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[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 901 Introduced in Senate (IS)]

106th CONGRESS
  1st Session
                                 S. 901

   To provide disadvantaged children with access to dental services.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                             April 28, 1999

 Mr. Bingaman introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL

 
   To provide disadvantaged children with access to dental services.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Children's Dental 
Health Improvement Act of 1999''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.
 TITLE I--EXPANDED OPPORTUNITIES FOR TRAINING PEDIATRIC DENTAL HEALTH 
                             CARE PROVIDERS

Sec. 101. Children's dental health training and demonstration programs.
Sec. 102. Increase in National Health Service Corps dental training 
                            positions.
Sec. 103. Maternal and child health centers for leadership in pediatric 
                            dentistry education.
Sec. 104. Dental officer multiyear retention bonus for the Indian 
                            Health Service.
Sec. 105. Medicare payments to approved nonhospital dentistry residency 
                            training programs; permanent dental 
                            exemption from voluntary residency 
                            reduction programs.
Sec. 106. Dental health professional shortage areas.
  TITLE II--ENSURING DELIVERY OF PEDIATRIC DENTAL SERVICES UNDER THE 
                      MEDICAID AND SCHIP PROGRAMS

Sec. 201. Increased FMAP and fee schedule for dental services provided 
                            to children under the medicaid program.
Sec. 202. Required minimum medicaid expenditures for dental health 
                            services.
Sec. 203. Requirement to verify sufficient numbers of participating 
                            dental health professionals under the 
                            medicaid program.
Sec. 204. Inclusion of recommended age for first dental visit in 
                            definition of EPSDT services.
Sec. 205. Approval of final regulations implementing changes to EPSDT 
                            services.
Sec. 206. Use of SCHIP funds to treat children with special dental 
                            health needs.
Sec. 207. Grants to supplement fees for the treatment of children with 
                            special dental health needs.
Sec. 208. Demonstration projects to increase access to pediatric dental 
                            services in underserved areas.
                  TITLE III--PEDIATRIC DENTAL RESEARCH

Sec. 301. Identification of interventions that reduce the burden and 
                            transmission of oral, dental, and 
                            craniofacial diseases in high risk 
                            populations; development of approaches for 
                            pediatric oral and craniofacial assessment.
Sec. 302. Agency for Health Care Policy and Research.
Sec. 303. Oral health professional research and training program.
Sec. 304. Consensus development conference.
               TITLE IV--SURVEILLANCE AND ACCOUNTABILITY

Sec. 401. CDC reports.
Sec. 402. Reporting requirements under the medicaid program.
Sec. 403. Administration on Children, Youth, and Families.
Sec. 404. Special supplemental food program for women, infants, and 
                            children.
         TITLE V--ORAL HEALTH PROMOTION AND DISEASE PREVENTION

Sec. 501. Grants to increase resources for community water 
                            fluoridation.
Sec. 502. Community water fluoridation.
Sec. 503. Community-based dental sealant program.
                        TITLE VI--MISCELLANEOUS

Sec. 601. Effective date.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) The 1995 Institute of Medicine report on dental 
        education finds that oral health is an integral part of total 
        health, and is integral to comprehensive health, including 
        primary care.
            (2) Tooth decay is the most prevalent preventable chronic 
        disease of childhood and only the common cold, the flu, and 
        otitis media occur more often among young children.
            (3) Despite the design of the medicaid program to reach 
        children and ensure access to routine dental care, in 1996, the 
        Inspector General of the Department of Health and Human 
        Services reported that only 18 percent of children eligible for 
        medicaid received even a single preventive dental service.
            (4) The United States is facing a major dental health care 
        crisis that primarily affects the poor children of our country, 
        with 80 percent of all dental caries in children found in 20 
        percent of the population.
            (5) Low income children eligible for the medicaid program 
        and the State children's health insurance program experience 
        disproportionately high levels of oral disease.
            (6) The United States is not training enough pediatric 
        dental health care providers to meet the increasing need for 
        dental services for children.
            (7) The United States needs to increase access to health 
        promotion and disease prevention activities in the area of oral 
        health for children by increasing access to dental health 
        providers for children.

 TITLE I--EXPANDED OPPORTUNITIES FOR TRAINING PEDIATRIC DENTAL HEALTH 
                             CARE PROVIDERS

SEC. 101. CHILDREN'S DENTAL HEALTH TRAINING AND DEMONSTRATION PROGRAMS.

    (a) In General.--Subpart 2 of part E of title VII of the Public 
Health Service Act, as amended by the Health Professions Education 
Partnerships Act of 1998 (Public Law 105-392) is amended by adding at 
the end the following:

``SEC. 771. CHILDREN'S DENTAL HEALTH PROGRAMS.

