69–006 

115TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 1st Session 115–328 

ACTION FOR DENTAL HEALTH ACT OF 2017 

SEPTEMBER 25, 2017.—Committed to the Committee of the Whole House on the 

State of the Union and ordered to be printed 

Mr. WALDEN, from the Committee on Energy and Commerce, 

submitted the following 

R E P O R T 

[To accompany H.R. 2422] 

[Including cost estimate of the Congressional Budget Office] 

The Committee on Energy and Commerce, to whom was referred 

the bill (H.R. 2422) to amend the Public Health Service Act to improve essential oral health care for low-income and other underserved individuals by breaking down barriers to care, and for other 

purposes, having considered the same, report favorably thereon 

with an amendment and recommend that the bill as amended do 

pass. 

CONTENTS 

Page 

Purpose and Summary ............................................................................................ 2 

Background and Need for Legislation .................................................................... 2 

Committee Action .................................................................................................... 3 

Committee Votes ...................................................................................................... 3 

Oversight Findings and Recommendations ........................................................... 3 

New Budget Authority, Entitlement Authority, and Tax Expenditures ............. 3 

Congressional Budget Office Estimate ................................................................... 4 

Federal Mandates Statement ................................................................................. 5 

Statement of General Performance Goals and Objectives .................................... 6 

Duplication of Federal Programs ............................................................................ 6 

Committee Cost Estimate ....................................................................................... 6 

Earmark, Limited Tax Benefits, and Limited Tariff Benefits ............................. 6 

Disclosure of Directed Rule Makings ..................................................................... 6 

Advisory Committee Statement .............................................................................. 6 

Applicability to Legislative Branch ........................................................................ 6 

Section-by-Section Analysis of the Legislation ...................................................... 6 

Changes in Existing Law Made by the Bill, as Reported ..................................... 7 

The amendment is as follows: 

Strike all after the enacting clause and insert the following: 

2 

SECTION 1. SHORT TITLE. 

This Act may be cited as the ‘‘Action for Dental Health Act of 2017’’. 

SEC. 2. VOLUNTEER DENTAL PROJECTS AND ACTION FOR DENTAL HEALTH PROGRAM. 

Section 317M of the Public Health Service Act (42 U.S.C. 247b–14) is amended— 

(1) by redesignating subsections (e) and (f) as subsections (f) and (g), respectively; 

(2) by inserting after subsection (d) the following new subsection: 

‘‘(e) ACTION FOR DENTAL HEALTH PROGRAM.— ‘‘(1) IN GENERAL.—The Secretary, in consultation with the Director of the Centers for Disease Control and Prevention and the Administrator of the Health 

Resources and Service Administration, may award grants to or enter into contracts with eligible entities to collaborate with State, county, or local public officials and other stakeholders to develop and implement initiatives to accomplish 

any of the following goals: 

‘‘(A) To improve oral health education and dental disease prevention, including through community-wide prevention programs, through the use of 

dental sealants and fluoride varnish, and by increasing oral health literacy. 

‘‘(B) To reduce geographic barriers, language barriers, cultural barriers, 

and other similar barriers to the provision of dental services. 

‘‘(2) ELIGIBLE ENTITY.—In this subsection, the term ‘eligible entity’ means an 

entity that is— 

‘‘(A) a State or local dental association; 

‘‘(B) a State oral health program; 

‘‘(C) a dental education, dental hygiene, or postdoctoral dental education 

program accredited by the Commission on Dental Accreditation; or 

‘‘(D) a community-based organization that— 

‘‘(i) partners with an academic institution; 

‘‘(ii) is exempt from tax under section 501(c) of the Internal Revenue 

Code of 1986; and 

‘‘(iii) partners with public and private stakeholders to facilitate the 

provision of dental services for underserved populations.’’; and 

(3) in subsection (g), as redesignated by paragraph (1), by striking ‘‘such sums 

as may be necessary for each of the fiscal years 2001 through 2005’’ and inserting ‘‘$18,000,000 for each of the fiscal years 2018 through 2022’’. 

SEC. 3. GRANTS FOR INNOVATIVE PROGRAMS. 

