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[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[S. 3272 Introduced in Senate (IS)]

112th CONGRESS
  2d Session
                                S. 3272

 To improve access to oral health care for vulnerable and underserved 
                              populations.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                              June 7, 2012

  Mr. Sanders introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL

 
 To improve access to oral health care for vulnerable and underserved 
                              populations.

    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 ``Comprehensive Dental Reform Act of 
2012''.

SEC. 2. TABLE OF CONTENTS.

    The table of contents of this Act is as follows:

Sec. 1. Short title.
Sec. 2. Table of contents.
Sec. 3. Findings.
                     TITLE I--MEDICARE AND MEDICAID

                          Subtitle A--Medicare

Sec. 101. Coverage of dental services under the Medicare program.
                          Subtitle B--Medicaid

Sec. 111. Coverage of dental services under the Medicaid program.
                       Subtitle C--Grant Programs

Sec. 121. Case management grant program.
                    TITLE II--PUBLIC HEALTH PROGRAMS

               Subtitle A--National Health Service Corps

Sec. 201. National Health Service Corps.
                   Subtitle B--Oral Health Education

Sec. 211. Authorization of appropriations for oral health education for 
                            medical providers.
Sec. 212. Oral health education for other non-health professionals.
Sec. 213. Dental education.
Sec. 214. Oral health professional student loans.
                 Subtitle C--Other Oral Health Programs

Sec. 221. Access points.
Sec. 222. Dental clinics in schools.
Sec. 223. Emergency room care coordination.
Sec. 224. Research funding.
Sec. 225. Mobile and portable dental services.
  TITLE III--DEPARTMENT OF VETERANS AFFAIRS AND DEPARTMENT OF DEFENSE 
                                MATTERS

           Subtitle A--Department of Veterans Affairs Matters

Sec. 301. Requiring Secretary of Veterans Affairs to furnish dental 
                            care in same manner as any other medical 
                            service.
Sec. 302. Demonstration program on training and employment of 
                            alternative dental health care providers 
                            for dental health care services for 
                            veterans in rural and other underserved 
                            communities.
               Subtitle B--Department of Defense Matters

Sec. 311. Demonstration program on training and employment of 
                            alternative dental health care providers 
                            for dental health care services for members 
                            of the Armed Forces and dependents lacking 
                            ready access to such services.
                  TITLE IV--FEDERAL BUREAU OF PRISONS

Sec. 401. Demonstration program on training and employment of 
                            alternative dental health care providers 
                            for dental health care services for 
                            prisoners within the custody of the Bureau 
                            of Prisons.
                     TITLE V--INDIAN HEALTH SERVICE

Sec. 501. Demonstration program on training and employment of 
                            alternative dental health care providers 
                            for dental health care services under the 
                            Indian Health Service.
                     TITLE VI--REPORTS TO CONGRESS

Sec. 601. Evaluation of expansion of coverage for dental services.
                           TITLE VII--FUNDING

Sec. 701. Transaction tax.

SEC. 3. FINDINGS.

    Congress makes the following findings:
            (1) The United States must establish a nationwide and 
        comprehensive approach to address the lack of access to needed 
        dental care and reduce oral health disparities.
            (2) Since 2000, when the Surgeon General of the United 
        States called dental disease a ``silent epidemic'', there has 
        been increasing but still insufficient attention given to 
        addressing oral health issues. The Healthy People 2020 
        initiative includes oral health as a leading health indicator 
        for the first time in the history of the Healthy People 
        program, and in 2011, the Institute of Medicine published 2 
        reports, ``Improving Access to Oral Health Care for Vulnerable 
        and Underserved Populations'' and ``Advancing Oral Health in 
        America'', that focused on oral health.
            (3) Dental caries, commonly known as cavities, are the most 
        common chronic disease for children in the United States, 
        affecting nearly 60 percent of children between 5 and 17 years 
        of age. Additionally, 25 percent of American adults who have 
        attained 65 years of age have lost all of their teeth.
            (4) Untreated oral health problems contribute to an 
        increased risk for serious medical conditions such as diabetes, 
        hospital-acquired pneumonia, and poor birth outcomes.
            (5) More than 47,000,000 individuals reside in areas where 
        it is difficult to access dental care. Only 45 percent of 
        Americans over 2 years of age have had a dental visit in the 
        preceding 12 months, and approximately 17,000,000 low-income 
        children go each year without seeing a dentist.
            (6) While the lack of access to oral health services is a 
        national problem, those who are most likely to remain 
        underserved are individuals with low incomes, racial and ethnic 
        minorities, pregnant women, older adults, individuals with 
        special needs, and individuals living in rural communities.
            (7) Nearly 9,500 additional dental providers are needed in 
        order to meet this Nation's current oral health needs, 
        especially to work in areas where the need for dental care is 
        the greatest. Only 20 percent of practicing dentists in the 
        United States provide care to individuals enrolled in Medicaid, 
        and a very small percentage of dentists devote a substantial 
        part of their practice towards caring for individuals who are 
        underserved.
            (8) Over 40 percent of the total expenditures on dental 
        care in the United States are out-of-pocket payments by 
        individuals.
            (9) The Medicare program and the Department of Veterans 
        Affairs do not provide dental coverage to the majority of their 
        beneficiaries, and States can elect whether to provide dental 
        coverage to adults under the Medicaid program.
            (10) The number of individuals without dental health 
        insurance is 3 times higher than the number of individuals who 
        lack general health insurance.
            (11) The lack of access to oral health services can be 
        extremely costly, resulting in higher health care expenditures. 
        In 2009, there were over 830,000 visits to emergency rooms 
        across the United States for preventable dental conditions, 
        which is 16 percent higher than in 2006.
            (12) According to a report by the Surgeon General of the 
        United States, students miss more than 51,000,000 hours of 
        school and employed adults lose more than 164,000,000 hours of 
        work each year due to dental disease and dental visits.

