[Congressional Record Volume 168, Number 98 (Wednesday, June 8, 2022)]
[Senate]
[Pages S2870-S2872]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

  SA 5074. Mr. SANDERS submitted an amendment intended to be proposed 
to amendment SA 5051 proposed by Mr. Tester (for himself and Mr. Moran) 
to the bill H.R. 3967, to improve health care and benefits for veterans 
exposed to toxic substances, and for other purposes; which was ordered 
to lie on the table; as follows:

       At the end of title I, add the following:

           Subtitle C--Expansion of Dental Care for Veterans

     SEC. 121. REQUIREMENT THAT SECRETARY OF VETERANS AFFAIRS 
                   FURNISH DENTAL CARE IN THE SAME MANNER AS ANY 
                   OTHER MEDICAL SERVICE.

       (a) In General.--Chapter 17 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; 
     and
       (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''.
       (b) Conforming and Clerical Amendments.--
       (1) Conforming amendments.--
       (A) Protection of health care eligibility.--Section 1525(a) 
     is amended by striking ``medicines under section 1712(d)'' 
     and inserting ``medicines under section 1712(b)''.
       (B) Dental insurance plan.--Section 1712C(h) is amended--
       (i) by striking ``section 1712 of this title'' and 
     inserting ``this chapter''; and
       (ii) by striking ``such section 1712'' and inserting ``this 
     chapter''.
       (2) Heading amendment.--The heading for section 1712 is 
     amended to read as follows:

     ``Sec. 1712. Appliances; drugs and medicines for certain 
       disabled veterans; vaccines''.

       (3) Clerical amendment.--The table of sections at the 
     beginning of subchapter II of chapter 17 is amended by 
     striking the item relating to section 1712 and inserting the 
     following new item:

``1712. Appliances; drugs and medicines for certain disabled veterans; 
              vaccines.''.
       (c) Effective Date.--The amendments made by this section 
     shall take effect on the date that is one year after the date 
     of the enactment of this Act.

     SEC. 122. EXPANSION OF FURNISHING BY DEPARTMENT OF VETERANS 
                   AFFAIRS OF DENTAL CARE TO ALL ENROLLED 
                   VETERANS.

       (a) In General.--The Secretary of Veterans Affairs shall 
     furnish dental care to all veterans 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, pursuant to the phased approach 
     required under this section.
       (b) Phase One Required.--
       (1) Commencement.--
       (A) In general.--Commencing not later than one year after 
     the date of the enactment of this Act, the Secretary of 
     Veterans Affairs shall furnish dental care to all covered 
     veterans who are not eligible for dental services and 
     treatment and related dental appliances under the laws 
     administered by the Secretary as of the date of the enactment 
     of this Act.
       (B) Phase one.--In this section, the furnishing of dental 
     care under subparagraph (A) shall be referred to as ``phase 
     one''.
       (2) Duration of phase one.--Phase one shall be carried out 
     during the two-year period beginning on the date of the 
     commencement of phase one.
       (3) Locations.--
       (A) In general.--The Secretary shall carry out phase one at 
     the following locations:
       (i) Each medical center of the Department with an 
     established dental clinic.
       (ii) Not fewer than four military medical treatment 
     facilities of the Department of Defense with the capacity to 
     furnish dental care, which shall be selected in consultation 
     with the Secretary of Defense.
       (iii) Not fewer than four community-based outpatient 
     clinics with space available for the furnishing of dental 
     care under phase one.
       (iv) Not fewer than four Federally Qualified Health 
     Centers.
       (v) Not fewer than four facilities of the Indian Health 
     Service with established dental clinics, which shall be 
     selected in consultation with the Secretary of Health and 
     Human Services.
       (B) Considerations.--In selecting locations for phase one, 
     the Secretary shall consider the feasibility and advisability 
     of selecting locations in each of the following:
       (i) Rural areas.
       (ii) Areas that are not in close proximity to an active 
     duty military installation.
       (iii) Areas representing different geographic locations, 
     such as census tracts established by the Bureau of the 
     Census.
       (C) Mobile dental clinics.--In carrying out phase one, the 
     Secretary shall test the efficacy of mobile dental clinics to 
     service rural areas that do not have a population base to 
     warrant a full-time clinic but where there are covered 
     veterans in need of dental care.
       (D) Home based dental care.--In carrying out phase one, the 
     Secretary shall test the efficacy of portable dental care 
     units to service rural veteran in their homes, as the 
     Secretary considers medically appropriate.
       (4) Scope of services.--The dental care furnished to 
     covered veterans under phase one shall be consistent with the 
     dental services and treatment furnished by the Secretary to 
     veterans with service-connected disabilities rated 100 
     percent disabling under the laws administered by the 
     Secretary.
       (5) Use of therapists and tele-dentistry.--In carrying out 
     phase one, the Secretary shall test the efficacy of the use 
     of

