Sec. 4251. Improving access to dental care

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Not later than 1 year after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress— a report on the Alaska Dental Health Aide Therapists program and the Dental Therapist and Advanced Dental Therapist programs in Minnesota, to assess the effectiveness of dental therapists in— improving access to timely dental care among communities of color; providing high-quality care; providing culturally competent care; and providing accessible care to people with disabilities; a report on State variations in the use of dental hygienists and the effectiveness of expanding the scope of practice for dental hygienists in— improving access to timely dental care among communities of color; providing high-quality care; providing culturally competent care; and providing accessible care to people with disabilities; and a report on the use of telehealth services to enhance services provided by dental hygienists and therapists, including recommendations for any modifications to the Medicare program under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. ) and the Medicaid program under title XIX of such Act ( 42 U.S.C. 1396 et seq. ) to better provide for telehealth consultations in conjunction with therapists’ and hygienists’ care.

Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services, acting through the Administrator of the Health Resources and Services Administration, shall submit to Congress a report which details geographic dental access shortages and the preparedness of dental providers to offer culturally and linguistically appropriate, affordable, accessible, and timely services. Section 119 of the Indian Health Care Improvement Act ( 25 U.S.C. 1616l ) is amended— in subsection (d)— by striking paragraph

(2)and inserting the following: Subject to paragraphs

(3)and (4), in establishing a national program under paragraph (1), the Secretary— shall not reduce the amounts provided for the Community Health Aide Program described in subsections

(a)and (b); shall exclude dental health aide therapist services from services covered under such Program; and shall include urban Indian organizations. ; and in paragraph (3), by striking or tribal organization each place it appears and inserting , tribal organization, or urban Indian organization ; and in subsection (e), by striking or a tribal organization and inserting a tribal organization, or an urban Indian organization . Section 1861(s)(2) of the Social Security Act ( 42 U.S.C. 1395x(s)(2) ) is amended— in subparagraph (GG), by striking and at the end; in subparagraph (HH), by striking the period at the end and inserting ; and ; and by adding at the end the following new subparagraph: dental and oral health services (as defined in subsection (nnn)); . Section 1861 of the Social Security Act ( 42 U.S.C. 1395x ), as amended by sections 2007(b) and 4221(a), is amended by adding at the end the following new subsection: The term dental and oral health services means services (as defined by the Secretary) that are necessary to prevent disease and promote oral health, restore oral structures to health and function, and treat emergency conditions, including— routine diagnostic and preventive care such as dental cleanings, exams, and x-rays; basic dental services such as fillings and extractions; major dental services such as root canals, crowns, and dentures; emergency dental care; and other necessary services related to dental and oral health (as defined by the Secretary). For purposes of paragraph (1), such term shall include mobile and portable oral health services (as defined by the Secretary) that— are provided for the purpose of overcoming mobility, transportation, and access barriers for individuals; and satisfy the standards and certification requirements established under section 1902(a)(82)(B) for the State in which the services are provided. . Section 1833(a)(1) of the Social Security Act ( 42 U.S.C. 1395l(a)(1) ) is amended— by striking and before

(DD); and by inserting before the semicolon at the end the following: and

(EE)with respect to dental and oral health services (as defined in section 1861(nnn)), the amount paid shall be

(i)in the case of such services that are preventive, 100 percent of the lesser of the actual charge for the services or the amount determined under the payment basis determined under section 1848, and

(ii)in the case of all other such services, 80 percent of the lesser of the actual charge for the services or the amount determined under the payment basis determined under section 1848 . Section 1848(j)(3) of the Social Security Act ( 42 U.S.C. 1395w–4(j)(3) ) is amended by inserting , (2)(II), after (including administration of the health risk assessment) . Section 1861(s)(8) of the Social Security Act ( 42 U.S.C. 1395x(s)(8) ) is amended— by striking (other than dental) and inserting (including dentures) ; and by striking internal body . Section 1862(a) of the Social Security Act ( 42 U.S.C. 1395y ) is amended by striking paragraph (12). The amendments made by this section shall apply to services furnished on or after January 1, 2023. Section 1902(a)(10)(A) of the Social Security Act ( 42 U.S.C. 1396a(a)(10)(A) ) is amended by inserting ,

