[House Report 118-243]
[From the U.S. Government Publishing Office]


118th Congress }                                          { REPORT 
                        HOUSE OF REPRESENTATIVES
 1st Session   }                                          { 118-243

======================================================================
 
                  ACTION FOR DENTAL HEALTH ACT OF 2023

                                _______
                                

October 3, 2023.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

Mrs. Rodgers of Washington, from the Committee on Energy and Commerce, 
                        submitted the following

                              R E P O R T

                        [To accompany H.R. 3843]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 3843) to amend title III of the Public Health 
Service Act to reauthorize grants to address dental workforce 
needs, having considered the same, reports favorably thereon 
without amendment and recommends that the bill do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     1
Background and Need for Legislation..............................     2
Committee Action.................................................     2
Committee Votes..................................................     2
Oversight Findings and Recommendations...........................     4
New Budget Authority, Entitlement Authority, and Tax Expenditures     4
Congressional Budget Office Estimate.............................     4
Federal Mandates Statement.......................................     4
Statement of General Performance Goals and Objectives............     4
Duplication of Federal Programs..................................     4
Related Committee and Subcommittee Hearings......................     4
Committee Cost Estimate..........................................     5
Earmark, Limited Tax Benefits, and Limited Tariff Benefits.......     5
Advisory Committee Statement.....................................     5
Applicability to Legislative Branch..............................     5
Section-by-Section Analysis of the Legislation...................     5
Changes in Existing Law Made by the Bill, as Reported............     5

                          Purpose and Summary

    H.R. 3843 reauthorizes section 340G of the Public Health 
Service Act for fiscal years 2024 through 2028 to address 
dental workforce needs.

                  Background and Need for Legislation

    The Action for Dental Health Act of 2023 reauthorizes a 
program to help states increase access to oral health treatment 
and prevention services and address dental workforce needs. The 
program aims to reduce dental disease through oral health 
education, grow the oral health workforce, particularly in 
underserved communities, and reduce emergency department visits 
by establishing dental homes. According to the Centers for 
Disease Control and Prevention (CDC), more than 1 in 4 adults 
have untreated tooth decay and almost half of adults 30 years 
may be suffering from gum disease.\1\ By 2030, there is 
estimated to be a 9 percent increase in total number of 
dentists and a 9 percent increase in demand for dentists.\2\ 
Additionally, there is projected to be a 20 percent increase in 
dental hygienists and a 7 percent increase in demand for dental 
hygienists by 2030.\3\ This legislation will continue funding 
for the dental health workforce to help keep up with demand.
---------------------------------------------------------------------------
    \1\Centers for Disease Control and Prevention, Adult Oral Health, 
December 22, 2020.
    \2\Health Resources and Service Administration, Oral Health 
Workforce Projections, August 2022.
    \3\Ibid.
---------------------------------------------------------------------------

                            Committee Action

    On June 14, 2023, the Subcommittee on Health held a hearing 
on H.R. 3843. The hearing was titled ``Examining Proposals that 
Provide Access to Care for Patients and Support Research for 
Rare Diseases.'' The Subcommittee received testimony from:
           Dr. Elizabeth Cherot, MD, MBA, Senior Vice 
        President and Chief Medical Health Officer, March of 
        Dimes;
           Dr. Alexis A. Thompson, MD, MPH, Chief of 
        Division of Hematology, Elias Schwartz MD Endowed Chair 
        in Hematology, Children's Hospital of Philadelphia, 
        Professor of Pediatrics, University of Pennsylvania 
        Perelman School of Medicine;
           Dr. Meredithe McNamara, MD, MS, FAAP, 
        Assistant Professor, Yale School of Medicine;
           Dr. Miriam Grossman, MD, Child, Adolescent, 
        and Adult Psychiatrist;
           Mr. George Manahan, Parkinson's Advocate and 
        Patient; and
           Mr. Kevin O'Connor, Assistant to the General 
        President for Government Affairs and Political Action, 
        International Association of Fire Fighters.
    On July 13, 2023, the Subcommittee on Health met in open 
markup session and forwarded H.R. 3843 without amendment, to 
the full Committee by a record vote of 27 yeas and 0 nays. On 
July 19, 2023, the full Committee on Energy and Commerce met in 
open markup session and ordered H.R. 3843, without amendment, 
favorably reported to the House by a record vote of 50 yeas and 
0 nays.