    ``(a) Training Program.--
            ``(1) In general.--The Secretary, acting through the Bureau 
        of Health Professions, shall develop training materials to be 
        used by health professionals to promote oral health through 
        health education.
            ``(2) Design.--The materials developed under paragraph (1) 
        shall be designed to enable health care professionals to--
                    ``(A) provide information to individuals concerning 
                the importance of oral health;
                    ``(B) recognize oral disease in individuals; and
                    ``(C) make appropriate referrals of individuals for 
                dental treatment.
            ``(3) Distribution.--The materials developed under 
        paragraph (1) shall be distributed to--
                    ``(A) accredited schools of the health sciences 
                (including schools for physician assistants, schools of 
                medicine, osteopathic medicine, dental hygiene, public 
                health, nursing, pharmacy, and dentistry), and public 
                or private institutions accredited for the provision of 
                graduate or specialized training programs in all 
                aspects of health; and
                    ``(B) health professionals and community-based 
                health care workers.
    ``(b) Demonstration Program.--
            ``(1) In general.--The Secretary shall make grants to 
        schools that train pediatric dental health providers to meet 
        the costs of projects--
                    ``(A) to plan and develop new training programs and 
                to maintain or improve existing training programs in 
                providing dental health services to children; and
                    ``(B) to assist dental health providers in managing 
                complex dental problems in children.
            ``(2) Administration.--
                    ``(A) Amount.--The amount of any grant under 
                paragraph (1) shall be determined by the Secretary.
                    ``(B) Application.--No grant may be made under 
                paragraph (1) unless an application therefore is 
                submitted to and approved by the Secretary. Such an 
                application shall be in such form, submitted in such 
                manner, and contain such information, as the Secretary 
                shall by regulation prescribe.
                    ``(C) Eligibility.--To be eligible for a grant 
                under subsection (a), the applicant must demonstrate to 
                the Secretary that it has or will have available full-
                time faculty and staff members with training and 
                experience in the field of pediatric dentistry and 
                support from other faculty and staff members trained in 
                pediatric dentistry and other relevant specialties and 
                disciplines such as dental public health and 
                pediatrics, as well as research.
    ``(c) Authorization of Appropriations.--There is authorized to be 
appropriated such sums as may be necessary to carry out this 
section.''.
    (b) Authorization of Appropriations for General and Pediatric 
Dentistry.--Section 747(e)(2)(A) of the Public Health Service Act (42 
U.S.C. 293k(e)(2)(A), as amended by the Health Professions Education 
Partnerships Act of 1998 (Public Law 105-392) is amended in striking 
clause (iv) and inserting the following:
                            ``(iv) not less than $8,000,000 for awards 
                        of grants and contracts under subsection (a) to 
                        programs of pediatric or general dentistry.''.

SEC. 102. INCREASE IN NATIONAL HEALTH SERVICE CORPS DENTAL TRAINING 
              POSITIONS.

    (a) In General.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary'') shall increase the 
number of dental health providers skilled in treating children who 
become members of the Commissioned Corps of the U.S. Public Health 
Service and who are assigned to duty for the National Health Service 
Corps (referred to in this section as the ``Corps'') under subpart II 
of part D of title III of the Public Health Service Act (42 U.S.C. 254d 
et seq.) so that there are at least 100 additional Commissioned Corps 
dentists and dental hygienists in the Corps by 2001, at least 150 
additional dentists and dental hygienists in the Commissioned Corps by 
2002, and at least 300 additional dentists and dental hygienists in the 
Commissioner Corps by 2003.
    (b) Determination of Dental Site Readiness.--By not later than 
January 1, 2001, the Secretary shall collaborate with dental education 
institutions, State and local public health dental officials and dental 
and dental hygienist societies to determine dental site readiness, 
specifically in inner city, rural, frontier and border areas.
    (c) Report by Corps.--The Corps shall annually report to Congress 
concerning how the Corps is meeting the oral health needs of children 
in underserved areas, including rural, frontier and border areas.
    (d) Loan Repayment Program.--The Secretary shall increase the 
number of Corps dentists selected for loan repayments under the 
provisions referred to in subsection (a) in a sufficient number to 
address the demand for such repayment by qualified dentists. The 
Secretary shall increase the number of private practice dentists who 
contract with the Corps and allow for such student loan repayment.
    (e) Pediatric Dentists.--The Secretary shall ensure that at least 
20 percent of the dentists in the Corps are pediatric dentists and that 
another 20 percent of the dentists in the Corps have general dentistry 
residency training.

SEC. 103. MATERNAL AND CHILD HEALTH CENTERS FOR LEADERSHIP IN PEDIATRIC 
              DENTISTRY EDUCATION.

    (a) Expansion of Training Programs.--The Secretary of Health and 
Human Services shall, through the Bureau of Health Professions, 
establish at least 10 Pediatric Dental Centers of Excellence with not 
less than 36 additional training positions annually for pediatric 
dentists at such centers of excellence. The Secretary shall ensure that 
such training programs are established in geographically diverse areas.
    (b) Definition.--In this section, the term `centers of excellence' 
means a health professions school designated under section 736 of the 
Public Health Service Act (42 U.S.C. 293).
    (c) Authorization of Appropriations.--There is authorized to be 
appropriated, such sums as may be necessary to carry out this section.

SEC. 104. DENTAL OFFICER MULTIYEAR RETENTION BONUS FOR THE INDIAN 
              HEALTH SERVICE.

