1) in paragraph (65), by striking the period and inserting 
     ``; and''; and
       (2) by inserting after paragraph (65) the following:
       ``(66) provide for payment under the State plan for dental 
     services for children at a rate that is designed to create an 
     incentive for providers of such services to treat children in 
     need of dental services (but that does not result in a 
     reduction or other adverse impact on the extent to which the 
     State provides dental services to adults).''.

     SEC. 202. REQUIRED MINIMUM MEDICAID EXPENDITURES FOR DENTAL 
                   HEALTH SERVICES.

       Section 1902(a) of the Social Security Act (42 U.S.C. 
     1396a(a)), as amended by section 201(b), is amended--
       (1) in paragraph (65), by striking ``and'' at the end;
       (2) in paragraph (66), by striking the period and inserting 
     ``; and''; and
       (3) by inserting after paragraph (66) the following:
       ``(67) provide that, beginning with fiscal year 1999--
       ``(A) not less than an amount equal to 7 percent of the 
     total annual expenditures under the State plan for medical 
     assistance provided to children will be expended during each 
     fiscal year for dental services for children (including the 
     prevention, screening, diagnosis, and treatment of dental 
     conditions); and
       ``(B) the State will not reduce or otherwise adversely 
     impact the extent to which the State provides dental services 
     to adults in order to meet the requirement of subparagraph 
     (A).''.

     SEC. 203. REQUIREMENT TO VERIFY SUFFICIENT NUMBERS OF 
                   PARTICIPATING DENTISTS UNDER THE MEDICAID 
                   PROGRAM.

       Section 1902(a) of the Social Security Act (42 U.S.C. 
     1396a(a)), as amended by section 202, is amended--
       (1) in paragraph (66), by striking ``and'' at the end;
       (2) in paragraph (67), by striking the period and inserting 
     ``; and''; and

[[Page S11979]]

       (3) by inserting after paragraph (67) the following:
       ``(68) provide that the State will annually verify that the 
     number of dentists participating under the State plan--
       ``(A) satisfies the minimum established degree of 
     participation of dentists to the population of children in 
     the State, as determined by the Secretary in accordance with 
     the criteria used by the Secretary under section 332(a)(4) of 
     the Public Health Service Act (42 U.S.C. 254e(a)(4)) to 
     designate a dental health professional shortage area; and
       ``(B) is sufficient to ensure that children enrolled in the 
     State plan have the same level of access to dental services 
     as the children residing in the State who are not eligible 
     for medical assistance under the State plan.''.

     SEC. 204. INCLUSION OF RECOMMENDED AGE FOR FIRST DENTAL VISIT 
                   IN DEFINITION OF EPSDT SERVICES.

       Section 1905(r)(1)(A)(i) of the Social Security Act (42 
     U.S.C. 1396d(r)(1)(A)(i)) is amended by inserting ``and, with 
     respect to dental services under paragraph (3), in accordance 
     with guidelines for the age of a first dental visit that are 
     consistent with guidelines of the American Dental 
     Association, the American Academy of Pediatric Dentistry, and 
     the Bright Futures program of the Health Resources and 
     Services Administration of the Department of Health and Human 
     Services,'' after ``vaccines,''.

     SEC. 205. APPROVAL OF FINAL REGULATIONS IMPLEMENTING CHANGES 
                   TO EPSDT SERVICES.

       Not later than 30 days after the date of enactment of this 
     Act, the Secretary of Health and Human Services shall issue 
     final regulations implementing the proposed regulations based 
     on section 6403 of the Omnibus Budget Reconciliation Act of 
     1989 (Public Law 101-239; 103 Stat. 2262) that were contained 
     in the Federal Register issued for October 1, 1993.

     SEC. 206. USE OF SCHIP FUNDS TO TREAT CHILDREN WITH SPECIAL 
                   DENTAL HEALTH NEEDS.

