II

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.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

4 (a) SHORT TITLE.—This Act may be cited as the

5 ‘‘Children’s Dental Health Improvement Act of 1999’’.

6 (b) TABLE OF CONTENTS.—The table of contents for

7 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.
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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.
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1 SEC. 2. FINDINGS.

2 Congress makes the following findings:

3 (1) The 1995 Institute of Medicine report on

4 dental education finds that oral health is an integral

5 part of total health, and is integral to comprehensive

6 health, including primary care.

7 (2) Tooth decay is the most prevalent prevent8 able chronic disease of childhood and only the com9 mon cold, the flu, and otitis media occur more often

10 among young children.

11 (3) Despite the design of the medicaid program

12 to reach children and ensure access to routine dental

13 care, in 1996, the Inspector General of the Depart14 ment of Health and Human Services reported that

15 only 18 percent of children eligible for medicaid re16 ceived even a single preventive dental service.

17 (4) The United States is facing a major dental

18 health care crisis that primarily affects the poor chil19 dren of our country, with 80 percent of all dental

20 caries in children found in 20 percent of the popu21 lation.

22 (5) Low income children eligible for the med23 icaid program and the State children’s health insur24 ance program experience disproportionately high lev25 els of oral disease.
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1 (6) The United States is not training enough

2 pediatric dental health care providers to meet the in3 creasing need for dental services for children.

4 (7) The United States needs to increase access

5 to health promotion and disease prevention activities

6 in the area of oral health for children by increasing

7 access to dental health providers for children.

8 TITLE I—EXPANDED OPPORTU9 NITIES FOR TRAINING PEDI10 ATRIC DENTAL HEALTH CARE

11 PROVIDERS

12 SEC. 101. CHILDREN’S DENTAL HEALTH TRAINING AND

13 DEMONSTRATION PROGRAMS.

14 (a) IN GENERAL.—Subpart 2 of part E of title VII

15 of the Public Health Service Act, as amended by the

16 Health Professions Education Partnerships Act of 1998

17 (Public Law 105–392) is amended by adding at the end

18 the following:

19 ‘‘SEC. 771. CHILDREN’S DENTAL HEALTH PROGRAMS.

20 ‘‘(a) TRAINING PROGRAM.—

21 ‘‘(1) IN GENERAL.—The Secretary, acting

22 through the Bureau of Health Professions, shall de23 velop training materials to be used by health profes24 sionals to promote oral health through health edu25 cation.
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1 ‘‘(2) DESIGN.—The materials developed under

2 paragraph (1) shall be designed to enable health

3 care professionals to—

4 ‘‘(A) provide information to individuals

5 concerning the importance of oral health;

6 ‘‘(B) recognize oral disease in individuals;

7 and

8 ‘‘(C) make appropriate referrals of individ9 uals for dental treatment.

10 ‘‘(3) DISTRIBUTION.—The materials developed

11 under paragraph (1) shall be distributed to—

12 ‘‘(A) accredited schools of the health

13 sciences (including schools for physician assist14 ants, schools of medicine, osteopathic medicine,

15 dental hygiene, public health, nursing, phar16 macy, and dentistry), and public or private in17 stitutions accredited for the provision of grad18 uate or specialized training programs in all as19 pects of health; and

20 ‘‘(B) health professionals and community21 based health care workers.

22 ‘‘(b) DEMONSTRATION PROGRAM.—

23 ‘‘(1) IN GENERAL.—The Secretary shall make

24 grants to schools that train pediatric dental health

25 providers to meet the costs of projects—
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1 ‘‘(A) to plan and develop new training pro2 grams and to maintain or improve existing

3 training programs in providing dental health

4 services to children; and

5 ‘‘(B) to assist dental health providers in

6 managing complex dental problems in children.

7 ‘‘(2) ADMINISTRATION.—

8 ‘‘(A) AMOUNT.—The amount of any grant

9 under paragraph (1) shall be determined by the

10 Secretary.

11 ‘‘(B) APPLICATION.—No grant may be

12 made under paragraph (1) unless an application

13 therefore is submitted to and approved by the

14 Secretary. Such an application shall be in such

15 form, submitted in such manner, and contain

16 such information, as the Secretary shall by reg17 ulation prescribe.

18 ‘‘(C) ELIGIBILITY.—To be eligible for a

19 grant under subsection (a), the applicant must

20 demonstrate to the Secretary that it has or will

21 have available full-time faculty and staff mem22 bers with training and experience in the field of

23 pediatric dentistry and support from other fac24 ulty and staff members trained in pediatric den25 tistry and other relevant specialties and dis-
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1 ciplines such as dental public health and pediat2 rics, as well as research.

3 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There

4 is authorized to be appropriated such sums as may be nec5 essary to carry out this section.’’.

6 (b) AUTHORIZATION OF APPROPRIATIONS FOR GEN7 ERAL AND PEDIATRIC DENTISTRY.—Section 747(e)(2)(A)

8 of the Public Health Service Act (42 U.S.C.

9 293k(e)(2)(A), as amended by the Health Professions

10 Education Partnerships Act of 1998 (Public Law 105–

11 392) is amended in striking clause (iv) and inserting the

12 following:

13 ‘‘(iv) not less than $8,000,000 for

14 awards of grants and contracts under sub15 section (a) to programs of pediatric or gen16 eral dentistry.’’.

17 SEC. 102. INCREASE IN NATIONAL HEALTH SERVICE CORPS

18 DENTAL TRAINING POSITIONS.

19 (a) IN GENERAL.—The Secretary of Health and

20 Human Services (referred to in this section as the ‘‘Sec21 retary’’) shall increase the number of dental health pro22 viders skilled in treating children who become members

23 of the Commissioned Corps of the U.S. Public Health

24 Service and who are assigned to duty for the National

25 Health Service Corps (referred to in this section as the
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1 ‘‘Corps’’) under subpart II of part D of title III of the

2 Public Health Service Act (42 U.S.C. 254d et seq.) so that

3 there are at least 100 additional Commissioned Corps den4 tists and dental hygienists in the Corps by 2001, at least

5 150 additional dentists and dental hygienists in the Com6 missioned Corps by 2002, and at least 300 additional den7 tists and dental hygienists in the Commissioner Corps by

8 2003.