                     TITLE I--MEDICARE AND MEDICAID

                          Subtitle A--Medicare

SEC. 101. COVERAGE OF DENTAL SERVICES UNDER THE MEDICARE PROGRAM.

    (a) Coverage.--Section 1861(s)(2) of the Social Security Act (42 
U.S.C. 1395x(s)(2)) is amended--
            (1) in subparagraph (EE), by striking ``and'' after the 
        semicolon at the end;
            (2) in subparagraph (FF), by adding ``and'' after the 
        semicolon at the end; and
            (3) by adding at the end the following new subparagraph:
            ``(GG) dental services (as defined in subsection (iii));''.
    (b) Dental Services Defined.--Section 1861(s) of the Social 
Security Act (42 U.S.C. 1395x(s)) is amended by adding at the end the 
following new subsection:

                           ``Dental Services

    ``(iii)(1) The term `dental services' means oral health services 
(as defined by the Secretary) provided by a licensed oral health care 
provider that are necessary to prevent disease and promote oral health, 
restore oral structures to health and function, and treat emergency 
conditions.
    ``(2) For purposes of paragraph (1), such term shall include mobile 
and portable oral health services (as defined by the Secretary) that--
            ``(A) are provided for the purpose of overcoming mobility, 
        transportation, and access barriers for individuals; and
            ``(B) satisfy the standards and certification requirements 
        established under section 1902(a)(84)(B) for the State in which 
        the services are provided.''.
    (c) Payment and Coinsurance.--Section 1833(a)(1) of the Social 
Security Act (42 U.S.C. 1395l(a)(1)) is amended--
            (1) by striking ``and'' before ``(Z)''; and
            (2) by inserting before the semicolon at the end the 
        following: ``, and (AA) with respect to dental services (as 
        defined in section 1861(iii)), the amount paid shall be (i) in 
        the case of such services that are dental health preventive 
        services described in paragraph (1)(D) of such section, 100 
        percent of the lesser of the actual charge for the services or 
        the amount determined under the payment basis determined under 
        section 1848, and (ii) in the case of all other such services, 
        80 percent of the lesser of the actual charge for the services 
        or the amount determined under the payment basis determined 
        under section 1848''.
    (d) Payment Under Physician Fee Schedule.--Section 1848(j)(3) of 
the Social Security Act (42 U.S.C. 1395w-4(j)(3)) is amended by 
inserting ``(2)(GG),'' after ``risk assessment),''.
    (e) Dentures.--Section 1861(s)(8) of the Social Security Act (42 
U.S.C. 1395x(s)(8)) is amended--
            (1) by striking ``(other than dental)'' and inserting 
        ``(including dentures)''; and
            (2) by striking ``internal body''.
    (f) Repeal of Ground for Exclusion.--Section 1862(a) of the Social 
Security Act (42 U.S.C. 1395y) is amended by striking paragraph (12).
    (g) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after January 1, 2013.

                          Subtitle B--Medicaid

SEC. 111. COVERAGE OF DENTAL SERVICES UNDER THE MEDICAID PROGRAM.

