SMILED Act

Subjects: Health


<html><body><pre>[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1422 Introduced in House (IH)]

&lt;DOC&gt;






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.

    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 ``Strengthening Medicaid Incentives 
for Licensees Enrolled in Dental Act'' or the ``SMILED Act''.

SEC. 2. SUPPORT FOR ENSURING INDIVIDUALS ENROLLED IN MEDICAID HAVE 
              DENTAL SERVICES ACCESS EQUAL TO THE POPULATION OF THE 
              STATE.

    Section 1903 of the Social Security Act (42 U.S.C. 1396b) is 
amended by adding at the end the following new subsection:
    ``(cc) Equal Access to Oral Health Care Plan.--
            ``(1) Provider participation and access requirements.--Not 
        later than 1 year after the date of enactment of this 
        paragraph, a State shall provide the Secretary with assurances 
        that administrative barriers to the participation of licensed 
        dentists under this title will be addressed, by--
                    ``(A) improving eligibility verification;
                    ``(B) ensuring that any such dentist may 
                participate in a publicly funded plan without also 
                having to participate in any other plan;
                    ``(C) simplifying claims forms processing; and
                    ``(D) assigning a single plan administrator for the 
                dental program.
            ``(2) Study on dentist participation.--Not later than 3 
        years after the date on which the assurance under paragraph (1) 
        is submitted, each State shall conduct a study to determine 
        whether the participation of licensed dentists have increased 
        following the assurance provided under paragraph (1).''.

SEC. 3. DENTAL AND ORAL HEALTH SERVICES DEFINED; AUDIT REQUIREMENT.

    (a) Dental and Oral Health Services Defined.--Section 1905 of the 
Social Security Act (42 U.S.C. 1396d) is amended--
            (1) in subsection (a)(10), by inserting ``and dental and 
        oral health services (as defined in subsection (jj))'' after 
        ``dental services''; and
            (2) by adding at the end the following new subsection:
    ``(jj) Dental and Oral Health Services.--
            ``(1) In general.--For purposes of subsection (a)(10), the 
        term `dental and oral health services' means dentures and 
        denture services, implants and implant services, and services 
        necessary to prevent oral disease and promote oral health, 
        restore oral structures to health and function, reduce oral 
        pain, and treat emergency oral conditions, that are furnished 
        by a provider who--
                    ``(A) is legally authorized to furnish such items 
                and services under State law (or the State regulatory 
                mechanism provided by State law);
                    ``(B) is initially credentialed by a State Medicaid 
                program (or the designated entity of such program) 
                through an integrated data collection system, as 
                described in paragraph (3); and
                    ``(C) is, as applicable, re-credentialed through 
                such integrated data collection system by a State 
                Medicaid program (or the designated entity of such 
                program).
            ``(2) Selection of data collection system.--Not later than 
        one year after the date of enactment of this subsection, the 
        State Medicaid Director shall select an integrated data 
        collection system (as defined in paragraph (3) that--
                    ``(A) minimizes provider paperwork burden; and
                    ``(B) communicates final credentialing decisions to 
                providers within 90 days of receipt of a completed 
                application.
            ``(3) Integrated data collection system defined.--For 
        purposes of this subsection, the term `integrated data 
        collection system' means an electronic system maintained by a 
        State and used for purposes of enrolling, screening, and 
        credentialing dentists under a State Medicaid program.''.
    (b) Dental and Oral Health Services Audit Requirement.--Not later 
than 90 days after the date of enactment of this Act, a State Medicaid 
program, including a program offered by a sponsor of a Medicaid managed 
care plan, that offers dental and oral health services audits a claim 
for such dental and oral health services shall--
            (1) utilize a licensed health care professional from the 
        dental specialty area of practice being audited to establish 
        relevant audit methodology consistent with--
                    (A) established practice guidelines, standards of 
                care, and State-issued dental Medicaid provider 
                handbooks; and
                    (B) established clinical practice guidelines and 
                acceptable standards of care established by the dental 
                professional or specialty organizations responsible for 
                setting such standards of care;
            (2) develop and implement, in consultation with the Centers 
        for Medicare & Medicaid Services, a procedure in which an 
        improper payment identified by an audit may be resubmitted as a 
        claims adjustment, including the resubmission of--
                    (A) claims denied as a result of an interpretation 
                of scope of services not previously held by the Centers 
                for Medicare & Medicaid Services;
                    (B) documentation when the document provided is 
                incomplete, illegible, or unclear; and
                    (C) documentation when clerical errors resulted in 
                a denial of claims for services actually provided; and
            (3) disallow the difference between the payment for the 
        service that was provided and the payment for the service that 
        should have been provided if a service was provided and 
        sufficiently documented, but denied because it was determined 
        that a different service should have been billed.
                                 &lt;all&gt;
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