Improving access to dental care

(a) Reports to Congress (1) GAO reports Not later than 1 year after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress— (A) a report on the Alaska Dental Health Aide Therapists program and the Dental Therapist and Advanced Dental Therapist programs in Minnesota, to assess the effectiveness of dental therapists in— (i) improving access to timely dental care among communities of color; (ii) providing high-quality care; (iii) providing culturally competent care; and (iv) providing accessible care to people with disabilities; (B) a report on State variations in the use of dental hygienists and the effectiveness of expanding the scope of practice for dental hygienists in— (i) improving access to timely dental care among communities of color; (ii) providing high-quality care; (iii) providing culturally competent care; and (iv) providing accessible care to people with disabilities; and (C) a report on the use of telehealth services to enhance services provided by dental hygienists and therapists, including recommendations for any modifications to the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) and the Medicaid program under title XIX of such Act (42 U.S.C. 1396 et seq.) to better provide for telehealth consultations in conjunction with therapists’ and hygienists’ care. (2) HRSA report on dental shortage areas Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services, acting through the Administrator of the Health Resources and Services Administration, shall submit to Congress a report which details geographic dental access shortages and the preparedness of dental providers to offer culturally and linguistically appropriate, affordable, accessible, and timely services. (b) Expansion of dental health aid therapists in Tribal and urban Indian communities Section 119 of the Indian Health Care Improvement Act (25 U.S.C. 1616l) is amended— (1) in subsection (d)— (A) by striking paragraph (2) and inserting the following: (2) Requirements; exclusion Subject to paragraphs (3) and (4), in establishing a national program under paragraph (1), the Secretary— (A) shall not reduce the amounts provided for the Community Health Aide Program described in subsections (a) and (b); (B) shall exclude dental health aide therapist services from services covered under that Program; and (C) shall include urban Indian organizations.; and (B) in paragraph (3)— (i) in the paragraph heading, by striking or tribal organization and inserting, tribal organization, or urban Indian organization; and (ii) in each of subparagraphs (A) and (B), by striking or tribal organization and inserting, tribal organization, or urban Indian organization; and (2) in subsection (e), by striking or a tribal organization and inserting a tribal organization, or an urban Indian organization. (c) Coverage of dental services under the Medicare program (1) Coverage Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)) is amended— (A) in subparagraph (JJ), by striking and at the end; (B) in subparagraph (KK), by inserting and at the end; and (C) by adding at the end the following new subparagraph: (LL) dental and oral health services (as defined in subsection (qqq));. (2) Dental and oral health services defined Section 1861 of the Social Security Act (42 U.S.C. 1395x), as amended by sections 2007(b) and 4221(a), is amended by adding at the end the following new subsection: (qqq) Dental and oral health services (1) The term dental and oral health services means services (as defined by the Secretary) that are necessary to prevent disease and promote oral health, restore oral structures to health and function, and treat emergency conditions, including— (A) routine diagnostic and preventive care such as dental cleanings, exams, and x-rays; (B) basic dental services such as fillings and extractions; (C) major dental services such as root canals, crowns, and dentures; (D) emergency dental care; and (E) other necessary services related to dental and oral health (as defined by the Secretary). (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)(82) for the State in which the services are provided.. (3) Payment and coinsurance Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) is amended— (A) by striking and before (HH); and (B) by inserting before the semicolon at the end the following: and (II) with respect to dental and oral health services (as defined in section 1861(qqq)), the amount paid shall be (i) in the case of such services that are preventive, 100 percent of the lesser of the actual charge for the services or the amount determined under the payment basis determined under section 1848, and (ii) in the case of all other such services, 80 percent of the lesser of the actual charge for the services or the amount determined under the payment basis determined under section 1848. (4) 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)(LL), after (including administration of the health risk assessment). (5) Dentures Section 1861(s)(8) of the Social Security Act (42 U.S.C. 1395x(s)(8)) is amended— (A) by striking (other than dental) and inserting (including dentures); and (B) by striking internal body. (6) Repeal of ground for exclusion Section 1862(a) of the Social Security Act (42 U.S.C. 1395y) is amended by striking paragraph (12). (7) Effective date The amendments made by this section shall apply to services furnished on or after January 1, 2028. (d) Requiring Medicaid coverage of dental and oral health services for adults (1) In general (A) Mandatory coverage (i) In general (I) Requirement Section 1902(a)(10)(A) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)) is amended by inserting (10), before (13)(B),. (II) Medically needy (aa) In