Medicaid Dental Benefit Act of 2021
Bill: S.3166 | Sponsor: Sen. Cardin, Benjamin L. (D-MD)
Policy area: Health

Summary:
Medicaid Dental Benefit Act of 2021
This bill requires state Medicaid programs to cover dental and oral health services for adults. It also increases the Federal Medical Assistance Percentage (i.e., federal matching rate) for such services.
The Centers for Medicare & Medicaid Services must develop oral health quality and equity measures and conduct outreach relating to such coverage. Additionally, the Medicaid and Children's Health Insurance Program (CHIP) Payment and Access Commission must report on specified information relating to adult oral health care.

To amend title XIX of the Social Security Act to improve coverage of 
  dental and oral health services for adults under Medicaid, 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 ``Medicaid Dental Benefit Act of 
2021''.

SEC. 2. REQUIRING MEDICAID COVERAGE OF DENTAL AND ORAL HEALTH SERVICES 
              FOR ADULTS.

    (a) In General.--
            (1) Mandatory coverage.--
                    (A) In general.--
                            (i) Requirement.--Section 1902(a)(10)(A) of 
                        the Social Security Act (42 U.S.C. 
                        1396a(a)(10)(A)) is amended by inserting 
                        ``(10),'' after ``(5),''.
                            (ii) Medically needy.--
                                    (I) In general.--Section 
                                1902(a)(10)(C)(iv) of such Act (42 
                                U.S.C. 1396a(a)(10)(C)(iv)) is amended 
                                by striking ``and (17)'' and inserting 
                                ``, (10), and (17)'' after ``(5)''.
                                    (II) Rule of construction.--Nothing 
                                in this section or the amendments made 
                                by this section shall be construed to 
                                limit the access of an individual 
                                residing in an institutional setting to 
                                dental and oral health services (as 
                                such term is defined in section 
                                1905(jj) of the Social Security Act, as 
                                added by paragraph (2)(B)).
                            (iii) Effective date.--The amendments made 
                        by clauses (i) and (ii) shall apply with 
                        respect to expenditures for medical assistance 
                        in calendar quarters beginning on or after 
                        January 1, 2023.
                    (B) Benchmark coverage.--Section 1937(b)(5) of the 
                Social Security Act (42 U.S.C. 1396u-7(b)(5)) is 
                amended by striking the period and inserting ``, and, 
                beginning January 1, 2023, coverage of dental and oral 
                health services (as such term is defined in section 
                1905(jj)).''.
                    (C) Optional application to territories.--Section 
                1902(j) of the Social Security Act (42 U.S.C. 1396a(j)) 
                is amended--
                            (i) by striking ``this title, the 
                        Secretary'' and inserting ``this title--
            ``(1) in the case of a State other than the 50 States and 
        the District of Columbia the requirement under subsection 
        (a)(10)(A) to provide the care and services listed in paragraph 
        (10) of section 1905(a) shall be optional; and
            ``(2) the Secretary''; and
                            (ii) by striking the second comma after 
                        ``section 1108(f)''.
            (2) Definition of dental and oral health services.--Section 
        1905 of the Social Security Act (42 U.S.C. 1396d) is amended--
                    (A) in subsection (a)(10), by inserting ``and 
                dental and oral health services (as defined in 
                subsection (jj))'' after ``dental services''; and
                    (B) by adding at the end the following new 
                subsection:
    ``(jj) Dental and Oral Health Services.--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 is 
legally authorized to furnish such items and services under State law 
(or the State regulatory mechanism provided by State law).''.
            (3) Conforming amendment.--
                    (A) In general.--Section 1905(a)(10) of the Social 
                Security Act (42 U.S.C. 1396d(a)(10)), as amended by 
                paragraph (2), is amended by striking ``dental services 
                and''.
                    (B) Effective date.--The amendment made by 
                subparagraph (A) shall take effect on January 1, 2023.
    (b) State Option for Additional Dental and Oral Health Benefits.--
Section 1905(a)(13) of the Social Security Act (42 U.S.C. 1396d(a)(13)) 
is amended by inserting the following new subparagraph after 
subparagraph (C):
                    ``(D) at State option, such items and services 
                related to dental and oral health services (as defined 
