I 

108TH CONGRESS 

2D SESSION H. R. 4622 

To provide disadvantaged children with access to dental services. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 18, 2004 

Mr. SIMPSON (for himself, Mr. DINGELL, Mr. PALLONE, Mr. WAXMAN, Mr. 

NORWOOD, Ms. ROYBAL-ALLARD, Mr. CRAMER, Mr. MCNULTY, Mr. 

BLUNT, Mr. LINDER, Mr. BOUCHER, Mr. PASTOR, Mrs. CHRISTENSEN, 

Mr. TOWNS, Mr. DICKS, Mr. ANDREWS, Mr. MEEHAN, Mr. KENNEDY of 

Rhode Island, Mr. SERRANO, Mr. MCINTYRE, Mr. MATSUI, Mr. LARSEN

of Washington, Mr. ENGEL, Mr. CONYERS, Mr. CUNNINGHAM, Mrs. 

MCCARTHY of New York, Mr. KILDEE, Mr. PASCRELL, Ms. BORDALLO, 

Mr. SHUSTER, Mr. FERGUSON, Mr. LOBIONDO, Mr. TURNER of Texas, 

Mr. BROWN of Ohio, Mr. STUPAK, Mr. STRICKLAND, Mr. SIMMONS, and 

Mr. ALLEN) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on 

Ways and Means, for a period to be subsequently determined by the 

Speaker, in each case for consideration of such provisions as fall within 

the jurisdiction of the committee concerned 

A BILL 

To provide disadvantaged children with access to dental 

services. 

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

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

5 ‘‘Children’s Dental Health Improvement Act of 2004’’. 
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1 (b) TABLE OF CONTENTS.—The table of contents of 

2 this Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—IMPROVING DELIVERY OF PEDIATRIC DENTAL 

SERVICES UNDER MEDICAID AND SCHIP 

Sec. 101. Grants to improve the provision of dental services under medicaid 

and SCHIP. 

Sec. 102. State option to provide wrap-around SCHIP coverage to children who 

have other health coverage. 

TITLE II—CORRECTING GME PAYMENTS FOR DENTAL 

RESIDENCY TRAINING PROGRAMS 

Sec. 201. Limitation on the application of the 1-year lag in the indirect medical 

education ratio (IME) changes and the 3-year rolling average 

for counting interns and residents for IME and direct graduate 

medical education (D–GME) payments under the medicare 

program. 

TITLE III—IMPROVING DELIVERY OF PEDIATRIC DENTAL SERVICES UNDER COMMUNITY HEALTH CENTERS, PUBLIC HEALTH 

DEPARTMENTS, AND THE INDIAN HEALTH SERVICE 

Sec. 301. Grants to improve the provision of dental health services through 

community health centers and public health departments. 

Sec. 302. Dental officer multiyear retention bonus for the Indian Health Service. 

Sec. 303. Demonstration projects to increase access to pediatric dental services 

in underserved areas. 

Sec. 304. Technical correction. 

TITLE IV—IMPROVING ORAL HEALTH PROMOTION AND DISEASE 

PREVENTION PROGRAMS 

Sec. 401. Oral health initiative. 

Sec. 402. CDC reports. 

Sec. 403. Early childhood caries. 

Sec. 404. School-based dental sealant program. 

Sec. 405. Basic oral health promotion. 
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1 TITLE I—IMPROVING DELIVERY 

2 OF PEDIATRIC DENTAL SERV3 ICES UNDER MEDICAID AND 

4 SCHIP 

5 SEC. 101. GRANTS TO IMPROVE THE PROVISION OF DENTAL 

6 SERVICES UNDER MEDICAID AND SCHIP. 

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

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

9 ‘‘SEC. 511. GRANTS TO IMPROVE THE PROVISION OF DEN10 TAL SERVICES UNDER MEDICAID AND SCHIP. 

11 ‘‘(a) AUTHORITY TO MAKE GRANTS.—In addition to 

12 any other payments made under this title to a State, the 

13 Secretary shall award grants to States that satisfy the re14 quirements of subsection (b) to improve the provision of 

15 dental services to children who are enrolled in a State plan 

16 under title XIX or a State child health plan under title 

17 XXI (in this section, collectively, referred to as the ‘State 

18 plans’). 

