[Congressional Record Volume 153, Number 35 (Thursday, March 1, 2007)]
[Senate]
[Pages S2505-S2510]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BINGAMAN (for himself, Mr. Cochran, Mr. Cardin, Mr. Kerry, 
        Ms. Cantwell, and Mrs. Lincoln):
  S. 739. A bill to provide disadvantaged children with access to 
dental services; to the Committee on Finance.
  Mr. BINGAMAN. Mr. President, today I am reintroducing legislation 
entitled the Children's Dental Health Improvement Act of 2007, along 
with several of my colleagues. This legislation is designed to improve 
the access and delivery of dental health services to our Nation's 
children through Medicaid, through the State Children's Health 
Insurance Program, SCHIP, through the Indian Health Services, or IHS, 
and also through our Nation's safety net of community health centers.
  The oral health problems facing children in this country are 
widespread. They are closely associated with poverty. Tooth decay 
remains the single most common childhood disease nationwide. Although 
poor children are more than twice as likely to have cavities as 
wealthier children, experts report that they are far less likely to 
receive treatment. The dramatic consequences of this lack of oral 
health care were underscored yesterday in the Washington Post article 
discussing the death of 12-year-old Deamonte Driver from complications 
arising from a lack of dental care. I know Senator Cardin has spoken on 
this same tragic incident.
  A little over a month ago, Deamonte Driver came home complaining of a 
toothache. Today, that young man is dead. What began as a simple 
toothache developed into an abscessed tooth and, eventually, a brain 
infection that killed him. Although his family attempted to access 
care, they could not acquire meaningful oral health services either 
when they were on the Medicaid Program or while they were uninsured.
  While this young man's death is shocking, the lack of access to 
dental care that it reflects is not unusual. The inspector general of 
the Department of Health and Human Services reported that only 18 
percent of the children who are eligible for Medicaid actually received 
even a single preventive dental service. The inspector general also 
reports that there is no State in the Union that provides preventive 
services to more than 50 percent of the eligible children. The factors 
are complex, but the primary one is due to the limited participation by 
dentists in the Medicaid Program because of the very low reimbursement 
rates that are provided. Such issues played a central role in the death 
of this young man.
  The Children's Dental Health Improvement Act of 2007 provides a 
comprehensive strategy to address the underlying oral health issues 
that led to Deamonte's death. First, the legislation provides grants to 
States to improve dental services to children enrolled in Medicaid and 
SCHIP. Such grants will not only assure improved delivery of dental 
services to children but also improved payment rates for dental 
services that are provided through those two programs. The bill will 
also include grants to federally qualified health centers, to county 
and local public health departments, to dental schools, Indian tribes, 
tribal corporation organizations, and others to increase the 
availability of primary dental care services in underserved areas.
  The bill also provides critical bonus payments to dentists within the 
Indian Health Service who commit to work there for 2, 3, or 4 years. 
The legislation also ensures SCHIP funds will be utilized to provide 
coverage for dental services for low-income children who have access to 
limited health insurance coverage that does not include dental 
services. This is known as wraparound coverage, and it is crucial that 
we provide for this.
  In addition, the bill would make important changes to the way in 
which dental residents are counted for Medicare graduate medical 
education or GME purposes to incentivize dental schools to train a 
larger number of dentists.
  Finally, the legislation also creates a comprehensive oral health 
initiative aimed at reducing oral health disparities for vulnerable 
populations such as low-income children and children with developmental 
disabilities. Such activities will be administered through the 
Department of Health and Human Services, the Centers for Disease 
Control, and a newly established chief dental officer for Medicaid and 
SCHIP. Such activities will also include school-based dental sealant 
programs as well as basic oral health promotion.

[[Page S2506]]

  I introduce the legislation in the hope that this Congress will act 
this year to ensure that Deamonte's death does not repeat itself, that 
no more of America's children will suffer needlessly or even, as in 
this case, die as a result of a lack of access to meaningful oral 
health care. I urge my colleagues in the Senate to join me in 
supporting this important legislation.
  I would like to thank the American Dental Association, the American 
Dental Education Association, the American Academy of Pediatric 
Dentistry, the National Association of Community Health Centers, Inc., 
the National Association of Children's Hospitals, the American Dental 
Hygienists' Association, and the Children's Dental Health Project for 
their outstanding support and/or their technical advice on this 
legislation. This bill is a result of their outstanding work.
  In particular, I want to thank Dr. Burt Edelstein, Libby Mullin, and 
Ann De Biasi of the Children's Dental Health Project for their vast 
knowledge and technical assistance on this issue. I want to thank Judy 
Sherman of the American Dental Association, Myla Moss and Jack Bresch 
of the American Dental Education Association, Dr. Herber Simmons and 
Scott Litch of the American Academy of Pediatric Dentistry, Karen 
Sealander of the American Dental Hygienists' Association, Dr. Jim 
Richeson and Judy Kloss Bynum of the Academy of General Dentistry, Dr. 
Stephen Corbin of Special Olympics, Inc., and Dan Hawkins, Chris 
Koppen, and Roger Schwartz of the National Association of Community 
Health Centers, Inc., for their valuable insight, technical advice, and 
continued support for this legislation. I look forward to working with 
them all to ensure that we achieve increased access to oral health care 
for our children.

