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[House Report 115-328]
[From the U.S. Government Publishing Office]

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:

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 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.

                  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
        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.

         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 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 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.--
          (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 
        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.
  [(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.
  [(f)] (g) Authorization of Appropriations.--For the purpose 
of carrying out this section, there are authorized to be 
appropriated [such 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;
                  (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 
                community-based 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; [and]
                  (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 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, [$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.

           *       *       *       *       *       *       *

                                  [all]
```