19 ‘‘(b) REQUIREMENTS.—In order to be eligible for a 

20 grant under this section, a State shall provide the Sec21 retary with the following assurances: 

22 ‘‘(1) IMPROVED SERVICE DELIVERY.—The 

23 State shall have a plan to improve the delivery of 

24 dental services to children, including children with 

25 special health care needs, who are enrolled in the 
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1 State plans, including providing outreach and ad2 ministrative case management, improving collection 

3 and reporting of claims data, and providing incen4 tives, in addition to raising reimbursement rates, to 

5 increase provider participation. 

6 ‘‘(2) ADEQUATE PAYMENT RATES.—The State 

7 has provided for payment under the State plans for 

8 dental services for children at levels consistent with 

9 the market-based rates and sufficient enough to en10 list providers to treat children in need of dental serv11 ices. 

12 ‘‘(3) ENSURED ACCESS.—The State shall en13 sure it will make dental services available to children 

14 enrolled in the State plans to the same extent as 

15 such services are available to the general population 

16 of the State. 

17 ‘‘(c) USE OF FUNDS.— 

18 ‘‘(1) IN GENERAL.—Funds provided under this 

19 section may be used to provide administrative re20 sources (such as program development, provider 

21 training, data collection and analysis, and research22 related tasks) to assist States in providing and as23 sessing services that include preventive and thera24 peutic dental care regimens. 
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1 ‘‘(2) LIMITATION.—Funds provided under this 

2 section may not be used for payment of direct den3 tal, medical, or other services or to obtain Federal 

4 matching funds under any Federal program. 

5 ‘‘(d) APPLICATION.—A State shall submit an applica6 tion to the Secretary for a grant under this section in such 

7 form and manner and containing such information as the 

8 Secretary may require. 

9 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

10 are authorized to be appropriated to make grants under 

11 this section $50,000,000 for fiscal year 2005 and each fis12 cal year thereafter. 

13 ‘‘(f) APPLICATION OF OTHER PROVISIONS OF

14 TITLE.— 

15 ‘‘(1) IN GENERAL.—Except as provided in para16 graph (2), the other provisions of this title shall not 

17 apply to a grant made under this section. 

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

19 this title shall apply to a grant made under sub20 section (a) to the same extent and in the same man21 ner as such provisions apply to allotments made 

22 under section 502(c): 

23 ‘‘(A) Section 504(b)(6) (relating to prohi24 bition on payments to excluded individuals and 

25 entities). 
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1 ‘‘(B) Section 504(c) (relating to the use of 

2 funds for the purchase of technical assistance). 

3 ‘‘(C) Section 504(d) (relating to a limita4 tion on administrative expenditures). 

5 ‘‘(D) Section 506 (relating to reports and 

6 audits), but only to the extent determined by 

7 the Secretary to be appropriate for grants made 

8 under this section. 

9 ‘‘(E) Section 507 (relating to penalties for 

10 false statements). 

11 ‘‘(F) Section 508 (relating to non12 discrimination). 

13 ‘‘(G) Section 509 (relating to the adminis14 tration of the grant program).’’. 

15 SEC. 102. STATE OPTION TO PROVIDE WRAP-AROUND 

16 SCHIP COVERAGE TO CHILDREN WHO HAVE 

17 OTHER HEALTH COVERAGE. 

18 (a) IN GENERAL.— 

19 (1) SCHIP.— 

20 (A) STATE OPTION TO PROVIDE WRAP21 AROUND COVERAGE.—Section 2110(b) of the 

22 Social Security Act (42 U.S.C. 1397jj(b)) is 

23 amended— 
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1 (i) in paragraph (1)(C), by inserting 

2 ‘‘, subject to paragraph (5),’’ after ‘‘under 

3 title XIX or’’; and 

4 (ii) by adding at the end the fol5 lowing: 

6 ‘‘(5) STATE OPTION TO PROVIDE WRAP-AROUND

7 COVERAGE.—A State may waive the requirement of 

8 paragraph (1)(C) that a targeted low-income child 

9 may not be covered under a group health plan or 

10 under health insurance coverage, if the State satis11 fies the conditions described in subsection (c)(8). 