9 (b) DETERMINATION OF DENTAL SITE READI10 NESS.—By not later than January 1, 2001, the Secretary

11 shall collaborate with dental education institutions, State

12 and local public health dental officials and dental and den13 tal hygienist societies to determine dental site readiness,

14 specifically in inner city, rural, frontier and border areas.

15 (c) REPORT BY CORPS.—The Corps shall annually

16 report to Congress concerning how the Corps is meeting

17 the oral health needs of children in underserved areas, in18 cluding rural, frontier and border areas.

19 (d) LOAN REPAYMENT PROGRAM.—The Secretary

20 shall increase the number of Corps dentists selected for

21 loan repayments under the provisions referred to in sub22 section (a) in a sufficient number to address the demand

23 for such repayment by qualified dentists. The Secretary

24 shall increase the number of private practice dentists who
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1 contract with the Corps and allow for such student loan

2 repayment.

3 (e) PEDIATRIC DENTISTS.—The Secretary shall en4 sure that at least 20 percent of the dentists in the Corps

5 are pediatric dentists and that another 20 percent of the

6 dentists in the Corps have general dentistry residency

7 training.

8 SEC. 103. MATERNAL AND CHILD HEALTH CENTERS FOR

9 LEADERSHIP IN PEDIATRIC DENTISTRY EDU10 CATION.

11 (a) EXPANSION OF TRAINING PROGRAMS.—The Sec12 retary of Health and Human Services shall, through the

13 Bureau of Health Professions, establish at least 10 Pedi14 atric Dental Centers of Excellence with not less than 36

15 additional training positions annually for pediatric den16 tists at such centers of excellence. The Secretary shall en17 sure that such training programs are established in geo18 graphically diverse areas.

19 (b) DEFINITION.—In this section, the term ‘centers

20 of excellence’ means a health professions school designated

21 under section 736 of the Public Health Service Act (42

22 U.S.C. 293).

23 (c) AUTHORIZATION OF APPROPRIATIONS.—There is

24 authorized to be appropriated, such sums as may be nec25 essary to carry out this section.
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1 SEC. 104. DENTAL OFFICER MULTIYEAR RETENTION BONUS

2 FOR THE INDIAN HEALTH SERVICE.

3 (a) TERMS AND DEFINITIONS.—In this section:

4 (1) DENTAL OFFICER.—The term ‘‘dental offi5 cer’’ means an officer of the Indian Health Service

6 designated as a dental officer.

7 (2) DIRECTOR.—The term ‘‘Director’’ means

8 the Director of the Indian Health Service.

9 (3) CREDITABLE SERVICE.—The term ‘‘cred10 itable service’’ includes all periods that a dental offi11 cer spent in graduate dental educational (GDE)

12 training programs while not on active duty in the In13 dian Health Service and all periods of active duty in

14 the Indian Health Service as a dental officer.

15 (4) RESIDENCY.—The term ‘‘residency’’ means

16 a graduate dental educational (GDE) training pro17 gram of at least 12 months leading to a speciality,

18 including general practice residency (GPR) or a 12-

19 month advanced education general dentistry

20 (AEGD).

21 (5) SPECIALTY.—The term ‘‘specialty’’ means a

22 dental specialty for which there is an Indian Health

23 Service specialty code number.

24 (b) REQUIREMENTS FOR BONUS.—

25 (1) IN GENERAL.—An eligible dental officer of

26 the Indian Health Service who executes a written
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1 agreement to remain on active duty for 2, 3, or 4

2 years after the completion of any other active duty

3 service commitment to the Indian Health Service

4 may, upon acceptance of the written agreement by

5 the Director, be authorized to receive a dental officer

6 multiyear retention bonus under this section. The

7 Director may, based on requirements of the Indian

8 Health Service, decline to offer such a retention

9 bonus to any specialty that is otherwise eligible, or

10 to restrict the length of such a retention bonus con11 tract for a specialty to less than 4 years.

12 (2) LIMITATIONS.—Each annual dental officer

13 multiyear retention bonus authorized under this sec14 tion shall not exceed the following:

15 (A) $14,000 for a 4-year written agree16 ment.

17 (B) $8,000 for a 3-year written agreement.

18 (C) $4,000 for a 2-year written agreement.

19 (c) ELIGIBILITY.—

20 (1) IN GENERAL.—In order to be eligible to re21 ceive a dental officer multiyear retention bonus

22 under this section, a dental officer shall—

23 (A) be at or below such grade as the Di24 rector shall determine;
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1 (B) have at least 8 years of creditable

2 service, or have completed any active duty serv3 ice commitment of the Indian Health Service

4 incurred for dental education and training;

5 (C) have completed initial residency train6 ing, or be scheduled to complete initial resi7 dency training before September 30 of the fiscal

8 year in which the officer enters into a dental of9 ficer multiyear retention bonus written service

10 agreement under this section; and

11 (D) have a dental specialty in pediatric

12 dentistry or oral and maxillofacial surgery, or

13 be a dental hygienist with a minimum of a bac14 calaureate degree.

15 (2) EXTENSION TO OTHER OFFICERS.—The Di16 rector may extend the retention bonus to dental offi17 cers other than officers with a dental specialty in pe18 diatric dentistry based on demonstrated need. The

19 criteria used as the basis for such an extension shall

20 be equitably determined and consistently applied.