    (a) Terms and Definitions.--In this section:
            (1) Dental officer.--The term ``dental officer'' means an 
        officer of the Indian Health Service designated as a dental 
        officer.
            (2) Director.--The term ``Director'' means the Director of 
        the Indian Health Service.
            (3) Creditable service.--The term ``creditable service'' 
        includes all periods that a dental officer spent in graduate 
        dental educational (GDE) training programs while not on active 
        duty in the Indian Health Service and all periods of active 
        duty in the Indian Health Service as a dental officer.
            (4) Residency.--The term ``residency'' means a graduate 
        dental educational (GDE) training program of at least 12 months 
        leading to a speciality, including general practice residency 
        (GPR) or a 12-month advanced education general dentistry 
        (AEGD).
            (5) Specialty.--The term ``specialty'' means a dental 
        specialty for which there is an Indian Health Service specialty 
        code number.
    (b) Requirements for Bonus.--
            (1) In general.--An eligible dental officer of the Indian 
        Health Service who executes a written agreement to remain on 
        active duty for 2, 3, or 4 years after the completion of any 
        other active duty service commitment to the Indian Health 
        Service may, upon acceptance of the written agreement by the 
        Director, be authorized to receive a dental officer multiyear 
        retention bonus under this section. The Director may, based on 
        requirements of the Indian Health Service, decline to offer 
        such a retention bonus to any specialty that is otherwise 
        eligible, or to restrict the length of such a retention bonus 
        contract for a specialty to less than 4 years.
            (2) Limitations.--Each annual dental officer multiyear 
        retention bonus authorized under this section shall not exceed 
        the following:
                    (A) $14,000 for a 4-year written agreement.
                    (B) $8,000 for a 3-year written agreement.
                    (C) $4,000 for a 2-year written agreement.
    (c) Eligibility.--
            (1) In general.--In order to be eligible to receive a 
        dental officer multiyear retention bonus under this section, a 
        dental officer shall--
                    (A) be at or below such grade as the Director shall 
                determine;
                    (B) have at least 8 years of creditable service, or 
                have completed any active duty service commitment of 
                the Indian Health Service incurred for dental education 
                and training;
                    (C) have completed initial residency training, or 
                be scheduled to complete initial residency training 
                before September 30 of the fiscal year in which the 
                officer enters into a dental officer multiyear 
                retention bonus written service agreement under this 
                section; and
                    (D) have a dental specialty in pediatric dentistry 
                or oral and maxillofacial surgery, or be a dental 
                hygienist with a minimum of a baccalaureate degree.
            (2) Extension to other officers.--The Director may extend 
        the retention bonus to dental officers other than officers with 
        a dental specialty in pediatric dentistry based on demonstrated 
        need. The criteria used as the basis for such an extension 
        shall be equitably determined and consistently applied.
    (d) Termination of Entitlement to Special Pay.--The Director may 
terminate at any time a dental officer's multiyear retention bonus 
contract under this section. If such a contract is terminated, the 
unserved portion of the retention bonus contract shall be recouped on a 
pro rata basis. The Director shall establish regulations that specify 
the conditions and procedures under which termination may take place. 
The regulations and conditions for termination shall be included in the 
written service contract for a dental officer multiyear retention bonus 
under this section.
    (e) Refunds.--
            (1) In general.--Prorated refunds shall be required for 
        sums paid under a retention bonus contract under this section 
        if a dental officer who has received the retention bonus fails 
        to complete the total period of service specified in the 
        contract, as conditions and circumstances warrant.
            (2) Debt to united states.--An obligation to reimburse the 
        United States imposed under paragraph (1) is a debt owed to the 
        United States.
            (3) No discharge in bankruptcy.--Notwithstanding any other 
        provision of law, a discharge in bankruptcy under title 11, 
        United States Code, that is entered less than 5 years after the 
        termination of a retention bonus contract under this section 
        does not discharge the dental officer who signed such a 
        contract from a debt arising under the contract or paragraph 
        (1).

SEC. 105. MEDICARE PAYMENTS TO APPROVED NONHOSPITAL DENTISTRY RESIDENCY 
              TRAINING PROGRAMS; PERMANENT DENTAL EXEMPTION FROM 
              VOLUNTARY RESIDENCY REDUCTION PROGRAMS.