12 The State may waive such requirement in order to 

13 provide— 

14 ‘‘(A) dental services; 

15 ‘‘(B) cost-sharing protection; or 

16 ‘‘(C) all services. 

17 In waiving such requirement, a State may limit the 

18 application of the waiver to children whose family in19 come does not exceed a level specified by the State, 

20 so long as the level so specified does not exceed the 

21 maximum income level otherwise established for 

22 other children under the State child health plan.’’. 

23 (B) CONDITIONS DESCRIBED.—Section 

24 2105(c) of the Social Security Act (42 U.S.C. 
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1 1397ee(c)) is amended by adding at the end the 

2 following: 

3 ‘‘(8) CONDITIONS FOR PROVISION OF WRAP4 AROUND COVERAGE.—For purposes of section 

5 2110(b)(5), the conditions described in this para6 graph are the following: 

7 ‘‘(A) INCOME ELIGIBILITY.—The State 

8 child health plan (whether implemented under 

9 title XIX or this XXI)— 

10 ‘‘(i) has the highest income eligibility 

11 standard permitted under this title as of 

12 January 1, 2004; 

13 ‘‘(ii) subject to subparagraph (B), 

14 does not limit the acceptance of applica15 tions for children; and 

16 ‘‘(iii) provides benefits to all children 

17 in the State who apply for and meet eligi18 bility standards. 

19 ‘‘(B) NO WAITING LIST IMPOSED.—With 

20 respect to children whose family income is at or 

21 below 200 percent of the poverty line, the State 

22 does not impose any numerical limitation, wait23 ing list, or similar limitation on the eligibility of 

24 such children for child health assistance under 

25 such State plan. 
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1 ‘‘(C) NO MORE FAVORABLE TREATMENT.— 

2 The State child health plan may not provide 

3 more favorable coverage of dental services to 

4 the children covered under section 2110(b)(5) 

5 than to children otherwise covered under this 

6 title.’’. 

7 (C) STATE OPTION TO WAIVE WAITING PE8 RIOD.—Section 2102(b)(1)(B) of the Social Se9 curity Act (42 U.S.C. 1397bb(b)(1)(B)) is 

10 amended— 

11 (i) in clause (i), by striking ‘‘and’’ at 

12 the end; 

13 (ii) in clause (ii), by striking the pe14 riod and inserting ‘‘; and’’; and 

15 (iii) by adding at the end the fol16 lowing: 

17 ‘‘(iii) at State option, may not apply 

18 a waiting period in the case of a child de19 scribed in section 2110(b)(5), if the State 

20 satisfies the requirements of section 

21 2105(c)(8).’’. 

22 (2) APPLICATION OF ENHANCED MATCH UNDER

23 MEDICAID.—Section 1905 of the Social Security Act 

24 (42 U.S.C. 1396d) is amended— 
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1 (A) in subsection (b), in the fourth sen2 tence, by striking ‘‘or subsection (u)(3)’’ and 

3 inserting ‘‘(u)(3), or (u)(4)’’; and 

4 (B) in subsection (u)— 

5 (i) by redesignating paragraph (4) as 

6 paragraph (5); and 

7 (ii) by inserting after paragraph (3) 

8 the following: 

9 ‘‘(4) For purposes of subsection (b), the ex10 penditures described in this paragraph are expendi11 tures for items and services for children described in 

12 section 2110(b)(5), but only in the case of a State 

13 that satisfies the requirements of section 

14 2105(c)(8).’’. 

15 (3) APPLICATION OF SECONDARY PAYOR PROVI16 SIONS.—Section 2107(e)(1) of the Social Security 

17 Act (42 U.S.C. 1397gg(e)(1)) is amended— 

18 (A) by redesignating subparagraphs (B) 

19 through (D) as subparagraphs (C) through (E), 

20 respectively; and 

21 (B) by inserting after subparagraph (A) 

22 the following: 

23 ‘‘(B) Section 1902(a)(25) (relating to co24 ordination of benefits and secondary payor pro-
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1 visions) with respect to children covered under 

2 a waiver described in section 2110(b)(5).’’. 