(10)after

(5). The amendment made by clause

(i)shall apply with respect to medical assistance furnished in calendar quarters beginning on or after the date that is 1 year after the date of the enactment of this Act. Section 1937(b)(5) of the Social Security Act ( 42 U.S.C. 1396u–7(b)(5) ) is amended by striking the period and inserting , and, beginning with the first quarter beginning on or after the date of the enactment of the . Health Equity and Accountability Act of 2022 , coverage of dental and oral health services (as defined in section 1905(kk)). Section 1905 of the Social Security Act ( 42 U.S.C. 1396d ), as amended by section 4107, is further amended— in subsection (a)(10), by striking dental services and inserting dental and oral health services (as defined in subsection (kk)(1)) ; and by adding at the end the following new subsection: For purposes of this title, the term dental and oral health services means services necessary to prevent disease and promote oral health, restore oral structures to health and function, reduce oral pain, and treat emergency oral conditions. Such term includes the services specified in paragraph (2). For purposes of paragraph (1), the services specified in this paragraph are the following: Routine diagnostic and preventive care (such as dental cleanings, exams, and x-rays). Basic dental services (such as fillings and extractions) and major dental services (such as root canals, crowns, and dentures). Emergency dental care. Temporomandibular

(TMD)and orofacial pain disorder treatment. Other necessary services related to dental and oral health (as specified by the Secretary).”. For purposes of paragraph (1), such term shall not include dental care or services provided to individuals under the age of 21 under subsection (r)(3). . Section 1902(a) of the Social Security Act ( 42 U.S.C. 1396a(a) ) is amended— in paragraph (10)(A), in the matter preceding clause (i), by inserting (10), after (5), ; in paragraph (86), by striking and at the end; in paragraph (87), by striking the period at the end and inserting ; and ; and by inserting after paragraph

(87)the following: provide for— informing, in writing, all individuals who have been determined to be eligible for medical assistance of the availability of dental and oral health services (as defined in section 1905(kk)); conducting targeted outreach to pregnant women who have been determined to be eligible for medical assistance about the availability of medical assistance for such dental services and the importance of receiving dental care while pregnant; and establishing and maintaining standards for and certification of mobile and portable oral health services (as described in section 1905(r)(3)(C)). . Section 1905(a)(12) of the Social Security Act ( 42 U.S.C. 1396d(a)(12) ) is amended by striking , dentures, . Section 1905(r)(3) of the Social Security Act ( 42 U.S.C. 1396d(r)(3) ) is amended— in subparagraph (A)(ii), by striking ; and and inserting a semicolon; in subparagraph (B), by striking the period at the end and inserting ; and ; and by adding at the end the following new subparagraph: which shall include mobile and portable oral health services (as defined by the Secretary) that— are provided for the purpose of overcoming mobility, transportation, or access barriers for children; and satisfy the standards and certification requirements established under section 1902(a)(88)(C) for the State in which the services are provided. . Section 1905 of the Social Security Act ( 42 U.S.C. 1396d ), as amended by paragraph (2), is further amended— in subsection (b), by striking and

(ii)and inserting (ii), and

(ll); and by adding at the end of the following new subsection: The Federal medical assistance percentage with respect to amounts expended by such State for medical assistance consisting of dental and oral health services (as defined in subsection (kk)) furnished during the first calendar quarter beginning on or after the date that is 1 year after the date of the enactment of this subsection or during any subsequent quarter) to individuals 21 years of age or older shall be equal to, in the case of such services furnished— during the 3-year period beginning on the first day of such first calendar year, 100 percent; during the 1-year period immediately following the period described in subparagraph (A), 95 percent; during each subsequent 1-year period (through the third such subsequent period), the percentage specified under this paragraph for the preceding 1-year period, reduced by 5 percentage points; and during any quarter beginning after the 7-year period beginning on the first day described in subparagraph (A), 80 percent. Paragraph

(1)shall not apply with respect to amounts expended by a State if the Federal medical assistance percentage otherwise applicable to such amounts without application of such paragraph would be higher than such percentage available to such amounts with application of such paragraph. . Section 1108 of the Social Security Act ( 42 U.S.C. 1308 ), as amended by section 4101(a), is amended— in subsection (f), in the matter preceding paragraph (1), by striking subsections (g), (h), and