Section 340G of the Public Health Service Act (42 U.S.C. 256g) is amended— 

(1) in subsection (b)(5)— 

(A) in subparagraph (B), by striking ‘‘and’’ at the end; and 

(B) by adding at the end the following: 

‘‘(D) the establishment of dental homes for children and adults, including 

for the aged, blind, and disabled populations; 

‘‘(E) the establishment of initiatives to reduce the use of emergency departments by individuals who seek dental services more appropriately delivered in a dental primary care setting; and 

‘‘(F) the provision of dental care to nursing home residents;’’; and 

(2) in subsection (f), by striking ‘‘$25,000,000 for the 5-fiscal year period beginning with fiscal year 2008’’ and inserting ‘‘$13,903,000 for each of fiscal years 

2018 through 2022’’. 

PURPOSE AND SUMMARY

H.R. 2422 was introduced on May 15, 2017, by Rep. Robin Kelly 

(D–IL). The bill reauthorizes the oral health promotion and disease 

prevention activities at the Centers for Disease Control and Prevention (CDC), expanding initiatives to enhance oral health education and community-wide dental disease prevention. The bill also 

reauthorizes the Health Resources and Services Administration’s 

(HRSA) Grants to States to Support Oral Health Workforce Activities, increasing access to dental care in underserved communities. 

BACKGROUND AND NEED FOR LEGISLATION

Many oral conditions, such as tooth decay and gum disease, can 

be avoided by straightforward preventive measures, such as regular cleaning and water fluoridation. Yet good oral health remains 

3 

an unmet medical need for many Americans. According to the 

CDC, on average, the nation spends more than $113 billion a year 

on costs related to dental care. 

Targeting resources to facilitate the provision of dental services 

to those in need, in addition to improving oral health education will 

help prevent dental diseases before they start. This will ultimately 

reduce medical complications, emergency room visits, and poor dental health outcomes in underserved communities. 

COMMITTEE ACTION

On May 17, 2017, the Subcommittee on Health held a hearing 

on H.R. 2422. The hearing was entitled ‘‘Examining Initiatives to 

Advance Public Health.’’ The Subcommittee received testimony 

from: 

• Kevin O’Connor, Assistant to the General President, International Association of Fire Fighters; 

• Cheryl D. Watson-Lowry, DDS; General Dentist, American 

Dental Association; 

• Martin S. Levine, DO, MPH, FACOFP, dist; Interim Clinical Dean, Professor of Family and Community Medicine, 

Touro College of Osteopathic Medicine; and 

• Jordan Greenbaum, MD; Medical Director, Institute for 

Healthcare and Human Trafficking at Children’s Healthcare of 

Atlanta; Medical Director, Global Initiative for Child Health 

and Well Being at the International Centre for Missing and 

Exploited Children. 

On June 29, 2017, the Subcommittee on Health met in open 

markup session and forwarded H.R. 2422, as amended, to the full 

Committee by a voice vote. On July 27, 2017, the full Committee 

on Energy and Commerce met in open markup session and ordered 

H.R. 2422, as amended, favorably reported to the House by a voice 

vote. 

COMMITTEE VOTES

Clause 3(b) of rule XIII requires the Committee to list the record 

votes on the motion to report legislation and amendments thereto. 

There were no record votes taken in connection with ordering H.R. 

2422 reported. 

OVERSIGHT FINDINGS AND RECOMMENDATIONS

Pursuant to clause 2(b)(1) of rule X and clause 3(c)(1) of rule 

XIII, the Committee held a hearing and made findings that are reflected in this report. 

NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX

EXPENDITURES

Pursuant to clause 3(c)(2) of rule XIII, the Committee finds that 

H.R. 2422 would result in no new or increased budget authority, 

entitlement authority, or tax expenditures or revenues. 

4 

CONGRESSIONAL BUDGET OFFICE ESTIMATE

Pursuant to clause 3(c)(3) of rule XIII, the following is the cost 

estimate provided by the Congressional Budget Office pursuant to 

section 402 of the Congressional Budget Act of 1974. 