21 (d) TERMINATION OF ENTITLEMENT TO SPECIAL

22 PAY.—The Director may terminate at any time a dental

23 officer’s multiyear retention bonus contract under this sec24 tion. If such a contract is terminated, the unserved portion

25 of the retention bonus contract shall be recouped on a pro
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1 rata basis. The Director shall establish regulations that

2 specify the conditions and procedures under which termi3 nation may take place. The regulations and conditions for

4 termination shall be included in the written service con5 tract for a dental officer multiyear retention bonus under

6 this section.

7 (e) REFUNDS.—

8 (1) IN GENERAL.—Prorated refunds shall be re9 quired for sums paid under a retention bonus con10 tract under this section if a dental officer who has

11 received the retention bonus fails to complete the

12 total period of service specified in the contract, as

13 conditions and circumstances warrant.

14 (2) DEBT TO UNITED STATES.—An obligation

15 to reimburse the United States imposed under para16 graph (1) is a debt owed to the United States.

17 (3) NO DISCHARGE IN BANKRUPTCY.—Notwith18 standing any other provision of law, a discharge in

19 bankruptcy under title 11, United States Code, that

20 is entered less than 5 years after the termination of

21 a retention bonus contract under this section does

22 not discharge the dental officer who signed such a

23 contract from a debt arising under the contract or

24 paragraph (1).
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1 SEC. 105. MEDICARE PAYMENTS TO APPROVED NONHOS2 PITAL DENTISTRY RESIDENCY TRAINING

3 PROGRAMS; PERMANENT DENTAL EXEMP4 TION FROM VOLUNTARY RESIDENCY REDUC5 TION PROGRAMS.

6 (a) MEDICARE PAYMENTS TO APPROVED NONHOS7 PITAL DENTISTRY TRAINING PROGRAMS.—Section 1886

8 of the Social Security Act (42 U.S.C. 1395ww) is amended

9 by adding at the end the following:

10 ‘‘(l) PAYMENTS FOR NONHOSPITAL BASED DENTAL

11 RESIDENCY TRAINING PROGRAMS.—

12 ‘‘(1) IN GENERAL.—Beginning January 1,

13 2000, the Secretary shall make payments under this

14 paragraph to approved nonhospital based dentistry

15 residency training programs providing oral health

16 care to children for the direct and indirect expenses

17 associated with operating such training programs.

18 ‘‘(2) PAYMENT AMOUNT.—

19 ‘‘(A) METHODOLOGY.—The Secretary shall

20 establish procedures for making payments

21 under this subsection.

22 ‘‘(B) TOTAL AMOUNT OF PAYMENTS.—In

23 making payments to approved non-hospital

24 based dentistry residency training programs

25 under this subsection, the Secretary shall en26 sure that the total amount of such payments
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1 will not result in a reduction of payments that

2 would otherwise be made under subsection (h)

3 or (k) to hospitals for dental residency training

4 programs.

5 ‘‘(C) APPROVED PROGRAMS.—The Sec6 retary shall establish procedures for the ap7 proval of nonhospital based dentistry residency

8 training programs under this subsection.’’.

9 (b) PERMANENT DENTAL EXEMPTION FROM VOL10 UNTARY RESIDENCY REDUCTION PROGRAMS.—

11 (1) IN GENERAL.—Section 1886(h)(6)(C) of the

12 Social Security Act (42 U.S.C. 1395ww(h)(6)(C)) is

13 amended—

14 (A) by redesignating clauses (i) through

15 (iii) as subclauses (I) through (III), respec16 tively, and indenting such subclauses (as so re17 designated) appropriately;

18 (B) by striking ‘‘For purposes’’ and insert19 ing the following:

20 ‘‘(i) IN GENERAL.—Subject to clause

21 (ii), for purposes’’; and

22 (C) by adding at the end the following:

23 ‘‘(ii) DEFINITION OF ‘APPROVED MED24 ICAL RESIDENCY TRAINING PROGRAM’.—In

25 this subparagraph, the term ‘approved
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1 medical residency training program’ means

2 only such programs in allopathic or osteo3 pathic medicine.’’.

4 (2) APPLICATION TO DEMONSTRATION

5 PROJECTS AND AUTHORITY.—Section 4626(b)(3) of

6 the Balanced Budget Act of 1997 (42 U.S.C.

7 1395ww note) is amended by inserting ‘‘in allopathic

8 or osteopathic medicine’’ before the period.

9 (c) REMOVAL OF DENTISTS FROM FULL-TIME

10 EQUIVALENT COUNT AVERAGING PROVISIONS.—

11 (1) MEDICARE IME.—Section 1886(d)(5)(B)(vi)

12 of the Social Security Act (42 U.S.C.

13 1395ww(d)(5)(B)(vi)) is amended by adding at the

14 end the following: ‘‘The determination (based on the

15 3-year average) described in subclause (II) shall

16 apply only to residents in the fields of allopathic

17 medicine and osteopathic medicine. All other resi18 dents shall be counted based on the actual full-time

19 equivalent resident count for the cost-reporting pe20 riod involved.’’.

21 (2) MEDICARE DIRECT GME.—Section

22 1886(h)(4)(G)(i) of the Social Security Act (42

23 U.S.C. 1395ww(h)(4)(G)(i)) is amended by adding

24 at the end the following: ‘‘Such determination (based

25 on the 3-year average) shall apply only to residents
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1 in the fields of allopathic medicine and osteopathic

2 medicine. All other residents shall be counted based

3 on the actual full-time equivalent resident count for

4 the cost-reporting period involved.’’.

5 (d) DEFINITION OF PRIMARY CARE RESIDENT.—

6 Section 1886(h)(5)(H) of the Social Security Act (42

7 U.S.C. 1395ww(h)(5)(H)) is amended by striking ‘‘or os8 teopathic general practice’’ and inserting ‘‘osteopathic

9 general practice, general dentistry, advanced general den10 tistry, pediatric dentistry, or dental public health’’.

11 (e) EFFECTIVE DATE.—

12 (1) IN GENERAL.—Except as provided in para13 graph (2), the amendments made by subsections (a),

14 (c), and (d) take effect on the date of enactment of

15 this Act.