[[Page S2871]]

     dental therapists and tele-dentistry to service the dental 
     care needs of covered veterans.
       (6) Voluntary participation.--The participation of a 
     covered veteran in phase one shall be at the election of the 
     veteran.
       (7) Copayments.--The Secretary may collect copayments for 
     dental care furnished under phase one in accordance with 
     authorities on the collection of copayments for medical care 
     of veterans under chapter 17 of title 38, United States Code.
       (8) Administration.--
       (A) Notice to covered veterans on phase one.--In carrying 
     out phase one, the Secretary shall inform all covered 
     veterans of the services and treatment available under phase 
     one.
       (B) Contracts.--
       (i) In general.--Subject to clause (iii), in carrying out 
     phase one, the Secretary may enter into contracts with 
     appropriate entities for the provision of dental care under 
     phase one.
       (ii) Performance standards and metrics.--Each contract 
     entered into under clause (i) shall specify performance 
     standards and metrics and processes for ensuring compliance 
     of the contractor concerned with such performance standards.
       (iii) Limitation.--The Secretary may only enter into 
     contracts under clause (i) if the Secretary determines that 
     the Department does not employ, and cannot recruit and 
     retain, qualified dentists, dental hygienists, and oral 
     surgeons in the applicable location.
       (9) Definitions.--In this subsection:
       (A) Covered veteran.--The term ``covered veteran'' means a 
     veteran 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, pursuant to paragraph (1) or (2) of such section.
       (B) 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)).
       (c) Expansion.--
       (1) In general.--After the completion of phase one, the 
     Secretary shall expand the provision of dental care under 
     this section to all veterans, including through the use of 
     the recommendations of the Secretary under subsection 
     (d)(2)(F), as follows:
       (A) In phase two, which shall--
       (i) commence not later than 90 days after the completion of 
     phase one; and
       (ii) consist of the provision of dental care to all 
     veterans 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, pursuant to paragraph (1), (2), (3), or (4) of such 
     section.
       (B) In phase three, which shall--
       (i) commence not later than 90 days after the completion of 
     phase two; and
       (ii) consist of the provision of dental care to all 
     veterans enrolled in such system pursuant to paragraph (1), 
     (2), (3), (4), (5), or (6) of such section.
       (C) In phase four, which shall--
       (i) commence not later than 90 days after the completion of 
     phase three; and
       (ii) consist of the provision of dental care to all 
     veterans enrolled in such system.
       (2) Facility expansion.--Under each phase specified in 
     paragraph (1), the Secretary shall expand the number of 
     facilities described in subsection (b)(3) furnishing dental 
     care under this section commensurate to the number of new 
     veterans furnished care under such phase, including through 
     the use of any other facilities to which veterans have 
     access.
       (3) Duration.--Each phase specified in paragraph (1) shall 
     be carried out during a period not to exceed two years and 
     all such phases, including phase one, shall be carried out 
     for a period not to exceed eight years.
       (4) Conclusion.--Upon the conclusion of phase four 
     specified under paragraph (1)(C), all veterans 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, shall be eligible 
     for dental care from the Department.
       (d) Reports.--
       (1) In general.--Not later than 90 days before the 
     completion of phase one, and not later than 180 days after 
     the completion of each subsequent phase under subsection 
     (c)(1), the Secretary shall submit to the Committee on 
     Veterans' Affairs and the Committee on Armed Services of the 
     Senate and the Committee on Veterans' Affairs and the 
     Committee on Armed Services of the House of Representatives a 
     report on the phase about to be completed and the plans of 
     the Secretary for implementation of expansion of the 
     provision of dental care pursuant to subsection (c).
       (2) Contents.--Each report under paragraph (1) shall 
     include the following:
       (A) A description of the implementation and operation of 
     the phase covered by the report.
       (B) The number of veterans receiving dental care under such 
     phase and a description of the dental care furnished to such 
     veterans.
       (C) An analysis of the costs and benefits of such phase, 
     including a comparison of costs and benefits by location 
     type.
       (D) An assessment of the impact of such phase on 
     appointments for care, prescriptions, hospitalizations, 
     emergency room visits, wellness, employability, and 
     satisfaction of patients, and perceived quality of life of 
     veterans.
       (E) An analysis and assessment of the efficacy of mobile 
     clinics and home based dental care to service the dental 
     needs of veterans during such phase.
       (F) An analysis and assessment of the efficacy of dental 
     therapists and tele-dentistry to service the dental needs of 
     covered veterans during such phase, to include a cost benefit 
     analysis of such services.
       (G) The findings and conclusions of the Secretary with 
     respect to such phase.
       (H) A comparison of the costs for private sector dental 
     care with cost of furnishing dental care from the Department, 
     broken down by each locality included in such phase.
       (I) Such recommendations for the expansion of dental care 
     pursuant to subsection (c) as the Secretary considers 
     appropriate.