  In addition to those organizations, I would like to thank the 
following groups for their support of the bill, whether in the past 
session of Congress or this year. They include: the Academy of General 
Dentistry, American Academy of Child and Adolescent Psychiatry, 
American Academy of Oral and Maxillofacial Pathology, American Academy 
of Periodontology, American Association of Dental Examiners, American 
Association of Dental Research, American Association of Endodontists, 
American Association of Public Health Dentistry, American Association 
of Oral and Maxillofacial Surgeons, American Association of 
Orthodontists, American Association of Women Dentists, American College 
of Dentists, American College of Preventive Medicine, American Dental 
Trade Association, American Public Health Association, American Society 
of Dentistry for Children, American Student Dental Association, 
Association of Clinicians for the Underserved, Association of Maternal 
and Child Health Programs, Association of State and Territorial Dental 
Directors, Dental Dealers of America, Dental Manufacturers of America, 
Inc., Family Voices, Hispanic Dental Association, International College 
of Dentists--USA, March of Dimes, National Association of City and 
County Health Officers, National Association of Local Boards of Health, 
National Dental Association, National Health Law Program, New Mexico 
Department of Health, Partnership for Prevention, Society of American 
Indian Dentists, Special Care Dentistry, and United Cerebral Palsy 
Associations.
  I ask unanimous consent that the Washington Post article and the text 
of the bill be printed in the Record.
  There being no objection, the materials were ordered to be printed in 
the Record, as follows:

               [From the Washington Post, Feb. 28, 2007]

                         For Want of a Dentist

                             (By Mary Otto)

