Comprehensive Dental Reform Act of 2012 - Title I: Medicare and Medicaid - Amends titles XVIII (Medicare) and XIX (Medicaid) of the Social Security Act to cover dental services.
Increases the federal medical assistance percentage (FMAP) for funding under Medicaid for dental services.
Directs the Secretary of Health and Human Services (HHS) to award grants to states and eligible entities to develop certain case management programs that: (1) identify eligible individuals in need of dental services, with a particular focus on pregnant women, individuals with disabilities, and older adults, and provide them with information regarding dental providers in proximity to their residence; (2) recruit licensed dental providers and coordinate their voluntary provision of medically recommended dental services at no charge; (3) provide community-level oral health education; and (4) identify and coordinate transportation necessary to overcome mobility impairments and transportation barriers.
Title II: Public Health Programs - Amends the Public Health Service Act to establish, revise, and extend funding for grant programs for: (1) educating nondental medical and other professionals about oral health care; (2) providing dental services in hospital emergency rooms or in community settings; (3) providing scholarships and education loans for dental therapists and oral health professional students; (4) providing comprehensive oral health services to low-income individuals and individuals in underserved areas; (5) building, operating, or expanding dental clinics in schools; (6) funding research by the Centers for Disease Control and Prevention (CDC) to prevent and manage oral health diseases; and (7) providing rural health clinics with mobile and portable, comprehensive dental services and outreach for senior-care facilities and facilities that provide federal health care and nutrition benefits for women and children.
Title III: Department of Veterans Affairs and Department of Defense Matters - Removes restrictions on the authority of the Secretary of Veterans Affairs (VA) to provide dental care to veterans (thereby requiring such care on the same basis as other VA-provided medical care and services). Authorizes such Secretary to carry out a demonstration program to train and employ alternative dental health care providers (providers) in order to increase access to dental health care services (dental services) for veterans in rural and other underserved communities.
Authorizes the Secretary of Defense (DOD) to carry out a similar demonstration program to train and employ such providers in order to increase access to dental services for members of the Armed Forces and their dependents who lack ready access to such services.
Title IV: Federal Bureau of Prisons - Authorizes the Director of the Bureau of Prisons to carry out a demonstration program to establish programs to train and employ alternative dental health care providers to increase access to dental health services for prisoners within the custody of the Bureau of Prisons.
Allows dental services provided under the demonstration program to be administered by alternative dental health care providers and any other dental care providers who are licensed to provide clinical care, through telehealth-enabled collaboration and supervision.
Title V: Indian Health Service - Authorizes the Secretary of HHS, through the Indian Health Service, to carry out a demonstration program to establish programs to train and employ alternative dental health care providers 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.
Allows dental services provided under the demonstration program to be administered by alternative dental health care providers and any other dental care providers who are licensed to provide clinical care, through telehealth-enabled collaboration and supervision.
Title VI: Reports to Congress - Directs the Secretary of HHS, by October 1, 2016, to submit a report that provides a comprehensive cost-benefit analysis regarding the expansion of coverage for dental services pursuant to this Act, including whether the provision of such services resulted in a reduction in total health care costs for individuals under the Medicare and Medicaid programs.
Directs the Comptroller General (GAO): (1) by October 1, 2015, to submit a report that provides a comprehensive analysis and evaluation of the implementation and utilization of the expanded coverage for dental services under this Act for individuals enrolled in Medicare and Medicaid, and (2) by October 1, 2016, to submit a report that provides a comprehensive analysis and evaluation of the demonstration programs authorized by this Act for the training and employment of alternative dental health care providers.
Title VII: Funding - Amends the Internal Revenue Code to impose an 0.025% excise tax on the purchase of a security: (1) if such purchase occurs on a trading facility located in the United States, or (2) the purchaser or seller is a U.S. person.
Defines "security" to include: (1) stocks, partnership interests, notes, bonds, debentures, or other evidences of indebtedness; and (2) interests in a derivative financial instrument (i.e., any option, forward contract, futures contract, notional principal contract, or any similar financial instrument).
Exempts from such tax: (1) initial issues of securities; (2) any note, bond, debenture, or other evidence of indebtedness which has a fixed maturity of not more than 100 days; and (3) securities traded pursuant to certain lending arrangements.
[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5909 Introduced in House (IH)]
112th CONGRESS
2d Session
H. R. 5909
To improve access to oral health care for vulnerable and underserved
populations.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 7, 2012
Mr. Cummings introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committees on
Ways and Means, the Judiciary, Natural Resources, Veterans' Affairs,
and Armed Services, for a period to be subsequently determined by the
Speaker, in each case for consideration of such provisions as fall
within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To improve access to oral health care for vulnerable and underserved
populations.
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 ``Comprehensive Dental Reform Act of
2012''.
SEC. 2. TABLE OF CONTENTS.
The table of contents of this Act is as follows:
Sec. 1. Short title.
Sec. 2. Table of contents.
Sec. 3. Findings.
TITLE I--MEDICARE AND MEDICAID
Subtitle A--Medicare
Sec. 101. Coverage of dental services under the Medicare program.
Subtitle B--Medicaid
Sec. 111. Coverage of dental services under the Medicaid program.
Subtitle C--Grant Programs
Sec. 121. Case management grant program.
TITLE II--PUBLIC HEALTH PROGRAMS
Subtitle A--National Health Service Corps
Sec. 201. National Health Service Corps.
Subtitle B--Oral Health Education
Sec. 211. Authorization of appropriations for oral health education for
medical providers.
Sec. 212. Oral health education for other non-health professionals.
Sec. 213. Dental education.
Sec. 214. Oral health professional student loans.
Subtitle C--Other Oral Health Programs
Sec. 221. Access points.
Sec. 222. Dental clinics in schools.
Sec. 223. Emergency room care coordination.
Sec. 224. Research funding.
Sec. 225. Mobile and portable dental services.