     SEC. 123. PROGRAM ON 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. 124. 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 service to veterans, shall 
     implement a loan reimbursement program for qualified 
     dentists, dental therapists, dental hygienists, and oral 
     surgeons who agree--
       (1) to be appointed by the Secretary as a dentist, dental 
     therapist, 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 therapist, 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.--
       (1) In general.--Except as provided in paragraph (2), the 
     Secretary may reimburse not more than--
       (A) $75,000 for each dentist participating in the program 
     under subsection (a);
       (B) $20,000 for each dental therapist participating in such 
     program;
       (C) $10,000 for each dental hygienist participating in such 
     program; and
       (D) $20,000 for each credentialed doctor of medicine in 
     dentistry serving as an oral surgeon and participating in 
     such program.
       (2) Dual eligibility.--The Secretary may reimburse an 
     individual serving in multiple

[[Page S2872]]

     positions described in subparagraphs (A) through (D) of 
     paragraph (1) not more than $95,000.
       (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 therapists, dental hygienists, or oral 
     surgeons, as the case may be, according to facility 
     enrollment and patient demand.

     SEC. 125. EDUCATIONAL AND TRAINING PARTNERSHIPS FOR DENTISTS, 
                   DENTAL THERAPISTS, DENTAL HYGIENISTS, AND ORAL 
                   SURGEONS.

       The Secretary of Veterans Affairs shall enter into 
     educational and training partnerships with dental schools to 
     provide training and employment opportunities for dentists, 
     dental therapists, dental hygienists, and oral surgeons.

     SEC. 126. AUTHORIZATION OF APPROPRIATIONS.

       (a) In General.--There is authorized to be appropriated for 
     the Department of Veterans Affairs for fiscal year 2023 such 
     sums as may be necessary to carry out this subtitle and the 
     amendments made by this subtitle.
       (b) Availability.--The amount authorized to be appropriated 
     under subsection (a) shall be available for obligation for 
     the eight-year period beginning on the date that is one year 
     after the date of the enactment of this Act.
                                 ______