I 

118TH CONGRESS 

1ST SESSION H. R. 1422 

To amend title XIX of the Social Security Act to improve oral health care 

and dental benefits under the Medicaid program, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 7, 2023 

Mr. SIMPSON 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 improve 

oral health care and dental benefits 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. 

4 This Act may be cited as the ‘‘Strengthening Med5 icaid Incentives for Licensees Enrolled in Dental Act’’ or 

6 the ‘‘SMILED Act’’. 


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1 SEC. 2. SUPPORT FOR ENSURING INDIVIDUALS ENROLLED 

2 IN MEDICAID HAVE DENTAL SERVICES AC3 CESS EQUAL TO THE POPULATION OF THE 

4 STATE. 

5 Section 1903 of the Social Security Act (42 U.S.C. 

6 1396b) is amended by adding at the end the following new 

7 subsection: 

8 ‘‘(cc) EQUAL ACCESS TO ORAL HEALTH CARE

9 PLAN.— 

10 ‘‘(1) PROVIDER PARTICIPATION AND ACCESS

11 REQUIREMENTS.—Not later than 1 year after the 

12 date of enactment of this paragraph, a State shall 

13 provide the Secretary with assurances that adminis14 trative barriers to the participation of licensed den15 tists under this title will be addressed, by— 

16 ‘‘(A) improving eligibility verification; 

17 ‘‘(B) ensuring that any such dentist may 

18 participate in a publicly funded plan without 

19 also having to participate in any other plan; 

20 ‘‘(C) simplifying claims forms processing; 

21 and 

22 ‘‘(D) assigning a single plan administrator 

23 for the dental program. 

24 ‘‘(2) STUDY ON DENTIST PARTICIPATION.—Not 

25 later than 3 years after the date on which the assur26 ance under paragraph (1) is submitted, each State 


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1 shall conduct a study to determine whether the par2 ticipation of licensed dentists have increased fol3 lowing the assurance provided under paragraph 

4 (1).’’. 

5 SEC. 3. DENTAL AND ORAL HEALTH SERVICES DEFINED; 

6 AUDIT REQUIREMENT. 

7 (a) DENTAL AND ORAL HEALTH SERVICES DE8 FINED.—Section 1905 of the Social Security Act (42 

9 U.S.C. 1396d) is amended— 

10 (1) in subsection (a)(10), by inserting ‘‘and 

11 dental and oral health services (as defined in sub12 section (jj))’’ after ‘‘dental services’’; and 

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

15 ‘‘(jj) DENTAL AND ORAL HEALTH SERVICES.— 

16 ‘‘(1) IN GENERAL.—For purposes of subsection 

17 (a)(10), the term ‘dental and oral health services’ 

18 means dentures and denture services, implants and 

19 implant services, and services necessary to prevent 

20 oral disease and promote oral health, restore oral 

21 structures to health and function, reduce oral pain, 

22 and treat emergency oral conditions, that are fur23 nished by a provider who— 

24 ‘‘(A) is legally authorized to furnish such 

25 items and services under State law (or the 


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1 State regulatory mechanism provided by State 

2 law); 

3 ‘‘(B) is initially credentialed by a State 

4 Medicaid program (or the designated entity of 

5 such program) through an integrated data col6 lection system, as described in paragraph (3); 

7 and 

8 ‘‘(C) is, as applicable, re-credentialed 

9 through such integrated data collection system 

10 by a State Medicaid program (or the designated 

11 entity of such program). 

12 ‘‘(2) SELECTION OF DATA COLLECTION SYS13 TEM.—Not later than one year after the date of en14 actment of this subsection, the State Medicaid Di15 rector shall select an integrated data collection sys16 tem (as defined in paragraph (3) that— 

17 ‘‘(A) minimizes provider paperwork bur18 den; and 

19 ‘‘(B) communicates final credentialing de20 cisions to providers within 90 days of receipt of 

21 a completed application. 

22 ‘‘(3) INTEGRATED DATA COLLECTION SYSTEM

23 DEFINED.—For purposes of this subsection, the 

24 term ‘integrated data collection system’ means an 

25 electronic system maintained by a State and used 


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1 for purposes of enrolling, screening, and 

2 credentialing dentists under a State Medicaid pro3 gram.’’. 

4 (b) DENTAL AND ORAL HEALTH SERVICES AUDIT

5 REQUIREMENT.—Not later than 90 days after the date 

6 of enactment of this Act, a State Medicaid program, in7 cluding a program offered by a sponsor of a Medicaid 

8 managed care plan, that offers dental and oral health serv9 ices audits a claim for such dental and oral health services 

10 shall— 

11 (1) utilize a licensed health care professional 

12 from the dental specialty area of practice being au13 dited to establish relevant audit methodology con14 sistent with— 

15 (A) established practice guidelines, stand16 ards of care, and State-issued dental Medicaid 

17 provider handbooks; and 

18 (B) established clinical practice guidelines 

19 and acceptable standards of care established by 

20 the dental professional or specialty organiza21 tions responsible for setting such standards of 

22 care; 

23 (2) develop and implement, in consultation with 

24 the Centers for Medicare & Medicaid Services, a pro25 cedure in which an improper payment identified by 


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1 an audit may be resubmitted as a claims adjust2 ment, including the resubmission of— 

3 (A) claims denied as a result of an inter4 pretation of scope of services not previously 

5 held by the Centers for Medicare & Medicaid 

6 Services; 

7 (B) documentation when the document 

8 provided is incomplete, illegible, or unclear; and 

9 (C) documentation when clerical errors re10 sulted in a denial of claims for services actually 

11 provided; and 

12 (3) disallow the difference between the payment 

13 for the service that was provided and the payment 

14 for the service that should have been provided if a 

15 service was provided and sufficiently documented, 

16 but denied because it was determined that a dif17 ferent service should have been billed. 

Æ 


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