I 

111TH CONGRESS 

2D SESSION H. R. 5364 

To amend title XIX of the Social Security Act to require States to provide 

oral health services to aged, blind, or disabled individuals under the 

Medicaid Program, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 20, 2010 

Mr. STUPAK introduced the following bill; which was referred to the 

Committee on Energy and Commerce 

A BILL 

To amend title XIX of the Social Security Act to require 

States to provide oral health services to aged, blind, 

or disabled individuals under the Medicaid Program, and 

for other purposes. 

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; FINDINGS. 

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

5 ‘‘Special Care Dentistry Act of 2010’’. 

6 (b) FINDINGS.—Congress finds the following: 

7 (1) According to the United States Surgeon 

8 General’s Report on Oral Health in America: 


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1 (A) No less than a silent epidemic of oral 

2 diseases is affecting our most vulnerable citi3 zens, including low income elderly, individuals 

4 with disabilities, and many members of racial 

5 and ethnic minority groups. 

6 (B) Oral diseases and conditions affect 

7 health and well-being throughout life. The bur8 den of oral problems is extensive and may be 

9 particularly severe in vulnerable populations. 

10 (C) Oral diseases and conditions are asso11 ciated with other health problems. Associations 

12 between chronic oral infections and other health 

13 problems, including diabetes, heart disease, and 

14 adverse pregnancy outcomes have been re15 ported. 

16 (2) Providing appropriate and necessary oral 

17 health benefits under Medicaid to individuals classi18 fied as aged, blind, or disabled would prevent unnec19 essary emergency room visits, hospitalizations, and 

20 downstream health care costs, reducing Medicaid 

21 spending. 

22 (3) While 28 percent of the people enrolled in 

23 Medicaid are aged, blind, or disabled, the high cost 

24 of medical expenditures for these populations conVerDate Mar 15 2010 23:47 May 21, 2010 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H5364.IH H5364

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1 sumes 72 percent of the total Medicaid budget. This 

2 is not the case with dental benefits. 

3 (4) For the aged, blind, or disabled, oral health 

4 services are deemed ‘‘optional’’ by the Federal Gov5 ernment and most States provide little to no Med6 icaid coverage for these services. Many of these vul7 nerable citizen’s mouths are infected with no hope of 

8 receiving access to even basic dental care. 

9 (5) In 2003, adult aged, blind, and disabled 

10 Medicaid recipients received basic oral health serv11 ices in only 6 States (Connecticut, New Jersey, New 

12 York, North Dakota, Pennsylvania, and Wisconsin). 

13 (6) Appropriate and necessary oral health serv14 ices for adult aged, blind, and disabled people will 

15 help reduce not only Medicaid costs for these popu16 lations, but also down-stream Medicare expenditures, 

17 which together total almost $600,000,000,000 annu18 ally. 

19 (7) Dental office overhead averages over 65 

20 percent. Unfortunately, Medicaid reimbursement 

21 rates fall far short of covering these expenses. 

22 (8) Additional Federal investment for the deliv23 ery of oral health services is needed to ensure vul24 nerable adults receive oral health benefits. 


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1 (9) Investments are needed for an oral health 

2 initiative to reduce the profound disparities in oral 

3 health by improving the health status of vulnerable 

4 populations to the level of health status that is en5 joyed by the majority of Americans. 

6 SEC. 2. REQUIREMENT TO PROVIDE AGED, BLIND, OR DIS7 ABLED INDIVIDUALS WITH ORAL HEALTH 

8 SERVICES UNDER THE MEDICAID PROGRAM. 

9 (a) IN GENERAL.—Title XIX of the Social Security 

10 Act (42 U.S.C. 1396 et seq.), as amended by the Patient 

11 Protection and Affordable Care Act (Public Law 111– 

12 148), is amended by inserting after section 1943 the fol13 lowing new section: 

14 ‘‘ORAL HEALTH SERVICES FOR AGED, BLIND, OR

15 DISABLED INDIVIDUALS

16 ‘‘SEC. 1944. (a) SERVICES UNDER A STATE ADULT

17 DENTAL PROGRAM FOR AGED, BLIND, OR DISABLED IN18 DIVIDUALS.—A State shall provide oral health coverage 

19 for aged, blind, or disabled individuals described in sub20 section (b) through a separate State adult dental program. 

21 The State shall demonstrate that the services and fees 

22 provided and program requirements under this section are 

23 at least equivalent to the services, fees, and requirements 

24 that are provided to children under this title and include 

25 age-appropriate services for such individuals, and that the 

26 services are provided at intervals to determine the existVerDate Mar 15 2010 23:47 May 21, 2010 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H5364.IH H5364

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1 ence of a suspected illness or condition consistent with rea2 sonable standards of dental practice (taking into account 

3 the increased needs and oral health complexities of the 

4 population) as determined by the Secretary after consulta5 tion with national professional dental organizations. 

