I
107TH CONGRESS
2D SESSION
H. R. 5098
To provide disadvantaged children with access to dental services.
IN THE HOUSE OF REPRESENTATIVES
JULY 11, 2002
Mr. DINGELL (for himself, Mr. UPTON, and Mr. WAXMAN) introduced the
following bill; which was referred to the Committee on Energy and Commerce
A BILL
To provide disadvantaged children with access to dental
services.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Children’s Access to Oral Health Act of 2002’’.
(b) TABLE OF CONTENTS.—The table of contents of
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. Requiring coverage of substantially equivalent dental services under
SCHIP.
Sec. 103. State option to provide wrap-around SCHIP coverage to children who
have other health coverage.
TITLE II—IMPROVING DELIVERY OF PEDIATRIC DENTAL SERV-
ICES UNDER COMMUNITY HEALTH CENTERS, PUBLIC HEALTH
DEPARTMENTS, AND THE INDIAN HEALTH SERVICE
Sec. 201. Grants to improve the provision of dental health services through
community health centers and public health departments.
Sec. 202. Dental officer multiyear retention bonus for the Indian Health Serv-
ice.
Sec. 203. Streamline process for designating dental health professional shortage
areas.
Sec. 204. Demonstration projects to increase access to pediatric dental services
in underserved areas.
TITLE III—IMPROVING ORAL HEALTH PROMOTION AND DISEASE
PREVENTION PROGRAMS
Sec. 301. Oral health initiative.
Sec. 302. CDC reports.
Sec. 303. Early childhood caries.
Sec. 304. School-based dental sealant program.
TITLE I—IMPROVING DELIVERY
OF PEDIATRIC DENTAL SERV-
ICES UNDER MEDICAID AND
SCHIP
SEC. 101. GRANTS TO IMPROVE THE PROVISION OF DENTAL
SERVICES UNDER MEDICAID AND SCHIP.
Title V of the Social Security Act (42 U.S.C. 701
et seq.) is amended by adding at the end the following:
‘‘SEC. 511. GRANTS TO IMPROVE THE PROVISION OF DEN-
TAL SERVICES UNDER MEDICAID AND SCHIP.
‘‘(a) AUTHORITY TO MAKE GRANTS.—In addition to
any other payments made under this title to a State, the
Secretary shall award grants to States that satisfy the re-
quirements of subsection (b) to improve the provision of
dental services to children who are enrolled in a State plan
under title XIX or a State child health plan under title
XXI (in this section, collectively referred to as the ‘State
plans’).
‘‘(b) REQUIREMENTS.—In order to be eligible for a
grant under this section, a State shall provide the Sec-
retary with the following assurances:
‘‘(1) 
IMPROVED
SERVICE
DELIVERY.—The
State shall have a plan to improve the delivery of
dental services to children who are enrolled in the
State plans, including providing outreach and ad-
ministrative case management, improving collection
and reporting of claims data, and providing incen-
tives, in addition to raising reimbursement rates, to
increase provider participation.
‘‘(2) ADEQUATE PAYMENT RATES.—The State
has provided for payment under the State plans for
dental services for children at levels consistent with
the market-based rates and sufficient enough to en-
list providers to treat children in need of dental serv-
ices.
‘‘(3) ENSURED ACCESS.—The State shall en-
sure it will make dental services available to children
enrolled in the State plans to the same extent as
such services are available to the general population
of the State.
‘‘(c) USE OF FUNDS.—
‘‘(1) IN GENERAL.—Funds provided under this
section may be used to provide administrative re-
sources (such as program development, provider
training, data collection and analysis, and research-
related tasks) to assist States in providing and as-
sessing services which include preventive and thera-
peutic dental care regimens.
‘‘(2) LIMITATION.—Such funds may not be
used for payment of direct dental, medical, or other
services or to obtain Federal matching funds under
any Federal program.
‘‘(d) APPLICATION.—A State shall submit an applica-
tion to the Secretary for a grant under this section in such
form and manner and containing such information as the
Secretary may require.
