Allows States the option of using Federal SCHIP funds to cover dental expenses for a child who is eligible for Medicaid under targeted low-income child Medicaid guidelines when the child has medical coverage that does not include dental services.
Allows States the option of covering dental services of adults receiving assistance under SCHIP.
Alters the Medicaid matching rate for adult full coverage dental benefits.
Establishes in the Treasury the Community Oral Health Expansion Fund to expand the availability of oral health services through community-based centers. Authorizes the use of funds for demonstration projects and demonstration partnerships with Head Start programs for identifying children at risk of dental disease and providing prevention measures.
Requires States to contribute, directly or indirectly, up to ten percent of demonstration project costs.
Requires the Secretary of Health and Human Services to give grant: (1) priority to States covering a Medicaid level of dental benefits under SCHIP; and (2) preference to States with market-based payment rates for dental services under both Medicaid and SCHIP.
[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5191 Introduced in House (IH)]
107th CONGRESS
2d Session
H. R. 5191
To amend titles XIX and XXI of the Social Security Act to provide for
expanded dental coverage under Medicaid and State children's health
insurance programs and to provide for funding for expanded community
oral health services.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 23, 2002
Mr. Sanders (for himself, Ms. Lee, Mr. Hinchey, Mr. Larson of
Connecticut, and Mr. Frank) introduced the following bill; which was
referred to the Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To amend titles XIX and XXI of the Social Security Act to provide for
expanded dental coverage under Medicaid and State children's health
insurance programs and to provide for funding for expanded community
oral health services.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Oral Health Promotion Act of 2002''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) Oral and general health are inseparable, and good
dental care is critical to our overall physical health and
well-being, yet 108 million Americans have no public or private
dental insurance.
(2) Although oral health in America has improved
dramatically over the last 50 years, dental caries (cavities)
are presently the single most common chronic childhood disease,
five times more likely than asthma and seven times more common
than hay fever.
(3) According to the Surgeon General, low-income, minority
children experience significant disparities in oral health
status and access to basic dental care. In a year-long study,
the Surgeon General found that fewer than one in five Medicaid-
covered children received a single dental visit during that
period and that 25 percent of poor and minority children never
visit a dentist before entering kindergarten.
(4) Poor children are more than twice as likely than their
more affluent peers to have dental caries, which cause a
significant amount of pain to children and cause difficulty
eating, playing and learning, as well as many missed days of
school, and which are more likely to go untreated. Surveys have
shown that children miss nearly 52 million hours of school each
year because of dental problems.
(5) Low-income adults face similar problems with pain and
limitations on daily activities and are more likely than those
with higher incomes to lose permanent teeth and have untreated
dental disease. Among adult workers, more than 164 million work
hours are lost annually because of dental problems.
SEC. 3. REQUIREMENT FOR DENTAL BENEFITS UNDER SCHIP.
(a) In General.--Section 2103(c)(2) of the Social Security Act (42
U.S.C. 1397cc(c)(2)) is amended by adding at the end the following new
subparagraph:
``(E) Dental services.''.
(b) Effective Date.--The amendments made by subsection (a) shall
take effect on January 1, 2003.
SEC. 4. 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) and at the option of a State, 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--
``(I) 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
coverage of dental services; or
``(II) such child meets the requirements
(other than income-related requirements) to be
a targeted low-income child; and''.
(B) Conditions described.--Section 2105(c) of such
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
title)--
``(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) Authorization of appropriations.--In addition
to any funds otherwise authorized to be appropriated,
there are authorized to be appropriated such additional
funds as may be necessary to carry out the amendments
made by subparagraphs (A) and (B).
(D) State option to waive waiting period.--Section
2102(b)(1)(B) of such 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 choose not to
apply a waiting period in the case of a 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.''.
(E) Optional application to adults covered under
waivers.--The amendments made by this paragraph shall
also apply under title XXI of the Social Security Act
at a State's option to adults receiving assistance
under such title in a manner comparable to the manner in which such
amendments apply to child health assistance furnished to a child
covered under such title.