                            Committee Votes

    Clause 3(b) of rule XIII requires the Committee to list the 
record votes on the motion to report legislation and amendments 
thereto. The following reflects the record votes taken during 
the Committee consideration:


                 Oversight Findings and Recommendations

    Pursuant to clause 2(b)(1) of rule X and clause 3(c)(1) of 
rule XIII, the Committee held a hearing and made findings that 
are reflected in this report.

           New Budget Authority, Entitlement Authority, and 
                            Tax Expenditures

    Pursuant to clause 3(c)(2) of rule XIII, the Committee 
finds that H.R. 3843 would result in no new or increased budget 
authority, entitlement authority, or tax expenditures or 
revenues.

                  Congressional Budget Office Estimate

    Pursuant to clause 3(c)(3) of rule XIII, at the time this 
report was filed, the cost estimate prepared by the Director of 
the Congressional Budget Office pursuant to section 402 of the 
Congressional Budget Act of 1974 was not available.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act.

         Statement of General Performance Goals and Objectives

    Pursuant to clause 3(c)(4) of rule XIII, the general 
performance goal or objective of this legislation is to 
reauthorize grants to address dental workforce needs.

                    Duplication of Federal Programs

    Pursuant to clause 3(c)(5) of rule XIII, no provision of 
H.R. 3843 is known to be duplicative of another Federal 
program, including any program that was included in a report to 
Congress pursuant to section 21 of Public Law 111-139 or the 
most recent Catalog of Federal Domestic Assistance.

              Related Committee and Subcommittee Hearings

    Pursuant to clause 3(c)(6) of rule XIII, the following 
related hearing was used to develop or consider H.R. 3843:
           On June 14, 2023, the Subcommittee on Health 
        held a hearing titled ``Examining Proposals that 
        Provide Access to Care for Patients and Support 
        Research for Rare Diseases.'' The Subcommittee received 
        testimony from:
                   Dr. Elizabeth Cherot, MD, MBA, 
                Senior Vice President and Chief Medical Health 
                Officer, March of Dimes;
                   Dr. Alexis A. Thompson, MD, MPH, 
                Chief of Division of Hematology, Elias Schwartz 
                MD Endowed Chair in Hematology, Children's 
                Hospital of Philadelphia, Professor of 
                Pediatrics, University of Pennsylvania Perelman 
                School of Medicine;
                   Dr. Meredithe McNamara, MD, MS, 
                FAAP, Assistant Professor, Yale School of 
                Medicine;
                   Dr. Miriam Grossman, MD, Child, 
                Adolescent, and Adult Psychiatrist;
                   Mr. George Manahan, Parkinson's 
                Advocate and Patient; and
                   Mr. Kevin O'Connor, Assistant to 
                the General President for Government Affairs 
                and Political Action, International Association 
                of Fire Fighters.

                        Committee Cost Estimate

    Pursuant to clause 3(d)(1) of rule XIII, the Committee 
adopts as its own the cost estimate prepared by the Director of 
the Congressional Budget Office pursuant to section 402 of the 
Congressional Budget Act of 1974. At the time this report was 
filed, the estimate was not available.

       Earmark, Limited Tax Benefits, and Limited Tariff Benefits

    Pursuant to clause 9(e), 9(f), and 9(g) of rule XXI, the 
Committee finds that H.R. 3843 contains no earmarks, limited 
tax benefits, or limited tariff benefits.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act were created by this 
legislation.

                  Applicability to Legislative Branch

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

             Section-by-Section Analysis of the Legislation


Section 1. Short title

    Section 1 provides a short title of ``Action for Dental 
Health Act of 2023''.

Section 2. Reauthorization of grants to address dental workforce needs

    Section 2 amends Section 340G of the Public Health Service 
act to reauthorize grants to address dental workforce needs for 
fiscal years 2024-2028.

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italics, and existing law in which no 
change is proposed is shown in roman):

                       PUBLIC HEALTH SERVICE ACT




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TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE

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Part D--Primary Health Care

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Subpart X--Primary Dental Programs

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SEC. 340G. GRANTS FOR INNOVATIVE PROGRAMS.