U.S. CONGRESS, 

CONGRESSIONAL BUDGET OFFICE, 

Washington, DC, September 11, 2017. 

Hon. GREG WALDEN, 

Chairman, Committee on Energy and Commerce, 

House of Representatives, Washington, DC. 

DEAR MR. CHAIRMAN: The Congressional Budget Office has prepared the enclosed cost estimate for H.R. 2422, the Action for Dental Health Act of 2017. 

If you wish further details on this estimate, we will be pleased 

to provide them. The CBO staff contact is Lisa Ramirez-Branum. 

Sincerely, 

KEITH HALL, 

Director. 

Enclosure. 

H.R. 2422—Action for Dental Health Act of 2017 

Summary: H.R. 2422 would amend the Public Health Service Act 

to reauthorize and amend grant programs conducted by the Health 

Resources and Services Administration (HRSA) and the Centers for 

Disease Control and Prevention (CDC). Those programs provide assistance to states and tribal governments to increase access to oral 

health care services. 

CBO estimates that implementing H.R. 2422 would cost $133 

million over the 2018–2022 period, assuming appropriation of the 

specified amounts. 

Pay-as-you-go procedures do not apply to this legislation because 

it would not affect direct spending or revenues. 

CBO estimates that enacting H.R. 2422 would not increase net 

direct spending or on-budget deficits in any of the four consecutive 

10-year periods beginning in 2028. 

H.R. 2422 contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act (UMRA). 

Estimated cost to the Federal Government: The estimated budgetary effect of H.R. 2422 is shown in the following table. The costs 

of this legislation fall within budget function 550 (health). 

By Fiscal Year, in Millions of Dollars 

2017 2018 2019 2020 2021 2022 2017– 

2022 

INCREASES IN SPENDING SUBJECT TO APPROPRIATION 

HRSA: 

Authorization Level ............................... 0 14 14 14 14 14 70 

Estimated Outlays ................................ 0 7 11 13 14 14 59 

CDC: 

Authorization Level ............................... 0 18 18 18 18 18 90 

Estimated Outlays ................................ 0 7 15 17 18 18 75 

Total Changes: 

Authorization Level ...................... 0 32 32 32 32 32 160 

5 

By Fiscal Year, in Millions of Dollars 

2017 2018 2019 2020 2021 2022 2017– 

2022 

Estimated Outlays ....................... 0 13 27 31 31 31 133 

Notes: Components may not acid to totals because of rounding; HRSA = Health Resources and Services Administration; CDC = Centers for 

Disease Control and Prevention. 

Basis of estimate: For this estimate, CBO assumes that the legislation will be enacted near the beginning of fiscal year 2018, that 

the authorized amounts will be appropriated in each year, and that 

spending will follow historical patterns for the authorized programs. CBO estimates that implementing H.R. 2422 would cost 

$133 million over the 2018–2022 period, assuming appropriation of 

the specified amounts. 

HRSA: The bill would authorize the appropriation of $13.9 million in each of the fiscal years 2018 through 2022 for HRSA to provide grants to states for dentistry and dental hygiene programs 

that support the needs of rural and other underserved communities. About $37 million was appropriated for this program in 

2017. The bill also would expand activities that can be carried out 

under the program such as providing dental care to residents of 

nursing homes. CBO estimates implementing those provisions 

would cost $59 million over the 2018–2022 period; the remaining 

amount would be spent in years after 2022. 

CDC: The bill would authorize the appropriation of $18 million 

in each of the fiscal years 2018 through 2022 for CDC to provide 

grants to community based organizations and dental education programs to improve oral health education, promote disease prevention, and reduce disparities in oral healthcare. About $18 million 

was appropriated for this program in 2017. CBO estimates implementing those provisions would cost $75 million over the 2018– 

2022 period; the remaining amounts would be spent in years after 

2022. 

Pay-as-You-Go considerations: None. 

Increase in long-term direct spending and deficits: CBO estimates that enacting H.R. 2422 would not increase net direct spending or on-budget deficits in any of the four consecutive 10-year periods beginning in 2028. 

Intergovernmental and private-sector impact: H.R. 2422 contains 

no intergovernmental or private-sector mandates as defined in 

UMRA and would impose no costs on state, local, or tribal governments. 