    (a) Medicare Payments To Approved Nonhospital Dentistry Training 
Programs.--Section 1886 of the Social Security Act (42 U.S.C. 1395ww) 
is amended by adding at the end the following:
    ``(l) Payments For Nonhospital Based Dental Residency Training 
Programs.--
            ``(1) In general.--Beginning January 1, 2000, the Secretary 
        shall make payments under this paragraph to approved 
        nonhospital based dentistry residency training programs 
        providing oral health care to children for the direct and 
        indirect expenses associated with operating such training 
        programs.
            ``(2) Payment amount.--
                    ``(A) Methodology.--The Secretary shall establish 
                procedures for making payments under this subsection.
                    ``(B) Total amount of payments.--In making payments 
                to approved non-hospital based dentistry residency 
                training programs under this subsection, the Secretary 
                shall ensure that the total amount of such 
payments will not result in a reduction of payments that would 
otherwise be made under subsection (h) or (k) to hospitals for dental 
residency training programs.
                    ``(C) Approved programs.--The Secretary shall 
                establish procedures for the approval of nonhospital 
                based dentistry residency training programs under this 
                subsection.''.
    (b) Permanent Dental Exemption From Voluntary Residency Reduction 
Programs.--
            (1) In general.--Section 1886(h)(6)(C) of the Social 
        Security Act (42 U.S.C. 1395ww(h)(6)(C)) is amended--
                    (A) by redesignating clauses (i) through (iii) as 
                subclauses (I) through (III), respectively, and 
                indenting such subclauses (as so redesignated) 
                appropriately;
                    (B) by striking ``For purposes'' and inserting the 
                following:
                            ``(i) In general.--Subject to clause (ii), 
                        for purposes''; and
                    (C) by adding at the end the following:
                            ``(ii) Definition of `approved medical 
                        residency training program'.--In this 
                        subparagraph, the term `approved medical 
                        residency training program' means only such 
                        programs in allopathic or osteopathic 
                        medicine.''.
            (2) Application to demonstration projects and authority.--
        Section 4626(b)(3) of the Balanced Budget Act of 1997 (42 
        U.S.C. 1395ww note) is amended by inserting ``in allopathic or 
        osteopathic medicine'' before the period.
    (c) Removal of Dentists From Full-Time Equivalent Count Averaging 
Provisions.--
            (1) Medicare ime.--Section 1886(d)(5)(B)(vi) of the Social 
        Security Act (42 U.S.C. 1395ww(d)(5)(B)(vi)) is amended by 
        adding at the end the following: ``The determination (based on 
        the 3-year average) described in subclause (II) shall apply 
        only to residents in the fields of allopathic medicine and 
        osteopathic medicine. All other residents shall be counted 
        based on the actual full-time equivalent resident count for the 
        cost-reporting period involved.''.
            (2) Medicare direct gme.--Section 1886(h)(4)(G)(i) of the 
        Social Security Act (42 U.S.C. 1395ww(h)(4)(G)(i)) is amended 
        by adding at the end the following: ``Such determination (based 
        on the 3-year average) shall apply only to residents in the 
        fields of allopathic medicine and osteopathic medicine. All 
        other residents shall be counted based on the actual full-time 
        equivalent resident count for the cost-reporting period 
        involved.''.
    (d) Definition of Primary Care Resident.--Section 1886(h)(5)(H) of 
the Social Security Act (42 U.S.C. 1395ww(h)(5)(H)) is amended by 
striking ``or osteopathic general practice'' and inserting 
``osteopathic general practice, general dentistry, advanced general 
dentistry, pediatric dentistry, or dental public health''.
    (e) Effective Date.--
            (1) In general.--Except as provided in paragraph (2), the 
        amendments made by subsections (a), (c), and (d) take effect on 
        the date of enactment of this Act.
            (2) Exception.--The amendments made by subsection (b) shall 
        take effect as if included in the enactment of the Balanced 
        Budget Act of 1997.

SEC. 106. DENTAL HEALTH PROFESSIONAL SHORTAGE AREAS.

    (a) Designation.--Section 332(a) of the Public Health Service Act 
(42 U.S.C. 254e(a)) is amended by adding at the end the following:
    ``(4)(A) In designating health professional shortage areas under 
this section, the Secretary may designate certain areas as dental 
health professional shortage areas if the Secretary determines that 
such areas have a severe shortage of dental health professionals. The 
Secretary shall develop, publish and periodically update criteria to be 
used in designating dental health professional shortage areas.
    ``(B) For purposes of this title a dental health professional 
shortage area shall be considered to be a health professional shortage 
area.''.
    ``(C) In subparagraph (A), the term `dental health professional' 
includes general and pediatric dentists and dental hygienists.''.
    (b) Loan Repayment Program.--Section 338B(b)(1)(A) of the Public 
Health Service Act (42 U.S.C. 254l-1(b)(1)(A)) is amended by inserting 
``(including dental hygienists)'' after ``profession''.
    (c) Technical Amendment.--Section 331(a)(2) of the Public Health 
Service Act (42 U.S.C. 254d(a)(2)) is amended by inserting ``(including 
dental health services)'' after ``services''.

  TITLE II--ENSURING DELIVERY OF PEDIATRIC DENTAL SERVICES UNDER THE 
                      MEDICAID AND SCHIP PROGRAMS

SEC. 201. INCREASED FMAP AND FEE SCHEDULE FOR DENTAL SERVICES PROVIDED 
              TO CHILDREN UNDER THE MEDICAID PROGRAM.

    (a) Increased FMAP.--Section 1903(a)(5) of the Social Security Act 
(42 U.S.C. 1396b(a)(5)) is amended--
            (1) by striking ``equal to 90 per centum'' and inserting 
        ``equal to--
                    ``(A) 90 per centum'';
            (2) by inserting ``and'' after the semicolon; and
            (3) by adding at the end the following:
                    ``(B) the greater of the Federal medical assistance 
                percentage or 75 per centum of the sums expended during 
                such quarter which are attributable to dental services 
                for children;''.
    (b) Fee Schedule.--Section 1902(a) of the Social Security Act (42 
U.S.C. 1396a(a)) is amended--
            (1) in paragraph (65), by striking the period and inserting 
        ``; and''; and
            (2) by inserting after paragraph (65) the following:
            ``(66) provide for payment under the State plan for dental 
        services for children at a rate that is designed to create an 
        incentive for providers of such services to treat children in 
        need of dental services (but that does not result in a 
        reduction or other adverse impact on the extent to which the 
        State provides dental services to adults).''.

SEC. 202. REQUIRED MINIMUM MEDICAID EXPENDITURES FOR DENTAL HEALTH 
              SERVICES.