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There
are authorized to be appropriated to make grants under
this section $50,000,000 for fiscal year 2003 and each fis-
cal year thereafter.
‘‘(f) APPLICATION
OF
OTHER
PROVISIONS
OF
TITLE.—
‘‘(1) IN GENERAL.—Except as provided in para-
graph (2), the other provisions of this title shall not
apply to a grant made under this section.
‘‘(2) EXCEPTIONS.—The following provisions of
this title shall apply to a grant made under sub-
section (a) to the same extent and in the same man-
ner as such provisions apply to allotments made
under section 502(c):
‘‘(A) Section 504(b)(6) (relating to prohi-
bition on payments to excluded individuals and
entities).
‘‘(B) Section 504(c) (relating to the use of
funds for the purchase of technical assistance).
‘‘(C) Section 504(d) (relating to a limita-
tion on administrative expenditures).
‘‘(D) Section 506 (relating to reports and
audits), but only to the extent determined by
the Secretary to be appropriate for grants made
under this section.
‘‘(E) Section 507 (relating to penalties for
false statements).
‘‘(F) 
Section 
508 
(relating 
to 
non-
discrimination).
‘‘(G) Section 509 (relating to the adminis-
tration of the grant program).’’.
SEC. 102. REQUIRING COVERAGE OF SUBSTANTIALLY
EQUIVALENT 
DENTAL 
SERVICES 
UNDER
SCHIP.
(a) IN GENERAL.—Section 2103(c)(2) of the Social
Security Act (42 U.S.C. 1397cc(c)(2)) is amended by add-
ing at the end the following new subparagraph:
‘‘(E) Dental services.’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall take effect on January 1, 2003.
SEC. 103. STATE OPTION TO PROVIDE WRAP-AROUND
SCHIP COVERAGE TO CHILDREN WHO HAVE
OTHER HEALTH COVERAGE.
(a) IN GENERAL.—
(1) SCHIP.—
(A) STATE
OPTION
TO
PROVIDE
WRAP-
AROUND
COVERAGE.—Section 2110(b) of the
Social Security Act (42 U.S.C. 1397jj(b)) is
amended—
(i) in paragraph (1)(C), by inserting
‘‘, subject to paragraph (5),’’ after ‘‘under
title XIX or’’; and
(ii) by adding at the end the following
new paragraph:
‘‘(5) STATE OPTION TO PROVIDE WRAP-AROUND
COVERAGE.—A State may waive the requirement of
paragraph (1)(C) that a targeted low-income child
may not be covered under a group health plan or
under health insurance coverage, if the State satis-
fies the conditions described in subsection (c)(8).
The State may waive such requirement in order to
provide—
‘‘(A) dental services;
‘‘(B) cost-sharing protection; or
‘‘(C) all services.
In waiving such requirement, a State may limit the
application of the waiver to children whose family in-
come does not exceed a level specified by the State,
so long as the level so specified does not exceed the
maximum income level otherwise established for
other children under the State child health plan.’’;
and
(B) 
CONDITIONS
DESCRIBED.—Section
2105(c) of such Act (42 U.S.C. 1397ee(c)) is
amended by adding at the end the following
new paragraph:
‘‘(8) CONDITIONS
FOR
PROVISION
OF
WRAP
AROUND
COVERAGE.—For 
purposes 
of 
section
2110(b)(5), the conditions described in this para-
graph are the following:
‘‘(A) INCOME
ELIGIBILITY.—The State
child health plan (whether implemented under
title XIX or this XXI)—
‘‘(i) has the highest income eligibility
standard permitted under this title as of
January 1, 2002;
‘‘(ii) subject to subparagraph (B),
does not limit the acceptance of applica-
tions for children; and
‘‘(iii) provides benefits to all children
in the State who apply for and meet eligi-
bility standards.
‘‘(B) NO WAITING LIST IMPOSED.—With
respect to children whose family income is at or
below 200 percent of the poverty line, the State
does not impose any numerical limitation, wait-
ing list, or similar limitation on the eligibility of
such children for child health assistance under
such State plan.