6 ‘‘(b) AGED, BLIND, OR DISABLED INDIVIDUALS DE7 SCRIBED.—For purposes of subsection (a), an aged, blind, 

8 or disabled individual described in this subsection is an 

9 individual— 

10 ‘‘(1) who is eligible for medical assistance under 

11 subclause (I) or (II) of section 1902(a)(10)(A)(i) 

12 (but only, in the case of subclause (I), with respect 

13 to an individual who is so eligible on the basis of re14 ceiving aid or assistance under any plan of the State 

15 approved under title I, X, XIV, or XVI); and 

16 ‘‘(2) who would be considered an aged, blind, or 

17 disabled individual under section 1614 (without re18 gard to whether the individual satisfies the income 

19 and resource requirements for receiving supple20 mental security income benefits under title XVI) and 

21 is otherwise eligible for medical assistance under the 

22 State plan or under a waiver of such plan. 

23 ‘‘(c) TRANSPORTATION.—The State shall provide 

24 transportation for aged, blind, or disabled individuals de25 scribed in subsection (b) to dental offices, hospitals, clinVerDate Mar 15 2010 23:47 May 21, 2010 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H5364.IH H5364

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1 ics, or other treatment centers for the provision of oral 

2 health services to the same extent that transportation is 

3 provided under the State plan for children eligible for 

4 medical assistance.’’. 

5 (b) DEFINITION OF ORAL HEALTH SERVICES.— 

6 (1) IN GENERAL.—Section 1905 of the Social 

7 Security Act (42 U.S.C. 1396d), as amended by the 

8 Patient Protection and Affordable Care Act (Public 

9 Law 111–148), is amended— 

10 (A) in subsection (a), by amending para11 graph (10) to read as follows: 

12 ‘‘(10) oral health services (as defined in sub13 section (dd)); and’’; and 

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

15 ‘‘(dd)(1) For purposes of this title, the term ‘oral 

16 health services’ means— 

17 ‘‘(A) relief of pain and infections; 

18 ‘‘(B) restoration or replacement of teeth; 

19 ‘‘(C) periodontal treatment; 

20 ‘‘(D) dental health preventive services, including 

21 adult fluoride application; 

22 ‘‘(E) in-patient and out-patient dental surgical, 

23 evaluation, and examination services; 

24 ‘‘(F) dentures or partial denture care; 


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1 ‘‘(G) per patient house call and long term care 

2 facility visits; 

3 ‘‘(H) sedation and anesthesia; and 

4 ‘‘(I) behavior management services. 

5 ‘‘(2) For the purpose of this subsection: 

6 ‘‘(A) The term ‘long term care facility’ means— 

7 ‘‘(i) a nursing facility; 

8 ‘‘(ii) an assisted living facility or a resident 

9 care program facility (as such terms are defined 

10 by the Secretary); 

11 ‘‘(iii) a board and care facility (as defined 

12 in section 1903(q)(4)(B), including a mental re13 tardation group home); 

14 ‘‘(iv) an intermediate care facility for the 

15 mentally retarded; and 

16 ‘‘(v) any other facility that is licensed or 

17 certified by the State and is determined appro18 priate by the Secretary, such as a community 

19 mental health center that meets the require20 ments of section 1913(c) of the Public Health 

21 Service Act, a psychiatric health facility, and a 

22 mental health rehabilitation center. 

23 ‘‘(B) The term ‘house call’ means the delivery 

24 of dental services in long term care facilities needed 


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1 to overcome mobility impairments and transpor2 tation barriers. 

3 ‘‘(C) The term ‘behavior management’ means 

4 services needed to accommodate physical or behav5 ioral impairment.’’. 

6 (c) CONFORMING AMENDMENTS.— 

7 (1) TERMINOLOGY.—Section 

8 1902(a)(43)(D)(iii) of the Social Security Act (42 

9 U.S.C. 1396a(a)(43)(D)(iii)) is amended by striking 

10 ‘‘dental’’ and inserting ‘‘oral health’’ each place it 

11 appears. 