TITLE III--DEPARTMENT OF VETERANS AFFAIRS AND DEPARTMENT OF DEFENSE
MATTERS
Subtitle A--Department of Veterans Affairs Matters
Sec. 301. Requiring Secretary of Veterans Affairs to furnish dental
care in same manner as any other medical
service.
Sec. 302. Demonstration program on training and employment of
alternative dental health care providers
for dental health care services for
veterans in rural and other underserved
communities.
Subtitle B--Department of Defense Matters
Sec. 311. Demonstration program on training and employment of
alternative dental health care providers
for dental health care services for members
of the Armed Forces and dependents lacking
ready access to such services.
TITLE IV--FEDERAL BUREAU OF PRISONS
Sec. 401. Demonstration program on training and employment of
alternative dental health care providers
for dental health care services for
prisoners within the custody of the Bureau
of Prisons.
TITLE V--INDIAN HEALTH SERVICE
Sec. 501. Demonstration program on training and employment of
alternative dental health care providers
for dental health care services under the
Indian Health Service.
TITLE VI--REPORTS TO CONGRESS
Sec. 601. Evaluation of expansion of coverage for dental services.
TITLE VII--FUNDING
Sec. 701. Transaction tax.
SEC. 3. FINDINGS.
Congress makes the following findings:
(1) The United States must establish a nationwide and
comprehensive approach to address the lack of access to needed
dental care and reduce oral health disparities.
(2) Since 2000, when the Surgeon General of the United
States called dental disease a ``silent epidemic'', there has
been increasing but still insufficient attention given to
addressing oral health issues. The Healthy People 2020
initiative includes oral health as a leading health indicator
for the first time in the history of the Healthy People
program, and in 2011, the Institute of Medicine published 2
reports, ``Improving Access to Oral Health Care for Vulnerable
and Underserved Populations'' and ``Advancing Oral Health in
America'', that focused on oral health.
(3) Dental caries, commonly known as cavities, are the most
common chronic disease for children in the United States,
affecting nearly 60 percent of children between 5 and 17 years
of age. Additionally, 25 percent of American adults who have
attained 65 years of age have lost all of their teeth.
(4) Untreated oral health problems contribute to an
increased risk for serious medical conditions such as diabetes,
hospital-acquired pneumonia, and poor birth outcomes.
(5) More than 47,000,000 individuals reside in areas where
it is difficult to access dental care. Only 45 percent of
Americans over 2 years of age have had a dental visit in the
preceding 12 months, and approximately 17,000,000 low-income
children go each year without seeing a dentist.
(6) While the lack of access to oral health services is a
national problem, those who are most likely to remain
underserved are individuals with low incomes, racial and ethnic
minorities, pregnant women, older adults, individuals with
special needs, and individuals living in rural communities.
(7) Nearly 9,500 additional dental providers are needed in
order to meet this Nation's current oral health needs,
especially to work in areas where the need for dental care is
the greatest. Only 20 percent of practicing dentists in the
United States provide care to individuals enrolled in Medicaid,
and a very small percentage of dentists devote a substantial
part of their practice towards caring for individuals who are
underserved.
(8) Over 40 percent of the total expenditures on dental
care in the United States are out-of-pocket payments by
individuals.
(9) The Medicare program and the Department of Veterans
Affairs do not provide dental coverage to the majority of their
beneficiaries, and States can elect whether to provide dental
coverage to adults under the Medicaid program.
(10) The number of individuals without dental health
insurance is 3 times higher than the number of individuals who
lack general health insurance.
(11) The lack of access to oral health services can be
extremely costly, resulting in higher health care expenditures.
In 2009, there were over 830,000 visits to emergency rooms
across the United States for preventable dental conditions,
which is 16 percent higher than in 2006.
(12) According to a report by the Surgeon General of the
United States, students miss more than 51,000,000 hours of
school and employed adults lose more than 164,000,000 hours of
work each year due to dental disease and dental visits.
TITLE I--MEDICARE AND MEDICAID
Subtitle A--Medicare
SEC. 101. COVERAGE OF DENTAL SERVICES UNDER THE MEDICARE PROGRAM.
(a) Coverage.--Section 1861(s)(2) of the Social Security Act (42
U.S.C. 1395x(s)(2)) is amended--
(1) in subparagraph (EE), by striking ``and'' after the
semicolon at the end;
(2) in subparagraph (FF), by adding ``and'' after the
semicolon at the end; and
(3) by adding at the end the following new subparagraph:
``(GG) dental services (as defined in subsection (iii));''.
(b) Dental Services Defined.--Section 1861(s) of the Social
Security Act (42 U.S.C. 1395x(s)) is amended by adding at the end the
following new subsection:
``Dental Services
``(iii)(1) The term `dental services' means oral health services
(as defined by the Secretary) provided by a licensed oral health care
provider that are necessary to prevent disease and promote oral health,
restore oral structures to health and function, and treat emergency
conditions.
``(2) For purposes of paragraph (1), such term shall include mobile
and portable oral health services (as defined by the Secretary) that--
``(A) are provided for the purpose of overcoming mobility,
transportation, and access barriers for individuals; and
``(B) satisfy the standards and certification requirements
established under section 1902(a)(84)(B) for the State in which
the services are provided.''.
(c) Payment and Coinsurance.--Section 1833(a)(1) of the Social
Security Act (42 U.S.C. 1395l(a)(1)) is amended--
(1) by striking ``and'' before ``(Z)''; and
(2) by inserting before the semicolon at the end the
following: ``, and (AA) with respect to dental services (as
defined in section 1861(iii)), the amount paid shall be (i) in
the case of such services that are dental health preventive
services described in paragraph (1)(D) of such section, 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''.
(d) Payment Under Physician Fee Schedule.--Section 1848(j)(3) of
the Social Security Act (42 U.S.C. 1395w-4(j)(3)) is amended by
inserting ``(2)(GG),'' after ``risk assessment),''.