‘‘(C) NO MORE FAVORABLE TREATMENT.—
The State child health plan may not provide
more favorable coverage of dental services to
the children covered under section 2110(b)(5)
than to children otherwise covered under this
title.’’.
(C) STATE OPTION TO WAIVE WAITING PE-
RIOD.—Section 2102(b)(1)(B) of such Act (42
U.S.C. 1397bb(b)(1)(B)) is amended—
(i) in clause (i), by striking ‘‘and’’ at
the end;
(ii) in clause (ii), by striking the pe-
riod and inserting ‘‘; and’’; and
(iii) by adding at the end the fol-
lowing new clause:
‘‘(iii) at State option, may not apply
a waiting period in the case of child de-
scribed in section 2110(b)(5), if the State
satisfies 
the 
requirements 
of 
section
2105(c)(8).’’.
(2) APPLICATION OF ENHANCED MATCH UNDER
MEDICAID.—Section 1905 of such Act (42 U.S.C.
1396d) is amended—
(A) in subsection (b), in the fourth sen-
tence, by striking ‘‘or subsection (u)(3)’’ and
inserting ‘‘(u)(3), or (u)(4)’’; and
(B) in subsection (u)—
(i) by redesignating paragraph (4) as
paragraph (5); and
(ii) by inserting after paragraph (3)
the following new paragraph:
TITLE II—IMPROVING DELIVERY
OF PEDIATRIC DENTAL SERV-
ICES 
UNDER 
COMMUNITY
HEALTH 
CENTERS, 
PUBLIC
HEALTH DEPARTMENTS, AND
THE INDIAN HEALTH SERV-
ICE
SEC. 201. GRANTS TO IMPROVE THE PROVISION OF DENTAL
HEALTH SERVICES THROUGH COMMUNITY
HEALTH CENTERS AND PUBLIC HEALTH DE-
PARTMENTS.
Part D of title III of the Public Health Service Act
(42 U.S.C. 254b et seq.) is amended by insert before sec-
tion 330, the following:
‘‘SEC. 329. GRANT PROGRAM TO EXPAND THE AVAIL-
ABILITY OF SERVICES.
‘‘(a) IN GENERAL.—The Secretary, acting through
the Health Resources and Services Administration, shall
establish a program under which the Secretary may award
grants to eligible entities and eligible individuals to expand
the availability of primary dental care services in dental
health professional shortage areas or medically under-
served areas.
‘‘(b) ELIGIBILITY.—
‘‘(1) ENTITIES.—To be eligible to receive a
grant under this section an entity—
‘‘(A) shall be—
‘‘(i) a health center receiving funds
under section 330 or designated as a Fed-
erally qualified health center;
‘‘(ii) a county or local public health
department, if located in a federally-des-
ignated dental health professional shortage
area;
‘‘(iii) an Indian tribe or tribal organi-
zation (as defined in section 4 of the In-
dian Self-Determination and Education
Assistance Act (25 U.S.C. 450b)); or
‘‘(iv) a dental education program ac-
credited by the Commission on Dental Ac-
creditation; and
‘‘(B) shall prepare and submit to the Sec-
retary an application at such time, in such
manner, and containing such information as the
Secretary may require.
‘‘(2) INDIVIDUALS.—To be eligible to receive a
grant under this section an individual shall—
‘‘(A) be a dental health professional li-
censed or certified in accordance with the laws
of State in which such individual provides den-
tal services;
‘‘(B) prepare and submit to the Secretary
an application at such time, in such manner,
and containing such information as the Sec-
retary may require; and
‘‘(C) provide assurances that—
‘‘(i) the individual will practice in a
federally-designated dental health profes-
sional shortage area; and
‘‘(ii) not less than 33 percent of the
patients of such individual are—
‘‘(I) receiving assistance under a
State plan under title XIX of the So-
cial Security Act (42 U.S.C. 1396 et
seq.);
‘‘(II) receiving assistance under a
State plan under title XXI of the So-
cial Security Act (42 U.S.C. 1397aa
et seq.); or
‘‘(III) uninsured.