       Twelve-year-old Deamonte Driver died of a toothache Sunday.
       A routine, $80 tooth extraction might have saved him.
       If his mother had been insured.
       If his family had not lost its Medicaid.
       If Medicaid dentists weren't so hard to find.
       If his mother hadn't been focused on getting a dentist for 
     his brother, who had six rotted teeth.
       By the time Deamonte's own aching tooth got any attention, 
     the bacteria from the abscess had spread to his brain, 
     doctors said. After two operations and more than six weeks of 
     hospital care, the Prince George's County boy died.
       Deamonte's death and the ultimate cost of his care, which 
     could total more than $250,000, underscore an often-
     overlooked concern in the debate over universal health 
     coverage: dental care.
       Some poor children have no dental coverage at all. Others 
     travel three hours to find a dentist willing to take Medicaid 
     patients and accept the incumbent paperwork. And some, 
     including Deamonte's brother, get in for a tooth cleaning but 
     have trouble securing an oral surgeon to fix deeper problems.
       In spite of efforts to change the system, fewer than one in 
     three children in Maryland's Medicaid program received any 
     dental service at all in 2005, the latest year for which 
     figures are available from the Federal Centers for Medicare 
     and Medicaid Services.
       The figures were worse elsewhere in the region. In the 
     District, 29.3 percent got treatment, and in Virginia, 24.3 
     percent were treated, although all three jurisdictions say 
     they have done a better job reaching children in recent 
     years.
       ``I certainly hope the state agencies responsible for 
     making sure these children have dental care take note so that 
     Deamonte didn't die in vain,'' said Laurie Norris, a lawyer 
     for the Baltimore-based Public Justice Center who tried to 
     help the Driver family. ``They know there is a problem, and 
     they have not devoted adequate resources to solving it.''
       Maryland officials emphasize that the delivery of basic 
     care has improved greatly since 1997, when the state 
     instituted a managed care program, and 1998, when legislation 
     that provided more money and set standards for access to 
     dental care for poor children was enacted.
       About 900 of the state's 5,500 dentists accept Medicaid 
     patients, said Arthur Fridley, last year's president of the 
     Maryland State Dental Association. Referring patients to 
     specialists can be particularly difficult.
       Fewer than 16 percent of Maryland's Medicaid children 
     received restorative services--such as filling cavities--in 
     2005, the most recent year for which figures are available.
       For families such as the Drivers, the systemic problems are 
     often compounded by personal obstacles: lack of 
     transportation, bouts of homelessness and erratic telephone 
     and mail service.
       The Driver children have never received routine dental 
     attention, said their mother, Alyce Driver. The bakery, 
     construction and home health-care jobs she has held have not 
     provided insurance. The children's Medicaid coverage had 
     temporarily lapsed at the time Deamonte was hospitalized. And 
     even with Medicaid's promise of dental care, the problem, she 
     said, was finding it.
       When Deamonte got sick, his mother had not realized that 
     his tooth had been bothering him. Instead, she was focusing 
     on his younger brother, 10-year-old DaShawn, who ``complains 
     about his teeth all the time,'' she said.
       DaShawn saw a dentist a couple of years ago, but the 
     dentist discontinued the treatments, she said, after the boy 
     squirmed too much in the chair. Then the family went through 
     a crisis and spent some time in an Adelphi homeless shelter. 
     From there, three of Driver's sons went to stay with their 
     grandparents in a two-bedroom mobile home in Clinton.
       By September, several of DaShawn's teeth had become 
     abscessed. Driver began making calls about the boy's coverage 
     but grew frustrated. She turned to Norris, who was working 
     with homeless families in Prince George's.
       Norris and her staff also ran into barriers: They said they 
     made more than two dozen calls before reaching an official at 
     the Driver family's Medicaid provider and a state supervising 
     nurse who helped them find a dentist.
       On Oct. 5, DaShawn saw Arthur Fridley, who cleaned the 
     boy's teeth, took an X-ray and referred him to an oral 
     surgeon. But the surgeon could not see him until Nov. 21, and 
     that would be only for a consultation. Driver said she 
     learned that DaShawn would need six teeth extracted and made 
     an appointment for the earliest date available: Jan. 16.
       But she had to cancel after learning Jan. 8 that the 
     children had lost their Medicaid coverage a month earlier. 
     She suspects that the paperwork to confirm their eligibility 
     was mailed to the shelter in Adelphi, where they no longer 
     live.
       It was on Jan. 11 that Deamonte came home from school 
     complaining of a headache. At Southern Maryland Hospital 
     Center, his mother said, he got medicine for a headache, 
     sinusitis and a dental abscess. But the next day, he was much 
     sicker.
       Eventually, he was rushed to Children's Hospital, where he 
     underwent emergency brain surgery. He began to have seizures 
     and had a second operation. The problem tooth was extracted.
       After more than 2 weeks of care at Children's Hospital, the 
     Clinton seventh-grader began undergoing 6 weeks of additional 
     medical treatment as well as physical and occupational 
     therapy at another hospital. He seemed to be mending slowly, 
     doing math problems and enjoying visits with his brothers and 
     teachers from his school, the Foundation School in Largo.
       On Saturday, their last day together, Deamonte refused to 
     eat but otherwise appeared happy, his mother said. They 
     played cards and watched a show on television, lying together 
     in his hospital bed. But after she left him that evening, he 
     called her.
       ``Make sure you pray before you go to sleep,'' he told her.
       The next morning at about 6, she got another call, this 
     time from the boy's grandmother. Deamonte was unresponsive. 
     She rushed back to the hospital.

[[Page S2507]]

       ``When I got there, my baby was gone,'' recounted his 
     mother.
       She said doctors are still not sure what happened to her 
     son. His death certificate listed two conditions associated 
     with brain infections: ``meningoencephalitis'' and ``subdural 
     empyema.''
       In spite of such modern innovations as the fluoridation of 
     drinking water, tooth decay is still the single most common 
     childhood disease nationwide, five times as common as asthma, 
     experts say. Poor children are more than twice as likely to 
     have cavities as their more affluent peers, research shows, 
     but far less likely to get treatment.
       Serious and costly medical consequences are ``not 
     uncommon,'' said Norman Tinanoff, chief of pediatric 
     dentistry at the University of Maryland Dental School in 
     Baltimore. For instance, Deamonte's bill for two weeks at 
     Children's alone was expected to be between $200,000 and 
     $250,000.
       The federal government requires states to provide oral 
     health services to children through Medicaid programs, but 
     the shortage of dentists who will treat indigent patients 
     remains a major barrier to care, according to the National 
     Conference of State Legislatures.
       Access is worst in rural areas, where some families travel 
     hours for dental care, Tinanoff said. In the Maryland General 
     Assembly this year, lawmakers are considering a bill that 
     would set aside $2 million a year for the next three years to 
     expand public clinics where dental care remains a rarity for 
     the poor.
       Providing such access, Tinanoff and others said, eventually 
     pays for itself, sparing children the pain and expense of a 
     medical crisis.
       Reimbursement rates for dentists remain low nationally, 
     although Maryland, Virginia and the District have increased 
     their rates in recent years.
       Dentists also cite administrative frustrations dealing with 
     the Medicaid bureaucracy and the difficulties of serving 
     poor, often transient patients, a study by the state 
     legislatures conference found.
       ``Whatever we've got is broke,'' Fridley said. ``It has 
     nothing to do with access to care for these children.''
                                  ____


