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[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 3017 Introduced in Senate (IS)]

<DOC>

117th CONGRESS
  1st Session
                                S. 3017

 To expand the provision and availability of dental care furnished by 
      the Department of Veterans Affairs, and for other purposes.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                            October 20, 2021

     Mr. Sanders (for himself, Mr. Blumenthal, Mr. Menendez, Mrs. 
Gillibrand, Mr. Booker, and Ms. Hirono) introduced the following bill; 
which was read twice and referred to the Committee on Veterans' Affairs

_______________________________________________________________________

                                 A BILL

 
 To expand the provision and availability of dental care furnished by 
      the Department of Veterans Affairs, and for other purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Veterans Dental Care Eligibility 
Expansion and Enhancement Act''.

SEC. 2. SENSE OF CONGRESS.

    It is the sense of Congress that--
            (1) the Department of Veterans Affairs has pioneered a 
        whole health approach to health care, which brought mental 
        health and suicide prevention under the umbrella of primary 
        care and integrated health, provides access to alternative 
        medicines, delivers a holistic approach to health and well-
        being, and repeatedly demonstrates better health outcomes than 
        the private sector at a low cost to taxpayers in the United 
        States;
            (2) the effects of poor dental care are seen in patients 
        who are at risk of or diagnosed with diabetes, cardiovascular 
        disease, pulmonary conditions, kidney impairment, and even 
        dementia;
            (3) the Department spends countless dollars on prescription 
        drugs, community care, urgent care, and emergency room visits 
        on preventable ailments that would be reduced or eliminated 
        through preventative dental care; and
            (4) in order to best achieve a whole health model for the 
        provision of health care to veterans and reduce long-term 
        costs, the Department must furnish veterans with preventative 
        and comprehensive dental care.

SEC. 3. REQUIREMENT THAT SECRETARY OF VETERANS AFFAIRS FURNISH DENTAL 
              CARE IN THE SAME MANNER AS ANY OTHER MEDICAL SERVICE.

    (a) In General.--Title 38, United States Code, is amended--
            (1) in section 1701(6)(B), by striking ``as described in 
        sections 1710 and 1712 of this title'';
            (2) in section 1710(c), by striking the second sentence; 
        and
            (3) in section 1712--
                    (A) by striking subsections (a) and (b);
                    (B) by redesignating subsections (c), (d), and (e) 
                as subsections (a), (b), and (c), respectively; and
                    (C) in subsection (a), as redesignated by 
                subparagraph (B)--
                            (i) by striking ``Dental appliances'' and 
                        inserting ``The Secretary may furnish dentures, 
                        dental appliances''; and
                            (ii) by striking ``to be furnished by the 
                        Secretary under this section may be procured by 
                        the Secretary'' and inserting ``under this 
                        section and may procure such appliances''.
    (b) Conforming and Clerical Amendments.--
            (1) Conforming amendments.--
                    (A) Protection of health care eligibility.--Section 
                1525(a) of such title is amended by striking 
                ``medicines under section 1712(d)'' and inserting 
                ``medicines under section 1712(b)''.
                    (B) Dental insurance plan.--Section 1712C(h) of 
                such title is amended--
                            (i) by striking ``section 1712 of this 
                        title'' and inserting ``this chapter''; and
                            (ii) by striking ``such section 1712'' and 
                        inserting ``this chapter''.
            (2) Heading amendment.--The heading for section 1712 of 
        such title is amended to read as follows:
``Sec. 1712. Appliances; drugs and medicines for certain disabled 
              veterans; vaccines''.
            (3) Clerical amendment.--The table of sections at the 
        beginning of subchapter II of chapter 17 of such title is 
        amended by striking the item relating to section 1712 and 
        inserting the following new item:

``1712. Appliances; drugs and medicines for certain disabled veterans; 
                            vaccines.''.
    (c) Effective Date.--The amendments made by this section shall take 
effect on the date that is one year after the date of the enactment of 
this Act.

SEC. 4. EXPANSION OF FURNISHING BY DEPARTMENT OF VETERANS AFFAIRS OF 
              DENTAL CARE TO ALL ENROLLED VETERANS.