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

4 subsection (a) shall take effect on January 1, 2004, and 

5 shall apply to child health assistance and medical assist6 ance provided on or after that date. 

7 TITLE II—CORRECTING GME 

8 PAYMENTS FOR DENTAL 

9 RESIDENCY TRAINING PRO10 GRAMS 

11 SEC. 201. LIMITATION ON THE APPLICATION OF THE 1- 

12 YEAR LAG IN THE INDIRECT MEDICAL EDU13 CATION RATIO (IME) CHANGES AND THE 3- 

14 YEAR ROLLING AVERAGE FOR COUNTING IN15 TERNS AND RESIDENTS FOR IME AND DI16 RECT GRADUATE MEDICAL EDUCATION (D–

17 GME) PAYMENTS UNDER THE MEDICARE 

18 PROGRAM. 

19 (a) IME RATIO AND ROLLING AVERAGE.—Section 

20 1886(d)(5)(B)(vi) of the Social Security Act (42 U.S.C. 

21 1395ww(d)(5)(B)(vi)) is amended by adding at the end 

22 the following new sentence: ‘‘For cost reporting periods 

23 beginning during fiscal years beginning on or after Octo24 ber 1, 2004, subclauses (I) and (II) shall be applied only 

25 with respect to a hospital’s approved medical residency 
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1 training program in the fields of allopathic medicine and 

2 osteopathic medicine.’’. 

3 (b) D–GME ROLLING AVERAGE.—Section 

4 1886(h)(4)(G) of the Social Security Act (42 U.S.C. 

5 1395ww(h)(4)(G)) is amended by adding at the end the 

6 following new clause: 

7 ‘‘(iv) APPLICATION FOR FY 2005 AND

8 SUBSEQUENT YEARS.—For cost reporting 

9 periods beginning during fiscal years be10 ginning on or after October 1, 2004, 

11 clauses (i) through (iii) shall be applied 

12 only with respect to a hospital’s approved 

13 medical residency training program in the 

14 fields of allopathic medicine and osteo15 pathic medicine.’’. 
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1 TITLE III—IMPROVING DELIV2 ERY OF PEDIATRIC DENTAL 

3 SERVICES UNDER COMMU4 NITY HEALTH CENTERS, PUB5 LIC HEALTH DEPARTMENTS, 

6 AND THE INDIAN HEALTH 

7 SERVICE 

8 SEC. 301. GRANTS TO IMPROVE THE PROVISION OF DENTAL 

9 HEALTH SERVICES THROUGH COMMUNITY 

10 HEALTH CENTERS AND PUBLIC HEALTH DE11 PARTMENTS. 

12 Subpart I of part D of title III of the Public Health 

13 Service Act (42 U.S.C. 254b et seq.) is amended by insert 

14 before section 330, the following: 

15 ‘‘SEC. 329. GRANT PROGRAM TO EXPAND THE AVAIL16 ABILITY OF SERVICES. 

17 ‘‘(a) IN GENERAL.—The Secretary, acting through 

18 the Health Resources and Services Administration, shall 

19 establish a program under which the Secretary may award 

20 grants to eligible entities and eligible individuals to expand 

21 the availability of primary dental care services in dental 

22 health professional shortage areas or medically under23 served areas. 

24 ‘‘(b) ELIGIBILITY.— 
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1 ‘‘(1) ENTITIES.—To be eligible to receive a 

2 grant under this section an entity— 

3 ‘‘(A) shall be— 

4 ‘‘(i) a health center receiving funds 

5 under section 330 or designated as a Fed6 erally qualified health center; 

7 ‘‘(ii) a county or local public health 

8 department, if located in a federally-des9 ignated dental health professional shortage 

10 area; 

11 ‘‘(iii) an Indian tribe or tribal organi12 zation (as defined in section 4 of the In13 dian Self-Determination and Education 

