Amends the Public Health Service Act to establish a grant program for eligible entities and individuals (including Indian tribes) to expand the availability of primary dental care services where necessary. Offers retention bonuses for eligible dental officers of the Indian Health Service. Revises the process for designating dental health professional shortage areas.
Directs the Secretary to establish: (1) demonstration projects to increase access to dental services for children in underserved areas; (2) an oral health initiative to reduce disparities in oral health, targeting low-income children and including community water fluoridation and dental sealants; and (3) a Chief Dental Officer for the Medicaid and State children's health insurance programs.
Requires the Director of the Centers for Disease Control and Prevention to annually collect data on the dental, craniofacial, and oral health of residents of at least one State and one Indian tribe from each region.
Requires the Secretary to identify populations at high risk for early childhood caries and provide for the development of prevention programs.
Revises the eligibility requirements for the school-based dental sealant program to include Indian tribes.
[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3659 Introduced in House (IH)]
107th CONGRESS
2d Session
H. R. 3659
To provide disadvantaged children with access to dental services.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
January 29, 2002
Mr. Murtha (for himself, Mrs. Lowey, Ms. Roybal-Allard, Mr. Stark, Mr.
Moran of Virginia, Mr. Upton, Mrs. Morella, Mr. Andrews, Mr. Norwood,
and Mr. Doyle) introduced the following bill; which was referred to the
Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To provide disadvantaged children with access to dental services.
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 2002''.
(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. Authority to provide dental coverage under SCHIP as a
supplement to other health coverage.
TITLE II--IMPROVING DELIVERY OF PEDIATRIC DENTAL SERVICES UNDER
COMMUNITY HEALTH CENTERS, PUBLIC HEALTH DEPARTMENTS, AND THE INDIAN
HEALTH SERVICE
Sec. 201. Grants to improve the provision of dental health services
through community health centers and public
health departments.
Sec. 202. Dental officer multiyear retention bonus for the Indian
Health Service.
Sec. 203. Streamline process for designating dental health professional
shortage areas.
Sec. 204. Demonstration projects to increase access to pediatric dental
services in underserved areas.
TITLE III--IMPROVING ORAL HEALTH PROMOTION AND DISEASE PREVENTION
PROGRAMS
Sec. 301. Oral health initiative.
Sec. 302. CDC reports.
Sec. 303. Early childhood caries.
Sec. 304. School-based dental sealant program.
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 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) 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.
``(d) Authorization of Appropriations.--There are authorized to be
appropriated to make grants under this section $50,000,000 for fiscal
year 2003 and each fiscal year thereafter.
``(e) 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. AUTHORITY TO PROVIDE DENTAL COVERAGE UNDER SCHIP AS A
SUPPLEMENT TO OTHER HEALTH COVERAGE.
(a) Authority To Provide Coverage.--
(1) SCHIP.--
(A) In general.--Section 2105(a)(1)(C) of the
Social Security Act (42 U.S.C. 1397ee(a)(1)(C)) is
amended--
(i) by inserting ``(i)'' after ``(C)''; and
(ii) by adding at the end the following:
``(ii) notwithstanding clause (i), in the case of a
State that satisfies the conditions described in
subsection (c)(8), for child health assistance that
consists only of coverage of dental services for a
child who would be considered a targeted low-income
child if that portion of subparagraph (C) of section
2110(b)(1) relating to coverage of the child under a
group health plan or under health insurance coverage
did not apply, and such child has such coverage that
does not include dental services; and''.
(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 dental services only
coverage.--For purposes of subsection (a)(1)(C)(ii), 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, 2002;
``(ii) subject to subparagraph (B), does
not limit the acceptance of applications for
children; and
``(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) 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
new clause:
``(iii) at State option, may not apply a
waiting period in the case of child described
in section 2105(a)(1)(C)(ii), if the State
satisfies the requirements of section
2105(c)(8) and provides such child with child
health assistance that consists only of
coverage of dental services.''.
(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 new paragraph:
``(4) For purposes of subsection (b), the expenditures described in
this paragraph are expenditures for dental services for children
described in section 2105(a)(1)(C)(ii), but only in the case of a State
that satisfies the requirements of section 2105(c)(8).''.
(b) Effective Date.--The amendments made by subsection (a) take
effect on October 1, 2002, and apply to child health assistance and
medical assistance provided on or after that date.
TITLE II--IMPROVING DELIVERY OF PEDIATRIC DENTAL SERVICES UNDER
COMMUNITY HEALTH CENTERS, PUBLIC HEALTH DEPARTMENTS, AND THE INDIAN
HEALTH SERVICE
SEC. 201. GRANTS TO IMPROVE THE PROVISION OF DENTAL HEALTH SERVICES
THROUGH COMMUNITY HEALTH CENTERS AND PUBLIC HEALTH
DEPARTMENTS.
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)); or
``(iv) a dental education program
accredited by the Commission on Dental
Accreditation; 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.
``(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; and
``(ii) not less than 33 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 2003 through 2007 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 75 percent of such amount to
make grants to eligible entities; and
``(B) not more than 25 percent of such amount to
make grants to eligible individuals.''.
SEC. 202. 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.--
(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. 203. STREAMLINE PROCESS FOR DESIGNATING DENTAL HEALTH PROFESSIONAL
SHORTAGE AREAS.
Section 332(a) of the Public Health Service Act (42 U.S.C. 254e(a))
is amended by adding at the end the following:
``(4) In designating health professional shortage areas under this
section, the Secretary may designate certain areas as dental health
professional shortage areas if the Secretary determines that such areas
have a severe shortage of dental health professionals. The Secretary
shall, in consultation with State and local dental societies and tribal
health organizations, streamline the process to develop, publish and
periodically update criteria to be used in designating dental health
professional shortage areas.''.
SEC. 204. 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.
TITLE III--IMPROVING ORAL HEALTH PROMOTION AND DISEASE PREVENTION
PROGRAMS
SEC. 301. 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, 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; and
(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.
(c) Coordination.--The Secretary of Health and Human Services
shall--
(1) through the Administrator of the Centers for Medicare &
Medicaid Services (formerly known as the Health Care Financing
Administration) establish a 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.);
and
(2) carry out this section in collaboration with such
Administrator and Chief Dental Officer and the Administrator
and Chief Dental Officer of the Health Resources and Services
Administration.
(d) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, $25,000,000 for fiscal year
2003, and such sums as may be necessary for each subsequent fiscal
year.
SEC. 302. CDC REPORTS.
(a) Collection of Data.--The Director of the Centers for Disease
Control and Prevention in collaboration with other organizations and
agencies shall annually collect data describing the dental,
craniofacial, and oral health of residents of at least 1 State and 1
Indian tribe from each region of the Department of Health and Human
Services.
(b) Reports.--The Director of the Centers for Disease Control and
Prevention shall compile and analyze data collected under subsection
(a) and annually prepare and submit to the appropriate committees of
Congress a report concerning the oral health of certain States and
tribes.
SEC. 303. 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;
(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. 304. SCHOOL-BASED DENTAL SEALANT PROGRAM.
Section 317M(c) of the Public Health Service Act (as added by
section 1602 of Public Law 106-310) 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 and 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 health
organization, including a grantee under section
330, that is under contract with an elementary
or secondary school described in subparagraph
(B) to provide dental services to school-age
children.''.
<all>
Introduced in House
Introduced in House
Sponsor introductory remarks on measure. (CR E45-46)
Referred to the House Committee on Energy and Commerce.
Referred to the Subcommittee on Health.
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