       (a) In General.--Section 1905 of the Social Security Act 
     (42 U.S.C. 1396d) is amended--
       (1) in subsection (b), by striking ``or subsection (u)(3)'' 
     and inserting ``subsection (u)(3), or subsection (u)(4)''; 
     and
       (2) in subsection (u)--
       (A) by redesignating paragraph (4) as paragraph (5); and
       (B) by inserting after paragraph (3) the following new 
     paragraph:
       ``(4)(A) For purposes of subsection (b), the expenditures 
     described in this paragraph are expenditures for medical 
     assistance described in subparagraph (B) for a low-income 
     child described in subparagraph (C), but only in the case of 
     such a child who resides in a State described in subparagraph 
     (D).
       ``(B) For purposes of subparagraph (A), the medical 
     assistance described in this subparagraph consists of the 
     following:
       ``(i) Dental services provided to children with special 
     oral health needs, including advanced oral, dental, and 
     craniofacial diseases and conditions.
       ``(ii) Outreach conducted to identify and treat children 
     with such special dental health needs.
       ``(C) For purposes of subparagraph (A), a low-income child 
     described in this subparagraph is a child whose family income 
     does not exceed 50 percentage points above the medicaid 
     applicable income level (as defined in section 2110(b)(4)).
       ``(D) A State described in this subparagraph is a State 
     that, as of August 5, 1997, has under a waiver authorized by 
     the Secretary or under section 1902(r)(2), established a 
     medicaid applicable income level (as defined in section 
     2110(b)(4)) for children under 19 years of age residing in 
     the State that is at or above 185 percent of the poverty line 
     (as defined in section 673(2) of the Community Services Block 
     Grant Act (42 U.S.C. 9902(2), including any revision required 
     by such section for a family of the size involved).''.
       (b) Effective Date.--The amendments made by this section 
     shall take effect as if included in the enactment of section 
     4911 of the Balanced Budget Act of 1997 (Public Law 105-33; 
     111 Stat. 570).

     SEC. 207. GRANTS TO SUPPLEMENT FEES FOR THE TREATMENT OF 
                   CHILDREN WITH SPECIAL DENTAL HEALTH NEEDS.

       Title V of the Social Security Act (42 U.S.C. 701 et seq.) 
     is amended by adding at the end the following:

     ``SEC. 511. GRANTS TO SUPPLEMENT FEES FOR THE TREATMENT OF 
                   CHILDREN WITH SPECIAL DENTAL HEALTH NEEDS.

       ``(a) Authority to Make Grants.--
       ``(1) In general.--In addition to any other payments made 
     under this title to a State, the Secretary shall award grants 
     to States to supplement payments made under the State 
     programs established under titles XIX and XXI for the 
     treatment of children with special oral health care needs.
       ``(2) Definition of children with special oral, dental, and 
     craniofacial health care needs.--In this section the term 
     `children with special oral health care needs' means children 
     with advanced oral, dental and craniofacial conditions or 
     disorders, and other chronic medical, genetic, and behavioral 
     disorders with dental manifestations.
       ``(b) Application of Other Provisions of Title.--
       ``(1) In general.--Except as provided in paragraph (2), the 
     other provisions of this title shall not apply to a grant 
     made, or activities of the Secretary, under this section.
       ``(2) Exceptions.--The following provisions of this title 
     shall apply to a grant made under subsection (a) to the same 
     extent and in the same manner as such provisions apply to 
     allotments made under section 502(c):
       ``(A) Section 504(b)(4) (relating to expenditures of funds 
     as a condition of receipt of Federal funds).
       ``(B) Section 504(b)(6) (relating to prohibition on 
     payments to excluded individuals and entities).
       ``(C) Section 506 (relating to reports and audits, but only 
     to the extent determined by the Secretary to be appropriate 
     for grants made under this section).
       ``(D) Section 508 (relating to nondiscrimination).
       ``(c) Authorization of Appropriations.--There is authorized 
     to be appropriated such sums as may be necessary to carry out 
     this section.''.

     SEC. 208. DEMONSTRATION PROJECTS TO INCREASE ACCESS TO 
                   PEDIATRIC DENTAL SERVICES IN UNDERSERVED AREAS.

       (a) Authority to Conduct Projects.--The Secretary of Health 
     and Human Services, through the Administrator of the Health 
     Care Financing Administration, the Administrator of the 
     Health Resources and Services Administration, the Director of 
     the Indian Health Service, and the Director of the Centers 
     for Disease Control and Prevention shall establish 
     demonstration projects that are designed to increase access 
     to dental services for children in underserved areas, as 
     determined by the Secretary.
       (b) Authorization of Appropriations.--There is authorized 
     to be appropriated such sums as may be necessary to carry out 
     this section.
                  TITLE III--PEDIATRIC DENTAL RESEARCH

     SEC. 301. IDENTIFICATION OF INTERVENTIONS THAT REDUCE THE 
                   BURDEN AND TRANSMISSION OF ORAL, DENTAL, AND 
                   CRANIOFACIAL DISEASES IN HIGH RISK POPULATIONS; 
                   DEVELOPMENT OF APPROACHES FOR PEDIATRIC ORAL 
                   AND CRANIOFACIAL ASSESSMENT.