14 Assistance Act (25 U.S.C. 450b)); 

15 ‘‘(iv) a dental education program ac16 credited by the Commission on Dental Ac17 creditation; or 

18 ‘‘(v) a community-based program 

19 whose child service population is made up 

20 of at least 33 percent of children who are 

21 eligible children, including at least 25 per22 cent of such children being children with 

23 mental retardation or related develop24 mental disabilities, unless specific docu-
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1 mentation of a lack of need for access by 

2 this sub-population is established; and 

3 ‘‘(B) shall prepare and submit to the Sec4 retary an application at such time, in such 

5 manner, and containing such information as the 

6 Secretary may require, including information 

7 concerning dental provider capacity to serve in8 dividuals with developmental disabilities. 

9 ‘‘(2) INDIVIDUALS.—To be eligible to receive a 

10 grant under this section an individual shall— 

11 ‘‘(A) be a dental health professional li12 censed or certified in accordance with the laws 

13 of State in which such individual provides den14 tal services; 

15 ‘‘(B) prepare and submit to the Secretary 

16 an application at such time, in such manner, 

17 and containing such information as the Sec18 retary may require; and 

19 ‘‘(C) provide assurances that— 

20 ‘‘(i) the individual will practice in a 

21 federally-designated dental health profes22 sional shortage area; or 

23 ‘‘(ii) not less than 25 percent of the 

24 patients of such individual are— 
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1 ‘‘(I) receiving assistance under a 

2 State plan under title XIX of the So3 cial Security Act (42 U.S.C. 1396 et 

4 seq.); 

5 ‘‘(II) receiving assistance under a 

6 State plan under title XXI of the So7 cial Security Act (42 U.S.C. 1397aa 

8 et seq.); or 

9 ‘‘(III) uninsured. 

10 ‘‘(c) USE OF FUNDS.— 

11 ‘‘(1) ENTITIES.—An entity shall use amounts 

12 received under a grant under this section to provide 

13 for the increased availability of primary dental serv14 ices in the areas described in subsection (a). Such 

15 amounts may be used to supplement the salaries of16 fered for individuals accepting employment as den17 tists in such areas. 

18 ‘‘(2) INDIVIDUALS.—A grant to an individual 

19 under subsection (a) shall be in the form of a 

20 $1,000 bonus payment for each month in which such 

21 individual is in compliance with the eligibility re22 quirements of subsection (b)(2)(C). 

23 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.— 

24 ‘‘(1) IN GENERAL.—Notwithstanding any other 

25 amounts appropriated under section 330 for health 
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1 centers, there is authorized to be appropriated 

2 $40,000,000 for each of fiscal years 2005 through 

3 2009 to hire and retain dental health care providers 

4 under this section. 

5 ‘‘(2) USE OF FUNDS.—Of the amount appro6 priated for a fiscal year under paragraph (1), the 

7 Secretary shall use— 

8 ‘‘(A) not less than 65 percent of such 

9 amount to make grants to eligible entities; and 

10 ‘‘(B) not more than 35 percent of such 

11 amount to make grants to eligible individuals.’’. 

12 SEC. 302. DENTAL OFFICER MULTIYEAR RETENTION BONUS 

13 FOR THE INDIAN HEALTH SERVICE. 

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

15 (1) CREDITABLE SERVICE.—The term ‘‘cred16 itable service’’ includes all periods that a dental offi17 cer spent in graduate dental educational (GDE) 

18 training programs while not on active duty in the In19 dian Health Service and all periods of active duty in 

20 the Indian Health Service as a dental officer. 

21 (2) DENTAL OFFICER.—The term ‘‘dental offi22 cer’’ means an officer of the Indian Health Service 

23 designated as a dental officer. 

24 (3) DIRECTOR.—The term ‘‘Director’’ means 

25 the Director of the Indian Health Service. 
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1 (4) RESIDENCY.—The term ‘‘residency’’ means 

2 a graduate dental educational (GDE) training pro3 gram of at least 12 months leading to a specialty, 

4 including general practice residency (GPR) or an ad5 vanced education general dentistry (AEGD). 