Estimate prepared by: Federal Costs: Lisa Ramirez-Branum and 

Rebecca Yip; Impact on State, Local, and Tribal Governments: Zach 

Byrum; Impact on the Private Sector: Amy Petz. 

Estimate approved by: Holly Harvey, Deputy Assistant Director 

for Budget Analysis. 

FEDERAL MANDATES STATEMENT

The Committee adopts as its own the estimate of Federal mandates prepared by the Director of the Congressional Budget Office 

pursuant to section 423 of the Unfunded Mandates Reform Act. 

6 

STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

Pursuant to clause 3(c)(4) of rule XIII, the general performance 

goal or objective of this legislation is to reduce disparities in oral 

health in underserved communities by fostering local preventive 

collaborative agreements, improving the provision of dental care, 

and enhancing Federal grants to States to support innovative dental health workforce activities. 

DUPLICATION OF FEDERAL PROGRAMS

Pursuant to clause 3(c)(5) of rule XIII, no provision of H.R. 2422 

is known to be duplicative of another Federal program, including 

any program that was included in a report to Congress pursuant 

to section 21 of Public Law 111–139 or the most recent Catalog of 

Federal Domestic Assistance. 

COMMITTEE COST ESTIMATE

Pursuant to clause 3(d)(1) of rule XIII, the Committee adopts as 

its own the cost estimate prepared by the Director of the Congressional Budget Office pursuant to section 402 of the Congressional 

Budget Act of 1974. 

EARMARK, LIMITED TAX BENEFITS, AND LIMITED TARIFF BENEFITS

Pursuant to clause 9(e), 9(f), and 9(g) of rule XXI, the Committee 

finds that H.R. 2422 contains no earmarks, limited tax benefits, or 

limited tariff benefits. 

DISCLOSURE OF DIRECTED RULE MAKINGS

Pursuant to section 3(i) of H. Res. 5, the Committee finds that 

H.R. 2422 contains no directed rule makings. 

ADVISORY COMMITTEE STATEMENT

No advisory committees within the meaning of section 5(b) of the 

Federal Advisory Committee Act were created by this legislation. 

APPLICABILITY TO LEGISLATIVE BRANCH

The Committee finds that the legislation does not relate to the 

terms and conditions of employment or access to public services or 

accommodations within the meaning of section 102(b)(3) of the Congressional Accountability Act. 

SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Short title 

Section 1 provides that the Act may be cited as the ‘‘Action for 

Dental Health Act of 2017.’’ 

Section 2. Volunteer dental projects and Action for Dental Health 

Program 

Section 2 authorizes the appropriation of $18 million for each of 

fiscal years 2018 to 2022 for oral health promotion and disease prevention programs at the CDC and establishes a grant program for 

State and local organizations to develop initiatives to improve oral 

7 

health education, enhance dental disease prevention, and reduce 

barriers to the provision of dental services. 

Section 3. Grants for innovative programs 

Section 3 authorizes the appropriation of $13.309 million for each 

of fiscal years 2018 to 2022 for HRSA’s Grants to States to Support 

Oral Health Workforce Activities and permits States to establish 

dental homes, mobile or portable dental clinics, initiatives to reduce 

emergency department visits, and initiatives to provide dental care 

to nursing home residents. 

CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

In compliance with clause 3(e) of rule XIII of the Rules of the 

House of Representatives, changes in existing law made by the bill, 

as reported, are shown as follows (existing law proposed to be omitted is enclosed in black brackets, new matter is printed in italic, 

and existing law in which no change is proposed is shown in 

roman): 

PUBLIC HEALTH SERVICE ACT 

* * * * * * * 

TITLE III—GENERAL POWERS AND DUTIES OF PUBLIC 

HEALTH SERVICE 

* * * * * * * 

PART B—FEDERAL-STATE COOPERATION

* * * * * * * 

ORAL HEALTH PROMOTION AND DISEASE PREVENTION

SEC. 317M. (a) GRANTS TO INCREASE RESOURCES FOR COMMUNITY

WATER FLUORIDATION.— 

(1) IN GENERAL.—The Secretary, acting through the Director 

of the Centers for Disease Control and Prevention, may make 

grants to States and Indian tribes for the purpose of increasing 

the resources available for community water fluoridation. 