    (a) In General.--The Secretary of Veterans Affairs shall furnish 
dental care to all veterans enrolled in the system of annual patient 
enrollment of the Department of Veterans Affairs established and 
operated under section 1705(a) of title 38, United States Code, 
pursuant to the phased approach required under this section.
    (b) Phase One Required.--
            (1) Commencement.--
                    (A) In general.--Commencing not later than one year 
                after the date of the enactment of this Act, the 
                Secretary of Veterans Affairs shall furnish dental care 
                to all covered veterans who are not eligible for dental 
                services and treatment and related dental appliances 
                under the laws administered by the Secretary as of the 
                date of the enactment of this Act.
                    (B) Phase one.--In this section, the furnishing of 
                dental care under subparagraph (A) shall be referred to 
                as ``phase one''.
            (2) Duration of phase one.--Phase one shall be carried out 
        during the two-year period beginning on the date of the 
        commencement of phase one.
            (3) Locations.--
                    (A) In general.--The Secretary shall carry out 
                phase one at the following locations:
                            (i) Each medical center of the Department 
                        with an established dental clinic.
                            (ii) Not fewer than four military medical 
                        treatment facilities of the Department of 
                        Defense with the capacity to furnish dental 
                        care, which shall be selected in consultation 
                        with the Secretary of Defense.
                            (iii) Not fewer than four community-based 
                        outpatient clinics with space available for the 
                        furnishing of dental care under phase one.
                            (iv) Not fewer than four Federally 
                        Qualified Health Centers.
                            (v) Not fewer than four facilities of the 
                        Indian Health Service with established dental 
                        clinics, which shall be selected in 
                        consultation with the Secretary of Health and 
                        Human Services.
                    (B) Considerations.--In selecting locations for 
                phase one, the Secretary shall consider the feasibility 
                and advisability of selecting locations in each of the 
                following:
                            (i) Rural areas.
                            (ii) Areas that are not in close proximity 
                        to an active duty military installation.
                            (iii) Areas representing different 
                        geographic locations, such as census tracts 
                        established by the Bureau of the Census.
                    (C) Mobile dental clinics.--In carrying out phase 
                one, the Secretary shall test the efficacy of mobile 
                dental clinics to service rural areas that do not have 
                a population base to warrant a full-time clinic but 
                where there are covered veterans in need of dental 
                care.
                    (D) Home-based dental care.--In carrying out phase 
                one, the Secretary shall test the efficacy of portable 
                dental care units to service rural veteran in their 
                homes, as the Secretary considers medically 
                appropriate.
            (4) Scope of services.--The dental care furnished to 
        covered veterans under phase one shall be consistent with the 
        dental services and treatment furnished by the Secretary to 
        veterans with service-connected disabilities rated 100-percent 
        disabling under the laws administered by the Secretary.
            (5) Use of telemedicine.--When providing dental services 
        via telemedicine under phase one, the Secretary shall use 
        Federal employees to the maximum extent possible.
            (6) Voluntary participation.--The participation of a 
        covered veteran in phase one shall be at the election of the 
        veteran.
            (7) Copayments.--The Secretary may collect copayments for 
        dental care furnished under phase one in accordance with 
        authorities on the collection of copayments for medical care of 
        veterans under chapter 17 of title 38, United States Code.
            (8) Administration.--
                    (A) Notice to covered veterans on phase one.--In 
                carrying out phase one, the Secretary shall inform all 
                covered veterans of the services and treatment 
                available under phase one.
                    (B) Contracts.--
                            (i) In general.--Subject to clause (iii), 
                        in carrying out phase one, the Secretary may 
                        enter into contracts with appropriate entities 
                        for the provision of dental care under phase 
                        one.
                            (ii) Performance standards and metrics.--
                        Each contract entered into under clause (i) 
                        shall specify performance standards and metrics 
                        and processes for ensuring compliance of the 
                        contractor concerned with such performance 
                        standards.
                            (iii) Limitation.--The Secretary may only 
                        enter into contracts under clause (i) if the 
                        Secretary determines that the Department does 
                        not employ, and cannot recruit and retain, 