                                 S. 739

       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 2007''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents

TITLE I--IMPROVING DELIVERY OF PEDIATRIC DENTAL SERVICES UNDER MEDICAID 
                               AND SCHIP

Sec. 101. Grants to improve the provision of dental services under 
              medicaid and SCHIP
Sec. 102. State option to provide wrap-around SCHIP coverage to 
              children who have other health coverage

    TITLE II--CORRECTING GME PAYMENTS FOR DENTAL RESIDENCY TRAINING 
                                PROGRAMS

Sec. 201. Limitation on the application of the 1-year lag in the 
              indirect medical education ratio (IME) changes and the 3-
              year rolling average for counting interns and residents 
              for IME and direct graduate medical education (D-GME) 
              payments under the medicare program

   TITLE III--IMPROVING DELIVERY OF PEDIATRIC DENTAL SERVICES UNDER 
  COMMUNITY HEALTH CENTERS, PUBLIC HEALTH DEPARTMENTS, AND THE INDIAN 
                             HEALTH SERVICE

Sec. 301. Grants to improve the provision of dental health services 
              through community health centers and public health 
              departments
Sec. 302. Dental officer multiyear retention bonus for the Indian 
              Health Service
Sec. 303. Demonstration projects to increase access to pediatric dental 
              services in underserved areas
Sec. 304. Technical correction

   TITLE IV--IMPROVING ORAL HEALTH PROMOTION AND DISEASE PREVENTION 
                                PROGRAMS

Sec. 401. Oral health initiative
Sec. 402. CDC reports
Sec. 403. Early childhood caries
Sec. 404. School-based dental sealant program
Sec. 405. Basic oral health promotion

TITLE I--IMPROVING DELIVERY OF PEDIATRIC DENTAL SERVICES UNDER MEDICAID 
                               AND SCHIP

     SEC. 101. GRANTS TO IMPROVE THE PROVISION OF DENTAL SERVICES 
                   UNDER MEDICAID AND SCHIP.

       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 IMPROVE THE PROVISION OF DENTAL 
                   SERVICES UNDER MEDICAID AND SCHIP.

       ``(a) Authority to Make Grants.--In addition to any other 
     payments made under this title to a State, the Secretary 
     shall award grants to States that satisfy the requirements of 
     subsection (b) to improve the provision of dental services to 
     children who are enrolled in a State plan under title XIX or 
     a State child health plan under title XXI (in this section, 
     collectively referred to as the `State plans').
       ``(b) Requirements.--In order to be eligible for a grant 
     under this section, a State shall provide the Secretary with 
     the following assurances:
       ``(1) Improved service delivery.--The State shall have a 
     plan to improve the delivery of dental services to children, 
     including children with special health care needs, who are 
     enrolled in the State plans, including providing outreach and 
     administrative case management, improving collection and 
     reporting of claims data, and providing incentives, in 
     addition to raising reimbursement rates, to increase provider 
     participation.
       ``(2) Adequate payment rates.--The State has provided for 
     payment under the State plans for dental services for 
     children at levels consistent with the market-based rates and 
     sufficient enough to enlist providers to treat children in 
     need of dental services.
       ``(3) Ensured access.--The State shall ensure it will make 
     dental services available to children enrolled in the State 
     plans to the same extent as such services are available to 
     the general population of the State.
       ``(c) Use of Funds.--
       ``(1) In general.--Funds provided under this section may be 
     used to provide administrative resources (such as program 
     development, provider training, data collection and analysis, 
     and research-related tasks) to assist States in providing and 
     assessing services that include preventive and therapeutic 
     dental care regimens.
       ``(2) Limitation.--Funds provided under this section may 
     not be used for payment of direct dental, medical, or other 
     services or to obtain Federal matching funds under any 
     Federal program.
       ``(d) Application.--A State shall submit an application to 
     the Secretary for a grant under this section in such form and 
     manner and containing such information as the Secretary may 
     require.
       ``(e) Authorization of Appropriations.--There are 
     authorized to be appropriated to make grants under this 
     section $50,000,000 for fiscal year 2008 and each fiscal year 
     thereafter.
       ``(f) 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 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)(6) (relating to prohibition on 
     payments to excluded individuals and entities).
       ``(B) Section 504(c) (relating to the use of funds for the 
     purchase of technical assistance).
       ``(C) Section 504(d) (relating to a limitation on 
     administrative expenditures).
       ``(D) 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.
       ``(E) Section 507 (relating to penalties for false 
     statements).
       ``(F) Section 508 (relating to nondiscrimination).
       ``(G) Section 509 (relating to the administration of the 
     grant program).''.