(2) USE OF FUNDS.—A State shall use amounts provided 

under a grant under paragraph (1)— 

(A) to purchase fluoridation equipment; 

(B) to train fluoridation engineers; 

(C) to develop educational materials on the benefits of 

fluoridation; or 

(D) to support the infrastructure necessary to monitor 

and maintain the quality of water fluoridation. 

(b) COMMUNITY WATER FLUORIDATION.— 

(1) IN GENERAL.—The Secretary, acting through the Director 

of the Centers for Disease Control and Prevention and in collaboration with the Director of the Indian Health Service, shall 

establish a demonstration project that is designed to assist 

rural water systems in successfully implementing the water 

fluoridation guidelines of the Centers for Disease Control and 

Prevention that are entitled ‘‘Engineering and Administrative 

8 

Recommendations for Water Fluoridation, 1995’’ (referred to in 

this subsection as the ‘‘EARWF’’). 

(2) REQUIREMENTS.— 

(A) COLLABORATION.—In collaborating under paragraph 

(1), the Directors referred to in such paragraph shall ensure that technical assistance and training are provided to 

tribal programs located in each of the 12 areas of the Indian Health Service. The Director of the Indian Health 

Service shall provide coordination and administrative support to tribes under this section. 

(B) GENERAL USE OF FUNDS.—Amounts made available 

under paragraph (1) shall be used to assist small water 

systems in improving the effectiveness of water fluoridation and to meet the recommendations of the EARWF. 

(C) FLUORIDATION SPECIALISTS.— 

(i) IN GENERAL.—In carrying out this subsection, the 

Secretary shall provide for the establishment of fluoridation specialist engineering positions in each of the 

Dental Clinical and Preventive Support Centers 

through which technical assistance and training will 

be provided to tribal water operators, tribal utility operators and other Indian Health Service personnel 

working directly with fluoridation projects. 

(ii) LIAISON.—A fluoridation specialist shall serve as 

the principal technical liaison between the Indian 

Health Service and the Centers for Disease Control 

and Prevention with respect to engineering and fluoridation issues. 

(iii) CDC.—The Director of the Centers for Disease 

Control and Prevention shall appoint individuals to 

serve as the fluoridation specialists. 

(D) IMPLEMENTATION.—The project established under 

this subsection shall be planned, implemented and evaluated over the 5-year period beginning on the date on which 

funds are appropriated under this section and shall be designed to serve as a model for improving the effectiveness 

of water fluoridation systems of small rural communities. 

(3) EVALUATION.—In conducting the ongoing evaluation as 

provided for in paragraph (2)(D), the Secretary shall ensure 

that such evaluation includes— 

(A) the measurement of changes in water fluoridation 

compliance levels resulting from assistance provided under 

this section; 

(B) the identification of the administrative, technical and 

operational challenges that are unique to the fluoridation 

of small water systems; 

(C) the development of a practical model that may be 

easily utilized by other tribal, State, county or local governments in improving the quality of water fluoridation 

with emphasis on small water systems; and 

(D) the measurement of any increased percentage of Native Americans or Alaskan Natives who receive the benefits of optimally fluoridated water. 

(c) SCHOOL-BASED DENTAL SEALANT PROGRAM.— 

9 

(1) IN GENERAL.—The Secretary, acting through the Director 

of the Centers for Disease Control and Prevention and in collaboration with the Administrator of the Health Resources and 

Services Administration, shall award a grant to each of the 50 

States and territories and to Indians, Indian tribes, tribal organizations and urban Indian organizations (as such terms are 

defined in section 4 of the Indian Health Care Improvement 

Act) to provide for the development of school-based dental sealant programs to improve the access of children to sealants. 

(2) USE OF FUNDS.—A State shall use amounts received 

under a grant under paragraph (1) to provide funds to eligible 

school-based entities or to public elementary or secondary 

schools to enable such entities or schools to provide children 

with access to dental care and dental sealant services. Such 

services shall be provided by licensed dental health professionals in accordance with State practice licensing laws. 