    (a) In General.--Section 1905 of the Social Security Act (42 U.S.C. 
1396d) is amended--
            (1) in subsection (a)(10), by adding ``(as described in 
        subsection (ee)(1))'' after ``dental services''; and
            (2) by adding at the end the following:
    ``(ee)(1) Subject to paragraphs (2) and (3), for purposes of this 
title, the term `dental services' means oral health services (as 
defined by the Secretary) provided by a licensed oral health care 
provider that are necessary to prevent disease and promote oral health, 
restore oral structures to health and function, and treat emergency 
conditions.
    ``(2) For purposes of paragraph (1), such term shall include mobile 
and portable oral health services (as defined by the Secretary) that--
            ``(A) are provided for the purpose of overcoming mobility, 
        transportation, and access barriers for individuals; and
            ``(B) satisfy the standards and certification requirements 
        established under section 1902(a)(84)(B) for the State in which 
        the services are provided.
    ``(3) For purposes of paragraph (1), such term shall not apply to 
dental care or services provided to individuals under the age of 21 
under subsection (r)(3).''.
    (b) Conforming Amendments.--Section 1902(a) of such Act (42 U.S.C. 
1396a(a)) is amended--
            (1) in paragraph (10)(A), in the matter preceding clause 
        (i), by inserting ``(10),'' after ``(5),'';
            (2) in paragraph (82)(C), by striking ``and'' at the end;
            (3) in paragraph (83), by striking the period at the end 
        and inserting ``; and''; and
            (4) by inserting after paragraph (83) the following:
            ``(84) provide for--
                    ``(A) informing, in writing, all individuals who 
                have been determined to be eligible for medical 
                assistance of the availability of dental services (as 
                defined in section 1905(ee)(1)); and
                    ``(B) establishing and maintaining standards for 
                and certification of mobile and portable oral health 
                services (as described in subsections (r)(3)(C) and 
                (ee)(2) of section 1905).''.
    (c) Mobile and Portable Oral Health Services Under EPSDT.--Section 
1905(r)(3) of the Social Security Act (42 U.S.C. 1396d(r)(3)) is 
amended--
            (1) in subparagraph (A)(ii), by striking ``; and'' and 
        inserting a semicolon;
            (2) in subparagraph (B), by striking the period at the end 
        and inserting ``; and''; and
            (3) by adding at the end the following new subparagraph:
            ``(C) which shall include mobile and portable oral health 
        services (as defined by the Secretary) that--
                    ``(i) are provided for the purpose of overcoming 
                mobility, transportation, or access barriers for 
                children; and
                    ``(ii) satisfy the standards and certification 
                requirements established under section 1902(a)(84)(B) 
                for the State in which the services are provided.''.
    (d) Increased Federal Funding for Dental Services.--
            (1) In general.--Section 1905 of the Social Security Act 
        (42 U.S.C. 1396d), as amended by subsection (a), is amended--
                    (A) in subsection (b), in the first sentence, by 
                striking ``and (aa)'' and inserting ``(aa), and (ff)''; 
                and
                    (B) by adding at the end the following new 
                subsection:
    ``(ff) Increased FMAP for Dental Services.--
            ``(1) In general.--Notwithstanding subsection (b) and 
        section 1903(a)(7) and subject to the requirements described in 
        paragraphs (3) and (4), with respect to amounts expended on or 
        after October 1, 2012, for covered dental expenses (as 
        described in paragraph (2)), the Federal medical assistance 
        percentage for a State that is one of the 50 States or the 
        District of Columbia for such expenses shall be equal to the 
        Federal medical assistance percentage that would otherwise 
        apply to the State for the fiscal year, as determined under 
        subsection (b) or section 1903(a)(7), increased by 10 
        percentage points.
            ``(2) Covered dental expenses.--For purposes of paragraph 
        (1), the term `covered dental expenses' means the amounts 
        expended for medical assistance for dental services (as 
        described in subsection (ee)(1)) and amounts expended for the 
        proper and efficient administration of the provision of such 
        dental services under the State plan.
            ``(3) Requirements.--For purposes of paragraph (1), the 
        Federal medical assistance percentage applicable to covered 
        dental expenses under this subsection shall not apply to a 
        State unless--
                    ``(A) the State plan for medical assistance 
                provides payment for dental services (as so defined) 
                furnished by a dental provider at a rate that is not 
                less than 70 percent of the usual and customary fee for 
                such services in the State; and
                    ``(B) the State satisfies such additional 
                requirements as are established by the Secretary, which 
                shall include--
                            ``(i) streamlining of administrative 
                        procedures for purposes of ensuring adequate 
                        provider participation and increasing patient 
                        utilization of dental services; and
                            ``(ii) the provision of technical 
                        assistance to dental providers designed to 
                        reduce the number of missed patient 
                        appointments and eliminate other barriers to 
                        the provision of oral health services.
            ``(4) Limitation.--For purposes of amounts expended for 
        covered dental services, in no case shall any increase under 
        this subsection result in a Federal medical assistance 
        percentage that exceeds 100 percent.''.
            (2) Conforming amendment.--Section 1903(a)(7) of the Social 
        Security Act (42 U.S.C. 1396b(a)(7)) is amended by striking 
        ``section 1919(g)(3)(B)'' and inserting ``sections 1905(ff) and 
        1919(g)(3)(B)''.
    (e) Effective Date.--
            (1) In general.--Except as provided in paragraph (2), the 
        amendments made by this section shall apply to calendar 
        quarters beginning on or after January 1, 2013, without regard 
        to whether or not final regulations to carry out such 
        amendments have been promulgated by such date.
            (2) Delay permitted for state plan amendment.--In the case 
        of a State plan for medical assistance under title XIX of the 
        Social Security Act which the Secretary of Health and Human 
        Services determines requires State legislation (other than 
        legislation appropriating funds) in order for the plan to meet 
        the additional requirements imposed by the amendments made by 
        this section, the State plan shall not be regarded as failing 
        to comply with the requirements of such title solely on the 
        basis of its failure to meet these 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 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 such 
        session shall be deemed to be a separate regular session of the 
        State legislature.

                       Subtitle C--Grant Programs

SEC. 121. CASE MANAGEMENT GRANT PROGRAM.

    (a) Establishment.--The Secretary shall award grants to States and 
eligible entities for the purpose of developing case management 
programs that--
            (1) identify eligible individuals who are in need of dental 
        services, with a particular focus on pregnant women, 
        individuals with disabilities, and older adults, and provide 
        them with information regarding dental providers in proximity 
        to their residence;
            (2) determine the coverage status of an eligible individual 
        or whether such individual is eligible for free dental 
        services;
            (3) recruit licensed dental providers and coordinate the 
        voluntary provision of medically recommended dental services by 
        such providers to eligible individuals described in subsection 
        (f)(2)(E) with no fee or charge to such individuals and in a 
        manner consistent with State licensing laws;
            (4) provide community-level oral health education, with a 
        focus on oral health literacy and prevention, and resource 
        information to eligible individuals; and
            (5) identify and coordinate transportation for eligible 
        individuals in need of dental services as necessary to overcome 
        mobility impairments and transportation barriers.
    (b) Application.--A State or eligible entity that desires to 
participate in the grant program under this section shall submit to the 
Secretary an application at such time, in such manner, and containing 
such information as the Secretary may require.
    (c) Duration and Scope.--From any amounts appropriated to carry out 
this section, the Secretary shall award grants to a total of 10 States 
and eligible entities, with the amount of each grant to be determined 
at the discretion of the Secretary.
    (d) Evaluation.--Not later than January 1, 2016, the Secretary 
shall--
            (1) conduct an evaluation of the grant program under this 
        section for purposes of determining if case management programs 
        established by participating States and eligible entities 
        sufficiently increased access to dental services; and
            (2) determine whether case management programs should be 
        made available on a nationwide basis.
    (e) Authorization.--To carry out the grant program under this 
section, there are authorized to be appropriated such sums as may be 
necessary for each of fiscal years 2013 through 2015.
    (f) Definitions.--In this section:
            (1) Eligible entity.--The term ``eligible entity'' means an 
        organization that is described in section 501(c)(3) of the 
        Internal Revenue Code of 1986 and exempt from tax under section 
        501(a) of such Code.
            (2) Eligible individual.--The term ``eligible individual'' 
        means an individual who is--
                    (A) entitled to, or enrolled for, benefits under 
                part A of title XVIII of the Social Security Act or 
                enrolled for benefits under part B of such title;
                    (B) eligible to receive medical assistance under a 
                State plan under title XIX of the Social Security Act 
                or any waiver approved with respect to such plan;
                    (C) eligible to receive child health assistance 
                under a State child health plan under title XXI of the 
                Social Security Act or any waiver approved with respect 
                to such plan;
                    (D) entitled to receive medical benefits under the 
                laws administered by the Secretary of Veterans Affairs; 
                or
                    (E) has an income below 200 percent of the Federal 
                poverty level and does not otherwise have any dental 
                insurance coverage.
            (3) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (4) State.--The term ``State'' means the 50 States and the 
        District of Columbia.