     SEC. 102. STATE OPTION TO PROVIDE WRAP-AROUND SCHIP COVERAGE 
                   TO CHILDREN WHO HAVE OTHER HEALTH COVERAGE.

       (a) In General.--
       (1) SCHIP.--
       (A) State option to provide wrap-around coverage.--Section 
     2110(b) of the Social Security Act (42 U.S.C. 1397jj(b)) is 
     amended--
       (i) in paragraph (1)(C), by inserting ``, subject to 
     paragraph (5),'' after ``under title XIX or''; and
       (ii) by adding at the end the following:
       ``(5) State option to provide wrap-around coverage.--A 
     State may waive the requirement of paragraph (1)(C) that a 
     targeted low-income child may not be covered under a group 
     health plan or under health insurance coverage, if the State 
     satisfies the conditions described in subsection (c)(8). The 
     State may waive such requirement in order to provide--
       ``(A) dental services;
       ``(B) cost-sharing protection; or
       ``(C) all services.
     In waiving such requirement, a State may limit the 
     application of the waiver to children whose family income 
     does not exceed a level specified by the State, so long as 
     the level so specified does not exceed the maximum income 
     level otherwise established for other children under the 
     State child health plan.''.
       (B) Conditions described.--Section 2105(c) of the Social 
     Security Act (42 U.S.C. 1397ee(c)) is amended by adding at 
     the end the following:
       ``(8) Conditions for provision of wrap-around coverage.--
     For purposes of section 2110(b)(5), the conditions described 
     in this paragraph are the following:
       ``(A) Income eligibility.--The State child health plan 
     (whether implemented under title XIX or this XXI)--
       ``(i) has the highest income eligibility standard permitted 
     under this title as of January 1, 2008;
       ``(ii) subject to subparagraph (B), does not limit the 
     acceptance of applications for children; and

[[Page S2508]]

       ``(iii) provides benefits to all children in the State who 
     apply for and meet eligibility standards.
       ``(B) No waiting list imposed.--With respect to children 
     whose family income is at or below 200 percent of the poverty 
     line, the State does not impose any numerical limitation, 
     waiting list, or similar limitation on the eligibility of 
     such children for child health assistance under such State 
     plan.
       ``(C) No more favorable treatment.--The State child health 
     plan may not provide more favorable coverage of dental 
     services to the children covered under section 2110(b)(5) 
     than to children otherwise covered under this title.''.
       (C) State option to waive waiting period.--Section 
     2102(b)(1)(B) of the Social Security Act (42 U.S.C. 
     1397bb(b)(1)(B)) is amended--
       (i) in clause (i), by striking ``and'' at the end;
       (ii) in clause (ii), by striking the period and inserting 
     ``; and''; and
       (iii) by adding at the end the following:
       ``(iii) at State option, may not apply a waiting period in 
     the case of a child described in section 2110(b)(5), if the 
     State satisfies the requirements of section 2105(c)(8).''.
       (2) Application of enhanced match under medicaid.--Section 
     1905 of the Social Security Act (42 U.S.C. 1396d) is 
     amended--
       (A) in subsection (b), in the fourth sentence, by striking 
     ``or subsection (u)(3)'' and inserting ``(u)(3), or (u)(4)''; 
     and
       (B) in subsection (u)--
       (i) by redesignating paragraph (4) as paragraph (5); and
       (ii) by inserting after paragraph (3) the following:
       ``(4) For purposes of subsection (b), the expenditures 
     described in this paragraph are expenditures for items and 
     services for children described in section 2110(b)(5), but 
     only in the case of a State that satisfies the requirements 
     of section 2105(c)(8).''.
       (3) Application of secondary payor provisions.--Section 
     2107(e)(1) of the Social Security Act (42 U.S.C. 
     1397gg(e)(1)) is amended--
       (A) by redesignating subparagraphs (B) through (D) as 
     subparagraphs (C) through (E), respectively; and
       (B) by inserting after subparagraph (A) the following:
       ``(B) Section 1902(a)(25) (relating to coordination of 
     benefits and secondary payor provisions) with respect to 
     children covered under a waiver described in section 
     2110(b)(5).''.
       (b) Effective Date.--The amendments made by subsection (a) 
     shall take effect on January 1, 2008, and shall apply to 
     child health assistance and medical assistance provided on or 
     after that date.