(e) Dentures.--Section 1861(s)(8) of the Social Security Act (42
U.S.C. 1395x(s)(8)) is amended--
(1) by striking ``(other than dental)'' and inserting
``(including dentures)''; and
(2) by striking ``internal body''.
(f) Repeal of Ground for Exclusion.--Section 1862(a) of the Social
Security Act (42 U.S.C. 1395y) is amended by striking paragraph (12).
(g) Effective Date.--The amendments made by this section shall
apply to services furnished on or after January 1, 2013.
Subtitle B--Medicaid
SEC. 111. COVERAGE OF DENTAL SERVICES UNDER THE MEDICAID PROGRAM.
(a) In General.--Section 1905 of the Social Security Act (42 U.S.C.
1396d) is amended--
(1) in subsection (a)(10), by adding ``(as described in
subsection (ee)(1))'' after ``dental services''; and
(2) by adding at the end the following:
``(ee)(1) Subject to paragraphs (2) and (3), for purposes of this
title, the term `dental services' means oral health services (as
defined by the Secretary) provided by a licensed oral health care
provider that are necessary to prevent disease and promote oral health,
restore oral structures to health and function, and treat emergency
conditions.
``(2) For purposes of paragraph (1), such term shall include mobile
and portable oral health services (as defined by the Secretary) that--
``(A) are provided for the purpose of overcoming mobility,
transportation, and access barriers for individuals; and
``(B) satisfy the standards and certification requirements
established under section 1902(a)(84)(B) for the State in which
the services are provided.
``(3) For purposes of paragraph (1), such term shall not apply to
dental care or services provided to individuals under the age of 21
under subsection (r)(3).''.
(b) Conforming Amendments.--Section 1902(a) of such Act (42 U.S.C.
1396a(a)) is amended--
(1) in paragraph (10)(A), in the matter preceding clause
(i), by inserting ``(10),'' after ``(5),'';
(2) in paragraph (82)(C), by striking ``and'' at the end;
(3) in paragraph (83), by striking the period at the end
and inserting ``; and''; and
(4) by inserting after paragraph (83) the following:
``(84) provide for--
``(A) informing, in writing, all individuals who
have been determined to be eligible for medical
assistance of the availability of dental services (as
defined in section 1905(ee)(1)); and
``(B) establishing and maintaining standards for
and certification of mobile and portable oral health
services (as described in subsections (r)(3)(C) and
(ee)(2) of section 1905).''.
(c) Mobile and Portable Oral Health Services Under EPSDT.--Section
1905(r)(3) of the Social Security Act (42 U.S.C. 1396d(r)(3)) is
amended--
(1) in subparagraph (A)(ii), by striking ``; and'' and
inserting a semicolon;
(2) in subparagraph (B), by striking the period at the end
and inserting ``; and''; and
(3) by adding at the end the following new subparagraph:
``(C) which shall include mobile and portable oral health
services (as defined by the Secretary) that--
``(i) are provided for the purpose of overcoming
mobility, transportation, or access barriers for
children; and
``(ii) satisfy the standards and certification
requirements established under section 1902(a)(84)(B)
for the State in which the services are provided.''.
(d) Increased Federal Funding for Dental Services.--
(1) In general.--Section 1905 of the Social Security Act
(42 U.S.C. 1396d), as amended by subsection (a), is amended--
(A) in subsection (b), in the first sentence, by
striking ``and (aa)'' and inserting ``(aa), and (ff)'';
and
(B) by adding at the end the following new
subsection:
``(ff) Increased FMAP for Dental Services.--
``(1) In general.--Notwithstanding subsection (b) and
section 1903(a)(7) and subject to the requirements described in
paragraphs (3) and (4), with respect to amounts expended on or
after October 1, 2012, for covered dental expenses (as
described in paragraph (2)), the Federal medical assistance
percentage for a State that is one of the 50 States or the
District of Columbia for such expenses shall be equal to the
Federal medical assistance percentage that would otherwise
apply to the State for the fiscal year, as determined under
subsection (b) or section 1903(a)(7), increased by 10
percentage points.
``(2) Covered dental expenses.--For purposes of paragraph
(1), the term `covered dental expenses' means the amounts
expended for medical assistance for dental services (as
described in subsection (ee)(1)) and amounts expended for the
proper and efficient administration of the provision of such
dental services under the State plan.
``(3) Requirements.--For purposes of paragraph (1), the
Federal medical assistance percentage applicable to covered
dental expenses under this subsection shall not apply to a
State unless--
``(A) the State plan for medical assistance
provides payment for dental services (as so defined)
furnished by a dental provider at a rate that is not
less than 70 percent of the usual and customary fee for
such services in the State; and
``(B) the State satisfies such additional
requirements as are established by the Secretary, which
shall include--
``(i) streamlining of administrative
procedures for purposes of ensuring adequate
provider participation and increasing patient
utilization of dental services; and
``(ii) the provision of technical
assistance to dental providers designed to
reduce the number of missed patient
appointments and eliminate other barriers to
the provision of oral health services.
``(4) Limitation.--For purposes of amounts expended for
covered dental services, in no case shall any increase under
this subsection result in a Federal medical assistance
percentage that exceeds 100 percent.''.
(2) Conforming amendment.--Section 1903(a)(7) of the Social
Security Act (42 U.S.C. 1396b(a)(7)) is amended by striking
``section 1919(g)(3)(B)'' and inserting ``sections 1905(ff) and
1919(g)(3)(B)''.
(e) Effective Date.--
(1) In general.--Except as provided in paragraph (2), the
amendments made by this section shall apply to calendar
quarters beginning on or after January 1, 2013, without regard
to whether or not final regulations to carry out such
amendments have been promulgated by such date.