  (a) Grant Program Authorized.--The Secretary, acting through 
the Administrator of the Health Resources and Services 
Administration, is authorized to award grants to States for the 
purpose of helping States develop and implement innovative 
programs to address the dental workforce needs of designated 
dental health professional shortage areas in a manner that is 
appropriate to the States' individual needs.
  (b) State Activities.--A State receiving a grant under 
subsection (a) may use funds received under the grant for--
          (1) loan forgiveness and repayment programs for 
        dentists who--
                  (A) agree to practice in designated dental 
                health professional shortage areas;
                  (B) are dental school graduates who agree to 
                serve as public health dentists for the 
                Federal, State, or local government; and
                  (C) agree to--
                          (i) provide services to patients 
                        regardless of such patients' ability to 
                        pay; and
                          (ii) use a sliding payment scale for 
                        patients who are unable to pay the 
                        total cost of services;
          (2) dental recruitment and retention efforts;
          (3) grants and low-interest or no-interest loans to 
        help dentists who participate in the medicaid program 
        under title XIX of the Social Security Act (42 U.S.C. 
        1396 et seq.) to establish or expand practices in 
        designated dental health professional shortage areas by 
        equipping dental offices or sharing in the overhead 
        costs of such practices;
          (4) the establishment or expansion of dental 
        residency programs in coordination with accredited 
        dental training institutions in States without dental 
        schools;
          (5) programs developed in consultation with State and 
        local dental societies to expand or establish oral 
        health services and facilities in designated dental 
        health professional shortage areas, including services 
        and facilities for children with special needs, such 
        as--
                  (A) the expansion or establishment of a 
                community-based dental facility, free-standing 
                dental clinic, consolidated health center 
                dental facility, school-linked dental facility, 
                or United States dental school-based facility;
                  (B) the establishment of a mobile or portable 
                dental clinic;
                  (C) the establishment or expansion of private 
                dental services to enhance capacity through 
                additional equipment or additional hours of 
                operation;
                  (D) the establishment or development of 
                models for the provision of dental services to 
                children and adults, such as dental homes, 
                including for the elderly, blind, individuals 
                with disabilities, and individuals living in 
                long-term care facilities; and
                  (E) the establishment of initiatives to 
                reduce the use of emergency departments by 
                individuals who seek dental services more 
                appropriately delivered in a dental primary 
                care setting;
          (6) placement and support of dental students, dental 
        residents, and advanced dentistry trainees;
          (7) continuing dental education, including distance-
        based education;
          (8) practice support through teledentistry conducted 
        in accordance with State laws;
          (9) community-based prevention services such as water 
        fluoridation and dental sealant programs;
          (10) coordination with local educational agencies 
        within the State to foster programs that promote 
        children going into oral health or science professions;
          (11) the establishment of faculty recruitment 
        programs at accredited dental training institutions 
        whose mission includes community outreach and service 
        and that have a demonstrated record of serving 
        underserved States;
          (12) the development of a State dental officer 
        position or the augmentation of a State dental office 
        to coordinate oral health and access issues in the 
        State; and
          (13) any other activities determined to be 
        appropriate by the Secretary.
  (c) Application.--
          (1) In general.--Each State desiring a grant under 
        this section shall submit an application to the 
        Secretary at such time, in such manner, and containing 
        such information as the Secretary may reasonably 
        require.
          (2) Assurances.--The application shall include 
        assurances that the State will meet the requirements of 
        subsection (d) and that the State possesses sufficient 
        infrastructure to manage the activities to be funded 
        through the grant and to evaluate and report on the 
        outcomes resulting from such activities.
  (d) Matching Requirement.--The Secretary may not make a grant 
to a State under this section unless that State agrees that, 
with respect to the costs to be incurred by the State in 
carrying out the activities for which the grant was awarded, 
the State will provide non-Federal contributions in an amount 
equal to not less than 40 percent of Federal funds provided 
under the grant. The State may provide the contributions in 
cash or in kind, fairly evaluated, including plant, equipment, 
and services and may provide the contributions from State, 
local, or private sources.
  (e) Report.--Not later than 5 years after the date of 
enactment of the Health Care Safety Net Amendments of 2002, the 
Secretary shall prepare and submit to the appropriate 
committees of Congress a report containing data relating to 
whether grants provided under this section have increased 
access to dental services in designated dental health 
professional shortage areas.
  (f) Authorization of Appropriations.--There is authorized to 
be appropriated to carry out this section, $13,903,000 for each 
of fiscal years [2019 through 2023] 2024 through 2028.

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