                        qualified dentists, dental hygienists, and oral 
                        surgeons in the applicable location.
            (9) Definitions.--In this subsection:
                    (A) Covered veteran.--The term ``covered veteran'' 
                means a veteran enrolled in the system of annual 
                patient enrollment of the Department of Veterans 
                Affairs established and operated under section 1705(a) 
                of title 38, United States Code, pursuant to paragraph 
                (1) or (2) of such section.
                    (B) Federally qualified health center.--The term 
                ``Federally Qualified Health Center'' means a 
                Federally-qualified health center as defined in section 
                1905(l)(2)(B) of the Social Security Act (42 U.S.C. 
                1396d(l)(2)(B)).
    (c) Expansion.--
            (1) In general.--After the completion of phase one, the 
        Secretary shall expand the provision of dental care under this 
        section to all veterans, including through the use of the 
        recommendations of the Secretary under subsection (d)(2)(F), as 
        follows:
                    (A) In phase two, which shall--
                            (i) commence not later than 90 days after 
                        the completion of phase one; and
                            (ii) consist of the provision of dental 
                        care to all veterans enrolled in the system of 
                        annual patient enrollment of the Department of 
                        Veterans Affairs established and operated under 
                        section 1705(a) of title 38, United States 
                        Code, pursuant to paragraph (1), (2), (3), or 
                        (4) of such section.
                    (B) In phase three, which shall--
                            (i) commence not later than 90 days after 
                        the completion of phase two; and
                            (ii) consist of the provision of dental 
                        care to all veterans enrolled in such system 
                        pursuant to paragraph (1), (2), (3), (4), (5), 
                        or (6) of such section.
                    (C) In phase four, which shall--
                            (i) commence not later than 90 days after 
                        the completion of phase three; and
                            (ii) consist of the provision of dental 
                        care to all veterans enrolled in such system.
            (2) Facility expansion.--Under each phase specified in 
        paragraph (1), the Secretary shall expand the number of 
        facilities described in subsection (b)(3) furnishing dental 
        care under this section commensurate to the number of new 
        veterans furnished care under such phase, including through the 
        use of any other facilities to which veterans have access.
            (3) Duration.--Each phase specified in paragraph (1) shall 
        be carried out during a period not to exceed two years and all 
        such phases, including phase one, shall be carried out for a 
        period not to exceed eight years.
            (4) Conclusion.--Upon the conclusion of phase four 
        specified under paragraph (1)(C), all veterans enrolled in the 
        system of annual patient enrollment of the Department of 
        Veterans Affairs established and operated under section 1705(a) 
        of title 38, United States Code, shall be eligible for dental 
        care from the Department.
    (d) Reports.--
            (1) In general.--Not later than 90 days before the 
        completion of phase one, and not later than 180 days after the 
        completion of each subsequent phase under subsection (c)(1), 
        the Secretary shall submit to the Committee on Veterans' 
        Affairs and the Committee on Armed Services of the Senate and 
        the Committee on Veterans' Affairs and the Committee on Armed 
        Services of the House of Representatives a report on the phase 
        about to be completed and the plans of the Secretary for 
        implementation of expansion of the provision of dental care 
        pursuant to subsection (c).
            (2) Contents.--Each report under paragraph (1) shall 
        include the following:
                    (A) A description of the implementation and 
                operation of the phase covered by the report.
                    (B) The number of veterans receiving dental care 
                under such phase and a description of the dental care 
                furnished to such veterans.
                    (C) An analysis of the costs and benefits of such 
                phase, including a comparison of costs and benefits by 
                location type.
                    (D) An assessment of the impact of such phase on 
                appointments for care, prescriptions, hospitalizations, 
                emergency room visits, wellness, employability, and 
                satisfaction of patients, and perceived quality of life 
                of veterans.
                    (E) An analysis and assessment of the efficacy of 
                mobile clinics and home-based dental care to service 
                the dental needs of veterans during such phase.
                    (F) The findings and conclusions of the Secretary 
                with respect to such phase.
                    (G) A comparison of the costs for private sector 
                dental care with cost of furnishing dental care from 
                the Department, broken down by each locality included 
                in such phase.
                    (H) Such recommendations for the expansion of 
                dental care pursuant to subsection (c) as the Secretary 
                considers appropriate.