(2) Delay permitted for state plan amendment.--In the case
of a State plan for medical assistance under title XIX of the
Social Security Act which the Secretary of Health and Human
Services determines requires State legislation (other than
legislation appropriating funds) in order for the plan to meet
the additional requirements imposed by the amendments made by
this section, the State plan shall not be regarded as failing
to comply with the requirements of such title solely on the
basis of its failure to meet these additional requirements
before the first day of the first calendar quarter beginning
after the close of the first regular session of the State
legislature that begins after the date of enactment of this
Act. For purposes of the previous sentence, in the case of a
State that has a 2-year legislative session, each year of such
session shall be deemed to be a separate regular session of the
State legislature.
Subtitle C--Grant Programs
SEC. 121. CASE MANAGEMENT GRANT PROGRAM.
(a) Establishment.--The Secretary shall award grants to States and
eligible entities for the purpose of developing case management
programs that--
(1) identify eligible individuals who are in need of dental
services, with a particular focus on pregnant women,
individuals with disabilities, and older adults, and provide
them with information regarding dental providers in proximity
to their residence;
(2) determine the coverage status of an eligible individual
or whether such individual is eligible for free dental
services;
(3) recruit licensed dental providers and coordinate the
voluntary provision of medically recommended dental services by
such providers to eligible individuals described in subsection
(f)(2)(E) with no fee or charge to such individuals and in a
manner consistent with State licensing laws;
(4) provide community-level oral health education, with a
focus on oral health literacy and prevention, and resource
information to eligible individuals; and
(5) identify and coordinate transportation for eligible
individuals in need of dental services as necessary to overcome
mobility impairments and transportation barriers.
(b) Application.--A State or eligible entity that desires to
participate in the grant program under this section shall submit to the
Secretary an application at such time, in such manner, and containing
such information as the Secretary may require.
(c) Duration and Scope.--From any amounts appropriated to carry out
this section, the Secretary shall award grants to a total of 10 States
and eligible entities, with the amount of each grant to be determined
at the discretion of the Secretary.
(d) Evaluation.--Not later than January 1, 2016, the Secretary
shall--
(1) conduct an evaluation of the grant program under this
section for purposes of determining if case management programs
established by participating States and eligible entities
sufficiently increased access to dental services; and
(2) determine whether case management programs should be
made available on a nationwide basis.
(e) Authorization.--To carry out the grant program under this
section, there are authorized to be appropriated such sums as may be
necessary for each of fiscal years 2013 through 2015.
(f) Definitions.--In this section:
(1) Eligible entity.--The term ``eligible entity'' means an
organization that is described in section 501(c)(3) of the
Internal Revenue Code of 1986 and exempt from tax under section
501(a) of such Code.
(2) Eligible individual.--The term ``eligible individual''
means an individual who is--
(A) entitled to, or enrolled for, benefits under
part A of title XVIII of the Social Security Act or
enrolled for benefits under part B of such title;
(B) eligible to receive medical assistance under a
State plan under title XIX of the Social Security Act
or any waiver approved with respect to such plan;
(C) eligible to receive child health assistance
under a State child health plan under title XXI of the
Social Security Act or any waiver approved with respect
to such plan;
(D) entitled to receive medical benefits under the
laws administered by the Secretary of Veterans Affairs;
or
(E) has an income below 200 percent of the Federal
poverty level and does not otherwise have any dental
insurance coverage.
(3) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(4) State.--The term ``State'' means the 50 States and the
District of Columbia.
TITLE II--PUBLIC HEALTH PROGRAMS
Subtitle A--National Health Service Corps
SEC. 201. NATIONAL HEALTH SERVICE CORPS.
(a) In General.--Section 331 of the Public Health Service Act (42
U.S.C. 254d) is amended--
(1) in subsection (a)(3), by adding at the end the
following:
``(F) The term `dental therapist' means, with
respect to a State that licenses such dental
therapists, a mid-level dental practitioner who is
licensed to practice under the law of the State and who
provides preventive and restorative services directly
to the public, commensurate with the scope of the
practice.''; and
(2) in subsection (b)--
(A) in paragraph (1), by inserting ``, dental
therapy,'' after ``dental''; and
(B) in paragraph (2), by inserting ``dental
therapists,'' after ``dentists,''.
(b) Facilitation of Effective Provision of Corps Services.--Section
336(f)(3) of the Public Health Service Act (42 U.S.C. 254h-1(f)(3)) is
amended by inserting ``dental therapists'' after ``midwives,''.
(c) Scholarship Program and Loan Repayment Program.--
(1) Scholarship program.--Section 338A of the Public Health
Service Act (42 U.S.C. 254l) is amended--
(A) in subsection (a)(1), by inserting ``dental
therapists,'' after ``dentists,''; and
(B) in subsection (b)(1), by inserting ``including
dental therapy,'' after ``or other health
profession,''.
(2) Loan repayment program.--Section 338B of the Public
Health Service Act (42 U.S.C. 254l-1) is amended--
(A) in subsection (a)(1), by inserting ``dental
therapists,'' after ``dentists,''; and
(B) in subsection (b)(1)--
(i) in subparagraph (A), by inserting
``dental therapist,'' after ``nurse
practitioner,'';
(ii) in subparagraph (B), by inserting
``dental therapy,'' after ``mental health,'';
and
(iii) in subparagraph (C)(ii), by inserting
``, including dental therapy,'' after ``health
profession''.
(3) Authorization of appropriations.--Section 338H of the
Public Health Service Act (42 U.S.C. 254q) is amended--
(A) in subsection (a), by striking ``this section''
and inserting ``this subpart''; and
(B) by adding at the end the following:
``(d) Authorization of Appropriations With Respect to Oral Health
Professionals.--To carry out this subpart with respect to dentists,
dental therapists, and dental hygienists, in addition to the amounts
authorized under subsection (a), there is authorized to be appropriated
such sums as may be necessary for fiscal years 2013 through 2016, which
shall be used to provide scholarships to such oral health
professionals.''.
Subtitle B--Oral Health Education
SEC. 211. AUTHORIZATION OF APPROPRIATIONS FOR ORAL HEALTH EDUCATION FOR
MEDICAL PROVIDERS.