    Section 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)), as 
amended by section 201(b), is amended--
            (1) in paragraph (65), by striking ``and'' at the end;
            (2) in paragraph (66), by striking the period and inserting 
        ``; and''; and
            (3) by inserting after paragraph (66) the following:
            ``(67) provide that, beginning with fiscal year 2000--
                    ``(A) not less than an amount equal to 7 percent of 
                the total annual expenditures under the State plan for 
                medical assistance provided to children will be 
                expended during each fiscal year for dental services 
                for children (including the prevention, screening, 
                diagnosis, and treatment of dental conditions); and
                    ``(B) the State will not reduce or otherwise 
                adversely impact the extent to which the State provides 
                dental services to adults in order to meet the 
                requirement of subparagraph (A).''.

SEC. 203. REQUIREMENT TO VERIFY SUFFICIENT NUMBERS OF PARTICIPATING 
              DENTAL HEALTH PROFESSIONALS UNDER THE MEDICAID PROGRAM.

    Section 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)), as 
amended by section 202, is amended--
            (1) in paragraph (66), by striking ``and'' at the end;
            (2) in paragraph (67), by striking the period and inserting 
        ``; and''; and
            (3) by inserting after paragraph (67) the following:
            ``(68) provide that the State will--
                    ``(A) annually verify that the number of dental 
                health professionals (as defined in section 
                332(a)(4)(C) of the Public Health Service Act) 
                participating under the State plan--
                            ``(i) satisfies the minimum established 
                        degree of participation of dental health 
                        professionals (as defined in section 
                        332(a)(4)(C) of the Public Health Service Act) 
                        to the population of children in the State, as 
                        determined by the Secretary in accordance with 
                        the criteria used by the Secretary under 
                        section 332(a)(4) of such Act (42 U.S.C. 
                        254e(a)(4)) to designate a dental health 
                        professional shortage area; and
                            ``(ii) is sufficient to ensure that 
                        children enrolled in the State plan have the 
                        same level of access to dental services as the 
                        children residing in the State who are not 
                        eligible for medical assistance under the State 
                        plan; and
                    ``(B) collect data on the number of children being 
                served by dental health professionals as compared to 
                the number of children eligible to be served, and the 
                actual services provided.''.

SEC. 204. INCLUSION OF RECOMMENDED AGE FOR FIRST DENTAL VISIT IN 
              DEFINITION OF EPSDT SERVICES.

    Section 1905(r)(1)(A)(i) of the Social Security Act (42 U.S.C. 
1396d(r)(1)(A)(i)) is amended by inserting ``and, with respect to 
dental services under paragraph (3), in accordance with guidelines for 
the age of a first dental visit that are consistent with guidelines of 
the American Dental Association, the American Dental Hygienist 
Association, the American Academy of Pediatric Dentistry, and the 
Bright Futures program of the Health Resources and Services 
Administration of the Department of Health and Human Services,'' after 
``vaccines,''.

SEC. 205. APPROVAL OF FINAL REGULATIONS IMPLEMENTING CHANGES TO EPSDT 
              SERVICES.

    Not later than 30 days after the date of enactment of this Act, the 
Secretary of Health and Human Services shall issue final regulations 
implementing the proposed regulations based on section 6403 of the 
Omnibus Budget Reconciliation Act of 1989 (Public Law 101-239; 103 
Stat. 2262) that were contained in the Federal Register issued for 
October 1, 1993.

SEC. 206. USE OF SCHIP FUNDS TO TREAT CHILDREN WITH SPECIAL DENTAL 
              HEALTH NEEDS.

    (a) In General.--Section 1905 of the Social Security Act (42 U.S.C. 
1396d) is amended--
            (1) in subsection (b), by striking ``or subsection (u)(3)'' 
        and inserting ``subsection (u)(3), or subsection (u)(4)''; and
            (2) in subsection (u)--
                    (A) by redesignating paragraph (4) as paragraph 
                (5); and
                    (B) by inserting after paragraph (3) the following 
                new paragraph:
    ``(4)(A) For purposes of subsection (b), the expenditures described 
in this paragraph are expenditures for medical assistance described in 
subparagraph (B) for a low-income child described in subparagraph (C), 
but only in the case of such a child who resides in a State described 
in subparagraph (D).
    ``(B) For purposes of subparagraph (A), the medical assistance 
described in this subparagraph consists of the following:
            ``(i) Dental services provided to children with special 
        oral health needs, including advanced oral, dental, and 
        craniofacial diseases and conditions.
            ``(ii) Outreach conducted to identify and treat children 
        with such special dental health needs.
    ``(C) For purposes of subparagraph (A), a low-income child 
described in this subparagraph is a child whose family income does not 
exceed 50 percentage points above the medicaid applicable income level 
(as defined in section 2110(b)(4)).
    ``(D) A State described in this subparagraph is a State that, as of 
August 5, 1997, has under a waiver authorized by the Secretary or under 
section 1902(r)(2), established a medicaid applicable income level (as 
defined in section 2110(b)(4)) for children under 19 years of age 
residing in the State that is at or above 185 percent of the poverty 
line (as defined in section 673(2) of the Community Services Block 
Grant Act (42 U.S.C. 9902(2), including any revision required by such 
section for a family of the size involved).''.
    (b) Effective Date.--The amendments made by this section shall take 
effect as if included in the enactment of section 4911 of the Balanced 
Budget Act of 1997 (Public Law 105-33; 111 Stat. 570).