‘‘(c) USE OF FUNDS.—
‘‘(1) ENTITIES.—An entity shall use amounts
received under a grant under this section to provide
for the increased availability of primary dental serv-
ices in the areas described in subsection (a). Such
amounts may be used to supplement the salaries of-
fered for individuals accepting employment as den-
tists in such areas.
‘‘(2) INDIVIDUALS.—A grant to an individual
under subsection (a) shall be in the form of a
$1,000 bonus payment for each month in which such
individual is in compliance with the eligibility re-
quirements of subsection (b)(2)(C).
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—
‘‘(1) IN GENERAL.—Notwithstanding any other
amounts appropriated under section 330 for health
centers, there is authorized to be appropriated
$40,000,000 for each of fiscal years 2003 through
2007 to hire and retain dental health care providers
under this section.
‘‘(2) USE OF FUNDS.—Of the amount appro-
priated for a fiscal year under paragraph (1), the
Secretary shall use—
‘‘(A) not less than 75 percent of such
amount to make grants to eligible entities; and
‘‘(B) not more than 25 percent of such
amount to make grants to eligible individuals.’’.
SEC. 202. DENTAL OFFICER MULTIYEAR RETENTION BONUS
FOR THE INDIAN HEALTH SERVICE.
(a) TERMS AND DEFINITIONS.—In this section:
(1) CREDITABLE
SERVICE.—The term ‘‘cred-
itable service’’ includes all periods that a dental offi-
cer spent in graduate dental educational (GDE)
training programs while not on active duty in the In-
dian Health Service and all periods of active duty in
the Indian Health Service as a dental officer.
(2) DENTAL OFFICER.—The term ‘‘dental offi-
cer’’ means an officer of the Indian Health Service
designated as a dental officer.
(3) DIRECTOR.—The term ‘‘Director’’ means
the Director of the Indian Health Service.
(4) RESIDENCY.—The term ‘‘residency’’ means
a graduate dental educational (GDE) training pro-
gram of at least 12 months leading to a specialty,
including general practice residency (GPR) or an ad-
vanced education general dentistry (AEGD).
(5) SPECIALTY.—The term ‘‘specialty’’ means a
dental specialty for which there is an Indian Health
Service specialty code number.
(b) REQUIREMENTS FOR BONUS.—
(1) IN GENERAL.—An eligible dental officer of
the Indian Health Service who executes a written
agreement to remain on active duty for 2, 3, or 4
years after the completion of any other active duty
service commitment to the Indian Health Service
may, upon acceptance of the written agreement by
the Director, be authorized to receive a dental officer
multiyear retention bonus under this section. The
Director may, based on requirements of the Indian
Health Service, decline to offer such a retention
bonus to any specialty that is otherwise eligible, or
to restrict the length of such a retention bonus con-
tract for a specialty to less than 4 years.
(2) LIMITATIONS.—Each annual dental officer
multiyear retention bonus authorized under this sec-
tion shall not exceed the following:
(A) $14,000 for a 4-year written agree-
ment.
(B) $8,000 for a 3-year written agreement.
(C) $4,000 for a 2-year written agreement.
(c) ELIGIBILITY.—
(1) IN GENERAL.—In order to be eligible to re-
ceive a dental officer multiyear retention bonus
under this section, a dental officer shall—
(A) be at or below such grade as the Di-
rector shall determine;
(B) have completed any active duty service
commitment of the Indian Health Service in-
curred for dental education and training or
have 8 years of creditable service;
(C) have completed initial residency train-
ing, or be scheduled to complete initial resi-
dency training before September 30 of the fiscal
year in which the officer enters into a dental of-
ficer multiyear retention bonus written service
agreement under this section; and
(D) have a dental specialty in pediatric
dentistry or oral and maxillofacial surgery.