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

7 dental specialty for which there is an Indian Health 

8 Service specialty code number. 

9 (b) REQUIREMENTS FOR BONUS.— 

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

11 the Indian Health Service who executes a written 

12 agreement to remain on active duty for 2, 3, or 4 

13 years after the completion of any other active duty 

14 service commitment to the Indian Health Service 

15 may, upon acceptance of the written agreement by 

16 the Director, be authorized to receive a dental officer 

17 multiyear retention bonus under this section. The 

18 Director may, based on requirements of the Indian 

19 Health Service, decline to offer such a retention 

20 bonus to any specialty that is otherwise eligible, or 

21 to restrict the length of such a retention bonus con22 tract for a specialty to less than 4 years. 

23 (2) LIMITATIONS.—Each annual dental officer 

24 multiyear retention bonus authorized under this sec25 tion shall not exceed the following: 
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1 (A) $14,000 for a 4-year written agree2 ment. 

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

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

5 (c) ELIGIBILITY.— 

6 (1) IN GENERAL.—In order to be eligible to re7 ceive a dental officer multiyear retention bonus 

8 under this section, a dental officer shall— 

9 (A) be at or below such grade as the Di10 rector shall determine; 

11 (B) have completed any active duty service 

12 commitment of the Indian Health Service in13 curred for dental education and training or 

14 have 8 years of creditable service; 

15 (C) have completed initial residency train16 ing, or be scheduled to complete initial resi17 dency training before September 30 of the fiscal 

18 year in which the officer enters into a dental of19 ficer multiyear retention bonus written service 

20 agreement under this section; and 

21 (D) have a dental specialty in pediatric 

22 dentistry or oral and maxillofacial surgery. 

23 (2) EXTENSION TO OTHER OFFICERS.—The Di24 rector may extend the retention bonus to dental offi25 cers other than officers with a dental specialty in pe-
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1 diatric dentistry, as well as to other dental hygien2 ists with a minimum of a baccalaureate degree, 

3 based on demonstrated need. 

4 (d) TERMINATION OF ENTITLEMENT TO SPECIAL

5 PAY.—The Director may terminate, with cause, at any 

6 time a dental officer’s multiyear retention bonus contract 

7 under this section. If such a contract is terminated, the 

8 unserved portion of the retention bonus contract shall be 

9 recouped on a pro rata basis. The Director shall establish 

10 regulations that specify the conditions and procedures 

11 under which termination may take place. The regulations 

12 and conditions for termination shall be included in the 

13 written service contract for a dental officer multiyear re14 tention bonus under this section. 

15 (e) REFUNDS.— 

16 (1) IN GENERAL.—Prorated refunds shall be re17 quired for sums paid under a retention bonus con18 tract under this section if a dental officer who has 

19 received the retention bonus fails to complete the 

20 total period of service specified in the contract, as 

21 conditions and circumstances warrant. 

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

23 to reimburse the United States imposed under para24 graph (1) is a debt owed to the United States. 
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1 (3) NO DISCHARGE IN BANKRUPTCY.—Notwith2 standing any other provision of law, a discharge in 

3 bankruptcy under title 11, United States Code, that 

4 is entered less than 5 years after the termination of 

5 a retention bonus contract under this section does 

6 not discharge the dental officer who signed such a 

7 contract from a debt arising under the contract or 

8 under paragraph (1). 

9 SEC. 303. DEMONSTRATION PROJECTS TO INCREASE AC10 CESS TO PEDIATRIC DENTAL SERVICES IN 

11 UNDERSERVED AREAS. 

12 (a) AUTHORITY TO CONDUCT PROJECTS.—The Sec13 retary of Health and Human Services, through the Admin14 istrator of the Health Resources and Services Administra15 tion and the Director of the Indian Health Service, shall 

16 establish demonstration projects that are designed to in17 crease access to dental services for children in underserved 

18 areas, as determined by the Secretary. 

19 (b) AUTHORIZATION OF APPROPRIATIONS.—There is 

20 authorized to be appropriated such sums as may be nec21 essary to carry out this section. 