SEC. 207. GRANTS TO SUPPLEMENT FEES FOR THE TREATMENT OF CHILDREN WITH 
              SPECIAL DENTAL HEALTH NEEDS.

    Title V of the Social Security Act (42 U.S.C. 701 et seq.) is 
amended by adding at the end the following:

``SEC. 511. GRANTS TO SUPPLEMENT FEES FOR THE TREATMENT OF CHILDREN 
              WITH SPECIAL DENTAL HEALTH NEEDS.

    ``(a) Authority To Make Grants.--
            ``(1) In general.--In addition to any other payments made 
        under this title to a State, the Secretary shall award grants 
        to States to supplement payments made under the State programs 
        established under titles XIX and XXI for the treatment of 
        children with special oral health care needs.
            ``(2) Definition of children with special oral, dental, and 
        craniofacial health care needs.--In this section the term 
        `children with special oral health care needs' means children 
        with oral, dental and craniofacial conditions or disorders, and 
        other acute or chronic medical, genetic, and behavioral 
        disorders with dental manifestations.
    ``(b) Application of Other Provisions of Title.--
            ``(1) In general.--Except as provided in paragraph (2), the 
        other provisions of this title shall not apply to a grant made, 
        or activities of the Secretary, under this section.
            ``(2) Exceptions.--The following provisions of this title 
        shall apply to a grant made under subsection (a) to the same 
        extent and in the same manner as such provisions apply to 
        allotments made under section 502(c):
                    ``(A) Section 504(b)(4) (relating to expenditures 
                of funds as a condition of receipt of Federal funds).
                    ``(B) Section 504(b)(6) (relating to prohibition on 
                payments to excluded individuals and entities).
                    ``(C) Section 506 (relating to reports and audits, 
                but only to the extent determined by the Secretary to 
                be appropriate for grants made under this section).
                    ``(D) Section 508 (relating to nondiscrimination).
    ``(c) Authorization of Appropriations.--There is authorized to be 
appropriated such sums as may be necessary to carry out this 
section.''.

SEC. 208. DEMONSTRATION PROJECTS TO INCREASE ACCESS TO PEDIATRIC DENTAL 
              SERVICES IN UNDERSERVED AREAS.

    (a) Authority To Conduct Projects.--The Secretary of Health and 
Human Services, through the Administrator of the Health Care Financing 
Administration, the Administrator of the Health Resources and Services 
Administration, the Director of the Indian Health Service, and the 
Director of the Centers for Disease Control and Prevention shall 
establish demonstration projects that are designed to increase access 
to dental services for children in underserved areas, as determined by 
the Secretary.
    (b) Authorization of Appropriations.--There is authorized to be 
appropriated such sums as may be necessary to carry out this section.

                  TITLE III--PEDIATRIC DENTAL RESEARCH

SEC. 301. IDENTIFICATION OF INTERVENTIONS THAT REDUCE THE BURDEN AND 
              TRANSMISSION OF ORAL, DENTAL, AND CRANIOFACIAL DISEASES 
              IN HIGH RISK POPULATIONS; DEVELOPMENT OF APPROACHES FOR 
              PEDIATRIC ORAL AND CRANIOFACIAL ASSESSMENT.

    (a) In General.--The Secretary of Health and Human Services, 
through the Maternal and Child Health Bureau, the Indian Health 
Service, and in consultation with the Agency for Health Care Policy and 
Research and the National Institutes of Health, shall--
            (1) support community based research that is designed to 
        improve our understanding of the etiology, pathogenesis, 
        diagnosis, prevention, and treatment of pediatric oral, dental, 
        craniofacial diseases and conditions and their sequelae in high 
        risk populations;
            (2) support demonstrations of preventive interventions in 
        high risk populations; and
            (3) develop clinical approaches to assess individual 
        patients for pediatric dental disease.
    (b) Authorization of Appropriations.--There is authorized to be 
appropriated, such sums as may be necessary to carry out this section.

SEC. 302. AGENCY FOR HEALTH CARE POLICY AND RESEARCH.

    Section 902(a) of the Public Health Service Act (42 U.S.C. 299a(a)) 
is amended--
            (1) in paragraph (7), by striking ``and'' at the end;
            (2) in paragraph (8), by striking the period and inserting 
        ``; and''; and
            (3) by adding at the end the following:
            ``(9) the barriers that exist, including access to oral 
        health care for children, and the establishment of measures of 
        oral health status and outcomes.''.

SEC. 303. ORAL HEALTH PROFESSIONAL RESEARCH AND TRAINING PROGRAM.

      Part G of title IV of the Public Health Service Act is amended by 
inserting after section 487E (42 U.S.C. 288-5) the following:

``SEC. 487F. ORAL HEALTH PROFESSIONAL RESEARCH AND TRAINING PROGRAM.