general Section 1902(a)(10)(C)(iv) of such Act (42 U.S.C. 1396a(a)(10)(C)(iv)) is amended by inserting (10), before (13)(B). (bb) Rule of construction Nothing in this section or the amendments made by this section shall be construed to limit the access of an individual residing in an institutional setting to dental and oral health services (as such term is defined in section 1905(mm) of the Social Security Act, as added by paragraph (2)(B)). (III) Effective date The amendments made by subclauses (I) and (II) shall apply with respect to expenditures for medical assistance in calendar quarters beginning on or after January 1, 2028. (ii) Benchmark coverage Section 1937(b)(5) of the Social Security Act (42 U.S.C. 1396u–7(b)(5)) is amended by striking the period at the end and inserting, and beginning January 1, 2028, coverage of dental and oral health services (as such term is defined in section 1905(mm)).. (iii) Optional application to territories Section 1902(j) of the Social Security Act (42 U.S.C. 1396a(j)) is amended— (I) by striking this title, the Secretary and inserting “this title— (1) in the case of a State other than the 50 States and the District of Columbia, the requirement under subsection (a)(10)(A) to provide the care and services listed in paragraph (10) of section 1905(a) shall be optional; and (2) the Secretary; and (II) by striking the second comma after section 1108(f). (B) Definition of dental and oral health services Section 1905 of the Social Security Act (42 U.S.C. 1396d), as amended by section 4107(c), is further amended— (i) in subsection (a)(10), by inserting and dental and oral health services (as defined in subsection (mm)) after dental services; and (ii) by adding at the end the following new subsection: (mm) Dental and oral health services For purposes of subsection (a)(10), the term dental and oral health services means dentures and denture services, implants and implant services, and services necessary to prevent oral disease and promote oral health, restore oral structures to health and function, reduce oral pain, and treat emergency oral conditions, that are furnished by a provider who is legally authorized to furnish such items and services under State law (or the State regulatory mechanism provided by State law).. (C) Conforming amendment (i) In general Section 1905(a)(10) of the Social Security Act (42 U.S.C. 1396d(a)(10)), as amended by paragraph (2), is further amended by striking dental services and. (ii) Effective date The amendment made by clause (i) shall take effect on January 1, 2028. (2) State option for additional dental and oral health benefits Section 1905(a)(13) of the Social Security Act (42 U.S.C. 1396d(a)(13)) is amended— (A) in subparagraph (B), by striking; and and inserting a semicolon; (B) in subparagraph (C), by striking the semicolon at the end and inserting; and; and (C) by inserting after subparagraph (C) the following new subparagraph: (D) at State option, such items and services related to dental and oral health services (as defined in subsection (mm)) that are in addition to those identified in such subsection (mm) as the State may specify;. (3) Increased FMAP (A) Medicaid Section 1905 of the Social Security Act (42 U.S.C. 1396d), as amended by paragraphs (1) and (2), is further amended— (i) in subsection (b), by striking and (ll) and inserting (ll), and (nn); (ii) in subsection (ff), by striking and (ii) and inserting, (ii), and (nn); and (iii) by adding at the end the following new subsection: (nn) Increased FMAP for expenditures related to dental and oral health services (1) In general (A) 50 States and DC Notwithstanding subsection (b), in the case of a State that is 1 of the 50 States or the District of Columbia, during the 12-quarter period that begins on January 1, 2028, the Federal medical assistance percentage shall be equal to 100 percent with respect to amounts expended by the State for medical assistance for dental and oral health services authorized under paragraph (10) of subsection (a). In no case may the application of this subparagraph result in the Federal medical assistance percentage determined for a State with respect to expenditures described in this subparagraph exceeding 100 percent. (B) Territories (i) In general Notwithstanding subsection (b), in the case of a State that is Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa, during a period described in clause (ii), the Federal medical assistance percentage shall be equal to 100 percent with respect to amounts expended by the State for medical assistance for any item or service that is included in dental and oral health services authorized under paragraph (10) of subsection (a). In no case may the application of this clause result in the Federal medical assistance percentage determined for a State with respect to expenditures described in this clause exceeding 100 percent. (ii) Period described A period described in this clause is, with respect to an item or service described in clause (i) and a State described in such clause, the 12-quarter period that begins with the first quarter beginning on or after January 1, 2028, in which such item or service is first covered under the State plan or under a waiver of such plan. (2) Exclusions The Federal medical assistance percentage specified in paragraph (1) shall not apply to amounts expended for medical assistance during any period for— (A) additional items and services authorized under paragraph (13)(D) of subsection (a); or (B) items and services furnished to an individual if, as of the date of enactment of this subsection, medical assistance was available to such individual for such items and services or medicare cost-sharing under the State plan or