(3) ELIGIBILITY.—To be eligible to receive funds under paragraph (1), an entity shall— 

(A) prepare and submit to the State an application at 

such time, in such manner and containing such information as the State may require; and 

(B) be a public elementary or secondary school— 

(i) that is located in an urban area in which and 

more than 50 percent of the student population is participating in Federal or State free or reduced meal programs; or 

(ii) that is located in a rural area and, with respect 

to the school district in which the school is located, the 

district involved has a median income that is at or 

below 235 percent of the poverty line, as defined in 

section 673(2) of the Community Services Block Grant 

Act (42 U.S.C. 9902(2)). 

(d) ORAL HEALTH INFRASTRUCTURE.— 

(1) COOPERATIVE AGREEMENTS.—The Secretary, acting 

through the Director of the Centers for Disease Control and 

Prevention, shall enter into cooperative agreements with State, 

territorial, and Indian tribes or tribal organizations (as those 

terms are defined in section 4 of the Indian Health Care Improvement Act) to establish oral health leadership and program guidance, oral health data collection and interpretation, 

(including determinants of poor oral health among vulnerable 

populations), a multi-dimensional delivery system for oral 

health, and to implement science-based programs (including 

dental sealants and community water fluoridation) to improve 

oral health. 

(2) AUTHORIZATION OF APPROPRIATIONS.—There is authorized 

to be appropriated such sums as necessary to carry out this 

subsection for fiscal years 2010 through 2014. 

(e) ACTION FOR DENTAL HEALTH PROGRAM.— 

(1) IN GENERAL.—The Secretary, in consultation with the Director of the Centers for Disease Control and Prevention and the 

Administrator of the Health Resources and Service Administration, may award grants to or enter into contracts with eligible 

entities to collaborate with State, county, or local public offiVerDate Sep 11 2014 05:15 Sep 27, 2017 Jkt 069006 PO 00000 Frm 00009 Fmt 6659 Sfmt 6603 E:\HR\OC\HR328.XXX HR328
10 

cials and other stakeholders to develop and implement initiatives to accomplish any of the following goals: 

(A) To improve oral health education and dental disease 

prevention, including through community-wide prevention 

programs, through the use of dental sealants and fluoride 

varnish, and by increasing oral health literacy. 

(B) To reduce geographic barriers, language barriers, cultural barriers, and other similar barriers to the provision 

of dental services. 

(2) ELIGIBLE ENTITY.—In this subsection, the term ‘‘eligible 

entity’’ means an entity that is— 

(A) a State or local dental association; 

(B) a State oral health program; 

(C) a dental education, dental hygiene, or postdoctoral 

dental education program accredited by the Commission on 

Dental Accreditation; or 

(D) a community-based organization that— 

(i) partners with an academic institution; 

(ii) is exempt from tax under section 501(c) of the Internal Revenue Code of 1986; and 

(iii) partners with public and private stakeholders to 

facilitate the provision of dental services for underserved populations. 

ø(e)¿ (f) DEFINITIONS.—For purposes of this section, the term ‘‘Indian tribe’’ means an Indian tribe or tribal organization as defined 

in section 4(b) and section 4(c) of the Indian Self-Determination 

and Education Assistance Act. 

ø(f)¿ (g) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of 

carrying out this section, there are authorized to be appropriated 

øsuch sums as may be necessary for each of the fiscal years 2001 

through 2005¿ $18,000,000 for each of the fiscal years 2018 through 

2022. 

* * * * * * * 

PART D—PRIMARY HEALTH CARE

* * * * * * * 

Subpart X—Primary Dental Programs 

* * * * * * * 

SEC. 340G. GRANTS FOR INNOVATIVE PROGRAMS. 

(a) GRANT PROGRAM AUTHORIZED.—The Secretary, acting 

through the Administrator of the Health Resources and Services 

Administration, is authorized to award grants to States for the purpose of helping States develop and implement innovative programs 

to address the dental workforce needs of designated dental health 

professional shortage areas in a manner that is appropriate to the 

States’ individual needs. 