                    TITLE II--PUBLIC HEALTH PROGRAMS

               Subtitle A--National Health Service Corps

SEC. 201. NATIONAL HEALTH SERVICE CORPS.

    (a) In General.--Section 331 of the Public Health Service Act (42 
U.S.C. 254d) is amended--
            (1) in subsection (a)(3), by adding at the end the 
        following:
                    ``(F) The term `dental therapist' means, with 
                respect to a State that licenses such dental 
                therapists, a mid-level dental practitioner who is 
                licensed to practice under the law of the State and who 
                provides preventive and restorative services directly 
                to the public, commensurate with the scope of the 
                practice.''; and
            (2) in subsection (b)--
                    (A) in paragraph (1), by inserting ``, dental 
                therapy,'' after ``dental''; and
                    (B) in paragraph (2), by inserting ``dental 
                therapists,'' after ``dentists,''.
    (b) Facilitation of Effective Provision of Corps Services.--Section 
336(f)(3) of the Public Health Service Act (42 U.S.C. 254h-1(f)(3)) is 
amended by inserting ``dental therapists'' after ``midwives,''.
    (c) Scholarship Program and Loan Repayment Program.--
            (1) Scholarship program.--Section 338A of the Public Health 
        Service Act (42 U.S.C. 254l) is amended--
                    (A) in subsection (a)(1), by inserting ``dental 
                therapists,'' after ``dentists,''; and
                    (B) in subsection (b)(1), by inserting ``including 
                dental therapy,'' after ``or other health 
                profession,''.
            (2) Loan repayment program.--Section 338B of the Public 
        Health Service Act (42 U.S.C. 254l-1) is amended--
                    (A) in subsection (a)(1), by inserting ``dental 
                therapists,'' after ``dentists,''; and
                    (B) in subsection (b)(1)--
                            (i) in subparagraph (A), by inserting 
                        ``dental therapist,'' after ``nurse 
                        practitioner,'';
                            (ii) in subparagraph (B), by inserting 
                        ``dental therapy,'' after ``mental health,''; 
                        and
                            (iii) in subparagraph (C)(ii), by inserting 
                        ``, including dental therapy,'' after ``health 
                        profession''.
            (3) Authorization of appropriations.--Section 338H of the 
        Public Health Service Act (42 U.S.C. 254q) is amended--
                    (A) in subsection (a), by striking ``this section'' 
                and inserting ``this subpart''; and
                    (B) by adding at the end the following:
    ``(d) Authorization of Appropriations With Respect to Oral Health 
Professionals.--To carry out this subpart with respect to dentists, 
dental therapists, and dental hygienists, in addition to the amounts 
authorized under subsection (a), there is authorized to be appropriated 
such sums as may be necessary for fiscal years 2013 through 2016, which 
shall be used to provide scholarships to such oral health 
professionals.''.

                   Subtitle B--Oral Health Education

SEC. 211. AUTHORIZATION OF APPROPRIATIONS FOR ORAL HEALTH EDUCATION FOR 
              MEDICAL PROVIDERS.

    Section 747(c) of the Public Health Service Act (42 U.S.C. 293k(c)) 
is amended by adding at the end the following:
            ``(4) Oral health education.--In addition to other amounts 
        authorized under this subsection for purposes of carrying out 
        this section, there is authorized to be appropriated such sums 
        as may be necessary for fiscal years 2013 through 2016 for the 
        purpose of educating nondental medical professionals, including 
        physicians, nurses, and pharmacists, about oral health, 
        including issues such as oral hygiene instruction, topical 
        application of fluoride, and oral health screenings, with the 
        goal of integrating oral health care into overall health 
        care.''.

SEC. 212. ORAL HEALTH EDUCATION FOR OTHER NON-HEALTH PROFESSIONALS.

    Subpart I of part C of title VII of the Public Health Service Act 
(42 U.S.C. 293k et seq.) is amended by inserting after section 748 the 
following:

``SEC. 748A. ORAL HEALTH EDUCATION FOR OTHER NON-ORAL HEALTH 
              PROFESSIONALS.

    ``(a) In General.--The Secretary may make grants to, or enter into 
contracts with, an accredited public or nonprofit private hospital, an 
educational institution, or a public or private nonprofit entity which 
the Secretary has determined is capable of carrying out such grant or 
contract to educate individuals, such as community health workers, 
social workers, nutritionists, health educators, occupational 
therapists, and psychologists, to promote oral health education and to 
provide support for behavior change and assistance with care 
coordination with respect to oral health.
    ``(b) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated such sums as may be necessary 
for fiscal years 2013 through 2016.''.

SEC. 213. DENTAL EDUCATION.

    (a) Training in General, Pediatric, and Public Health Dentistry.--
Section 748 of the Public Health Service Act (42 U.S.C. 293k-2) is 
amended--
            (1) in subsection (a)(1)(H), by striking ``pediatric 
        training programs'' and inserting ``pediatric dental training 
        programs''; and
            (2) in subsection (c)--
                    (A) by striking the subsection heading and 
                inserting ``Requirements for Award.--'';
                    (B) by amending the matter preceding paragraph (1) 
                to read as follows: ``With respect to training provided 
                for under this section, the Secretary shall award 
                grants or contracts only to eligible entities that meet 
                at least 7 of the following criteria:'';
                    (C) in paragraph (2), by striking ``have a record 
                of training the greatest percentage of providers, or 
                that have demonstrated significant improvements in the 
                percentage of providers, who enter and'' and inserting 
                ``train significant numbers of providers who'';
                    (D) in paragraph (3)--
                            (i) by striking ``have a record of 
                        training'' and inserting ``intent to train''; 
                        and
                            (ii) by striking the period at the end and 
                        inserting ``and have faculty with experience in 
                        treating underserved populations.'';
                    (E) in paragraph (8), by inserting ``or have 
                established'' after ``establish''; and
                    (F) by adding at the end the following:
            ``(9) Qualified applicants that require not less than 200 
        hours of community-based education rotations.''.
    (b) Dental Residency Programs.--Part B of title III of the Public 
Health Service Act (42 U.S.C. 243 et seq.) is amended by adding at the 
end the following:

``SEC. 320B. DENTAL RESIDENCY PROGRAMS.