    TITLE II--CORRECTING GME PAYMENTS FOR DENTAL RESIDENCY TRAINING 
                                PROGRAMS

     SEC. 201. LIMITATION ON THE APPLICATION OF THE 1-YEAR LAG IN 
                   THE INDIRECT MEDICAL EDUCATION RATIO (IME) 
                   CHANGES AND THE 3-YEAR ROLLING AVERAGE FOR 
                   COUNTING INTERNS AND RESIDENTS FOR IME AND 
                   DIRECT GRADUATE MEDICAL EDUCATION (D-GME) 
                   PAYMENTS UNDER THE MEDICARE PROGRAM.

       (a) IME Ratio and Rolling Average.--Section 
     1886(d)(5)(B)(vi) of the Social Security Act (42 U.S.C. 
     1395ww(d)(5)(B)(vi)) is amended by adding at the end the 
     following new sentence: ``For cost reporting periods 
     beginning during fiscal years beginning on or after October 
     1, 2007, subclauses (I) and (II) shall be applied only with 
     respect to a hospital's approved medical residency training 
     program in the fields of allopathic medicine and osteopathic 
     medicine.''.
       (b) D-GME Rolling Average.--Section 1886(h)(4)(G) of the 
     Social Security Act (42 U.S.C. 1395ww(h)(4)(G)) is amended by 
     adding at the end the following new clause:
       ``(iv) Application for fy 2008 and subsequent years.--For 
     cost reporting periods beginning during fiscal years 
     beginning on or after October 1, 2007, clauses (i) through 
     (iii) shall be applied only with respect to a hospital's 
     approved medical residency training program in the fields of 
     allopathic medicine and osteopathic medicine.''.

   TITLE III--IMPROVING DELIVERY OF PEDIATRIC DENTAL SERVICES UNDER 
  COMMUNITY HEALTH CENTERS, PUBLIC HEALTH DEPARTMENTS, AND THE INDIAN 
                             HEALTH SERVICE

     SEC. 301. GRANTS TO IMPROVE THE PROVISION OF DENTAL HEALTH 
                   SERVICES THROUGH COMMUNITY HEALTH CENTERS AND 
                   PUBLIC HEALTH DEPARTMENTS.

       Subpart I of part D of title III of the Public Health 
     Service Act (42 U.S.C. 254b et seq.) is amended by insert 
     before section 330, the following:

     ``SEC. 329. GRANT PROGRAM TO EXPAND THE AVAILABILITY OF 
                   SERVICES.

       ``(a) In General.--The Secretary, acting through the Health 
     Resources and Services Administration, shall establish a 
     program under which the Secretary may award grants to 
     eligible entities and eligible individuals to expand the 
     availability of primary dental care services in dental health 
     professional shortage areas or medically underserved areas.
       ``(b) Eligibility.--
       ``(1) Entities.--To be eligible to receive a grant under 
     this section an entity--
       ``(A) shall be--
       ``(i) a health center receiving funds under section 330 or 
     designated as a Federally qualified health center;
       ``(ii) a county or local public health department, if 
     located in a federally-designated dental health professional 
     shortage area;
       ``(iii) an Indian tribe or tribal organization (as defined 
     in section 4 of the Indian Self-Determination and Education 
     Assistance Act (25 U.S.C. 450b));
       ``(iv) a dental education program accredited by the 
     Commission on Dental Accreditation; or
       ``(v) a community-based program whose child service 
     population is made up of at least 33 percent of children who 
     are eligible children, including at least 25 percent of such 
     children being children with mental retardation or related 
     developmental disabilities, unless specific documentation of 
     a lack of need for access by this sub-population is 
     established; and
       ``(B) shall prepare and submit to the Secretary an 
     application at such time, in such manner, and containing such 
     information as the Secretary may require, including 
     information concerning dental provider capacity to serve 
     individuals with developmental disabilities.
       ``(2) Individuals.--To be eligible to receive a grant under 
     this section an individual shall--
       ``(A) be a dental health professional licensed or certified 
     in accordance with the laws of State in which such individual 
     provides dental services;
       ``(B) prepare and submit to the Secretary an application at 
     such time, in such manner, and containing such information as 
     the Secretary may require; and
       ``(C) provide assurances that--
       ``(i) the individual will practice in a federally-
     designated dental health professional shortage area; or
       ``(ii) not less than 25 percent of the patients of such 
     individual are--

       ``(I) receiving assistance under a State plan under title 
     XIX of the Social Security Act (42 U.S.C. 1396 et seq.);
       ``(II) receiving assistance under a State plan under title 
     XXI of the Social Security Act (42 U.S.C. 1397aa et seq.); or
       ``(III) uninsured.