Section 747(c) of the Public Health Service Act (42 U.S.C. 293k(c))
is amended by adding at the end the following:
``(4) Oral health education.--In addition to other amounts
authorized under this subsection for purposes of carrying out
this section, there is authorized to be appropriated such sums
as may be necessary for fiscal years 2013 through 2016 for the
purpose of educating nondental medical professionals, including
physicians, nurses, and pharmacists, about oral health,
including issues such as oral hygiene instruction, topical
application of fluoride, and oral health screenings, with the
goal of integrating oral health care into overall health
care.''.
SEC. 212. ORAL HEALTH EDUCATION FOR OTHER NON-HEALTH PROFESSIONALS.
Subpart I of part C of title VII of the Public Health Service Act
(42 U.S.C. 293k et seq.) is amended by inserting after section 748 the
following:
``SEC. 748A. ORAL HEALTH EDUCATION FOR OTHER NON-ORAL HEALTH
PROFESSIONALS.
``(a) In General.--The Secretary may make grants to, or enter into
contracts with, an accredited public or nonprofit private hospital, an
educational institution, or a public or private nonprofit entity which
the Secretary has determined is capable of carrying out such grant or
contract to educate individuals, such as community health workers,
social workers, nutritionists, health educators, occupational
therapists, and psychologists, to promote oral health education and to
provide support for behavior change and assistance with care
coordination with respect to oral health.
``(b) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated such sums as may be necessary
for fiscal years 2013 through 2016.''.
SEC. 213. DENTAL EDUCATION.
(a) Training in General, Pediatric, and Public Health Dentistry.--
Section 748 of the Public Health Service Act (42 U.S.C. 293k-2) is
amended--
(1) in subsection (a)(1)(H), by striking ``pediatric
training programs'' and inserting ``pediatric dental training
programs''; and
(2) in subsection (c)--
(A) by striking the subsection heading and
inserting ``Requirements for Award.--'';
(B) by amending the matter preceding paragraph (1)
to read as follows: ``With respect to training provided
for under this section, the Secretary shall award
grants or contracts only to eligible entities that meet
at least 7 of the following criteria:'';
(C) in paragraph (2), by striking ``have a record
of training the greatest percentage of providers, or
that have demonstrated significant improvements in the
percentage of providers, who enter and'' and inserting
``train significant numbers of providers who'';
(D) in paragraph (3)--
(i) by striking ``have a record of
training'' and inserting ``intent to train'';
and
(ii) by striking the period at the end and
inserting ``and have faculty with experience in
treating underserved populations.'';
(E) in paragraph (8), by inserting ``or have
established'' after ``establish''; and
(F) by adding at the end the following:
``(9) Qualified applicants that require not less than 200
hours of community-based education rotations.''.
(b) Dental Residency Programs.--Part B of title III of the Public
Health Service Act (42 U.S.C. 243 et seq.) is amended by adding at the
end the following:
``SEC. 320B. DENTAL RESIDENCY PROGRAMS.
``As a condition for receiving Federal funds, dental training
residency programs shall require individuals enrolled in such residency
programs to provide dental services--
``(1) in hospital emergency rooms; or
``(2) in community settings, in addition to the dental
training otherwise required by such residency program.''.
SEC. 214. ORAL HEALTH PROFESSIONAL STUDENT LOANS.
Part F of title VII of the Public Health Service Act (42 U.S.C.
295j) is amended by adding at the end the following:
``SEC. 799C. ORAL HEALTH PROFESSIONAL STUDENT LOANS.
``(a) In General.--The Secretary shall establish and operate a
student loan fund for oral health professional students, including
dental hygienists, dental therapists, and dentists.
``(b) Content.--The Secretary shall establish and operate the
student loan fund program under subsection (a) in the same manner and
subject to the same terms as the loan fund program established with
schools of nursing under section 835.
``(c) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for fiscal years 2013 through 2016.''.
Subtitle C--Other Oral Health Programs
SEC. 221. ACCESS POINTS.
Subpart X of part D of title III of the Public Health Service Act
(42 U.S.C. 256f et seq.) is amended by adding at the end the following:
``SEC. 340G-2. FUNDING FOR ORAL HEALTH SERVICES.
``(a) In General.--The Secretary, acting through the Administrator
of the Health Resources and Services Administration, shall establish a
program to award grants to eligible entities to provide oral health
services, or to contract with private dental practices to provide
comprehensive oral health services, to low income individuals and
individuals who are underserved with respect to oral health care.
``(b) Technical Assistance.--The Secretary shall provide technical
assistance to entities receiving grants under subsection (a) to provide
technical assistance to such entities in order to--
``(1) with respect to oral health care services, increase
efficiency and minimize missed appointments, contract with
offsite providers, recruit providers (including oral health
specialists), and operate programs outside the physical
facilities to take advantage of new systems to improve access
to oral health services; or
``(2) contract with private dental practices that will
provide oral health services other than preventive oral health
care, including restoration and maintenance of oral health, in
order to meet the need for oral health services in the
community.
``(c) Eligible Entities.--To be eligible to receive a grant under
subsection (a), an entity shall--
``(1) be--
``(A) a Federally qualified health center (as
defined in section 1861(aa) of the Social Security
Act);
``(B) a safety net clinic or a free clinic (as
defined by the Secretary);
``(C) a health care clinic that provides services
to tribal organizations or urban Indian organizations
(as such terms are defined in section 4 of the Indian
Health Care Improvement Act); or
``(D) any other interested public or private sector
health care provider or organization that the Secretary
determines has a demonstrated history in serving a high
number of uninsured and or low-income individuals or
those who lack ready access to oral health services;
and
``(2) demonstrate a clear need to expand oral health care
services beyond preventive oral health care.
``(d) Allocation for Hiring Oral Health Care Specialists.--A
portion of the funds available under this section shall be allocated
toward hiring oral health care specialists, such as oral surgeons, at
entities receiving grants under this section.