    ``As a condition for receiving Federal funds, dental training 
residency programs shall require individuals enrolled in such residency 
programs to provide dental services--
            ``(1) in hospital emergency rooms; or
            ``(2) in community settings, in addition to the dental 
        training otherwise required by such residency program.''.

SEC. 214. ORAL HEALTH PROFESSIONAL STUDENT LOANS.

    Part F of title VII of the Public Health Service Act (42 U.S.C. 
295j) is amended by adding at the end the following:

``SEC. 799C. ORAL HEALTH PROFESSIONAL STUDENT LOANS.

    ``(a) In General.--The Secretary shall establish and operate a 
student loan fund for oral health professional students, including 
dental hygienists, dental therapists, and dentists.
    ``(b) Content.--The Secretary shall establish and operate the 
student loan fund program under subsection (a) in the same manner and 
subject to the same terms as the loan fund program established with 
schools of nursing under section 835.
    ``(c) Authorization of Appropriations.--To carry out this section, 
there are authorized to be appropriated such sums as may be necessary 
for fiscal years 2013 through 2016.''.

                 Subtitle C--Other Oral Health Programs

SEC. 221. ACCESS POINTS.

    Subpart X of part D of title III of the Public Health Service Act 
(42 U.S.C. 256f et seq.) is amended by adding at the end the following:

``SEC. 340G-2. FUNDING FOR ORAL HEALTH SERVICES.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration, shall establish a 
program to award grants to eligible entities to provide oral health 
services, or to contract with private dental practices to provide 
comprehensive oral health services, to low income individuals and 
individuals who are underserved with respect to oral health care.
    ``(b) Technical Assistance.--The Secretary shall provide technical 
assistance to entities receiving grants under subsection (a) to provide 
technical assistance to such entities in order to--
            ``(1) with respect to oral health care services, increase 
        efficiency and minimize missed appointments, contract with 
        offsite providers, recruit providers (including oral health 
        specialists), and operate programs outside the physical 
        facilities to take advantage of new systems to improve access 
        to oral health services; or
            ``(2) contract with private dental practices that will 
        provide oral health services other than preventive oral health 
        care, including restoration and maintenance of oral health, in 
        order to meet the need for oral health services in the 
        community.
    ``(c) Eligible Entities.--To be eligible to receive a grant under 
subsection (a), an entity shall--
            ``(1) be--
                    ``(A) a Federally qualified health center (as 
                defined in section 1861(aa) of the Social Security 
                Act);
                    ``(B) a safety net clinic or a free clinic (as 
                defined by the Secretary);
                    ``(C) a health care clinic that provides services 
                to tribal organizations or urban Indian organizations 
                (as such terms are defined in section 4 of the Indian 
                Health Care Improvement Act); or
                    ``(D) any other interested public or private sector 
                health care provider or organization that the Secretary 
                determines has a demonstrated history in serving a high 
                number of uninsured and or low-income individuals or 
                those who lack ready access to oral health services; 
                and
            ``(2) demonstrate a clear need to expand oral health care 
        services beyond preventive oral health care.
    ``(d) Allocation for Hiring Oral Health Care Specialists.--A 
portion of the funds available under this section shall be allocated 
toward hiring oral health care specialists, such as oral surgeons, at 
entities receiving grants under this section.
    ``(e) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated such sums as may be necessary 
for each of fiscal years 2013 through 2016.''.

SEC. 222. DENTAL CLINICS IN SCHOOLS.

    Part Q of title III of the Public Health Service Act (42 U.S.C. 
280h et seq.) is amended by adding at the end the following:

``SEC. 399Z-2. DENTAL CLINICS IN SCHOOLS.

    ``(a) In General.--The Secretary shall award grants to qualified 
entities for the purpose of funding the building, operation, or 
expansion of dental clinics in schools.
    ``(b) Qualified Entities.--To receive a grant under this section, a 
qualified entity shall submit an application to the Secretary at such 
time, in such manner, and containing such information as the Secretary 
may require.
    ``(c) Requirements.--An entity receiving a grant under this section 
shall--
            ``(1) provide comprehensive oral health services at a 
        dental clinic based at a school, including oral health 
        education, oral screening, fluoride application, prophylaxis, 
        and sealants;
            ``(2) refer patients to an available qualified oral health 
        provider in the community for any required oral health services 
        not provided in the dental clinic in the school, to ensure that 
        all the oral health needs of students are met; and
            ``(3) maintain clinic hours that extend beyond school 
        hours.
    ``(d) Authorization of Appropriations.--For purposes of carrying 
out this section, there is authorized to be appropriated such sums as 
may be necessary for fiscal years 2013 through 2016.''.

SEC. 223. EMERGENCY ROOM CARE COORDINATION.