    ``(a) In General.--The Secretary, in consultation with the Director 
of the National Institute of Dental and Craniofacial Research, shall 
establish a program under which the Secretary will enter into contracts 
with qualified oral health professionals and such professionals will 
agree to conduct research or provide training with respect to pediatric 
oral, dental, and craniofacial diseases and conditions and in exchange 
the Secretary will agree to repay, for each year of service, not more 
than $35,000 of the principal and interest of the educational loans of 
such professionals.
    ``(b) Qualified Oral Health Professional.--
            ``(1) Definition.--In this section, the term `qualified 
        oral health professional' includes dentists and allied dental 
        personnel serving in faculty positions.
            ``(2) Special preference.--In entering into contacts under 
        subsection (a), the Secretary shall give preference to 
        qualified oral health professionals--
                    ``(A) who are serving, or who have served in 
                research or training programs of the National Institute 
                of Dental and Craniofacial Research; or
                    ``(B) who are providing services at institutions 
                that provide oral health care to underserved pediatric 
                populations in rural or border areas.
    ``(c) Priorities.--The Secretary shall annually determine the 
clinical and basic research and training priorities for contracts under 
subsection (a), including dental caries, orofacial accidents or 
traumas, birth defects such as cleft lip and palate and severe 
malocclusions, and new techniques and approaches to treatment.
    ``(d) Contracts, Obligated Service, and Breach of Contract.--The 
provisions of section 338B concerning contracts, obligated service, and 
breach of contract, except as inconsistent with this section, shall 
apply to contracts under this section to the same extent and in the 
same manner as such provisions apply to contracts under such section 
338B.
    ``(e) Availability of Funds.--Amounts available for carrying out 
this section shall remain available until the expiration of the second 
fiscal year beginning after the fiscal year for which such amounts were 
made available.''.

SEC. 304. CONSENSUS DEVELOPMENT CONFERENCE.

    (a) In General.--Not later than April 1, 2000, the Secretary of 
Health and Human Services, acting through the National Institute of 
Child Health and Human Development and the National Institute of Dental 
and Craniofacial Research, shall convene a conference (to be known as 
the ``Consensus Development Conference'') to examine the management of 
early childhood caries and to support the design and conduct of 
research on the biology and physiologic dynamics of infectious 
transmission of dental caries. The Secretary shall ensure that 
representatives of interested consumers and other professional 
organizations participate in the Consensus Development Conference.
    (b) Experts.--In administering the conference under subsection (a), 
the Secretary of Health and Human Services shall solicit the 
participation of experts in dentistry, including pediatric dentistry, 
dental hygiene, public health, and other appropriate medical and child 
health professionals.
    (c) Authorization of Appropriations.--There is authorized to be 
appropriated such sums as may be necessary to carry out this section.

               TITLE IV--SURVEILLANCE AND ACCOUNTABILITY

SEC. 401. CDC REPORTS.

    (a) Collection of Data.--The Director of the Centers for Disease 
Control and Prevention in collaboration with other organizations and 
agencies shall annually collect data describing the dental, 
craniofacial, and oral health of residents of at least 1 State from 
each region of the Department of Health and Human Services.
    (b) Reports.--The Director shall compile and analyze data collected 
under subsection (a) and annually prepare and submit to the appropriate 
committees of Congress a report concerning the oral health of certain 
States.

SEC. 402. REPORTING REQUIREMENTS UNDER THE MEDICAID PROGRAM.

    Section 1902(a)(43)(D) of the Social Security Act (42 U.S.C. 
1396a(43)(D)) is amended--
            (1) in clause (iii), by striking ``and'' and inserting 
        ``with the specific dental condition and treatment provided 
        identified,'';
            (2) in clause (iv), by striking the semicolon and inserting 
        a comma; and
            (3) by adding at the end the following:
                            ``(v) the percentage of expenditures for 
                        such services that were for dental services,
                            ``(vi) the percentage of dental health 
                        professionals (as defined in section 
                        332(a)(4)(C) of the Public Health Service Act) 
                        who are licensed in the State and provide 
                        services commensurate with eligibility under 
                        the State plan, and
                            ``(vii) collect and submit data on the 
                        number of children being served as compared to 
                        the number of children who are eligible for 
                        services, and the actual services provided;''.

SEC. 403. ADMINISTRATION ON CHILDREN, YOUTH, AND FAMILIES.

    The Administrator of the Administration on Children, Youth, and 
Families shall annually prepare and submit to the appropriate 
committees of Congress a report concerning the percentage of children 
enrolled in a Head Start or Early Start program who have access to and 
who obtain dental care, including children with special oral, dental, 
and craniofacial health needs. The Administrator of the Administration 
of Children, Youth and Families shall seek methods to reestablish 
intraagency agreements with the Administrator of the Health Resources 
and Services Administration to address technical assistance for its 
grantees in addressing access to preventive clinical services.

SEC. 404. SPECIAL SUPPLEMENTAL FOOD PROGRAM FOR WOMEN, INFANTS, AND 
              CHILDREN.

    Section 17(f) of the Child Nutrition Act of 1966 (42 U.S.C. 
1786(f)) is amended by adding at the end the following:
    ``(25) The State shall collect and submit data on the number of 
children being served under this section as compared to the number of 
children who are eligible for services, and the actual services 
provided.''.

         TITLE V--ORAL HEALTH PROMOTION AND DISEASE PREVENTION

SEC. 501. GRANTS TO INCREASE RESOURCES FOR COMMUNITY WATER 
              FLUORIDATION.