                in subsection (jj)) that are in addition to those 
                identified in such subsection (jj) as the State may 
                specify;''.
    (c) Increased FMAP.--
            (1) Medicaid.--Section 1905 of the Social Security Act (42 
        U.S.C. 1396d), as amended by subsection (a), is further 
        amended--
                    (A) in subsection (b), by striking ``and (ii)'' and 
                inserting ``(ii), and (kk)'';
                    (B) in subsection (ff), by striking ``and (ii)'' 
                and inserting ``, (ii), and (kk)''; and
                    (C) by adding at the end the following new 
                subsection:
    ``(kk) Increased FMAP for Expenditures Related to Dental and Oral 
Health Services.--
            ``(1) In general.--
                    ``(A) 50 states and dc.--Notwithstanding subsection 
                (b), in the case of a State that is 1 of the 50 States 
                or the District of Columbia, during the 12-quarter 
                period that begins on January 1, 2023, the Federal 
                medical assistance percentage shall be equal to 100 
                percent with respect to amounts expended by the State 
                for medical assistance for dental and oral health 
                services authorized under paragraph (10) of subsection 
                (a). In no case may the application of this 
                subparagraph result in the Federal medical assistance 
                percentage determined for a State with respect to 
                expenditures described in this subparagraph exceeding 
                100 percent.
                    ``(B) Territories.--
                            ``(i) In general.--Notwithstanding 
                        subsection (b), in the case of a State that is 
                        Puerto Rico, the Virgin Islands, Guam, the 
                        Northern Mariana Islands, or American Samoa, 
                        during a period described in clause (ii), the 
                        Federal medical assistance percentage shall be 
                        equal to 100 percent with respect to amounts 
                        expended by the State for medical assistance 
                        for any item or service that is included in 
                        dental and oral health services authorized 
                        under paragraph (10) of subsection (a). In no 
                        case may the application of this clause result 
                        in the Federal medical assistance percentage 
                        determined for a State with respect to 
                        expenditures described in this clause exceeding 
                        100 percent.
                            ``(ii) Period described.--A period 
                        described in this clause is, with respect to an 
                        item or service described in clause (i) and a 
                        State described in such clause, the 12-quarter 
                        period that begins with the first quarter 
                        beginning on or after January 1, 2023, in which 
                        such item or service is first covered under the 
                        State plan or under a waiver of such plan.
            ``(2) Exclusions.--The Federal medical assistance 
        percentage specified in paragraph (1) shall not apply to 
        amounts expended for medical assistance during any period for--
                    ``(A) additional items and services authorized 
                under paragraph (13)(D) of subsection (a); or
                    ``(B) items and services furnished to an individual 
                if, as of the date of enactment of this subsection, 
                medical assistance was available to such individual for 
                such items and services or medicare cost-sharing under 
                the State plan or a waiver of such plan.''.
            (2) Exclusion of amounts attributable to increased fmap 
        from territorial caps.--Section 1108 of the Social Security Act 
        (42 U.S.C. 1308) is amended--
                    (A) in subsection (f), in the matter preceding 
                paragraph (1), by striking ``subsections (g) and (h)'' 
                and inserting ``subsections (g), (h), and (i)''; and
                    (B) by adding at the end the following:
    ``(i) Exclusion From Caps of Amounts Attributable to Increased FMAP 
for Coverage of Dental and Oral Health Services.--Any additional amount 
paid to Puerto Rico, the Virgin Islands, Guam, the Northern Mariana 
Islands, and American Samoa for expenditures for medical assistance 
that is attributable to an increase in the Federal medical assistance 
percentage applicable to such expenditures under section 1905(kk) shall 
not be taken into account for purposes of applying payment limits under 
subsections (f) and (g).''.

SEC. 3. ADULT ORAL HEALTH QUALITY AND EQUITY MEASURES.

    (a) In General.--Title XI of the Social Security Act (42 U.S.C. 
1301 et seq.) is amended by inserting after section 1139B the following 
new section:

``SEC. 1139C. ADULT ORAL HEALTH QUALITY AND EQUITY MEASURES.

