[Congressional Record Volume 169, Number 120 (Thursday, July 13, 2023)]
[Senate]
[Pages S2852-S2853]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

  SA 726. Mr. SANDERS (for himself, Mr. Fetterman, Mr. Welch, Mr. 
Wyden, Mr. Durbin, and Ms. Stabenow) submitted an amendment intended to 
be proposed by him to the bill S. 2226, to authorize appropriations for 
fiscal year 2024 for military activities of the Department of Defense, 
for military construction, and for defense activities of the Department 
of Energy, to prescribe military personnel strengths for such fiscal 
year, and for other purposes; which was ordered to lie on the table; as 
follows:

        At the end of title X, add the following:

Subtitle H--Improving Whole Health for Veterans With Chronic Conditions 
                                  Act

     SEC. 1091. SHORT TITLE.

       This subtitle may be cited as the ``Improving Whole Health 
     for Veterans with Chronic Conditions Act''.

     SEC. 1092. SENSE OF CONGRESS.

       It is the sense of Congress that--
       (1) the Department of Veterans Affairs has pioneered a 
     whole health approach to health care that provides access to 
     alternative medicines, delivers a holistic approach to health 
     and well-being, and repeatedly demonstrates better health 
     outcomes than the private sector at a low cost to taxpayers 
     in the United States;
       (2) the effects of poor dental care are shown to worsen the 
     symptoms of diabetes and heart disease;
       (3) diabetes and heart disease are shown to increase risk 
     of periodontal disease;
       (4) the combination of diabetes, heart disease, and 
     periodontal disease can be fatal; and
       (5) to best achieve a whole health model for the provision 
     of health care to veterans with diabetes and heart disease 
     and reduce long-term costs, the Department must furnish 
     preventative and comprehensive dental care to veterans 
     diagnosed with diabetes and heart disease.

     SEC. 1093. DEFINITIONS.

       In this subtitle:
       (1) Covered care.--The term ``covered care'' means dental 
     care that is comprehensive in nature and consistent with the 
     dental services and treatment furnished by the Secretary of 
     Veterans Affairs to veterans pursuant to section 
     1712(a)(1)(G) of title 38, United States Code.
       (2) Covered veteran.--The term ``covered veteran'' means a 
     veteran who--
       (A) is enrolled in the system of annual patient enrollment 
     of the Department of Veterans Affairs established and 
     operated under subsection (a) of section 1705 of title 38, 
     United States Code, pursuant to paragraph (1) or (2) of such 
     subsection or is not enrolled in such system but is otherwise 
     entitled to hospital care and medical services under 
     subsection (c)(2) of such section;
       (B) is not eligible for dental services and treatment and 
     related dental appliances under the laws administered by the 
     Secretary of Veterans Affairs as of the date of the enactment 
     of this Act; and
       (C) has a diagnosis of--
       (i) type 1 or type 2 diabetes; or
       (ii) ischemic heart disease.

     SEC. 1094. PILOT PROGRAM TO FURNISH DENTAL CARE FROM THE 
                   DEPARTMENT OF VETERANS AFFAIRS TO CERTAIN 
                   VETERANS DIAGNOSED WITH DIABETES OR ISCHEMIC 
                   HEART DISEASE.