a waiver of such plan.. (B) Exclusion of amounts attributable to increased FMAP from territorial caps Section 1108 of the Social Security Act (42 U.S.C. 1308), as amended by section 4101, is amended— (i) in subsection (f), in the matter preceding paragraph (1), by striking (h), and (j) and inserting (h), (j), and (k); and (ii) by adding at the end the following: (k) Exclusion from caps of amounts attributable to increased FMAP for coverage of dental and oral health services Any additional amount paid to Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa for expenditures for medical assistance that is attributable to an increase in the Federal medical assistance percentage applicable to such expenditures under section 1905(nn) shall not be taken into account for purposes of applying payment limits under subsections (f) and (g).. (e) Oral health services as an essential health benefit Section 1302(b) of the Patient Protection and Affordable Care Act (42 U.S.C. 18022(b)), as amended by section 2013(a), is further amended— (1) in paragraph (1)— (A) in subparagraph (J), by striking oral and; and (B) by adding at the end the following: (L) Oral health services for children and adults.; and (2) by adding at the end the following: (6) Oral health services For purposes of paragraph (1)(L), the term oral health services means services (as defined by the Secretary) that are necessary to prevent any oral disease and promote oral health, restore oral structures to health and function, and treat emergency oral conditions.. (f) 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 (1) 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 who are entitled to such services from the Department of Veterans Affairs and reside in rural and other underserved communities. (2) Telehealth For purposes of alternative dental health care providers and other dental care providers who are licensed to provide clinical care, dental services provided under the demonstration program under this subsection may be administered by such providers through telehealth-enabled collaboration and supervision when appropriate and feasible. (3) Alternative dental health care providers defined In this subsection, the term alternative dental health care providers has the meaning given that term in section 340G–1(a)(2) of the Public Health Service Act (42 U.S.C. 256g–1(a)(2)). (4) Authorization of appropriations There are authorized to be appropriated such sums as are necessary to carry out the demonstration program under this subsection. (g) 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 (1) 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 individuals: (A) Members and dependents who reside in rural areas or areas otherwise underserved by dental health care providers. (B) Members of a reserve component of the Armed Forces in active status who are potentially deployable. (2) Telehealth For purposes of alternative dental health care providers and other dental care providers who are licensed to provide clinical care, dental services provided under the demonstration program under this subsection may be administered by such providers through telehealth-enabled collaboration and supervision when appropriate and feasible. (3) Definitions In this subsection: (A) Active status The term active status has the meaning given that term in section 101(d) of title 10, United States Code. (B) Alternative dental health care providers 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)). (4) Authorization of appropriations There are authorized to be appropriated such sums as are necessary to carry out the demonstration program under this subsection. (h) 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 (1) 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. (2) Telehealth For purposes of alternative dental health care providers and other dental care providers who are licensed to provide clinical care, dental services provided under the demonstration program under this subsection may be administered by such providers through telehealth-enabled collaboration and supervision when appropriate and feasible. (3) Alternative dental health care providers defined In this subsection, the term alternative dental health care providers has the meaning given that term in section 340G–1(a)(2) of the Public Health Service Act (42 U.S.C. 256g–1(a)(2)). (4) Authorization of appropriations There are authorized to be appropriated such sums as are necessary to carry out the demonstration program under this subsection. (i) Demonstration program on training and employment of alternative dental health care providers for dental health care services under the Indian Health Service (1) Definitions In this subsection: (A) Alternative dental health care providers defined The term alternative dental health care providers has the meaning given the term in section 340G–1(a)(2) of the Public Health Service Act (42 U.S.C. 256g–1(a)(2)). (B) Indian Health Care Improvement Act terms The terms Indian tribe, tribal organization, and Urban Indian organization have the meaning given those terms in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603). (2) 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. (3) Telehealth For purposes of alternative dental health care providers and other dental care providers who are licensed to provide clinical care, dental services provided under the demonstration program under this subsection may be administered by such providers through telehealth-enabled collaboration and supervision when appropriate and feasible. (4) Authorization of appropriations There are authorized to be appropriated such sums as are necessary to carry out the demonstration program under this subsection.