    ``(a) Development of Core Set of Adult Oral Health Care Quality and 
Equity Measures.--
            ``(1) In general.--The Secretary shall identify and publish 
        a recommended core set of health quality and equity measures 
        for individuals enrolled in a State plan (or waiver of such 
        plan) under title XIX who are over the age of 21 in the same 
        manner as the Secretary identifies and publishes a core set of 
        child health quality measures under section 1139A, including 
        with respect to identifying and publishing existing oral health 
        quality measures for such individuals that are in use under 
        public and privately sponsored health care coverage 
        arrangements, or that are part of reporting systems that 
        measure both the presence and duration of health insurance 
        coverage over time, that may be applicable to enrolled adults.
            ``(2) Alignment with existing core set.--In identifying and 
        publishing the recommended core set of adult oral health 
        quality and equity measures required under paragraph (1), the 
        Secretary shall ensure that, to the extent possible, such 
        measures align with and do not duplicate the core set of adult 
        health quality and equity measures identified, published, and 
        revised under section 1139B.
            ``(3) Process for adult oral health quality and equity 
        measures program.--In identifying gaps in existing adult oral 
        health quality and equity measures and establishing priorities 
        for the development and advancement of such measures, the 
        Secretary shall consult with--
                    ``(A) States;
                    ``(B) health care providers;
                    ``(C) patient representatives;
                    ``(D) dental professionals; and
                    ``(E) national organizations with expertise in oral 
                health quality or equity measurement.
    ``(b) Deadlines.--
            ``(1) Recommended measures.--Not later than 1 year after 
        enactment of this Act, the Secretary shall identify and publish 
        for comment a recommended core set of adult oral health quality 
        and equity measures that includes the following:
                    ``(A) Measures of utilization of oral health and 
                dental services across health care settings.
                    ``(B) Measures that address the availability of 
                oral evaluations during or following medical visits for 
                enrolled adults.
                    ``(C) Measures that address the incidence of 
                emergency department visits for non-traumatic dental 
                conditions.
                    ``(D) Measures that address the availability and 
                receipt of follow-up dental care after emergency 
                department visits for non-traumatic dental conditions 
                during pregnancy.
                    ``(E) Measures that address the availability of 
                counseling of enrolled adults aimed at improving oral 
                health outcomes.
                    ``(F) Measures that address the availability and 
                receipt of care for beneficiaries who meet the medical 
                necessity criteria for general anesthesia and 
                intravenous sedation.
                    ``(G) Measures that address screening and 
                evaluation for caries risk and periodontitis and 
                treatment for caries risk and periodontitis, including 
                the following:
                            ``(i) The percentage of enrolled adults who 
                        have caries risk documented in the reporting 
                        year involved.
                            ``(ii) The percentage of enrolled adults 
                        who received a topical fluoride application or 
                        sealants based on an oral health risk 
                        assessment demonstrating the need for such 
                        application or sealants during the reporting 
                        year involved.
                            ``(iii) The percentage of enrolled adults 
                        who received a comprehensive or periodic oral 
                        evaluation or a comprehensive periodontal 
                        evaluation during the reporting year involved.
                            ``(iv) The percentage of enrolled adults 
                        with a history of periodontitis who received an 
                        oral prophylaxis, scaling or root planing, or 
                        periodontal maintenance visit at least 2 times 
                        during the reporting year involved.
                            ``(v) The percentage of enrolled adults 
                        with diabetes who receive a comprehensive or 
                        periodic evaluation or a comprehensive 
                        periodontal evaluation during the reporting 
                        year involved.
                            ``(vi) The percentage of enrolled adults 
                        who require tooth extraction during the 
                        reporting year involved.
                            ``(vii) The percentage of enrolled adults 
                        who require partial or full dentures during the 
                        reporting year involved.
            ``(2) Dissemination.--Not later than 1 year after enactment 
        of this Act, the Secretary shall publish an initial core set of 
        oral health quality and equity measures that are applicable to 
        enrolled adults.
            ``(3) Standardized reporting.--Not later than 2 years after 
        the date of the enactment of this Act, the Secretary, in 
        consultation with States, shall develop a standardized format 
        for the collection and reporting of information based on the 
        initial core set of adult oral health quality and equity 
        measures (stratified by race, ethnicity, primary language, 
        disability status, sexual orientation and gender identity) and 
        create guidelines, procedures, and incentives to States to use 
        such measures and to collect and report information regarding 
        the quality and equity of oral health care for enrolled adults.
            ``(4) Reports to congress.--Not later than 3 years after 
        enactment of this act, and every 3 years thereafter, the 
        Secretary shall include in the report to Congress required 
        under section 1139A(a)(6) information similar to the 
        information required under that section with respect to the 
        measures established under this section.
    ``(c) Annual State Reports Regarding State-Specific Oral Health 
Quality and Equity Measures Applied Under Medicaid.--
            ``(1) In general.--Each State with a plan approved under 
        title XIX (or with a waiver of such plan in effect) shall 
        annually report (separately or as part of the annual report 
        required under section 1139A(c)) to the Secretary on--
                    ``(A) the State-specific adult oral health quality 
                and equity measures applied by the State under such a 
                plan or waiver, including measures described in 
                subsection (b)(1);
                    ``(B) the State-specific information on the quality 
                and equity of oral health care furnished to enrolled 
                adults under such a plan or waiver, including 
                information collected through external quality reviews 
                of managed care organizations under section 1932 and 
                benchmark plans under section 1937, disaggregated by 
                race, ethnicity, primary language, disability status, 
                sexual orientation, and gender identity;
                    ``(C) the State-specific information regarding the 
                dental benefits available to enrolled adults under such 
                a plan or waiver, including any limits on such benefits 
                and the amount of reimbursement provided under such 
                plan or waiver for such benefits; and
                    ``(D) the State-specific plan to identify, 
                evaluate, and reduce in meaningful and measurable ways, 
                to the extent practicable, health disparities based on 
                age, sex, race, ethnicity, primary language, sexual 
                orientation and gender identity, and disability status.
            ``(2) Publication.--Not later than 2 years after the date 
        of enactment of this Act, and annually thereafter, the 
        Secretary shall collect, analyze, and make publicly available 
        the information reported by States under paragraph (1).
    ``(d) Authorization of Appropriations.--There are authorized to be 
appropriated $10,000,000 to carry out this section. Funds appropriated 
under this subsection shall remain available until expended.''.
    (b) Required Reporting.--
            (1) Medicaid.--Section 1902(a) of the Social Security Act 
        (42 U.S.C. 1396a(a)) is amended--
                    (A) in paragraph (86), by striking ``and'' at the 
                end;
                    (B) in paragraph (87)(D), by striking the period 
                and inserting ``; and''; and
                    (C) by inserting after paragraph (87) the following 
                new paragraph:
            ``(88) provide for the reporting required under section 
        1139C(c).''.
            (2) CHIP.--Section 2102 of the Social Security Act (42 
        U.S.C. 1397bb) is amended by adding at the end the following 
        new subsection:
    ``(d) Reporting Requirements.--A State child health plan shall 
provide for the reporting required under section 1139C(c).''.