``(e) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated such sums as may be necessary
for each of fiscal years 2013 through 2016.''.
SEC. 222. DENTAL CLINICS IN SCHOOLS.
Part Q of title III of the Public Health Service Act (42 U.S.C.
280h et seq.) is amended by adding at the end the following:
``SEC. 399Z-2. DENTAL CLINICS IN SCHOOLS.
``(a) In General.--The Secretary shall award grants to qualified
entities for the purpose of funding the building, operation, or
expansion of dental clinics in schools.
``(b) Qualified Entities.--To receive a grant under this section, a
qualified entity shall submit an application to the Secretary at such
time, in such manner, and containing such information as the Secretary
may require.
``(c) Requirements.--An entity receiving a grant under this section
shall--
``(1) provide comprehensive oral health services at a
dental clinic based at a school, including oral health
education, oral screening, fluoride application, prophylaxis,
and sealants;
``(2) refer patients to an available qualified oral health
provider in the community for any required oral health services
not provided in the dental clinic in the school, to ensure that
all the oral health needs of students are met; and
``(3) maintain clinic hours that extend beyond school
hours.
``(d) Authorization of Appropriations.--For purposes of carrying
out this section, there is authorized to be appropriated such sums as
may be necessary for fiscal years 2013 through 2016.''.
SEC. 223. EMERGENCY ROOM CARE COORDINATION.
Part B of title III of the Public Health Service Act (42 U.S.C. 243
et seq.), as amended by section 213(b), is further amended by adding at
the end the following:
``SEC. 320C. EMERGENCY ROOM CARE COORDINATION WITH RESPECT TO DENTAL
CARE.
``(a) In General.--The Secretary, acting through the Administrator
of the Health Resources and Services Administration, shall establish a
grant program to enable individuals to receive dental care at a
facility operated by a grant recipient rather than at a hospital
emergency room.
``(b) Eligible Entities.--To be eligible to receive a grant under
this section, an entity shall be--
``(1) a hospital in partnership with a Federally qualified
health center;
``(2) a Federally qualified health center;
``(3) a private dental practice; or
``(4) any other interested public or private sector health
care provider or organization that the Secretary determines has
the capacity to serve a high number of individuals who lack
access to oral health services.
``(c) Oral Health Education for ER Physicians.--The Secretary shall
allocate a portion of the amounts appropriated under subsection (e)
toward medical education for emergency room physicians to be trained in
oral health.
``(d) Report.--Not later than January 1, 2016, the Secretary shall
submit to Congress a report on the best practices determined by the
program established under this section to address oral health needs of
individuals who go to emergency rooms in need of oral health care.
``(e) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated such sums as may be necessary
for fiscal years 2013 through 2016.''.
SEC. 224. RESEARCH FUNDING.
For fiscal years 2013 through 2016, there is authorized to be
appropriated such sums as may be necessary to each of--
(1) the Centers for Disease Control and Prevention, for the
purpose of conducting research on--
(A) the prevention of oral health disease; and
(B) oral health disease management;
(2) the Agency for Healthcare Research and Quality, for the
purpose of conducting--
(A) research with respect to oral health services
and the delivery of oral health services; and
(B) an evaluation of oral health service delivery
to underserved and vulnerable populations;
(3) the National Institute of Dental and Craniofacial
Research for the purpose of conducting research on oral health
disease management including pharmaceutical-behavioral
intervention; and
(4) the Maternal and Child Health Bureau for the purpose of
conducting research on maternal and child oral health issues.
SEC. 225. MOBILE AND PORTABLE DENTAL SERVICES.
Subpart X of part D of title III of the Public Health Service Act
(42 U.S.C. 256f et seq.), as amended by section 221, is further amended
by adding at the end the following:
``SEC. 340G-3. MOBILE AND PORTABLE DENTAL SERVICES.
``(a) In General.--The Secretary shall award grants to rural health
clinics, as defined in section 1861(aa)(2) of the Social Security Act
(42 U.S.C. 1395x(aa)(2)), to provide mobile and portable, comprehensive
dental services (including dental services provided by licensed
providers through telehealth-enabled collaboration and supervision) and
outreach for dental services at locations such as senior centers,
nursing homes, assisted living facilities, schools, licensed day care
centers that serve children who receive benefits under the State
Children's Health Insurance Program under title XXI of the Social
Security Act (42 U.S.C. 1397aa et seq.) or the Medicaid program under
title XIX of the Social Security Act (42 U.S.C. 1396 et seq.), and
facilities that provide services under the Special Supplemental
Nutrition Program for Women, Infants, and Children (the WIC program) or
the Head Start Act (42 U.S.C. 9831 et seq.).
``(b) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be
necessary.''.
TITLE III--DEPARTMENT OF VETERANS AFFAIRS AND DEPARTMENT OF DEFENSE
MATTERS
Subtitle A--Department of Veterans Affairs Matters
SEC. 301. REQUIRING SECRETARY OF VETERANS AFFAIRS TO FURNISH DENTAL
CARE IN SAME MANNER AS ANY OTHER MEDICAL SERVICE.
(a) In General.--Title 38, United States Code, is amended--
(1) in section 1701(6), by striking ``as described in
sections 1710 and 1712 of this title'';
(2) in section 1710(c), by striking the second sentence;
(3) in section 1712--
(A) by striking subsections (a) and (b); and
(B) by redesignating subsections (c) through (e) as
subsections (a) through (c), respectively; and
(4) by striking section 2062.
(b) Conforming Amendments.--Such title is further amended--
(1) in section 1525(a), by striking ``medicines under
section 1712(d)'' and inserting ``medicines under section
1712(b)''; and
(2) in section 1703(a)(7), by striking ``, for a veteran
described in section 1712(a)(1)(F) of this title''.