(b) STATE ACTIVITIES.—A State receiving a grant under subsection (a) may use funds received under the grant for— 

(1) loan forgiveness and repayment programs for dentists 

who— 

(A) agree to practice in designated dental health professional shortage areas; 

11 

(B) are dental school graduates who agree to serve as 

public health dentists for the Federal, State, or local government; and 

(C) agree to— 

(i) provide services to patients regardless of such patients’ ability to pay; and 

(ii) use a sliding payment scale for patients who are 

unable to pay the total cost of services; 

(2) dental recruitment and retention efforts; 

(3) grants and low-interest or no-interest loans to help dentists who participate in the medicaid program under title XIX 

of the Social Security Act (42 U.S.C. 1396 et seq.) to establish 

or expand practices in designated dental health professional 

shortage areas by equipping dental offices or sharing in the 

overhead costs of such practices; 

(4) the establishment or expansion of dental residency programs in coordination with accredited dental training institutions in States without dental schools; 

(5) programs developed in consultation with State and local 

dental societies to expand or establish oral health services and 

facilities in designated dental health professional shortage 

areas, including services and facilities for children with special 

needs, such as— 

(A) the expansion or establishment of a communitybased dental facility, free-standing dental clinic, consolidated health center dental facility, school-linked dental facility, or United States dental school-based facility; 

(B) the establishment of a mobile or portable dental clinic; øand¿ 

(C) the establishment or expansion of private dental 

services to enhance capacity through additional equipment 

or additional hours of operation; 

(D) the establishment of dental homes for children and 

adults, including for the aged, blind, and disabled populations; 

(E) the establishment of initiatives to reduce the use of 

emergency departments by individuals who seek dental 

services more appropriately delivered in a dental primary 

care setting; and 

(F) the provision of dental care to nursing home residents; 

(6) placement and support of dental students, dental residents, and advanced dentistry trainees; 

(7) continuing dental education, including distance-based 

education; 

(8) practice support through teledentistry conducted in accordance with State laws; 

(9) community-based prevention services such as water fluoridation and dental sealant programs; 

(10) coordination with local educational agencies within the 

State to foster programs that promote children going into oral 

health or science professions; 

(11) the establishment of faculty recruitment programs at accredited dental training institutions whose mission includes 

12 

community outreach and service and that have a demonstrated 

record of serving underserved States; 

(12) the development of a State dental officer position or the 

augmentation of a State dental office to coordinate oral health 

and access issues in the State; and 

(13) any other activities determined to be appropriate by the 

Secretary. 

(c) APPLICATION.— (1) IN GENERAL.—Each State desiring a grant under this section shall submit an application to the Secretary at such time, 

in such manner, and containing such information as the Secretary may reasonably require. 

(2) ASSURANCES.—The application shall include assurances 

that the State will meet the requirements of subsection (d) and 

that the State possesses sufficient infrastructure to manage 

the activities to be funded through the grant and to evaluate 

and report on the outcomes resulting from such activities. 

(d) MATCHING REQUIREMENT.—The Secretary may not make a 

grant to a State under this section unless that State agrees that, 

with respect to the costs to be incurred by the State in carrying out 

the activities for which the grant was awarded, the State will provide non-Federal contributions in an amount equal to not less than 

40 percent of Federal funds provided under the grant. The State 

may provide the contributions in cash or in kind, fairly evaluated, 

including plant, equipment, and services and may provide the contributions from State, local, or private sources. 

(e) REPORT.—Not later than 5 years after the date of enactment 

of the Health Care Safety Net Amendments of 2002, the Secretary 

shall prepare and submit to the appropriate committees of Congress a report containing data relating to whether grants provided 

under this section have increased access to dental services in designated dental health professional shortage areas. 

(f) AUTHORIZATION OF APPROPRIATIONS.—There is authorized to 

be appropriated to carry out this section, ø$25,000,000 for the 5- 

fiscal year period beginning with fiscal year 2008¿ $13,903,000 for 

each of fiscal years 2018 through 2022. 

* * * * * * * 

Æ