(2) EXTENSION TO OTHER OFFICERS.—The Di-
rector may extend the retention bonus to dental offi-
cers other than officers with a dental specialty in pe-
diatric dentistry, as well as to other dental hygien-
ists with a minimum of a baccalaureate degree,
based on demonstrated need.
(d) TERMINATION
OF ENTITLEMENT
TO SPECIAL
PAY.—The Director may terminate, with cause, at any
time a dental officer’s multiyear retention bonus contract
under this section. If such a contract is terminated, the
unserved portion of the retention bonus contract shall be
recouped on a pro rata basis. The Director shall establish
regulations that specify the conditions and procedures
under which termination may take place. The regulations
and conditions for termination shall be included in the
written service contract for a dental officer multiyear re-
tention bonus under this section.
(e) REFUNDS.—
(1) IN GENERAL.—Prorated refunds shall be re-
quired for sums paid under a retention bonus con-
tract under this section if a dental officer who has
received the retention bonus fails to complete the
total period of service specified in the contract, as
conditions and circumstances warrant.
(2) DEBT TO UNITED STATES.—An obligation
to reimburse the United States imposed under para-
graph (1) is a debt owed to the United States.
(3) NO DISCHARGE IN BANKRUPTCY.—Notwith-
standing any other provision of law, a discharge in
bankruptcy under title 11, United States Code, that
is entered less than 5 years after the termination of
a retention bonus contract under this section does
not discharge the dental officer who signed such a
contract from a debt arising under the contract or
under paragraph (1).
SEC. 203. STREAMLINE PROCESS FOR DESIGNATING DEN-
TAL 
HEALTH 
PROFESSIONAL 
SHORTAGE
AREAS.
Section 332(a) of the Public Health Service Act (42
U.S.C. 254e(a)) is amended by adding at the end the fol-
lowing:
‘‘(4) In designating health professional shortage
areas under this section, the Secretary may designate cer-
tain areas as dental health professional shortage areas if
the Secretary determines that such areas have a severe
shortage of dental health professionals. The Secretary
shall, in consultation with State and local dental societies
and tribal health organizations, streamline the process to
develop, publish and periodically update criteria to be used
in designating dental health professional shortage areas.’’.
SEC. 204. DEMONSTRATION PROJECTS TO INCREASE AC-
CESS TO PEDIATRIC DENTAL SERVICES IN
UNDERSERVED AREAS.
(a) AUTHORITY TO CONDUCT PROJECTS.—The Sec-
retary of Health and Human Services, through the Admin-
istrator of the Health Resources and Services Administra-
tion and the Director of the Indian Health Service, shall
establish demonstration projects that are designed to in-
crease access to dental services for children in underserved
areas, as determined by the Secretary.
(b) AUTHORIZATION OF APPROPRIATIONS.—There is
authorized to be appropriated such sums as may be nec-
essary to carry out this section.
TITLE 
III—IMPROVING 
ORAL
HEALTH 
PROMOTION 
AND
DISEASE PREVENTION PRO-
GRAMS
SEC. 301. ORAL HEALTH INITIATIVE.
(a) ESTABLISHMENT.—The Secretary of Health and
Human Services shall establish an oral health initiative
to reduce the profound disparities in oral health by im-
proving the health status of vulnerable populations, par-
ticularly low-income children, to the level of health status
that is enjoyed by the majority of Americans.
(b) ACTIVITIES.—The Secretary of Health and
Human Services shall, through the oral health initiative—
(1) carry out activities to improve intra- and
inter-agency collaborations, including activities to
identify, engage, and encourage existing Federal and
State programs to maximize their potential to ad-
dress oral health;
(2) carry out activities to encourage public-pri-
vate partnerships to engage private sector commu-
nities of interest (including health professionals,
educators, State policymakers, foundations, business,
and the public) in partnerships that promote oral
health and dental care; and
(3) carry out activities to reduce the disease
burden in high risk populations through the applica-
tion of best-science in oral health, including pro-
grams such as community water fluoridation and
dental sealants.
