Medicaid Dental Benefit Act
Bill: H.R.4439 | Sponsor: Rep. Barragan, Nanette Diaz (D-CA)
Policy area: Health

Summary:
Medicaid Dental Benefit Act
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 
   adult oral health care 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 ``Medicaid Dental Benefit Act''.

SEC. 2. REQUIRING COVERAGE OF ORAL HEALTH SERVICES FOR ADULTS UNDER THE 
              MEDICAID PROGRAM.

    (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) Effective date.--The amendment made by 
                        clause (i) shall apply with respect to medical 
                        assistance furnished in calendar quarters 
                        beginning on or after the date that is 1 year 
                        after the date of the enactment of this Act.
                    (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 with the first quarter beginning on or after 
                the date that is 1 year after the date of the enactment 
                of the Medicaid Dental Benefit Act, coverage of dental 
                and oral health services (as defined in section 
                1905(jj)).''.
            (2) Definition of services.--Section 1905 of the Social 
        Security Act (42 U.S.C. 1396d) is amended--
                    (A) in subsection (a)(10), by striking ``dental 
                services'' and inserting ``dental and oral health 
                services (as defined in subsection (jj))''; and
                    (B) by adding at the end the following new 
                subsection:
    ``(jj) Definition of Dental and Oral Health Services.--
            ``(1) In general.--For purposes of this title, the term 
        `dental and oral health services' means services necessary to 
        prevent disease and promote oral health, restore oral 
        structures to health and function, reduce oral pain, and treat 
        emergency oral conditions. Such term includes the services 
        specified in paragraph (2).
            ``(2) Specified services.--For purposes of paragraph (1), 
        the services specified in this paragraph are the following:
                    ``(A) Routine diagnostic and preventive care (such 
                as dental cleanings, exams, and x-rays).
                    ``(B) Basic dental services (such as fillings and 
                extractions) and major dental services (such as root 
                canals, crowns, and dentures).
                    ``(C) Emergency dental care.
                    ``(D) Temporomandibular (TMD) and orofacial pain 
                disorder treatment.
                    ``(E) Other necessary services related to dental 
                and oral health (as specified by the Secretary).''.
    (b) Enhanced FMAP; Maintenance of Effort.--
            (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)''; and
                    (B) by adding at the end the following new 
                subsection:
    ``(kk) Increased FMAP for Expenditures for Dental and Oral Health 
Services.--
            ``(1) In general.--The Federal medical assistance 
        percentage with respect to amounts expended by such State for 
        medical assistance consisting of dental and oral health 
        services (as defined in subsection (jj)) furnished during the 
        first calendar quarter beginning on or after the date that is 1 
        year after the date of the enactment of this subsection (or 
        during any subsequent quarter) to individuals 21 years of age 
        or older shall be equal to, in the case of such services 
        furnished--
                    ``(A) during the 3-year period beginning on the 
                first day of such first calendar quarter, 100 percent;
                    ``(B) during the 1-year period immediately 
                following the period described in subparagraph (A), 95 
                percent;
                    ``(C) during each subsequent 1-year period (through 
                the third such subsequent period), the percentage 
                specified under this paragraph for the preceding 1-year 
                period, reduced by 5 percentage points; and
                    ``(D) during any quarter beginning after the 7-year 
                period beginning on the first day described in 
                subparagraph (A), 80 percent.
            ``(2) No reduction in fmap.--Paragraph (1) shall not apply 
        with respect to amounts expended by a State if the Federal 
        medical assistance percentage otherwise applicable to such 
        amounts without application of such paragraph would be higher 
        than such percentage applicable to such amounts with 
        application of such paragraph.''.
            (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 payment made to a 
territory for expenditures for medical assistance that are subject to 
an increase 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) to the extent that such payment exceeds the amount of the 
payment that would have been made to the territory for such 
expenditures without regard to such section.''.

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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