    Part B of title III of the Public Health Service Act (42 U.S.C. 243 
et seq.), as amended by section 213(b), is further amended by adding at 
the end the following:

``SEC. 320C. EMERGENCY ROOM CARE COORDINATION WITH RESPECT TO DENTAL 
              CARE.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration, shall establish a 
grant program to enable individuals to receive dental care at a 
facility operated by a grant recipient rather than at a hospital 
emergency room.
    ``(b) Eligible Entities.--To be eligible to receive a grant under 
this section, an entity shall be--
            ``(1) a hospital in partnership with a Federally qualified 
        health center;
            ``(2) a Federally qualified health center;
            ``(3) a private dental practice; or
            ``(4) any other interested public or private sector health 
        care provider or organization that the Secretary determines has 
        the capacity to serve a high number of individuals who lack 
        access to oral health services.
    ``(c) Oral Health Education for ER Physicians.--The Secretary shall 
allocate a portion of the amounts appropriated under subsection (e) 
toward medical education for emergency room physicians to be trained in 
oral health.
    ``(d) Report.--Not later than January 1, 2016, the Secretary shall 
submit to Congress a report on the best practices determined by the 
program established under this section to address oral health needs of 
individuals who go to emergency rooms in need of oral health care.
    ``(e) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated such sums as may be necessary 
for fiscal years 2013 through 2016.''.

SEC. 224. RESEARCH FUNDING.

    For fiscal years 2013 through 2016, there is authorized to be 
appropriated such sums as may be necessary to each of--
            (1) the Centers for Disease Control and Prevention, for the 
        purpose of conducting research on--
                    (A) the prevention of oral health disease; and
                    (B) oral health disease management;
            (2) the Agency for Healthcare Research and Quality, for the 
        purpose of conducting--
                    (A) research with respect to oral health services 
                and the delivery of oral health services; and
                    (B) an evaluation of oral health service delivery 
                to underserved and vulnerable populations;
            (3) the National Institute of Dental and Craniofacial 
        Research for the purpose of conducting research on oral health 
        disease management including pharmaceutical-behavioral 
        intervention; and
            (4) the Maternal and Child Health Bureau for the purpose of 
        conducting research on maternal and child oral health issues.

SEC. 225. MOBILE AND PORTABLE DENTAL SERVICES.

    Subpart X of part D of title III of the Public Health Service Act 
(42 U.S.C. 256f et seq.), as amended by section 221, is further amended 
by adding at the end the following:

``SEC. 340G-3. MOBILE AND PORTABLE DENTAL SERVICES.

    ``(a) In General.--The Secretary shall award grants to rural health 
clinics, as defined in section 1861(aa)(2) of the Social Security Act 
(42 U.S.C. 1395x(aa)(2)), to provide mobile and portable, comprehensive 
dental services (including dental services provided by licensed 
providers through telehealth-enabled collaboration and supervision) and 
outreach for dental services at locations such as senior centers, 
nursing homes, assisted living facilities, schools, licensed day care 
centers that serve children who receive benefits under the State 
Children's Health Insurance Program under title XXI of the Social 
Security Act (42 U.S.C. 1397aa et seq.) or the Medicaid program under 
title XIX of the Social Security Act (42 U.S.C. 1396 et seq.), and 
facilities that provide services under the Special Supplemental 
Nutrition Program for Women, Infants, and Children (the WIC program) or 
the Head Start Act (42 U.S.C. 9831 et seq.).
    ``(b) Authorization of Appropriations.--To carry out this section, 
there are authorized to be appropriated such sums as may be 
necessary.''.

  TITLE III--DEPARTMENT OF VETERANS AFFAIRS AND DEPARTMENT OF DEFENSE 
                                MATTERS

           Subtitle A--Department of Veterans Affairs Matters

SEC. 301. REQUIRING SECRETARY OF VETERANS AFFAIRS TO FURNISH DENTAL 
              CARE IN SAME MANNER AS ANY OTHER MEDICAL SERVICE.

    (a) In General.--Title 38, United States Code, is amended--
            (1) in section 1701(6), by striking ``as described in 
        sections 1710 and 1712 of this title'';
            (2) in section 1710(c), by striking the second sentence;
            (3) in section 1712--
                    (A) by striking subsections (a) and (b); and
                    (B) by redesignating subsections (c) through (e) as 
                subsections (a) through (c), respectively; and
            (4) by striking section 2062.
    (b) Conforming Amendments.--Such title is further amended--
            (1) in section 1525(a), by striking ``medicines under 
        section 1712(d)'' and inserting ``medicines under section 
        1712(b)''; and
            (2) in section 1703(a)(7), by striking ``, for a veteran 
        described in section 1712(a)(1)(F) of this title''.
    (c) Clerical Amendments.--Such title is further amended--
            (1) in section 1712, in the heading for such section, by 
        striking ``Dental care; drugs'' and inserting ``Drugs'';
            (2) in the table of sections at the beginning of chapter 
        17, by striking the item relating to section 1712 and inserting 
        the following new item:

``1712. Drugs and medicines for certain disabled veterans; vaccines.'';
        and
            (3) in the table of sections at the beginning of chapter 
        20, by striking the item relating to section 2062.

SEC. 302. DEMONSTRATION PROGRAM ON TRAINING AND EMPLOYMENT OF 
              ALTERNATIVE DENTAL HEALTH CARE PROVIDERS FOR DENTAL 
              HEALTH CARE SERVICES FOR VETERANS IN RURAL AND OTHER 
              UNDERSERVED COMMUNITIES.

    (a) Demonstration Program Authorized.--The Secretary of Veterans 
Affairs may carry out a demonstration program to establish programs to 
train and employ alternative dental health care providers in order to 
increase access to dental health care services for veterans entitled to 
such services who reside in rural and other underserved communities.
    (b) Telehealth.--For purposes of alternative dental health care 
providers and any other dental care providers who are licensed to 
provide clinical care, dental services provided under the demonstration 
program under this section may be administered by such providers 
through telehealth-enabled collaboration and supervision when deemed 
appropriate and feasible.
    (c) Alternative Dental Health Care Providers Defined.--In this 
section, the term ``alternative dental health care providers'' has the 
meaning given that term in section 340G-1(a)(2) of the Public Health 
Service Act (42 U.S.C. 256g-1(a)(2)).
    (d) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as are necessary to carry out the demonstration 
program under this section.