(c) COORDINATION.—The Secretary of Health and
Human Services shall—
(1) through the Administrator of the Centers
for Medicare & Medicaid Services (formerly known
as the Health Care Financing Administration) es-
tablish a Chief Dental Officer for the medicaid and
State children’s health insurance programs estab-
lished under titles XIX and XXI, respectively, of the
Social Security Act (42 U.S.C. 1396 et seq. 1397aa
et seq.); and
(2) carry out this section in collaboration with
such Administrator and Chief Dental Officer and
the Administrator and Chief Dental Officer of the
Health Resources and Services Administration.
(d) AUTHORIZATION OF APPROPRIATIONS.—There is
authorized to be appropriated to carry out this section,
$25,000,000 for fiscal year 2003, and such sums as may
be necessary for each subsequent fiscal year.
SEC. 302. CDC REPORTS.
(a) COLLECTION
OF DATA.—The Director of the
Centers for Disease Control and Prevention in collabora-
tion with other organizations and agencies shall annually
collect data describing the dental, craniofacial, and oral
health of residents of at least 1 State and 1 Indian tribe
from each region of the Department of Health and Human
Services.
(b) REPORTS.—The Director of the Centers for Dis-
ease Control and Prevention shall compile and analyze
data collected under subsection (a) and annually prepare
and submit to the appropriate committees of Congress a
report concerning the oral health of certain States and
tribes.
(c) AUTHORIZATION OF APPROPRIATIONS.—There is
authorized to be appropriated to carry out this section
such sums as may be necessary for each fiscla year 2003
and each subsequent fiscal year.
SEC. 303. EARLY CHILDHOOD CARIES.
(a) IN GENERAL.—The Secretary of Health and
Human Services, acting through the Director of the Cen-
ters for Disease Control and Prevention, shall—
(1) expand existing surveillance activities to in-
clude the identification of children at high risk of
early childhood caries;
(2) assist State, local, and tribal health agen-
cies and departments in collecting, analyzing and
disseminating data on early childhood caries; and
(3) provide for the development of public health
nursing programs and public health education pro-
grams on early childhood caries prevention.
(b) APPROPRIATENESS
OF ACTIVITIES.—The Sec-
retary of Health and Human Services shall carry out pro-
grams and activities under subsection (a) in a culturally
appropriate manner with respect to populations at risk of
early childhood caries.
(c) AUTHORIZATION OF APPROPRIATIONS.—There is
authorized to be appropriated to carry out this section,
such sums as may be necessary for each fiscal year.
SEC. 304. SCHOOL-BASED DENTAL SEALANT PROGRAM.
Section 317M(c) of the Public Health Service Act (as
added by section 1602 of Public Law 106–310)) is
amended—
(1) in paragraph (1), by inserting ‘‘and school-
linked’’ after ‘‘school-based’’;
(2) in the first sentence of paragraph (2)—
(A) by inserting ‘‘and school-linked’’ after
‘‘school-based’’; and
(B) by inserting ‘‘or Indian tribe’’ after
‘‘State’’; and
(3) by striking paragraph (3) and inserting the
following:
‘‘(3) ELIGIBILITY.—To be eligible to receive
funds under paragraph (1), an entity shall—
‘‘(A) prepare and submit to the State or
Indian tribe an application at such time, in
such manner and containing such information
as the State or Indian tribe may require; and
‘‘(B) be a—
‘‘(i) public elementary or secondary
school—
‘‘(I) that is located in an urban
area in which and more than 50 per-
cent of the student population is par-
ticipating in Federal or State free or
reduced meal programs; or
‘‘(II) that is located in a rural
area and, with respect to the school
district in which the school is located,
the district involved has a median in-
come that is at or below 235 percent
of the poverty line, as defined in sec-
tion 673(2) of the Community Serv-
ices Block Grant Act (42 U.S.C.
9902(2)); or
‘‘(ii) public or non-profit health orga-
nization, including a grantee under section
330, that is under contract with an ele-
mentary or secondary school described in
subparagraph (B) to provide dental serv-
ices to school-age children.’’.
Æ