SEC. 4. ADULT ORAL HEALTH CARE REPORT.

    Not later than 2 years after the date of enactment of this Act, the 
Medicaid and CHIP Payment and Access Commission shall submit to 
Congress a report on issues related to adult oral health across the 50 
States, tribes, and the territories, including--
            (1) the availability of adult oral health coverage, and 
        enrollment in such coverage;
            (2) a survey of adult oral health status among low-income 
        women of childbearing age;
            (3) barriers to accessing adult oral health care, including 
        for racially diverse, ethnically diverse, and limited English 
        proficient communities;
            (4) innovations and potential solutions to problems of 
        access (including disparities in access) to adult oral health 
        care, including innovations that would expand access to such 
        care beyond dental offices; and
            (5) the impact of the amendments made by section 2 and 
        recommendations for improving reimbursement rates for such 
        provider of dental and oral health services under the Medicaid 
        program.

SEC. 5. ORAL HEALTH OUTREACH AND EDUCATION.

    Not later than 1 year after the date of enactment of this Act, the 
Secretary shall develop a program, to be implemented through contracts 
with entities that fund or provide oral health care, to provide--
            (1) culturally competent and linguistically appropriate 
        information on the availability and scope of oral health and 
        dental coverage for adults who are eligible for or enrolled 
        under a State plan (or waiver of such plan) under title XIX of 
        the Social Security Act (42 U.S.C. 1396 et seq.);
            (2) assistance in connecting adults and underserved 
        populations enrolled in such a plan (or waiver) to oral health 
        care;
            (3) education to dental, oral health, and medical 
        professionals to strengthen core competencies in delivering 
        culturally competent oral health care to adults enrolled in 
        such a plan (or waiver), including: individuals with physical 
        and intellectual disabilities, pregnant and postpartum 
        individuals, Alaskan-Native and American-Indian populations, 
        and people living in urban, rural and, other underserved 
        communities; and
            (4) culturally competent and linguistically appropriate 
        interactive oral health education aimed at promoting good oral 
        health practices for adults, including racially and ethnically 
        diverse Medicaid beneficiaries.
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