SEC. 5. REQUIREMENT OF DENTAL CLINIC OF DEPARTMENT OF VETERANS AFFAIRS 
              IN EACH STATE.

    (a) In General.--The Secretary of Veterans Affairs shall ensure 
that each State has a dental clinic of the Department of Veterans 
Affairs to service the needs of the veterans within that State.
    (b) Effective Date.--This section shall take effect on the date 
that is one year after the date of the enactment of this Act.

SEC. 6. PROGRAM ON EDUCATION TO PROMOTE DENTAL HEALTH IN VETERANS.

    (a) Program Required.--The Secretary of Veterans Affairs shall 
carry out a program of education to promote dental health for veterans 
who are enrolled in the system of annual patient enrollment of the 
Department of Veterans Affairs established and operated under section 
1705(a) of title 38, United States Code.
    (b) Elements.--The program required by subsection (a) shall provide 
education for veterans on the following:
            (1) The association between dental health and overall 
        health and well-being.
            (2) Proper techniques for dental care.
            (3) Signs and symptoms of commonly occurring dental 
        conditions.
            (4) Treatment options for commonly occurring dental issues.
            (5) Options for obtaining access to dental care, including 
        information on eligibility for dental care through the 
        Department.
            (6) Available and accessible options for obtaining low or 
        no-cost dental care, including through dental schools and 
        Federally Qualified Health Centers.
            (7) Such other matters relating to dental health as the 
        Secretary considers appropriate.
    (c) Delivery of Educational Materials.--
            (1) In general.--The Secretary shall provide educational 
        materials to veterans under the program required by subsection 
        (a) through a variety of mechanisms, including the following:
                    (A) The availability and distribution of print 
                materials at facilities of the Department (including at 
                medical centers, clinics, Vet Centers, and readjustment 
                counseling centers) and to providers (including members 
                of Patient Aligned Care Teams).
                    (B) The availability and distribution of materials 
                over the internet, including through webinars, My 
                HealtheVet, and VA.gov.
                    (C) Presentations by the dental program office of 
                the Department of information, including both small 
                group and large group presentations, and distribution 
                of such information to all locations in which the 
                program is being carried out.
            (2) Selection of mechanisms.--In selecting mechanisms under 
        paragraph (1), the Secretary shall select mechanisms designed 
        to maximize the number of veterans who receive education under 
        the program.
    (d) Construction.--Nothing in this section shall be construed to 
alter or revise the eligibility of any veteran for dental care under 
the laws administered by the Secretary.
    (e) Definitions.--In this section--
            (1) Federally qualified health center.--The term 
        ``Federally Qualified Health Center'' means a Federally-
        qualified health center as defined in section 1905(l)(2)(B) of 
        the Social Security Act (42 U.S.C. 1396d(l)(2)(B)).
            (2) Vet center.--The term ``Vet Center'' has the meaning 
        given that term in section 1712A(h) of title 38, United States 
        Code.
    (f) Effective Date.--This section shall take effect on the date 
that is one year after the date of the enactment of this Act.

SEC. 7. STUDENT LOAN REPAYMENT PROGRAM TO INCENTIVIZE DENTAL TRAINING 
              AND ENSURE THE DENTAL WORKFORCE OF THE DEPARTMENT OF 
              VETERANS AFFAIRS.

    (a) Program Required.--The Secretary of Veterans Affairs, to ensure 
that the Department of Veterans Affairs has sufficient staff to provide 
dental service to veterans, shall implement a loan reimbursement 
program for qualified dentists, dental hygienists, and oral surgeons 
who agree--
            (1) to be appointed by the Secretary as a dentist, dental 
        hygienist, or oral surgeon, as the case may be, under section 
        7401 of title 38, United States Code; and
            (2) to serve as a dentist, dental hygienist, or oral 
        surgeon, as the case may be, of the Department pursuant to such 
        appointment at a dental clinic of the Department for a period 
        of not less than five years.
    (b) Maximum Amount.--The Secretary may reimburse not more than--
            (1) $75,000 for each dentist participating in the program 
        under subsection (a);
            (2) $10,000 for each dental hygienist participating in such 
        program; and
            (3) $20,000 for each oral surgeon participating in such 
        program.
    (c) Selection of Locations.--The Secretary shall monitor demand 
among veterans for dental care and require participants in the program 
under subsection (a) to choose from dental clinics of the Department 
with the greatest need for dentists, dental hygienists, or oral 
surgeons, as the case may be, according to facility enrollment and 
patient demand.

SEC. 8. EDUCATIONAL AND TRAINING PARTNERSHIPS FOR DENTISTS, DENTAL 
              HYGIENISTS, AND ORAL SURGEONS.

    The Secretary of Veterans Affairs shall enter into educational and 
training partnerships with dental schools to provide training and 
employment opportunities for dentists, dental hygienists, and oral 
surgeons.

SEC. 9. AUTHORIZATION OF APPROPRIATIONS.

    (a) In General.--There is authorized to be appropriated for the 
Department of Veterans Affairs for fiscal year 2021 such sums as may be 
necessary to carry out this Act and the amendments made by this Act.
    (b) Availability.--The amount authorized to be appropriated under 
subsection (a) shall be available for obligation for the eight-year 
period beginning on the date that is one year after the date of the 
enactment of this Act.
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