Adult oral health quality and equity measures

(a) In general Title XI of the Social Security Act (42 U.S.C. 1301 et seq.) is amended by inserting after section 1139B the following new section: 1139C. Adult oral health quality and equity measures (a) Development of core set of adult oral health care quality and equity measures (1) In general The Secretary shall identify and publish a recommended core set of health quality and equity measures for individuals enrolled in a State plan (or waiver of such plan) under title XIX who are over the age of 21 in the same manner as the Secretary identifies and publishes a core set of child health quality measures under section 1139A, including with respect to identifying and publishing existing oral health quality measures for such individuals that are in use under public and privately sponsored health care coverage arrangements, or that are part of reporting systems that measure both the presence and duration of health insurance coverage over time, that may be applicable to enrolled adults. (2) Alignment with existing core set In identifying and publishing the recommended core set of adult oral health quality and equity measures required under paragraph (1), the Secretary shall ensure that, to the extent possible, such measures align with and do not duplicate the core set of adult health quality measures identified, published, and revised under section 1139B. (3) Process for adult oral health quality and equity measures program In identifying gaps in existing adult oral health quality and equity measures and establishing priorities for the development and advancement of such measures, the Secretary shall consult with— (A) States; (B) health care providers; (C) patient representatives; (D) dental professionals; and (E) national organizations with expertise in oral health quality or equity measurement. (b) Deadlines (1) Recommended measures Not later than 1 year after the date of enactment of this section, the Secretary shall identify and publish for comment a recommended core set of adult oral health quality and equity measures that includes the following: (A) Measures of utilization of oral health and dental services across health care settings. (B) Measures that address the availability of oral evaluations during or following medical visits for enrolled adults. (C) Measures that address the incidence of emergency department visits for non-traumatic dental conditions. (D) Measures that address the availability and receipt of follow-up dental care after emergency department visits for non-traumatic dental conditions during pregnancy. (E) Measures that address the availability of counseling of enrolled adults aimed at improving oral health outcomes. (F) Measures that address the availability and receipt of care for beneficiaries who meet the medical necessity criteria for general anesthesia and intravenous sedation. (G) Measures that address screening and evaluation for caries risk and periodontitis and treatment for caries risk and periodontitis, including the following: (i) The percentage of enrolled adults who have caries risk documented in the reporting year involved. (ii) The percentage of enrolled adults who received a topical fluoride application or sealants based on an oral health risk assessment demonstrating the need for such application or sealants during the reporting year involved. (iii) The percentage of enrolled adults who received a comprehensive or periodic oral evaluation or a comprehensive periodontal evaluation during the reporting year involved. (iv) The percentage of enrolled adults with a history of periodontitis who received an oral prophylaxis, scaling or root planing, or periodontal maintenance visit at least 2 times during the reporting year involved. (v) The percentage of enrolled adults with diabetes who receive a comprehensive or periodic evaluation or a comprehensive periodontal evaluation during the reporting year involved. (vi) The percentage of enrolled adults who require tooth extraction during the reporting year involved. (vii) The percentage of enrolled adults who require partial or full dentures during the reporting year involved. (2) Dissemination Not later than 1 year after the date of enactment of this section, the Secretary shall publish an initial core set of oral health quality and equity measures that are applicable to enrolled adults. (3) Standardized reporting Not later than 2 years after the date of the enactment of this section the Secretary, in consultation with States, shall develop a standardized format for the collection and reporting of information based on the initial core set of adult oral health quality and equity measures (stratified by race, ethnicity, primary language, disability status, sexual orientation, and gender identity) and create guidelines, procedures, and incentives to States to use such measures and to collect and report information regarding the quality and equity of oral health care for enrolled adults. (4) Reports to Congress Not later than 3 years after the date of enactment of this section, and every 3 years thereafter, the Secretary shall include in the report to Congress required under section 1139A(a)(6) information similar to the information required under that section with respect to the measures established under this section. (c) Annual state reports regarding state-Specific oral health quality and equity measures applied under medicaid (1) In general Each State with a plan approved under title XIX (or with a waiver of such plan in effect) shall annually report (separately or as part of the annual report required under section 1139A(c)) to the Secretary on— (A) the State-specific adult oral health quality and equity measures applied by the State under such a plan or waiver, including measures described in subsection (b)(1); (B) the State-specific information on the quality and equity of oral health care furnished to enrolled adults under such a plan or waiver, including information collected through external quality reviews of managed care organizations under section 1932 and benchmark plans under section 1937, disaggregated by race, ethnicity, primary language, disability status, sexual orientation, and gender identity; (C) the State-specific information regarding the dental benefits available to enrolled adults under such a plan or waiver, including any limits on such benefits and the amount of reimbursement provided under such plan or waiver for such benefits; and (D) the State-specific plan to identify, evaluate, and reduce in meaningful and measurable ways, to the extent practicable, health disparities based on age, sex, race, ethnicity, primary language, sexual orientation, gender identity, and disability status. (2) Publication Not later than 2 years after the date of enactment of this section, and annually thereafter, the Secretary shall collect, analyze, and make publicly available the information reported by States under paragraph (1). (d) Authorization of appropriations There are authorized to be appropriated $10,000,000 to carry out this section. Funds appropriated under this subsection shall remain available until expended.. (b) Required reporting (1) Medicaid Section 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)) is amended— (A) in paragraph (89), by striking and at the end; (B) in paragraph (90)(C), by striking the period at the end and inserting; and; and (C) by inserting after paragraph (90) the following new paragraph: (91) provide for the reporting required under section 1139C(c).. (2) CHIP Section 2102 of the Social Security Act (42 U.S.C. 1397bb) is amended by adding at the end the following new subsection: (e) Reporting requirements A State child health plan shall provide for the reporting required under section 1139C(c)..