       ``(c) Use of Funds.--
       ``(1) Entities.--An entity shall use amounts received under 
     a grant under this section to provide for the increased 
     availability of primary dental services in the areas 
     described in subsection (a). Such amounts may be used to 
     supplement the salaries offered for individuals accepting 
     employment as dentists in such areas.
       ``(2) Individuals.--A grant to an individual under 
     subsection (a) shall be in the form of a $1,000 bonus payment 
     for each month in which such individual is in compliance with 
     the eligibility requirements of subsection (b)(2)(C).
       ``(d) Authorization of Appropriations.--
       ``(1) In general.--Notwithstanding any other amounts 
     appropriated under section 330 for health centers, there is 
     authorized to be appropriated $40,000,000 for each of fiscal 
     years 2008 through 2012 to hire and retain dental health care 
     providers under this section.
       ``(2) Use of funds.--Of the amount appropriated for a 
     fiscal year under paragraph (1), the Secretary shall use--
       ``(A) not less than 65 percent of such amount to make 
     grants to eligible entities; and
       ``(B) not more than 35 percent of such amount to make 
     grants to eligible individuals.''.

     SEC. 302. DENTAL OFFICER MULTIYEAR RETENTION BONUS FOR THE 
                   INDIAN HEALTH SERVICE.

       (a) Terms and Definitions.--In this section:
       (1) 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.
       (2) Dental officer.--The term ``dental officer'' means an 
     officer of the Indian Health Service designated as a dental 
     officer.
       (3) Director.--The term ``Director'' means the Director of 
     the Indian Health Service.
       (4) Residency.--The term ``residency'' means a graduate 
     dental educational (GDE) training program of at least 12 
     months leading to a specialty, including general practice 
     residency (GPR) or an 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.--
       (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 such a retention bonus to any specialty that is 
     otherwise eligible, or to restrict the length of 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.--

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       (1) In general.--In order to be eligible to receive a 
     dental officer multiyear retention bonus under this section, 
     a dental officer shall--
       (A) be at or below such grade as the Director shall 
     determine;
       (B) have completed any active duty service commitment of 
     the Indian Health Service incurred for dental education and 
     training or have 8 years of creditable service;
       (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, as well as to 
     other dental hygienists with a minimum of a baccalaureate 
     degree, based on demonstrated need.
       (d) Termination of Entitlement to Special Pay.--The 
     Director may terminate, with cause, 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 under 
     paragraph (1).

     SEC. 303. 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 
     Resources and Services Administration and the Director of the 
     Indian Health Service, 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.

     SEC. 304. TECHNICAL CORRECTION.

       Section 340G(b)(1)(B) of the Public Health Service Act (42 
     U.S.C. 256g(b)(1)(B)) is amended by striking ``and'' at the 
     end and inserting ``or''.

   TITLE IV--IMPROVING ORAL HEALTH PROMOTION AND DISEASE PREVENTION 
                                PROGRAMS

     SEC. 401. ORAL HEALTH INITIATIVE.

       (a) Establishment.--The Secretary of Health and Human 
     Services shall establish an oral health initiative to reduce 
     the profound disparities in oral health by improving the 
     health status of vulnerable populations, particularly low-
     income children and children with developmental disabilities, 
     to the level of health status that is enjoyed by the majority 
     of Americans.
       (b) Activities.--The Secretary of Health and Human Services 
     shall, through the oral health initiative--
       (1) carry out activities to improve intra- and inter-agency 
     collaborations, including activities to identify, engage, and 
     encourage existing Federal and State programs to maximize 
     their potential to address oral health;
       (2) carry out activities to encourage public-private 
     partnerships to engage private sector communities of interest 
     (including health professionals, educators, State 
     policymakers, foundations, business, and the public) in 
     partnerships that promote oral health and dental care;
       (3) carry out activities to reduce the disease burden in 
     high risk populations through the application of best-science 
     in oral health, including programs such as community water 
     fluoridation and dental sealants; and
       (4) carry out activities to improve the oral health 
     literacy of the public through school-based education 
     programs.
       (c) Coordination.--The Secretary of Health and Human 
     Services shall--
       (1) through the Administrator of the Centers for Medicare & 
     Medicaid Services, establish the Chief Dental Officer for the 
     medicaid and State children's health insurance programs 
     established under titles XIX and XXI, respectively, of the 
     Social Security Act (42 U.S.C. 1396 et seq. 1397aa et seq.);
       (2) through the Administrator of the Health Resources and 
     Services Administration, establish the Chief Dental Office 
     for all oral health programs within the Health Resources and 
     Services Administration;
       (3) through the Director of the Centers for Disease Control 
     and Prevention, establish the Chief Dental Officer for all 
     oral health programs within such Centers; and
       (4) carry out this section in collaboration with the 
     Administrators and Chief Dental Officers described in 
     paragraphs (1), (2), and (3).
       (d) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, $25,000,000 for 
     fiscal year 2008, and such sums as may be necessary for each 
     subsequent fiscal year.