22 SEC. 304. TECHNICAL CORRECTION. 

23 Section 340G(b)(1)(B) of the Public Health Service 

24 Act (42 U.S.C. 256g(b)(1)(B)) is amended by striking 

25 ‘‘and’’ at the end and inserting ‘‘or’’. 
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1 TITLE IV—IMPROVING ORAL 

2 HEALTH PROMOTION AND 

3 DISEASE PREVENTION PRO4 GRAMS 

5 SEC. 401. ORAL HEALTH INITIATIVE. 

6 (a) ESTABLISHMENT.—The Secretary of Health and 

7 Human Services shall establish an oral health initiative 

8 to reduce the profound disparities in oral health by im9 proving the health status of vulnerable populations, par10 ticularly low-income children and children with develop11 mental disabilities, to the level of health status that is en12 joyed by the majority of Americans. 

13 (b) ACTIVITIES.—The Secretary of Health and 

14 Human Services shall, through the oral health initiative— 

15 (1) carry out activities to improve intra- and 

16 inter-agency collaborations, including activities to 

17 identify, engage, and encourage existing Federal and 

18 State programs to maximize their potential to ad19 dress oral health; 

20 (2) carry out activities to encourage public-pri21 vate partnerships to engage private sector commu22 nities of interest (including health professionals, 

23 educators, State policymakers, foundations, business, 

24 and the public) in partnerships that promote oral 

25 health and dental care; 
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1 (3) carry out activities to reduce the disease 

2 burden in high risk populations through the applica3 tion of best-science in oral health, including pro4 grams such as community water fluoridation and 

5 dental sealants; and 

6 (4) carry out activities to improve the oral 

7 health literacy of the public through school-based 

8 education programs. 

9 (c) COORDINATION.—The Secretary of Health and 

10 Human Services shall— 

11 (1) through the Administrator of the Centers 

12 for Medicare & Medicaid Services, establish the 

13 Chief Dental Officer for the medicaid and State chil14 dren’s health insurance programs established under 

15 titles XIX and XXI, respectively, of the Social Secu16 rity Act (42 U.S.C. 1396 et seq. 1397aa et seq.); 

17 (2) through the Administrator of the Health 

18 Resources and Services Administration, establish the 

19 Chief Dental Office for all oral health programs 

20 within the Health Resources and Services Adminis21 tration; 

22 (3) through the Director of the Centers for Dis23 ease Control and Prevention, establish the Chief 

24 Dental Officer for all oral health programs within 

25 such Centers; and 
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1 (4) carry out this section in collaboration with 

2 the Administrators and Chief Dental Officers de3 scribed in paragraphs (1), (2), and (3). 

4 (d) AUTHORIZATION OF APPROPRIATIONS.—There is 

5 authorized to be appropriated to carry out this section, 

6 $25,000,000 for fiscal year 2005, and such sums as may 

7 be necessary for each subsequent fiscal year. 

8 SEC. 402. CDC REPORTS. 

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

10 Centers for Disease Control and Prevention, in collabora11 tion with other organizations and agencies, shall collect 

12 data through State-based oral health surveillance systems 

13 describing the dental, craniofacial, and oral health of resi14 dents of all 50 States and certain Indian tribes. 

15 (b) REPORTS.—The Director of the Centers for Dis16 ease Control and Prevention shall compile and analyze 

17 data collection under subsection (a) and annually prepare 

18 and submit to the appropriate committees of Congress a 

19 report concerning the oral health of States and Indian 

20 tribes. 

21 SEC. 403. EARLY CHILDHOOD CARIES. 

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

23 Human Services, acting through the Director of the Cen24 ters for Disease Control and Prevention, shall— 
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1 (1) expand existing surveillance activities to in2 clude the identification of children at high risk of 

3 early childhood caries, including sub-populations 

4 such as children with developmental disabilities; 

5 (2) assist State, local, and tribal health agen6 cies and departments in collecting, analyzing and 

7 disseminating data on early childhood caries; and 

8 (3) provide for the development of public health 

9 nursing programs and public health education pro10 grams on early childhood caries prevention. 