12 (2) STATE PLAN.—Section 1902(a) of such Act 

13 (42 U.S.C. 1396a(a)), as amended by the Patient 

14 Protection and Affordable Care Act, is amended— 

15 (A) in paragraph (81), by striking ‘‘and’’ 

16 at the end; 

17 (B) in paragraph (82), by striking the pe18 riod at the end and inserting ‘‘; and’’; and 

19 (C) by inserting after paragraph (82) the 

20 following: 

21 ‘‘(83) provide for— 

22 ‘‘(A) making oral health services available 

23 to aged, blind, or disabled individuals described 

24 in subsection (b) of section 1944 in accordance 

25 with the requirements of that section; 


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1 ‘‘(B) informing all persons in the State 

2 who are aged, blind, or disabled and have been 

3 determined to be eligible for medical assistance 

4 including oral health services (as defined in sec5 tion 1905(dd)), of the availability of such serv6 ices; 

7 ‘‘(C) providing or arranging for the provi8 sion of such services in all cases where they are 

9 requested; 

10 ‘‘(D) arranging for (directly or through re11 ferral to appropriate agencies, organizations, or 

12 individuals) corrective treatment the need for 

13 which is disclosed by such services; and 

14 ‘‘(E) reporting to the Secretary (in a uni15 form form and manner established by the Sec16 retary, by aged, blind, or disabled group and by 

17 basis of eligibility for medical assistance, and by 

18 not later than April 1 after the end of each fis19 cal year, beginning with fiscal year 2011) the 

20 information relating to oral health services pro21 vided under the plan during each fiscal year 

22 consisting of— 

23 ‘‘(i) the number of aged, blind, or dis24 abled individuals who reside in the State; 


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1 ‘‘(ii) the number of aged, blind, or 

2 disabled individuals provided oral health 

3 services; 

4 ‘‘(iii) the number of such individuals 

5 referred for corrective treatment (the need 

6 for which is disclosed by such services); 

7 ‘‘(iv) the amount of, and type of, pre8 ventive oral health services needed and 

9 provided; 

10 ‘‘(v) the amount of, and type of, sur11 gical restorative oral health services needed 

12 and provided; and 

13 ‘‘(vi) the amount of, and type of, 

14 other oral health services needed and pro15 vided, disaggregated into whether the serv16 ices were— 

17 ‘‘(I) emergency; 

18 ‘‘(II) preventive; 

19 ‘‘(III) surgical; 

20 ‘‘(IV) restorative; 

21 ‘‘(V) periodontal; 

22 ‘‘(VI) endodontic; or 

23 ‘‘(VII) prosthodontic.’’. 

24 (3) NURSING FACILITIES.—Section 

25 1919(b)(4)(A)(vi) of such Act (42 U.S.C. 


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1 1396r(b)(4)(A)(vi)) is amended by inserting, ‘‘oral 

2 health services (as defined in section 1905(dd)) for 

3 an aged, blind, or disabled individual described in 

4 section 1944(b) who is a resident of the nursing fa5 cility,’’ after ‘‘plan)’’. 

6 (d) FEDERAL FUNDING FOR COST OF COVERING

7 AGED, BLIND, OR DISABLED.—Section 1905 of the Social 

8 Security Act (42 U.S.C. 1396d), as amended by sub9 section (b)(1), is amended— 

10 (1) in subsection (b), in the first sentence, by 

11 inserting ‘‘subsection (dd) and’’ before ‘‘section 

12 1933(d)’’ ; and 

13 (2) by adding at the end the following new sub14 section: 

15 ‘‘(ee) INCREASED FMAP FOR MEDICAL ASSISTANCE

16 FOR AGED, BLIND, AND DISABLED INDIVIDUALS.—The 

17 Federal medical assistance percentage determined for a 

18 State that is one of the 50 States or the District of Colum19 bia for each fiscal year with respect to amounts expended 

20 for medical assistance for aged, blind and disabled individ21 uals described in section 1944(b) shall be equal to 100 

22 percent.’’. 

23 (e) EFFECTIVE DATE.— 

24 (1) IN GENERAL.—Except as provided in para25 graph (2), the amendments made by this section 


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1 shall apply to calendar quarters beginning on or 

2 after October 1, 2010, without regard to whether or 

3 not final regulations to carry out such amendments 

4 have been promulgated by such date. 

5 (2) DELAY PERMITTED FOR STATE PLAN

6 AMENDMENT.—In the case of a State plan for med7 ical assistance under title XIX of the Social Security 

8 Act which the Secretary of Health and Human Serv9 ices determines requires State legislation (other than 

10 legislation appropriating funds) in order for the plan 

11 to meet the additional requirements imposed by the 

12 amendments made by this section, the State plan 

13 shall not be regarded as failing to comply with the 

14 requirements of such title solely on the basis of its 

15 failure to meet these additional requirements before 

16 the first day of the first calendar quarter beginning 

17 after the close of the first regular session of the 

18 State legislature that begins after the date of enact19 ment of this Act. For purposes of the previous sen20 tence, in the case of a State that has a 2-year legis21 lative session, each year of such session shall be 

22 deemed to be a separate regular session of the State 

23 legislature. 

Æ 


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