       (a) In General.--Commencing not later than one year after 
     the date of the enactment of this Act, the Secretary of 
     Veterans Affairs shall carry out a pilot program (in this 
     section referred to as the ``pilot program'') under which the 
     Secretary shall furnish covered care to covered veterans for 
     the duration of the pilot program.
       (b) Duration.--The pilot program shall be carried out 
     during the four-year period beginning on the date of the 
     commencement of the pilot program.
       (c) Locations.--
       (1) In general.--The Secretary shall carry out the pilot 
     program at the following locations:
       (A) Each medical center of the Department with an 
     established dental clinic.
       (B) Each community-based outpatient clinic with an 
     established dental clinic.
       (2) Mobile dental clinics.--In carrying out the pilot 
     program, 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.
       (3) Home-based dental care.--In carrying out the pilot 
     program, the Secretary shall test the efficacy of portable 
     dental care units to service rural veteran in their homes, as 
     the Secretary considers medically appropriate.
       (d) Dental Therapists and Tele-dentistry.--
       (1) In general.--In carrying out the pilot program, The 
     Secretary shall test the efficacy of the use of dental 
     therapists and tele-dentistry to service the dental care 
     needs of covered veterans.
       (2) Use of tele-dentistry.--When providing tele-dentistry 
     under paragraph (1), the Secretary shall use Federal 
     employees to the maximum extent possible.
       (e) Administration.--
       (1) Notice to covered veterans.--In carrying out the pilot 
     program, the Secretary shall inform all covered veterans of 
     the covered care available under the pilot program.
       (2) Copayments.--The Secretary may collect copayments for 
     covered care furnished under the pilot program in accordance 
     with authorities on the collection of copayments for medical 
     care of veterans under chapter 17 of title 38, United States 
     Code.
       (f) Reports.--
       (1) In general.--Not later than 90 days before the 
     completion of the pilot program, and not later than 180 days 
     after the completion of the pilot program, 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 pilot program.
       (2) Contents.--Each report under paragraph (1) shall 
     include the following:
       (A) A description of the implementation and operation of 
     the provision of covered care under the pilot program.
       (B) The number of covered veterans receiving covered care 
     under the pilot program and a description of the covered care 
     furnished to such veterans.
       (C) An analysis of the costs and benefits of covered care 
     provided under the pilot program, including a comparison of 
     costs and benefits by location type.
       (D) An assessment of the impact of the pilot program on 
     appointments for care, prescriptions, hospitalizations, 
     emergency room visits, wellness, employability, satisfaction, 
     and perceived quality of life of covered veterans related to 
     their diagnosis of diabetes or ischemic heart disease.
       (E) An analysis and assessment of the efficacy of mobile 
     clinics and portable dental care units, to the extent such 
     modalities are used, to service the needs of covered veterans 
     under the pilot program.
       (F) An analysis and assessment of the efficacy of dental 
     therapists and tele-dentistry to service the needs of covered 
     veterans under the pilot program, to include a cost benefit 
     analysis of such services.
       (G) The findings and conclusions of the Secretary with 
     respect to the pilot program.
       (H) Such recommendations as the Secretary considers 
     appropriate for the expansion of dental care to all veterans 
     eligible for health care from the Department.
       (g) Impact on Community Care.--Nothing in this section 
     limits a covered veteran from accessing care or services 
     pursuant to section 1703 of title 38, United States Code.

     SEC. 1095. 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 covered care to covered veterans, 
     shall implement a loan reimbursement program for qualified 
     dentists, dental hygienists, and oral surgeons who agree--
       (1) to be appointed by the Secretary as a dentist, dental 
     hygienist, or oral surgeon, as the case may be, under section 
     7401 of title 38, United States Code; and
       (2) to serve as a dentist, dental hygienist, or oral 
     surgeon, as the case may be, of the Department pursuant to 
     such appointment at a dental clinic of the Department 
     selected under subsection (c) for a period that is not less 
     than the duration of the pilot program under section 4.
       (b) Maximum Amount.--
       (1) In general.--Except as provided in paragraph (2), the 
     Secretary may reimburse not more than--
       (A) $100,000 for each dentist participating in the program 
     under subsection (a);
       (B) $25,000 for each dental hygienist participating in such 
     program; and
       (C) $40,000 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 positions described in 
     subparagraphs (A) through (C) of paragraph (1) not more than 
     $140,000.
       (c) Selection of Locations.--The Secretary shall monitor 
     demand among covered veterans for covered care and require 
     participants in the program under subsection (a) to choose 
     from dental clinics of the Department with the greatest need 
     for dentists, dental hygienists, or oral surgeons, as the 
     case may be, according to facility enrollment and patient 
     demand.

     SEC. 1096. AUTHORIZATION OF APPROPRIATIONS.

       (a) In General.--There is authorized to be appropriated for 
     the Department of Veterans Affairs for fiscal year 2024 such 
     sums as may be necessary to carry out 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.

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