16 (2) EXCEPTION.—The amendments made by

17 subsection (b) shall take effect as if included in the

18 enactment of the Balanced Budget Act of 1997.

19 SEC. 106. DENTAL HEALTH PROFESSIONAL SHORTAGE

20 AREAS.

21 (a) DESIGNATION.—Section 332(a) of the Public

22 Health Service Act (42 U.S.C. 254e(a)) is amended by

23 adding at the end the following:

24 ‘‘(4)(A) In designating health professional shortage

25 areas under this section, the Secretary may designate cer-
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1 tain areas as dental health professional shortage areas if

2 the Secretary determines that such areas have a severe

3 shortage of dental health professionals. The Secretary

4 shall develop, publish and periodically update criteria to

5 be used in designating dental health professional shortage

6 areas.

7 ‘‘(B) For purposes of this title a dental health profes8 sional shortage area shall be considered to be a health pro9 fessional shortage area.’’.

10 ‘‘(C) In subparagraph (A), the term ‘dental health

11 professional’ includes general and pediatric dentists and

12 dental hygienists.’’.

13 (b) LOAN REPAYMENT PROGRAM.—Section

14 338B(b)(1)(A) of the Public Health Service Act (42

15 U.S.C. 254l–1(b)(1)(A)) is amended by inserting ‘‘(includ16 ing dental hygienists)’’ after ‘‘profession’’.

17 (c) TECHNICAL AMENDMENT.—Section 331(a)(2) of

18 the Public Health Service Act (42 U.S.C. 254d(a)(2)) is

19 amended by inserting ‘‘(including dental health services)’’

20 after ‘‘services’’.
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1 TITLE II—ENSURING DELIVERY

2 OF PEDIATRIC DENTAL SERV3 ICES UNDER THE MEDICAID

4 AND SCHIP PROGRAMS

5 SEC. 201. INCREASED FMAP AND FEE SCHEDULE FOR DEN6 TAL SERVICES PROVIDED TO CHILDREN

7 UNDER THE MEDICAID PROGRAM.

8 (a) INCREASED FMAP.—Section 1903(a)(5) of the

9 Social Security Act (42 U.S.C. 1396b(a)(5)) is amended—

10 (1) by striking ‘‘equal to 90 per centum’’ and

11 inserting ‘‘equal to—

12 ‘‘(A) 90 per centum’’;

13 (2) by inserting ‘‘and’’ after the semicolon; and

14 (3) by adding at the end the following:

15 ‘‘(B) the greater of the Federal medical as16 sistance percentage or 75 per centum of the

17 sums expended during such quarter which are

18 attributable to dental services for children;’’.

19 (b) FEE SCHEDULE.—Section 1902(a) of the Social

20 Security Act (42 U.S.C. 1396a(a)) is amended—

21 (1) in paragraph (65), by striking the period

22 and inserting ‘‘; and’’; and

23 (2) by inserting after paragraph (65) the fol24 lowing:
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1 ‘‘(66) provide for payment under the State plan

2 for dental services for children at a rate that is de3 signed to create an incentive for providers of such

4 services to treat children in need of dental services

5 (but that does not result in a reduction or other ad6 verse impact on the extent to which the State pro7 vides dental services to adults).’’.

8 SEC. 202. REQUIRED MINIMUM MEDICAID EXPENDITURES

9 FOR DENTAL HEALTH SERVICES.

10 Section 1902(a) of the Social Security Act (42 U.S.C.

11 1396a(a)), as amended by section 201(b), is amended—

12 (1) in paragraph (65), by striking ‘‘and’’ at the

13 end;

14 (2) in paragraph (66), by striking the period

15 and inserting ‘‘; and’’; and

16 (3) by inserting after paragraph (66) the fol17 lowing:

18 ‘‘(67) provide that, beginning with fiscal year

19 2000—

20 ‘‘(A) not less than an amount equal to 7

21 percent of the total annual expenditures under

22 the State plan for medical assistance provided

23 to children will be expended during each fiscal

24 year for dental services for children (including
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1 the prevention, screening, diagnosis, and treat2 ment of dental conditions); and

3 ‘‘(B) the State will not reduce or otherwise

4 adversely impact the extent to which the State

5 provides dental services to adults in order to

6 meet the requirement of subparagraph (A).’’.

7 SEC. 203. REQUIREMENT TO VERIFY SUFFICIENT NUMBERS

8 OF PARTICIPATING DENTAL HEALTH PRO9 FESSIONALS UNDER THE MEDICAID PRO10 GRAM.

11 Section 1902(a) of the Social Security Act (42 U.S.C.

12 1396a(a)), as amended by section 202, is amended—

13 (1) in paragraph (66), by striking ‘‘and’’ at the

14 end;

15 (2) in paragraph (67), by striking the period

16 and inserting ‘‘; and’’; and

17 (3) by inserting after paragraph (67) the fol18 lowing:

19 ‘‘(68) provide that the State will—

20 ‘‘(A) annually verify that the number of

21 dental health professionals (as defined in sec22 tion 332(a)(4)(C) of the Public Health Service

23 Act) participating under the State plan—

24 ‘‘(i) satisfies the minimum established

25 degree of participation of dental health
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1 professionals (as defined in section

2 332(a)(4)(C) of the Public Health Service

3 Act) to the population of children in the

4 State, as determined by the Secretary in

5 accordance with the criteria used by the

6 Secretary under section 332(a)(4) of such

7 Act (42 U.S.C. 254e(a)(4)) to designate a

8 dental health professional shortage area;

9 and

10 ‘‘(ii) is sufficient to ensure that chil11 dren enrolled in the State plan have the

12 same level of access to dental services as

13 the children residing in the State who are

14 not eligible for medical assistance under

15 the State plan; and

16 ‘‘(B) collect data on the number of chil17 dren being served by dental health professionals

18 as compared to the number of children eligible

19 to be served, and the actual services provided.’’.