       (a) In General.--The Secretary of Health and Human 
     Services, through the Maternal and Child Health Bureau, the 
     Indian Health Service, and in consultation with the Agency 
     for Health Care Policy and Research and the National 
     Institutes of Health, shall--
       (1) support community based research that is designed to 
     improve our understanding of the etiology, pathogenesis, 
     diagnosis, prevention, and treatment of pediatric oral, 
     dental, craniofacial diseases and conditions and their 
     sequelae in high risk populations; and
       (2) develop clinical approaches for pediatric dental 
     disease risk assessment.
       (b) Authorization of Appropriations.--There is authorized 
     to be appropriated, such sums as may be necessary to carry 
     out this section.

     SEC. 302. AGENCY FOR HEALTH CARE POLICY AND RESEARCH.

       Section 902(a) of the Public Health Service Act (42 U.S.C. 
     299a(a)) is amended--
       (1) in paragraph (7), by striking ``and'' at the end;
       (2) in paragraph (8), by striking the period and inserting 
     ``; and''; and
       (3) by adding at the end the following:
       ``(9) the barriers that exist to dental care for children 
     and the establishment of measures of oral health quality, 
     including access to oral health care for children.''.

     SEC. 303. CONSENSUS DEVELOPMENT CONFERENCE.

       (a) In General.--Not later than January 1, 2000, the 
     Secretary of Health and Human Services, acting through the 
     National Institute of Child Health and Human Development and 
     the National Institute of Dental Research, shall convene a 
     conference (to be known as the ``Consensus Development 
     Conference'') to examine the management of early childhood 
     caries and to support the design and conduct of research on 
     the biology and physiologic dynamics of infectious 
     transmission of dental caries. The Secretary shall ensure 
     that representatives of interested consumers and other 
     professional organizations participate in the Consensus 
     Development Conference.
       (b) Experts.--In administering the conference under 
     subsection (a), the Secretary of Health and Human Services 
     shall solicit the participation of experts in dentistry, 
     including pediatric dentistry, public health, and other 
     appropriate medical and child health professionals.
       (c) Authorization of Appropriations.--There is authorized 
     to be appropriated such sums as may be necessary to carry out 
     this section.
               TITLE IV--SURVEILLANCE AND ACCOUNTABILITY

     SEC. 401. CDC REPORTS.

       (a) Collection of Data.--The Director of the Centers for 
     Disease Control and Prevention in collaboration with other 
     organizations and agencies shall annually collect data 
     describing the dental, craniofacial, and oral health of 
     residents of at least 1 State from each region of the 
     Department of Health and Human Services.
       (b) Reports.--The Director shall compile and analyze data 
     collected under subsection (a) and annually prepare and 
     submit to the appropriate committees of Congress a report 
     concerning the oral health of certain States.

[[Page S11980]]

     SEC. 402. REPORTING REQUIREMENTS UNDER THE MEDICAID PROGRAM.

       Section 1902(a)(43)(D) of the Social Security Act (42 
     U.S.C. 1396a(43)(D)) is amended--
       (1) in clause (iii), by striking ``and'' and inserting 
     ``with the specific dental condition and treatment provided 
     identified,'';
       (2) in clause (iv), by striking the semicolon and inserting 
     a comma; and
       (3) by adding at the end the following:
       ``(v) the percentage of expenditures for such services that 
     were for dental services, and
       ``(vi) the percentage of general and pediatric dentists who 
     are licensed in the State and provide services commensurate 
     with eligibility under the State plan;''.

     SEC. 403. ADMINISTRATION ON CHILDREN, YOUTH, AND FAMILIES.

       The Administrator of the Administration on Children, Youth, 
     and Families shall annually prepare and submit to the 
     appropriate committees of Congress a report concerning the 
     percentage of children enrolled in a Head Start or Early 
     Start program who have access to and who obtain dental care, 
     including children with special oral, dental, and 
     craniofacial health needs.
                         TITLE V--MISCELLANEOUS

     SEC. 501. EFFECTIVE DATE.

       (a) In General.--Except as otherwise provided in this Act, 
     this Act and the amendments made by this Act take effect on 
     the date of enactment of this Act.
       (b) Extension of effective date for state law amendment.--
     In the case of a State plan under title XIX of the Social 
     Security Act which the Secretary of Health and Human Services 
     determines requires State legislation in order for the plan 
     to meet the additional requirements imposed by the amendments 
     made by this Act, the State plan shall not be regarded as 
     failing to comply with the requirements of such amendments 
     solely on the basis of its failure to meet the 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 the 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 the session is considered 
     to be a separate regular session of the State 
     legislature.
                                 ______