    (a) In General.--The Secretary of Health and Human Services, acting 
through the Director of the Division of Oral Health of the Centers for 
Disease Control and Prevention, may make grants to State or locality 
for the purpose of increasing the resources available for community 
water fluoridation.
    (b) Use of Funds.--A State shall use amounts provided under a grant 
under subsection (a)--
            (1) to purchase fluoridation equipment;
            (2) to train fluoridation engineers; or
            (3) to develop educational materials on the advantages of 
        fluoridation.
    (c) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $25,000,000 for fiscal year 
2000, and such sums as may be necessary for each subsequent fiscal 
year.

SEC. 502. COMMUNITY WATER FLUORIDATION.

    (a) In General.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary''), acting through the 
Director of the Indian Health Service and the Director of the Centers 
for Disease Control and Prevention, shall establish a demonstration 
project that is designed to assist rural water systems in successfully 
implementing the Centers for Disease Control and Prevention water 
fluoridation guidelines entitled ``Engineering and Administrative 
Recommendations for Water Fluoridation'' (referred to in this section 
as the ``EARWF'').
    (b) Requirements.--
            (1) Collaboration.--The Director of the Indian Health 
        Services shall collaborate with the Director of the Centers for 
        Disease Control and Prevention in developing the project under 
        subsection (a). Through such collaboration the Directors 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.
            (2) General use of funds.--Amounts made available under 
        this section shall be used to assist small water systems in 
        improving the effectiveness of water fluoridation and to meet 
        the recommendations of the EARWF.
            (3) Fluoridation specialists.--
                    (A) In general.--In carrying out this section, 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.
                    (B) 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.
                    (C) CDC.--The Director of the Centers for Disease 
                Control and Prevention shall appoint individuals to 
serve as the fluoridation specialists.
            (4) Implementation.--The project established under this 
        section 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.
    (c) Evaluation.--In conducting the ongoing evaluation as provided 
for in subsection (b)(4), the Secretary shall ensure that such 
evaluation includes--
            (1) the measurement of changes in water fluoridation 
        compliance levels resulting from assistance provided under this 
        section;
            (2) the identification of the administrative, technical and 
        operational challenges that are unique to the fluoridation of 
        small water systems;
            (3) 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
            (4) the measurement of any increased percentage of Native 
        Americans or Alaskan Natives who receive the benefits of 
        optimally fluoridated water.
    (d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $25,000,000 for fiscal year 
2000, and such sums as may be necessary for each subsequent fiscal 
year.

SEC. 503. SCHOOL-BASED DENTAL SEALANT PROGRAM.

    (a) In General.--The Secretary of Health and Human Services, acting 
through the Director of the Maternal and Child Health Bureau of the 
Health Resources and Services Administration, may award grants to 
States or localities to provide for the development of school-based 
dental sealant programs to improve the access of children to sealants.
    (b) Use of Funds.--A State shall use amounts received under a grant 
under subsection (a) to provide funds to eligible school-based entities 
or to public elementary or secondary schools to enable such entities or 
schools to provide children in second or sixth grade 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.
    (c) Eligibility.--To be eligible to receive funds under this 
section an entity shall--
            (1) prepare and submit to the State an application at such 
        time, in such manner and containing such information as the 
        State may require; and
            (2) be a public elementary or secondary school--
                    (A) that located in an urban area and in which and 
                more than 50 percent of the student population is 
                participating in Federal or State free or reduced meal 
                programs; or
                    (B) 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)).
Preference in awarding grants shall be provided to eligible entities 
that use dental health care professionals in the most cost effective 
manner.
    (d) Coordination With Other Programs.--
            (1) In general.--An entity that receives funds from a State 
        under this section shall serve as an enrollment site for 
        purposes of enabling individuals to enroll in the State plan 
        under title XIX of the Social Security Act (42 U.S.C. 1396 et 
        seq.) or in the State Children's Health Insurance Program under 
        title XXI of such Act (42 U.S.C. 1397aa et seq.).
            (2) Conforming amendment.--Section 1920A(b)(3)(A)(i) of the 
        Social Security Act (42 U.S.C. 1396r-1a(b)(3)(A)(i)) is 
        amended--
                    (A) by striking ``or (II)'' and inserting ``, 
                (II)''; and
                    (B) by inserting ``, or (III) is an eligible 
                community-based entity or a public elementary or 
                secondary school that participates in the school-based 
                dental sealant program established under section 503 of 
                the Children's Dental Health Improvement Act of 1999'' 
                before the semicolon.
    (e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $5,000,000 for fiscal year 
2000, and such sums as may be necessary for each subsequent fiscal 
year.

                        TITLE VI--MISCELLANEOUS

SEC. 601. EFFECTIVE DATE.

    (a) In General.--Except as otherwise provided in this Act, this Act 
and the amendments made by this Act take effect on the date of 
enactment of this Act.
    (b) Extension of Effective Date for State Law Amendment.--In the 
case of a State plan under title XIX of the Social Security Act which 
the Secretary of Health and Human Services determines requires State 
legislation in order for the plan to meet the additional requirements 
imposed by the amendments made by this Act, the State plan shall not be 
regarded as failing to comply with the requirements of such amendments 
solely on the basis of its failure to meet the additional requirements 
before the first day of the first calendar quarter beginning after the 
close of the first regular session of the State legislature that begins 
after the date of the enactment of this Act. For purposes of the 
previous sentence, in the case of a State that has a 2-year legislative 
session, each year of the session is considered to be a separate 
regular session of the State legislature.
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