     SEC. 402. CDC REPORTS.

       (a) Collection of Data.--The Director of the Centers for 
     Disease Control and Prevention, in collaboration with other 
     organizations and agencies, shall collect data through State-
     based oral health surveillance systems describing the dental, 
     craniofacial, and oral health of residents of all 50 States 
     and certain Indian tribes.
       (b) Reports.--The Director of the Centers for Disease 
     Control and Prevention shall compile and analyze data 
     collection under subsection (a) and annually prepare and 
     submit to the appropriate committees of Congress a report 
     concerning the oral health of States and Indian tribes.

     SEC. 403. EARLY CHILDHOOD CARIES.

       (a) In General.--The Secretary of Health and Human 
     Services, acting through the Director of the Centers for 
     Disease Control and Prevention, shall--
       (1) expand existing surveillance activities to include the 
     identification of children at high risk of early childhood 
     caries, including sub-populations such as children with 
     developmental disabilities;
       (2) assist State, local, and tribal health agencies and 
     departments in collecting, analyzing and disseminating data 
     on early childhood caries; and
       (3) provide for the development of public health nursing 
     programs and public health education programs on early 
     childhood caries prevention.
       (b) Appropriateness of Activities.--The Secretary of Health 
     and Human Services shall carry out programs and activities 
     under subsection (a) in a culturally appropriate manner with 
     respect to populations at risk of early childhood caries.
       (c) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, such sums as 
     may be necessary for each fiscal year.

     SEC. 404. SCHOOL-BASED DENTAL SEALANT PROGRAM.

       Section 317M(c) of the Public Health Service Act (42 U.S.C. 
     247b-14(c)) is amended--
       (1) in paragraph (1), by inserting ``and school-linked'' 
     after ``school-based'';
       (2) in the first sentence of paragraph (2)--
       (A) by inserting ``and school-linked'' after ``school-
     based''; and
       (B) by inserting ``or Indian tribe'' after ``State''; and
       (3) by striking paragraph (3) and inserting the following:
       ``(3) Eligibility.--To be eligible to receive funds under 
     paragraph (1), an entity shall--
       ``(A) prepare and submit to the State or Indian tribe an 
     application at such time, in such manner and containing such 
     information as the State or Indian tribe may require; and
       ``(B) be a--
       ``(i) public elementary or secondary school--

       ``(I) that is located in an urban area in which more than 
     50 percent of the student population is participating in 
     Federal or State free or reduced meal programs; or
       ``(II) that is located in a rural area and, with respect to 
     the school district in which the school is located, the 
     district involved has a median income that is at or below 235 
     percent of the poverty line, as defined in section 673(2) of 
     the Community Services Block Grant Act (42 U.S.C. 9902(2)); 
     or

       ``(ii) public or non-profit organization, including a 
     grantee under section 330 and urban Indian clinics under 
     title V of the Indian Health Care Improvement Act, that is 
     under contract with an elementary or secondary school 
     described in subparagraph (B) to provide dental services to 
     school-age children.''.

     SEC. 405. BASIC ORAL HEALTH PROMOTION.

       (a) In General.--The Secretary of Health and Human 
     Services, acting through the Director of the Centers for 
     Disease Control and Prevention and in consultation with 
     dental organizations (including organizations having 
     expertise in the prevention and treatment of oral disease in 
     underserved pediatric populations), shall award grants to 
     States and Indian tribes to improve the basic capacity of 
     such States and tribes to improve the oral health of children 
     and their families.
       (b) Requirements.--A State or Indian tribes shall use 
     amounts received under a grant under this section to conduct 
     one or more of the following activities:
       (1) Establish an oral health plan, policies, effective 
     prevention programs, and accountability measures and systems.
       (2) Establish and guide coalitions, partnerships, and 
     alliances to accomplish the establishment of the plan, 
     policies, programs and systems under paragraph (1).

[[Page S2510]]

       (3) Monitor changes in oral disease burden, disparities, 
     and the utilization of preventive services by high-risk 
     populations.
       (4) Identify, test, establish, support, and evaluate 
     prevention interventions to reduce oral health disparities.
       (5) Promote public awareness and education in support of 
     improvements of oral health.
       (6) Support training programs for dental and other health 
     professions needed to strengthen oral health prevention 
     programs.
       (7) Establish, enhance, or expand oral disease prevention 
     and disparity reduction programs.
       (8) Evaluate the progress and effectiveness of the State's 
     oral disease prevention and disparity reduction program.
       (c) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, such sums as 
     may be necessary for fiscal year 2008 and each subsequent 
     fiscal year.
                                 ______