(c) Clerical Amendments.--Such title is further amended--
(1) in section 1712, in the heading for such section, by
striking ``Dental care; drugs'' and inserting ``Drugs'';
(2) in the table of sections at the beginning of chapter
17, by striking the item relating to section 1712 and inserting
the following new item:
``1712. Drugs and medicines for certain disabled veterans; vaccines.'';
and
(3) in the table of sections at the beginning of chapter
20, by striking the item relating to section 2062.
SEC. 302. DEMONSTRATION PROGRAM ON TRAINING AND EMPLOYMENT OF
ALTERNATIVE DENTAL HEALTH CARE PROVIDERS FOR DENTAL
HEALTH CARE SERVICES FOR VETERANS IN RURAL AND OTHER
UNDERSERVED COMMUNITIES.
(a) Demonstration Program Authorized.--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 entitled to
such services who reside in rural and other underserved communities.
(b) Telehealth.--For purposes of alternative dental health care
providers and any other dental care providers who are licensed to
provide clinical care, dental services provided under the demonstration
program under this section may be administered by such providers
through telehealth-enabled collaboration and supervision when deemed
appropriate and feasible.
(c) Alternative Dental Health Care Providers Defined.--In this
section, 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)).
(d) Authorization of Appropriations.--There are authorized to be
appropriated such sums as are necessary to carry out the demonstration
program under this section.
Subtitle B--Department of Defense Matters
SEC. 311. DEMONSTRATION PROGRAM ON TRAINING AND EMPLOYMENT OF
ALTERNATIVE DENTAL HEALTH CARE PROVIDERS FOR DENTAL
HEALTH CARE SERVICES FOR MEMBERS OF THE ARMED FORCES AND
DEPENDENTS LACKING READY ACCESS TO SUCH SERVICES.
(a) Demonstration Program Authorized.--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:
(1) Members and dependents who reside in rural areas or
areas otherwise underserved by dental health care providers.
(2) Members of the National Guard and Reserves in active
status who are potentially deployable.
(b) Telehealth.--For purposes of alternative dental health care
providers and any other dental care providers who are licensed to
provide clinical care, dental services provided under the demonstration
program under this section may be administered by such providers
through telehealth-enabled collaboration and supervision when deemed
appropriate and feasible.
(c) Alternative Dental Health Care Providers Defined.--In this
section, 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)).
(d) Authorization of Appropriations.--There are authorized to be
appropriated such sums as are necessary to carry out the demonstration
program under this section.
TITLE IV--FEDERAL BUREAU OF PRISONS
SEC. 401. DEMONSTRATION PROGRAM ON TRAINING AND EMPLOYMENT OF
ALTERNATIVE DENTAL HEALTH CARE PROVIDERS FOR DENTAL
HEALTH CARE SERVICES FOR PRISONERS WITHIN THE CUSTODY OF
THE BUREAU OF PRISONS.
(a) Demonstration Program Authorized.--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.
(b) Telehealth.--For purposes of alternative dental health care
providers and any other dental care providers who are licensed to
provide clinical care, dental services provided under the demonstration
program under this section may be administered by such providers
through telehealth-enabled collaboration and supervision when deemed
appropriate and feasible.
(c) Alternative Dental Health Care Providers Defined.--In this
section, 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)).
(d) Authorization of Appropriations.--There are authorized to be
appropriated such sums as are necessary to carry out the demonstration
program under this section.
TITLE V--INDIAN HEALTH SERVICE
SEC. 501. DEMONSTRATION PROGRAM ON TRAINING AND EMPLOYMENT OF
ALTERNATIVE DENTAL HEALTH CARE PROVIDERS FOR DENTAL
HEALTH CARE SERVICES UNDER THE INDIAN HEALTH SERVICE.
(a) Demonstration Program Authorized.--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 (as those terms
are defined in section 4 of the Indian Health Care Improvement Act (25
U.S.C. 1603)).
(b) Telehealth.--For purposes of alternative dental health care
providers and any other dental care providers who are licensed to
provide clinical care, dental services provided under the demonstration
program under this section may be administered by such providers
through telehealth-enabled collaboration and supervision when deemed
appropriate and feasible.
(c) Alternative Dental Health Care Providers Defined.--In this
section, 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)).
(d) Authorization of Appropriations.--There are authorized to be
appropriated such sums as are necessary to carry out the demonstration
program under this section.
TITLE VI--REPORTS TO CONGRESS
SEC. 601. EVALUATION OF EXPANSION OF COVERAGE FOR DENTAL SERVICES.
(a) Secretary of Health and Human Services.--Not later than October
1, 2016, the Secretary of Health and Human Services shall submit to
Congress a report that provides a comprehensive cost-benefit analysis
regarding the expansion of coverage for dental services pursuant to
this Act, including whether the provision of such services resulted in
a reduction in total health care costs for individuals under the
Medicare and Medicaid programs.
(b) Comptroller General.--
(1) Medicaid and medicare.--Not later than October 1, 2015,
the Comptroller General of the United States shall submit to
Congress a report that provides a comprehensive analysis and
evaluation of the implementation and utilization of the
expanded coverage for dental services pursuant to this Act for
individuals enrolled in the Medicare and Medicaid programs.
(2) Demonstration programs.--Not later than October 1,
2016, the Comptroller General of the United States shall submit
to Congress a report that provides a comprehensive analysis and
evaluation of the demonstration programs described in sections
302, 311, 401, and 501, including--
(A) the extent to which the programs improved
access to oral health care and increased utilization of
oral health services; and
(B) an examination of the training provided under
the programs to alternative dental health care
providers and the quality of care provided by such
providers.
TITLE VII--FUNDING
SEC. 701. TRANSACTION TAX.
(a) In General.--Chapter 36 of the Internal Revenue Code of 1986 is
amended by inserting after subchapter B the following new subchapter:
``Subchapter C--Tax on Trading Transactions
``Sec. 4475. Tax on trading transactions.
``SEC. 4475. TAX ON TRADING TRANSACTIONS.