20 SEC. 204. INCLUSION OF RECOMMENDED AGE FOR FIRST

21 DENTAL VISIT IN DEFINITION OF EPSDT

22 SERVICES.

23 Section 1905(r)(1)(A)(i) of the Social Security Act

24 (42 U.S.C. 1396d(r)(1)(A)(i)) is amended by inserting

25 ‘‘and, with respect to dental services under paragraph (3),
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1 in accordance with guidelines for the age of a first dental

2 visit that are consistent with guidelines of the American

3 Dental Association, the American Dental Hygienist Asso4 ciation, the American Academy of Pediatric Dentistry, and

5 the Bright Futures program of the Health Resources and

6 Services Administration of the Department of Health and

7 Human Services,’’ after ‘‘vaccines,’’.

8 SEC. 205. APPROVAL OF FINAL REGULATIONS IMPLE9 MENTING CHANGES TO EPSDT SERVICES.

10 Not later than 30 days after the date of enactment

11 of this Act, the Secretary of Health and Human Services

12 shall issue final regulations implementing the proposed

13 regulations based on section 6403 of the Omnibus Budget

14 Reconciliation Act of 1989 (Public Law 101–239; 103

15 Stat. 2262) that were contained in the Federal Register

16 issued for October 1, 1993.

17 SEC. 206. USE OF SCHIP FUNDS TO TREAT CHILDREN WITH

18 SPECIAL DENTAL HEALTH NEEDS.

19 (a) IN GENERAL.—Section 1905 of the Social Secu20 rity Act (42 U.S.C. 1396d) is amended—

21 (1) in subsection (b), by striking ‘‘or subsection

22 (u)(3)’’ and inserting ‘‘subsection (u)(3), or sub23 section (u)(4)’’; and

24 (2) in subsection (u)—
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1 (A) by redesignating paragraph (4) as

2 paragraph (5); and

3 (B) by inserting after paragraph (3) the

4 following new paragraph:

5 ‘‘(4)(A) For purposes of subsection (b), the expendi6 tures described in this paragraph are expenditures for

7 medical assistance described in subparagraph (B) for a

8 low-income child described in subparagraph (C), but only

9 in the case of such a child who resides in a State described

10 in subparagraph (D).

11 ‘‘(B) For purposes of subparagraph (A), the medical

12 assistance described in this subparagraph consists of the

13 following:

14 ‘‘(i) Dental services provided to children with

15 special oral health needs, including advanced oral,

16 dental, and craniofacial diseases and conditions.

17 ‘‘(ii) Outreach conducted to identify and treat

18 children with such special dental health needs.

19 ‘‘(C) For purposes of subparagraph (A), a low-income

20 child described in this subparagraph is a child whose fam21 ily income does not exceed 50 percentage points above the

22 medicaid applicable income level (as defined in section

23 2110(b)(4)).

24 ‘‘(D) A State described in this subparagraph is a

25 State that, as of August 5, 1997, has under a waiver au-
25

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1 thorized by the Secretary or under section 1902(r)(2), es2 tablished a medicaid applicable income level (as defined

3 in section 2110(b)(4)) for children under 19 years of age

4 residing in the State that is at or above 185 percent of

5 the poverty line (as defined in section 673(2) of the Com6 munity Services Block Grant Act (42 U.S.C. 9902(2), in7 cluding any revision required by such section for a family

8 of the size involved).’’.

9 (b) EFFECTIVE DATE.—The amendments made by

10 this section shall take effect as if included in the enact11 ment of section 4911 of the Balanced Budget Act of 1997

12 (Public Law 105–33; 111 Stat. 570).

13 SEC. 207. GRANTS TO SUPPLEMENT FEES FOR THE TREAT14 MENT OF CHILDREN WITH SPECIAL DENTAL

15 HEALTH NEEDS.

16 Title V of the Social Security Act (42 U.S.C. 701

17 et seq.) is amended by adding at the end the following:

18 ‘‘SEC. 511. GRANTS TO SUPPLEMENT FEES FOR THE TREAT19 MENT OF CHILDREN WITH SPECIAL DENTAL

20 HEALTH NEEDS.

21 ‘‘(a) AUTHORITY TO MAKE GRANTS.—

22 ‘‘(1) IN GENERAL.—In addition to any other

23 payments made under this title to a State, the Sec24 retary shall award grants to States to supplement

25 payments made under the State programs estab-
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1 lished under titles XIX and XXI for the treatment

2 of children with special oral health care needs.

3 ‘‘(2) DEFINITION OF CHILDREN WITH SPECIAL

4 ORAL, DENTAL, AND CRANIOFACIAL HEALTH CARE

5 NEEDS.—In this section the term ‘children with spe6 cial oral health care needs’ means children with oral,

7 dental and craniofacial conditions or disorders, and

8 other acute or chronic medical, genetic, and behav9 ioral disorders with dental manifestations.

10 ‘‘(b) APPLICATION OF OTHER PROVISIONS OF

11 TITLE.—

12 ‘‘(1) IN GENERAL.—Except as provided in para13 graph (2), the other provisions of this title shall not

14 apply to a grant made, or activities of the Secretary,

15 under this section.

16 ‘‘(2) EXCEPTIONS.—The following provisions of

17 this title shall apply to a grant made under sub18 section (a) to the same extent and in the same man19 ner as such provisions apply to allotments made

20 under section 502(c):

21 ‘‘(A) Section 504(b)(4) (relating to ex22 penditures of funds as a condition of receipt of

23 Federal funds).
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1 ‘‘(B) Section 504(b)(6) (relating to prohi2 bition on payments to excluded individuals and

3 entities).

4 ‘‘(C) Section 506 (relating to reports and

5 audits, but only to the extent determined by the

6 Secretary to be appropriate for grants made

7 under this section).