               Subtitle B--Department of Defense Matters

SEC. 311. DEMONSTRATION PROGRAM ON TRAINING AND EMPLOYMENT OF 
              ALTERNATIVE DENTAL HEALTH CARE PROVIDERS FOR DENTAL 
              HEALTH CARE SERVICES FOR MEMBERS OF THE ARMED FORCES AND 
              DEPENDENTS LACKING READY ACCESS TO SUCH SERVICES.

    (a) Demonstration Program Authorized.--The Secretary of Defense may 
carry out a demonstration program to establish programs to train and 
employ alternative dental health care providers in order to increase 
access to dental health care services for members of the Armed Forces 
and their dependents who lack ready access to such services, including 
the following:
            (1) Members and dependents who reside in rural areas or 
        areas otherwise underserved by dental health care providers.
            (2) Members of the National Guard and Reserves in active 
        status who are potentially deployable.
    (b) Telehealth.--For purposes of alternative dental health care 
providers and any other dental care providers who are licensed to 
provide clinical care, dental services provided under the demonstration 
program under this section may be administered by such providers 
through telehealth-enabled collaboration and supervision when deemed 
appropriate and feasible.
    (c) Alternative Dental Health Care Providers Defined.--In this 
section, the term ``alternative dental health care providers'' has the 
meaning given that term in section 340G-1(a)(2) of the Public Health 
Service Act (42 U.S.C. 256g-1(a)(2)).
    (d) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as are necessary to carry out the demonstration 
program under this section.

                  TITLE IV--FEDERAL BUREAU OF PRISONS

SEC. 401. DEMONSTRATION PROGRAM ON TRAINING AND EMPLOYMENT OF 
              ALTERNATIVE DENTAL HEALTH CARE PROVIDERS FOR DENTAL 
              HEALTH CARE SERVICES FOR PRISONERS WITHIN THE CUSTODY OF 
              THE BUREAU OF PRISONS.

    (a) Demonstration Program Authorized.--The Attorney General, acting 
through the Director of the Bureau of Prisons, may carry out a 
demonstration program to establish programs to train and employ 
alternative dental health care providers in order to increase access to 
dental health services for prisoners within the custody of the Bureau 
of Prisons.
    (b) Telehealth.--For purposes of alternative dental health care 
providers and any other dental care providers who are licensed to 
provide clinical care, dental services provided under the demonstration 
program under this section may be administered by such providers 
through telehealth-enabled collaboration and supervision when deemed 
appropriate and feasible.
    (c) Alternative Dental Health Care Providers Defined.--In this 
section, the term ``alternative dental health care providers'' has the 
meaning given that term in section 340G-1(a)(2) of the Public Health 
Service Act (42 U.S.C. 256g-1(a)(2)).
    (d) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as are necessary to carry out the demonstration 
program under this section.

                     TITLE V--INDIAN HEALTH SERVICE

SEC. 501. DEMONSTRATION PROGRAM ON TRAINING AND EMPLOYMENT OF 
              ALTERNATIVE DENTAL HEALTH CARE PROVIDERS FOR DENTAL 
              HEALTH CARE SERVICES UNDER THE INDIAN HEALTH SERVICE.

    (a) Demonstration Program Authorized.--The Secretary of Health and 
Human Services, acting through the Indian Health Service, may carry out 
a demonstration program to establish programs to train and employ 
alternative dental health care providers in order to help eliminate 
oral health disparities and increase access to dental services through 
health programs operated by the Indian Health Service, Indian tribes, 
tribal organizations, and Urban Indian organizations (as those terms 
are defined in section 4 of the Indian Health Care Improvement Act (25 
U.S.C. 1603)).
    (b) Telehealth.--For purposes of alternative dental health care 
providers and any other dental care providers who are licensed to 
provide clinical care, dental services provided under the demonstration 
program under this section may be administered by such providers 
through telehealth-enabled collaboration and supervision when deemed 
appropriate and feasible.
    (c) Alternative Dental Health Care Providers Defined.--In this 
section, the term ``alternative dental health care providers'' has the 
meaning given that term in section 340G-1(a)(2) of the Public Health 
Service Act (42 U.S.C. 256g-1(a)(2)).
    (d) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as are necessary to carry out the demonstration 
program under this section.

                     TITLE VI--REPORTS TO CONGRESS

SEC. 601. EVALUATION OF EXPANSION OF COVERAGE FOR DENTAL SERVICES.

    (a) Secretary of Health and Human Services.--Not later than October 
1, 2016, the Secretary of Health and Human Services shall submit to 
Congress a report that provides a comprehensive cost-benefit analysis 
regarding the expansion of coverage for dental services pursuant to 
this Act, including whether the provision of such services resulted in 
a reduction in total health care costs for individuals under the 
Medicare and Medicaid programs.
    (b) Comptroller General.--
            (1) Medicaid and medicare.--Not later than October 1, 2015, 
        the Comptroller General of the United States shall submit to 
        Congress a report that provides a comprehensive analysis and 
        evaluation of the implementation and utilization of the 
        expanded coverage for dental services pursuant to this Act for 
        individuals enrolled in the Medicare and Medicaid programs.
            (2) Demonstration programs.--Not later than October 1, 
        2016, the Comptroller General of the United States shall submit 
        to Congress a report that provides a comprehensive analysis and 
        evaluation of the demonstration programs described in sections 
        302, 311, 401, and 501, including--
                    (A) the extent to which the programs improved 
                access to oral health care and increased utilization of 
                oral health services; and
                    (B) an examination of the training provided under 
                the programs to alternative dental health care 
                providers and the quality of care provided by such 
                providers.

                           TITLE VII--FUNDING

SEC. 701. TRANSACTION TAX.

    (a) In General.--Chapter 36 of the Internal Revenue Code of 1986 is 
amended by inserting after subchapter B the following new subchapter:

              ``Subchapter C--Tax on Trading Transactions

``Sec. 4475. Tax on trading transactions.

``SEC. 4475. TAX ON TRADING TRANSACTIONS.