``(a) Imposition of Tax.--There is hereby imposed a tax on each
covered transaction with respect to any security.
``(b) Rate of Tax.--The tax imposed under subsection (a) with
respect to any covered transaction shall be 0.025 percent of the
specified base amount with respect to such covered transaction.
``(c) Specified Base Amount.--For purposes of this section, the
term `specified base amount' means--
``(1) except as provided in paragraph (2), the fair market
value of the security (determined as of the time of the covered
transaction), and
``(2) in the case of any payment described in subsection
(h), the amount of such payment.
``(d) Covered Transaction.--For purposes of this section, the term
`covered transaction' means--
``(1) except as provided in paragraph (2), any purchase
if--
``(A) such purchase occurs or is cleared on a
facility located in the United States, or
``(B) the purchaser or seller is a United States
person, and
``(2) any transaction with respect to a security described
in subparagraph (D), (E), or (F) of subsection (e)(1), if--
``(A) such security is traded or cleared on a
facility located in the United States, or
``(B) any party with rights under such security is
a United States person.
``(e) Security and Other Definitions.--For purposes of this
section:
``(1) In general.--The term `security' means--
``(A) any share of stock in a corporation,
``(B) any partnership or beneficial ownership
interest in a partnership or trust,
``(C) any note, bond, debenture, or other evidence
of indebtedness,
``(D) any evidence of an interest in, or a
derivative financial instrument with respect to, any
security or securities described in subparagraph (A),
(B), or (C),
``(E) any derivative financial instrument with
respect to any currency or commodity, and
``(F) any other derivative financial instrument any
payment with respect to which is calculated by
reference to any specified index.
``(2) Derivative financial instrument.--The term
`derivative financial instrument' includes any option, forward
contract, futures contract, notional principal contract, or any
similar financial instrument.
``(3) Specified index.--The term `specified index' means
any 1 or more of any combination of--
``(A) a fixed rate, price, or amount, or
``(B) a variable rate, price, or amount,
which is based on any current objectively determinable
information which is not within the control of any of the
parties to the contract or instrument and is not unique to any
of the parties' circumstances.
``(4) Treatment of exchanges.--
``(A) In general.--An exchange shall be treated as
the sale of the property transferred and a purchase of
the property received by each party to the exchange.
``(B) Certain deemed exchanges.--In the case of a
distribution treated as an exchange for stock under
section 302 or 331, the corporation making such
distribution shall be treated as having purchased such
stock for purposes of this section.
``(f) Exceptions.--
``(1) Exception for initial issues.--No tax shall be
imposed under subsection (a) on any covered transaction with
respect to the initial issuance of any security described in
subparagraph (A), (B), or (C) of subsection (e)(1).
``(2) Exception for certain traded short-term
indebtedness.--A note, bond, debenture, or other evidence of
indebtedness which--
``(A) is traded on a trading facility located in
the United States, and
``(B) has a fixed maturity of not more than 100
days,
shall not be treated as described in subsection (e)(1)(C).
``(3) Exception for securities lending arrangements.--No
tax shall be imposed under subsection (a) on any covered
transaction with respect to which gain or loss is not
recognized by reason of section 1058.
``(g) By Whom Paid.--
``(1) In general.--The tax imposed by this section shall be
paid by--
``(A) in the case of a transaction which occurs or
is cleared on a facility located in the United States,
such facility, and
``(B) in the case of a purchase not described in
subparagraph (A) which is executed by a broker (as
defined in section 6045(c)(1)) which is a United States
person, such broker.
``(2) Special rules for direct, etc., transactions.--In the
case of any transaction to which paragraph (1) does not apply,
the tax imposed by this section shall be paid by--
``(A) in the case of a transaction described in
subsection (d)(1)--
``(i) the purchaser if the purchaser is a
United States person, and
``(ii) the seller if the purchaser is not a
United States person, and
``(B) in the case of a transaction described in
subsection (d)(2)--
``(i) the payor if the payor is a United
States person, and
``(ii) the payee if the payor is not a
United States person.
``(h) Certain Payments Treated as Separate Transactions.--Except as
otherwise provided by the Secretary, any payment with respect to a
security described in subparagraph (D), (E), or (F) of subsection
(e)(1) shall be treated as a separate transaction for purposes of this
section, including--
``(1) any net initial payment, net final or terminating
payment, or net periodical payment with respect to a notional
principal contract (or similar financial instrument),
``(2) any payment with respect to any forward contract (or
similar financial instrument), and
``(3) any premium paid with respect to any option (or
similar financial instrument).
``(i) Administration.--The Secretary shall carry out this section
in consultation with the Securities and Exchange Commission and the
Commodity Futures Trading Commission.
``(j) Guidance; Regulations.--The Secretary shall--
``(1) provide guidance regarding such information reporting
concerning covered transactions as the Secretary deems
appropriate, and
``(2) prescribe such regulations as are necessary or
appropriate to prevent avoidance of the purposes of this
section, including the use of non-United States persons in such
transactions.''.
(b) Clerical Amendment.--The table of subchapters for chapter 36 of
the Internal Revenue Code of 1986 is amended by inserting after the
item relating to subchapter B the following new item:
``Subchapter C. Tax on trading transactions.''.
(c) Effective Date.--The amendments made by this section shall
apply to transactions after December 31, 2012.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, the Judiciary, Natural Resources, Veterans' Affairs, and Armed Services, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, the Judiciary, Natural Resources, Veterans' Affairs, and Armed Services, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, the Judiciary, Natural Resources, Veterans' Affairs, and Armed Services, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, the Judiciary, Natural Resources, Veterans' Affairs, and Armed Services, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, the Judiciary, Natural Resources, Veterans' Affairs, and Armed Services, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
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Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, the Judiciary, Natural Resources, Veterans' Affairs, and Armed Services, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
Referred to the Subcommittee Indian and Alaska Native Affairs.
Referred to the Subcommittee on Crime, Terrorism, and Homeland Security.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Military Personnel.