8 ‘‘(D) Section 508 (relating to non9 discrimination).

10 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There

11 is authorized to be appropriated such sums as may be nec12 essary to carry out this section.’’.

13 SEC. 208. DEMONSTRATION PROJECTS TO INCREASE AC14 CESS TO PEDIATRIC DENTAL SERVICES IN

15 UNDERSERVED AREAS.

16 (a) AUTHORITY TO CONDUCT PROJECTS.—The Sec17 retary of Health and Human Services, through the Admin18 istrator of the Health Care Financing Administration, the

19 Administrator of the Health Resources and Services Ad20 ministration, the Director of the Indian Health Service,

21 and the Director of the Centers for Disease Control and

22 Prevention shall establish demonstration projects that are

23 designed to increase access to dental services for children

24 in underserved areas, as determined by the Secretary.
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1 (b) AUTHORIZATION OF APPROPRIATIONS.—There is

2 authorized to be appropriated such sums as may be nec3 essary to carry out this section.

4 TITLE III—PEDIATRIC DENTAL

5 RESEARCH

6 SEC. 301. IDENTIFICATION OF INTERVENTIONS THAT RE7 DUCE THE BURDEN AND TRANSMISSION OF

8 ORAL, DENTAL, AND CRANIOFACIAL DIS9 EASES IN HIGH RISK POPULATIONS; DEVEL10 OPMENT OF APPROACHES FOR PEDIATRIC

11 ORAL AND CRANIOFACIAL ASSESSMENT.

12 (a) IN GENERAL.—The Secretary of Health and

13 Human Services, through the Maternal and Child Health

14 Bureau, the Indian Health Service, and in consultation

15 with the Agency for Health Care Policy and Research and

16 the National Institutes of Health, shall—

17 (1) support community based research that is

18 designed to improve our understanding of the eti19 ology, pathogenesis, diagnosis, prevention, and treat20 ment of pediatric oral, dental, craniofacial diseases

21 and conditions and their sequelae in high risk popu22 lations;

23 (2) support demonstrations of preventive inter24 ventions in high risk populations; and
29

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1 (3) develop clinical approaches to assess indi2 vidual patients for pediatric dental disease.

3 (b) AUTHORIZATION OF APPROPRIATIONS.—There is

4 authorized to be appropriated, such sums as may be nec5 essary to carry out this section.

6 SEC. 302. AGENCY FOR HEALTH CARE POLICY AND RE7 SEARCH.

8 Section 902(a) of the Public Health Service Act (42

9 U.S.C. 299a(a)) is amended—

10 (1) in paragraph (7), by striking ‘‘and’’ at the

11 end;

12 (2) in paragraph (8), by striking the period and

13 inserting ‘‘; and’’; and

14 (3) by adding at the end the following:

15 ‘‘(9) the barriers that exist, including access to

16 oral health care for children, and the establishment

17 of measures of oral health status and outcomes.’’.

18 SEC. 303. ORAL HEALTH PROFESSIONAL RESEARCH AND

19 TRAINING PROGRAM.

20 Part G of title IV of the Public Health Service Act

21 is amended by inserting after section 487E (42 U.S.C.

22 288–5) the following:
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1 ‘‘SEC. 487F. ORAL HEALTH PROFESSIONAL RESEARCH AND

2 TRAINING PROGRAM.

3 ‘‘(a) IN GENERAL.—The Secretary, in consultation

4 with the Director of the National Institute of Dental and

5 Craniofacial Research, shall establish a program under

6 which the Secretary will enter into contracts with qualified

7 oral health professionals and such professionals will agree

8 to conduct research or provide training with respect to pe9 diatric oral, dental, and craniofacial diseases and condi10 tions and in exchange the Secretary will agree to repay,

11 for each year of service, not more than $35,000 of the

12 principal and interest of the educational loans of such pro13 fessionals.

14 ‘‘(b) QUALIFIED ORAL HEALTH PROFESSIONAL.—

15 ‘‘(1) DEFINITION.—In this section, the term

16 ‘qualified oral health professional’ includes dentists

17 and allied dental personnel serving in faculty posi18 tions.

19 ‘‘(2) SPECIAL PREFERENCE.—In entering into

20 contacts under subsection (a), the Secretary shall

21 give preference to qualified oral health

22 professionals—

23 ‘‘(A) who are serving, or who have served

24 in research or training programs of the Na25 tional Institute of Dental and Craniofacial Re26 search; or
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1 ‘‘(B) who are providing services at institu2 tions that provide oral health care to under3 served pediatric populations in rural or border

4 areas.

5 ‘‘(c) PRIORITIES.—The Secretary shall annually de6 termine the clinical and basic research and training prior7 ities for contracts under subsection (a), including dental

8 caries, orofacial accidents or traumas, birth defects such

9 as cleft lip and palate and severe malocclusions, and new

10 techniques and approaches to treatment.

11 ‘‘(d) CONTRACTS, OBLIGATED SERVICE, AND

12 BREACH OF CONTRACT.—The provisions of section 338B

13 concerning contracts, obligated service, and breach of con14 tract, except as inconsistent with this section, shall apply

15 to contracts under this section to the same extent and in

16 the same manner as such provisions apply to contracts

17 under such section 338B.

18 ‘‘(e) AVAILABILITY OF FUNDS.—Amounts available

19 for carrying out this section shall remain available until

20 the expiration of the second fiscal year beginning after the

21 fiscal year for which such amounts were made available.’’.

22 SEC. 304. CONSENSUS DEVELOPMENT CONFERENCE.

23 (a) IN GENERAL.—Not later than April 1, 2000, the

24 Secretary of Health and Human Services, acting through

25 the National Institute of Child Health and Human Devel-
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1 opment and the National Institute of Dental and

2 Craniofacial Research, shall convene a conference (to be

3 known as the ‘‘Consensus Development Conference’’) to

4 examine the management of early childhood caries and to

5 support the design and conduct of research on the biology

6 and physiologic dynamics of infectious transmission of

7 dental caries. The Secretary shall ensure that representa8 tives of interested consumers and other professional orga9 nizations participate in the Consensus Development Con10 ference.