    ``(a) Imposition of Tax.--There is hereby imposed a tax on each 
covered transaction with respect to any security.
    ``(b) Rate of Tax.--The tax imposed under subsection (a) with 
respect to any covered transaction shall be 0.025 percent of the 
specified base amount with respect to such covered transaction.
    ``(c) Specified Base Amount.--For purposes of this section, the 
term `specified base amount' means--
            ``(1) except as provided in paragraph (2), the fair market 
        value of the security (determined as of the time of the covered 
        transaction), and
            ``(2) in the case of any payment described in subsection 
        (h), the amount of such payment.
    ``(d) Covered Transaction.--For purposes of this section, the term 
`covered transaction' means--
            ``(1) except as provided in paragraph (2), any purchase 
        if--
                    ``(A) such purchase occurs or is cleared on a 
                facility located in the United States, or
                    ``(B) the purchaser or seller is a United States 
                person, and
            ``(2) any transaction with respect to a security described 
        in subparagraph (D), (E), or (F) of subsection (e)(1), if--
                    ``(A) such security is traded or cleared on a 
                facility located in the United States, or
                    ``(B) any party with rights under such security is 
                a United States person.
    ``(e) Security and Other Definitions.--For purposes of this 
section:
            ``(1) In general.--The term `security' means--
                    ``(A) any share of stock in a corporation,
                    ``(B) any partnership or beneficial ownership 
                interest in a partnership or trust,
                    ``(C) any note, bond, debenture, or other evidence 
                of indebtedness,
                    ``(D) any evidence of an interest in, or a 
                derivative financial instrument with respect to, any 
                security or securities described in subparagraph (A), 
                (B), or (C),
                    ``(E) any derivative financial instrument with 
                respect to any currency or commodity, and
                    ``(F) any other derivative financial instrument any 
                payment with respect to which is calculated by 
                reference to any specified index.
            ``(2) Derivative financial instrument.--The term 
        `derivative financial instrument' includes any option, forward 
        contract, futures contract, notional principal contract, or any 
        similar financial instrument.
            ``(3) Specified index.--The term `specified index' means 
        any 1 or more of any combination of--
                    ``(A) a fixed rate, price, or amount, or
                    ``(B) a variable rate, price, or amount,   
        which is based on any current objectively determinable 
        information which is not within the control of any of the 
        parties to the contract or instrument and is not unique to any 
        of the parties' circumstances.
            ``(4) Treatment of exchanges.--
                    ``(A) In general.--An exchange shall be treated as 
                the sale of the property transferred and a purchase of 
                the property received by each party to the exchange.
                    ``(B) Certain deemed exchanges.--In the case of a 
                distribution treated as an exchange for stock under 
                section 302 or 331, the corporation making such 
                distribution shall be treated as having purchased such 
                stock for purposes of this section.
    ``(f) Exceptions.--
            ``(1) Exception for initial issues.--No tax shall be 
        imposed under subsection (a) on any covered transaction with 
        respect to the initial issuance of any security described in 
        subparagraph (A), (B), or (C) of subsection (e)(1).
            ``(2) Exception for certain traded short-term 
        indebtedness.--A note, bond, debenture, or other evidence of 
        indebtedness which--
                    ``(A) is traded on a trading facility located in 
                the United States, and
                    ``(B) has a fixed maturity of not more than 100 
                days,
        shall not be treated as described in subsection (e)(1)(C).
            ``(3) Exception for securities lending arrangements.--No 
        tax shall be imposed under subsection (a) on any covered 
        transaction with respect to which gain or loss is not 
        recognized by reason of section 1058.
    ``(g) By Whom Paid.--
            ``(1) In general.--The tax imposed by this section shall be 
        paid by--
                    ``(A) in the case of a transaction which occurs or 
                is cleared on a facility located in the United States, 
                such facility, and
                    ``(B) in the case of a purchase not described in 
                subparagraph (A) which is executed by a broker (as 
                defined in section 6045(c)(1)) which is a United States 
                person, such broker.
            ``(2) Special rules for direct, etc., transactions.--In the 
        case of any transaction to which paragraph (1) does not apply, 
        the tax imposed by this section shall be paid by--
                    ``(A) in the case of a transaction described in 
                subsection (d)(1)--
                            ``(i) the purchaser if the purchaser is a 
                        United States person, and
                            ``(ii) the seller if the purchaser is not a 
                        United States person, and
                    ``(B) in the case of a transaction described in 
                subsection (d)(2)--
                            ``(i) the payor if the payor is a United 
                        States person, and
                            ``(ii) the payee if the payor is not a 
                        United States person.
    ``(h) Certain Payments Treated as Separate Transactions.--Except as 
otherwise provided by the Secretary, any payment with respect to a 
security described in subparagraph (D), (E), or (F) of subsection 
(e)(1) shall be treated as a separate transaction for purposes of this 
section, including--
            ``(1) any net initial payment, net final or terminating 
        payment, or net periodical payment with respect to a notional 
        principal contract (or similar financial instrument),
            ``(2) any payment with respect to any forward contract (or 
        similar financial instrument), and
            ``(3) any premium paid with respect to any option (or 
        similar financial instrument).
    ``(i) Administration.--The Secretary shall carry out this section 
in consultation with the Securities and Exchange Commission and the 
Commodity Futures Trading Commission.
    ``(j) Guidance; Regulations.--The Secretary shall--
            ``(1) provide guidance regarding such information reporting 
        concerning covered transactions as the Secretary deems 
        appropriate, and
            ``(2) prescribe such regulations as are necessary or 
        appropriate to prevent avoidance of the purposes of this 
        section, including the use of non-United States persons in such 
        transactions.''.
    (b) Clerical Amendment.--The table of subchapters for chapter 36 of 
the Internal Revenue Code of 1986 is amended by inserting after the 
item relating to subchapter B the following new item:

``Subchapter C. Tax on trading transactions.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to transactions after December 31, 2012.
                                 <all>
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