(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 the date of the enactment of this Act, and apply to child
health assistance and medical assistance provided on or after that
date.
SEC. 5. ENHANCED MATCHING RATE UNDER MEDICAID FOR COVERAGE OF FULL
ADULT DENTAL BENEFITS.
(a) In General.--Section 1905(a)(4) of the Social Security Act (42
U.S.C. 1396d(a)(4)) is amended--
(1) by inserting ``(A)'' after ``with respect to''; and
(2) by inserting before the period at the end the
following: ``and (B) with respect to medical assistance
provided for dental benefits for adults but only if such
benefits cover the full range of dental benefits (including
orthodontia and dentures)''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply to medical assistance for items and services furnished on or
after the date of the enactment of this Act, regardless of whether the
State medicaid plan provided for full adult dental benefits before such
date.
SEC. 6. ESTABLISHMENT OF FUND FOR ORAL HEALTH SERVICES THROUGH
COMMUNITY-BASED HEALTH CENTERS.
(a) In General.--There is established in the Treasury of the United
States a fund to be known as Community Oral Health Expansion Fund
(referred to in this section as the ``Fund''). The Fund shall consist
of such amounts as may be appropriated under subsection (b) to the
Fund. Amounts appropriated for the Fund shall remain available until
expended.
(b) Authorization of Appropriations to Fund.--For each fiscal year
beginning with fiscal year 2003, there is authorized to be appropriated
to the Fund $140,000,000.
(c) Use of Fund.--
(1) In general.--Amounts in the Fund and available pursuant
to appropriations Act shall be used by the Secretary of Health
and Human Services to make grants to the States for the purpose
of establishing or expanding the availability of oral health
services through Federally-qualified health centers (as defined
in section 1905(l)(2)(B) of the Social Security Act) or through
other nonprofit private or public community-based providers of
health services.
(2) Certain uses.--The purposes for which a grant under
paragraph (1) may be expended include, with respect to oral
health services--
(A) recruiting and compensating staff;
(B) purchasing equipment; and
(C) constructing, modernizing, or renovating
facilities.
(3) Use for demonstration projects.--In conjunction with
any of the uses specified under paragraph (2), grants under
paragraph (1) also may be used by health centers and other
community-based providers described in paragraph (1) for
demonstration projects and demonstration partnerships with Head
Start programs for identifying children at risk of dental
disease and providing early intervention and prevention of such
disease.
(d) Requirement of Matching Funds.--
(1) In general.--With respect to the costs of the program
to be carried out under subsection (c) by a State, a grant
under such subsection may be made only if the State agrees to
make available (directly or through donations from public or
private entities) non-Federal contributions toward such costs
in an amount that is not less than 10 percent of such costs ($1
for each $9 of Federal funds provided in the grant).
(2) Determination of amount contributed.--Non-Federal
contributions required in paragraph (1) may be in cash or in
kind, fairly evaluated, including plant, equipment, or
services. Amounts provided by the Federal Government, or
services assisted or subsidized to any significant extent by
the Federal Government, may not be included in determining the
amount of such non-Federal contributions.
(e) Priority for States Covering Medicaid Level of Dental Benefits
Under SCHIP and Preference for States With Market-Based Payment Rates
for Dental Services Under Medicaid and SCHIP.--In awarding grants to
States under this section, the Secretary of Health and Human Services
shall--
(1) give priority to those States that provide, under its
State child health insurance plan under title XXI of the Social
Security Act, for the coverage of dental benefits in an amount,
duration, and scope equivalent to that provided under its State
medicaid plan under title XIX of such Act; and
(2) give preference to States that provide for
reimbursement under its State medicaid plan and its State child
health insurance plan under titles XIX and XXI of such Act for
dental services at levels consistent with market-based rates.
(f) State Defined.--For purposes of this section, the term
``State'' has the meaning given such term for purposes of title XIX of
the Social Security Act.
<all>
Introduced in House
Introduced in House
Referred to the House Committee on Energy and Commerce.
Referred to the Subcommittee on Health.
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