11 (b) EXPERTS.—In administering the conference

12 under subsection (a), the Secretary of Health and Human

13 Services shall solicit the participation of experts in den14 tistry, including pediatric dentistry, dental hygiene, public

15 health, and other appropriate medical and child health

16 professionals.

17 (c) AUTHORIZATION OF APPROPRIATIONS.—There is

18 authorized to be appropriated such sums as may be nec19 essary to carry out this section.

20 TITLE IV—SURVEILLANCE AND

21 ACCOUNTABILITY

22 SEC. 401. CDC REPORTS.

23 (a) COLLECTION OF DATA.—The Director of the

24 Centers for Disease Control and Prevention in collabora25 tion with other organizations and agencies shall annually
33

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1 collect data describing the dental, craniofacial, and oral

2 health of residents of at least 1 State from each region

3 of the Department of Health and Human Services.

4 (b) REPORTS.—The Director shall compile and ana5 lyze data collected under subsection (a) and annually pre6 pare and submit to the appropriate committees of Con7 gress a report concerning the oral health of certain States.

8 SEC. 402. REPORTING REQUIREMENTS UNDER THE MED9 ICAID PROGRAM.

10 Section 1902(a)(43)(D) of the Social Security Act

11 (42 U.S.C. 1396a(43)(D)) is amended—

12 (1) in clause (iii), by striking ‘‘and’’ and insert13 ing ‘‘with the specific dental condition and treatment

14 provided identified,’’;

15 (2) in clause (iv), by striking the semicolon and

16 inserting a comma; and

17 (3) by adding at the end the following:

18 ‘‘(v) the percentage of expenditures

19 for such services that were for dental serv20 ices,

21 ‘‘(vi) the percentage of dental health

22 professionals (as defined in section

23 332(a)(4)(C) of the Public Health Service

24 Act) who are licensed in the State and pro-
34

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1 vide services commensurate with eligibility

2 under the State plan, and

3 ‘‘(vii) collect and submit data on the

4 number of children being served as com5 pared to the number of children who are

6 eligible for services, and the actual services

7 provided;’’.

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

9 FAMILIES.

10 The Administrator of the Administration on Chil11 dren, Youth, and Families shall annually prepare and sub12 mit to the appropriate committees of Congress a report

13 concerning the percentage of children enrolled in a Head

14 Start or Early Start program who have access to and who

15 obtain dental care, including children with special oral,

16 dental, and craniofacial health needs. The Administrator

17 of the Administration of Children, Youth and Families

18 shall seek methods to reestablish intraagency agreements

19 with the Administrator of the Health Resources and Serv20 ices Administration to address technical assistance for its

21 grantees in addressing access to preventive clinical serv22 ices.
35

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1 SEC. 404. SPECIAL SUPPLEMENTAL FOOD PROGRAM FOR

2 WOMEN, INFANTS, AND CHILDREN.

3 Section 17(f) of the Child Nutrition Act of 1966 (42

4 U.S.C. 1786(f)) is amended by adding at the end the fol5 lowing:

6 ‘‘(25) The State shall collect and submit data on the

7 number of children being served under this section as com8 pared to the number of children who are eligible for serv9 ices, and the actual services provided.’’.

10 TITLE V—ORAL HEALTH PRO11 MOTION AND DISEASE PRE12 VENTION

13 SEC. 501. GRANTS TO INCREASE RESOURCES FOR COMMU14 NITY WATER FLUORIDATION.

15 (a) IN GENERAL.—The Secretary of Health and

16 Human Services, acting through the Director of the Divi17 sion of Oral Health of the Centers for Disease Control

18 and Prevention, may make grants to State or locality for

19 the purpose of increasing the resources available for com20 munity water fluoridation.

21 (b) USE OF FUNDS.—A State shall use amounts pro22 vided under a grant under subsection (a)—

23 (1) to purchase fluoridation equipment;

24 (2) to train fluoridation engineers; or

25 (3) to develop educational materials on the ad26 vantages of fluoridation.
36

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1 (c) AUTHORIZATION OF APPROPRIATIONS.—There is

2 authorized to be appropriated to carry out this section,

3 $25,000,000 for fiscal year 2000, and such sums as may

4 be necessary for each subsequent fiscal year.

5 SEC. 502. COMMUNITY WATER FLUORIDATION.

6 (a) IN GENERAL.—The Secretary of Health and

7 Human Services (referred to in this section as the ‘‘Sec8 retary’’), acting through the Director of the Indian Health

9 Service and the Director of the Centers for Disease Con10 trol and Prevention, shall establish a demonstration

11 project that is designed to assist rural water systems in

12 successfully implementing the Centers for Disease Control

13 and Prevention water fluoridation guidelines entitled ‘‘En14 gineering and Administrative Recommendations for Water

15 Fluoridation’’ (referred to in this section as the

16 ‘‘EARWF’’).

17 (b) REQUIREMENTS.—

18 (1) COLLABORATION.—The Director of the In19 dian Health Services shall collaborate with the Di20 rector of the Centers for Disease Control and Pre21 vention in developing the project under subsection

22 (a). Through such collaboration the Directors shall

23 ensure that technical assistance and training are

24 provided to tribal programs located in each of the 12

25 areas of the Indian Health Service. The Director of
37

•S 901 IS

1 the Indian Health Service shall provide coordination

2 and administrative support to tribes under this sec3 tion.

4 (2) GENERAL USE OF FUNDS.—Amounts made

5 available under this section shall be used to assist

6 small water systems in improving the effectiveness of

7 water fluoridation and to meet the recommendations

8 of the EARWF.