11 (b) APPROPRIATENESS OF ACTIVITIES.—The Sec12 retary of Health and Human Services shall carry out pro13 grams and activities under subsection (a) in a culturally 

14 appropriate manner with respect to populations at risk of 

15 early childhood caries. 

16 (c) AUTHORIZATION OF APPROPRIATIONS.—There is 

17 authorized to be appropriated to carry out this section, 

18 such sums as may be necessary for each fiscal year. 

19 SEC. 404. SCHOOL-BASED DENTAL SEALANT PROGRAM. 

20 Section 317M(c) of the Public Health Service Act (as 

21 added by section 1602 of Public Law 106–310) is amend22 ed— 

23 (1) in paragraph (1), by inserting ‘‘and school24 linked’’ after ‘‘school-based’’; 

25 (2) in the first sentence of paragraph (2)— 
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1 (A) by inserting ‘‘and school-linked’’ after 

2 ‘‘school-based’’; and 

3 (B) by inserting ‘‘or Indian tribe’’ after 

4 ‘‘State’’; and 

5 (3) by striking paragraph (3) and inserting the 

6 following: 

7 ‘‘(3) ELIGIBILITY.—To be eligible to receive 

8 funds under paragraph (1), an entity shall— 

9 ‘‘(A) prepare and submit to the State or 

10 Indian tribe an application at such time, in 

11 such manner and containing such information 

12 as the State or Indian tribe may require; and 

13 ‘‘(B) be a— 

14 ‘‘(i) public elementary or secondary 

15 school— 

16 ‘‘(I) that is located in an urban 

17 area in which more than 50 percent of 

18 the student population is participating 

19 in Federal or State free or reduced 

20 meal programs; or 

21 ‘‘(II) that is located in a rural 

22 area and, with respect to the school 

23 district in which the school is located, 

24 the district involved has a median in25 come that is at or below 235 percent 
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1 of the poverty line, as defined in sec2 tion 673(2) of the Community Serv3 ices Block Grant Act (42 U.S.C. 

4 9902(2)); or 

5 ‘‘(ii) public or non-profit organization, 

6 including a grantee under section 330 and 

7 urban Indian clinics under title V of the 

8 Indian Health Care Improvement Act, that 

9 is under contract with an elementary or 

10 secondary school described in subpara11 graph (B) to provide dental services to 

12 school-age children.’’. 

13 SEC. 405. BASIC ORAL HEALTH PROMOTION. 

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

15 Human Services, acting through the Director of the Cen16 ters for Disease Control and Prevention and in consulta17 tion with dental organizations (including organizations 

18 having expertise in the prevention and treatment of oral 

19 disease in underserved pediatric populations), shall award 

20 grants to States and Indian tribes to improve the basic 

21 capacity of such States and tribes to improve the oral 

22 health of children and their families. 

23 (b) REQUIREMENTS.—A State or Indian tribe shall 

24 use amounts received under a grant under this section to 

25 conduct one or more of the following activities: 
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1 (1) Establish an oral health plan, policies, effec2 tive prevention programs, and accountability meas3 ures and systems. 

4 (2) Establish and guide coalitions, partnerships, 

5 and alliances to accomplish the establishment of the 

6 plan, policies, programs and systems under para7 graph (1). 

8 (3) Monitor changes in oral disease burden, dis9 parities, and the utilization of preventive services by 

10 high-risk populations. 

11 (4) Identify, test, establish, support, and evalu12 ate prevention interventions to reduce oral health 

13 disparities. 

14 (5) Promote public awareness and education in 

15 support of improvements of oral health. 

16 (6) Support training programs for dental and 

17 other health professions needed to strengthen oral 

18 health prevention programs. 

19 (7) Establish, enhance, or expand oral disease 

20 prevention and disparity reduction programs. 

21 (8) Evaluate the progress and effectiveness of 

22 the State’s oral disease prevention and disparity re23 duction program. 

24 (c) AUTHORIZATION OF APPROPRIATIONS.—There is 

25 authorized to be appropriated to carry out this section, 
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1 such sums as may be necessary for fiscal year 2005 and 

2 each subsequent fiscal year. 

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