(i); and by adding at the end the following: Any payment made to a territory for expenditures for medical assistance that are subject to an increase in the Federal medical assistance percentage applicable to such expenditures under section 1905(ll) shall not be taken into account for purposes of applying payment limits under subsections

(f)and

(g)to the extent that such payment exceeds the amount of the payment that would have been made to the territory for such expenditures without regard to such section. . Section 1302(b) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18022(b) ), as amended by section 2013(a), is further amended— in paragraph (1)— in subparagraph (J), by striking oral and ; and by adding at the end the following: Oral health services for children and adults. ; and by adding at the end the following: For purposes of paragraph (1)(K), the term oral health services means services (as defined by the Secretary) that are necessary to prevent any oral disease and promote oral health, restore oral structures to health and function, and treat emergency oral conditions. . The Secretary of Veterans Affairs may carry out a demonstration program to establish programs to train and employ alternative dental health care providers in order to increase access to dental health care services for veterans who are entitled to such services from the Department of Veterans Affairs and reside in rural and other underserved communities. For purposes of alternative dental health care providers and other dental care providers who are licensed to provide clinical care, dental services provided under the demonstration program under this subsection may be administered by such providers through telehealth-enabled collaboration and supervision when appropriate and feasible. In this subsection, the term alternative dental health care providers has the meaning given that term in section 340G–1(a)(2) of the Public Health Service Act ( 42 U.S.C. 256g–1(a)(2) ). There are authorized to be appropriated such sums as are necessary to carry out the demonstration program under this subsection. The Secretary of Defense may carry out a demonstration program to establish programs to train and employ alternative dental health care providers in order to increase access to dental health care services for members of the Armed Forces and their dependents who lack ready access to such services, including the following: Members and dependents who reside in rural areas or areas otherwise underserved by dental health care providers. Members of a reserve component of the Armed Forces in active status who are potentially deployable. For purposes of alternative dental health care providers and other dental care providers who are licensed to provide clinical care, dental services provided under the demonstration program under this subsection may be administered by such providers through telehealth-enabled collaboration and supervision when appropriate and feasible. In this subsection: The term active status has the meaning given that term in section 101(d) of title 10, United States Code. The term alternative dental health care providers has the meaning given that term in section 340G–1(a)(2) of the Public Health Service Act ( 42 U.S.C. 256g–1(a)(2) ). There are authorized to be appropriated such sums as are necessary to carry out the demonstration program under this subsection. The Attorney General, acting through the Director of the Bureau of Prisons, may carry out a demonstration program to establish programs to train and employ alternative dental health care providers in order to increase access to dental health services for prisoners within the custody of the Bureau of Prisons. For purposes of alternative dental health care providers and other dental care providers who are licensed to provide clinical care, dental services provided under the demonstration program under this subsection may be administered by such providers through telehealth-enabled collaboration and supervision when appropriate and feasible. In this subsection, the term alternative dental health care providers has the meaning given that term in section 340G–1(a)(2) of the Public Health Service Act ( 42 U.S.C. 256g–1(a)(2) ). There are authorized to be appropriated such sums as are necessary to carry out the demonstration program under this subsection. The Secretary of Health and Human Services, acting through the Indian Health Service, may carry out a demonstration program to establish programs to train and employ alternative dental health care providers in order to help eliminate oral health disparities and increase access to dental services through health programs operated by the Indian Health Service, Indian tribes, tribal organizations, and Urban Indian organizations. For purposes of alternative dental health care providers and other dental care providers who are licensed to provide clinical care, dental services provided under the demonstration program under this subsection may be administered by such providers through telehealth-enabled collaboration and supervision when appropriate and feasible. In this subsection: The term alternative dental health care providers has the meaning given that term in section 340G–1(a)(2) of the Public Health Service Act ( 42 U.S.C. 256g–1(a)(2) ). The terms Indian tribe , tribal organization , and Urban Indian organization have the meaning given the terms in section 4 of the Indian Health Care Improvement Act ( 25 U.S.C. 1603 ). There are authorized to be appropriated such sums as are necessary to carry out the demonstration program under this subsection.

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