9 (3) FLUORIDATION SPECIALISTS.—

10 (A) IN GENERAL.—In carrying out this

11 section, the Secretary shall provide for the es12 tablishment of fluoridation specialist engineer13 ing positions in each of the Dental Clinical and

14 Preventive Support Centers through which tech15 nical assistance and training will be provided to

16 tribal water operators, tribal utility operators

17 and other Indian Health Service personnel

18 working directly with fluoridation projects.

19 (B) LIAISON.—A fluoridation specialist

20 shall serve as the principal technical liaison be21 tween the Indian Health Service and the Cen22 ters for Disease Control and Prevention with

23 respect to engineering and fluoridation issues.

24 (C) CDC.—The Director of the Centers

25 for Disease Control and Prevention shall ap-
38

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1 point individuals to serve as the fluoridation

2 specialists.

3 (4) IMPLEMENTATION.—The project established

4 under this section shall be planned, implemented

5 and evaluated over the 5-year period beginning on

6 the date on which funds are appropriated under this

7 section and shall be designed to serve as a model for

8 improving the effectiveness of water fluoridation sys9 tems of small rural communities.

10 (c) EVALUATION.—In conducting the ongoing evalua11 tion as provided for in subsection (b)(4), the Secretary

12 shall ensure that such evaluation includes—

13 (1) the measurement of changes in water fluori14 dation compliance levels resulting from assistance

15 provided under this section;

16 (2) the identification of the administrative,

17 technical and operational challenges that are unique

18 to the fluoridation of small water systems;

19 (3) the development of a practical model that

20 may be easily utilized by other tribal, State, county

21 or local governments in improving the quality of

22 water fluoridation with emphasis on small water sys23 tems; and
39

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1 (4) the measurement of any increased percent2 age of Native Americans or Alaskan Natives who re3 ceive the benefits of optimally fluoridated water.

4 (d) AUTHORIZATION OF APPROPRIATIONS.—There is

5 authorized to be appropriated to carry out this section,

6 $25,000,000 for fiscal year 2000, and such sums as may

7 be necessary for each subsequent fiscal year.

8 SEC. 503. SCHOOL-BASED DENTAL SEALANT PROGRAM.

9 (a) IN GENERAL.—The Secretary of Health and

10 Human Services, acting through the Director of the Ma11 ternal and Child Health Bureau of the Health Resources

12 and Services Administration, may award grants to States

13 or localities to provide for the development of school-based

14 dental sealant programs to improve the access of children

15 to sealants.

16 (b) USE OF FUNDS.—A State shall use amounts re17 ceived under a grant under subsection (a) to provide funds

18 to eligible school-based entities or to public elementary or

19 secondary schools to enable such entities or schools to pro20 vide children in second or sixth grade with access to dental

21 care and dental sealant services. Such services shall be

22 provided by licensed dental health professionals in accord23 ance with State practice licensing laws.

24 (c) ELIGIBILITY.—To be eligible to receive funds

25 under this section an entity shall—
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1 (1) prepare and submit to the State an applica2 tion at such time, in such manner and containing

3 such information as the State may require; and

4 (2) be a public elementary or secondary

5 school—

6 (A) that located in an urban area and in

7 which and more than 50 percent of the student

8 population is participating in Federal or State

9 free or reduced meal programs; or

10 (B) that is located in a rural area and,

11 with respect to the school district in which the

12 school is located, the district involved has a me13 dian income that is at or below 235 percent of

14 the poverty line, as defined in section 673(2) of

15 the Community Services Block Grant Act (42

16 U.S.C. 9902(2)).

17 Preference in awarding grants shall be provided to eligible

18 entities that use dental health care professionals in the

19 most cost effective manner.

20 (d) COORDINATION WITH OTHER PROGRAMS.—

21 (1) IN GENERAL.—An entity that receives funds

22 from a State under this section shall serve as an en23 rollment site for purposes of enabling individuals to

24 enroll in the State plan under title XIX of the Social

25 Security Act (42 U.S.C. 1396 et seq.) or in the
41

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1 State Children’s Health Insurance Program under

2 title XXI of such Act (42 U.S.C. 1397aa et seq.).

3 (2) CONFORMING AMENDMENT.—Section

4 1920A(b)(3)(A)(i) of the Social Security Act (42

5 U.S.C. 1396r–1a(b)(3)(A)(i)) is amended—

6 (A) by striking ‘‘or (II)’’ and inserting ‘‘,

7 (II)’’; and

8 (B) by inserting ‘‘, or (III) is an eligible

9 community-based entity or a public elementary

10 or secondary school that participates in the

11 school-based dental sealant program established

12 under section 503 of the Children’s Dental

13 Health Improvement Act of 1999’’ before the

14 semicolon.

15 (e) AUTHORIZATION OF APPROPRIATIONS.—There is

16 authorized to be appropriated to carry out this section,

17 $5,000,000 for fiscal year 2000, and such sums as may

18 be necessary for each subsequent fiscal year.

19 TITLE VI—MISCELLANEOUS

20 SEC. 601. EFFECTIVE DATE.

21 (a) IN GENERAL.—Except as otherwise provided in

22 this Act, this Act and the amendments made by this Act

23 take effect on the date of enactment of this Act.

24 (b) EXTENSION OF EFFECTIVE DATE FOR STATE

25 LAW AMENDMENT.—In the case of a State plan under
42

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1 title XIX of the Social Security Act which the Secretary

2 of Health and Human Services determines requires State

3 legislation in order for the plan to meet the additional re4 quirements imposed by the amendments made by this Act,

5 the State plan shall not be regarded as failing to comply

6 with the requirements of such amendments solely on the

7 basis of its failure to meet the additional requirements be8 fore the first day of the first calendar quarter beginning

9 after the close of the first regular session of the State leg10 islature that begins after the date of the enactment of this

11 Act. For purposes of the previous sentence, in the case

12 of a State that has a 2-year legislative session, each year

13 of the session is considered to be a separate regular ses14 sion of the State legislature.

Æ