II 117th CONGRESS 1st Session S. 3017 IN THE SENATE OF THE UNITED STATES October 20, 2021 Mr. Sanders (for himself, Mr. Blumenthal , Mr. Menendez , Mrs. Gillibrand , Mr. Booker , and Ms. Hirono ) introduced the following bill; which was read twice and referred to the Committee on Veterans' Affairs A BILL To expand the provision and availability of dental care furnished by the Department of Veterans Affairs, and for other purposes.

1. Short title This Act may be cited as the Veterans Dental Care Eligibility Expansion and Enhancement Act . 2. Sense of Congress It is the sense of Congress that— (1) the Department of Veterans Affairs has pioneered a whole health approach to health care, which brought mental health and suicide prevention under the umbrella of primary care and integrated health, provides access to alternative medicines, delivers a holistic approach to health and well-being, and repeatedly demonstrates better health outcomes than the private sector at a low cost to taxpayers in the United States; (2) the effects of poor dental care are seen in patients who are at risk of or diagnosed with diabetes, cardiovascular disease, pulmonary conditions, kidney impairment, and even dementia; (3) the Department spends countless dollars on prescription drugs, community care, urgent care, and emergency room visits on preventable ailments that would be reduced or eliminated through preventative dental care; and (4) in order to best achieve a whole health model for the provision of health care to veterans and reduce long-term costs, the Department must furnish veterans with preventative and comprehensive dental care. 3. Requirement that Secretary of Veterans Affairs furnish dental care in the same manner as any other medical service (a) In general Title 38, United States Code, is amended— (1) in section 1701(6)(B), by striking as described in sections 1710 and 1712 of this title ; (2) in section 1710(c), by striking the second sentence; and (3) in section 1712— (A) by striking subsections (a) and (b); (B) by redesignating subsections (c), (d), and (e) as subsections (a), (b), and (c), respectively; and (C) in subsection (a), as redesignated by subparagraph (B)— (i) by striking Dental appliances and inserting The Secretary may furnish dentures, dental appliances ; and (ii) by striking to be furnished by the Secretary under this section may be procured by the Secretary and inserting under this section and may procure such appliances . (b) Conforming and clerical amendments (1) Conforming amendments (A) Protection of health care eligibility Section 1525(a) of such title is amended by striking medicines under section 1712(d) and inserting medicines under section 1712(b) . (B) Dental insurance plan Section 1712C(h) of such title is amended— (i) by striking section 1712 of this title and inserting this chapter ; and (ii) by striking such section 1712 and inserting this chapter . (2) Heading amendment The heading for section 1712 of such title is amended to read as follows: 1712. Appliances; drugs and medicines for certain disabled veterans; vaccines . (3) Clerical amendment The table of sections at the beginning of subchapter II of chapter 17 of such title is amended by striking the item relating to section 1712 and inserting the following new item: 1712. Appliances; drugs and medicines for certain disabled veterans; vaccines. . (c) Effective date The amendments made by this section shall take effect on the date that is one year after the date of the enactment of this Act. 4. Expansion of furnishing by Department of Veterans Affairs of dental care to all enrolled veterans (a) In general The Secretary of Veterans Affairs shall furnish dental care to all veterans enrolled in the system of annual patient enrollment of the Department of Veterans Affairs established and operated under section 1705(a) of title 38, United States Code, pursuant to the phased approach required under this section. (b) Phase one required (1) Commencement (A) In general Commencing not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall furnish dental care to all covered veterans who are not eligible for dental services and treatment and related dental appliances under the laws administered by the Secretary as of the date of the enactment of this Act. (B) Phase one In this section, the furnishing of dental care under subparagraph (A) shall be referred to as phase one . (2) Duration of phase one Phase one shall be carried out during the two-year period beginning on the date of the commencement of phase one. (3) Locations (A) In general The Secretary shall carry out phase one at the following locations: (i) Each medical center of the Department with an established dental clinic. (ii) Not fewer than four military medical treatment facilities of the Department of Defense with the capacity to furnish dental care, which shall be selected in consultation with the Secretary of Defense. (iii) Not fewer than four community-based outpatient clinics with space available for the furnishing of dental care under phase one. (iv) Not fewer than four Federally Qualified Health Centers. (v) Not fewer than four facilities of the Indian Health Service with established dental clinics, which shall be selected in consultation with the Secretary of Health and Human Services. (B) Considerations In selecting locations for phase one, the Secretary shall consider the feasibility and advisability of selecting locations in each of the following: (i) Rural areas. (ii) Areas that are not in close proximity to an active duty military installation. (iii) Areas representing different geographic locations, such as census tracts established by the Bureau of the Census. (C) Mobile dental clinics In carrying out phase one, the Secretary shall test the efficacy of mobile dental clinics to service rural areas that do not have a population base to warrant a full-time clinic but where there are covered veterans in need of dental care. (D) Home-based dental care In carrying out phase one, the Secretary shall test the efficacy of portable dental care units to service rural veteran in their homes, as the Secretary considers medically appropriate. (4) Scope of services The dental care furnished to covered veterans under phase one shall be consistent with the dental services and treatment furnished by the Secretary to veterans with service-connected disabilities rated 100-percent disabling under the laws administered by the Secretary. (5) Use of telemedicine When providing dental services via telemedicine under phase one, the Secretary shall use Federal employees to the maximum extent possible. (6) Voluntary participation The participation of a covered veteran in phase one shall be at the election of the veteran. (7) Copayments The Secretary may collect copayments for dental care furnished under phase one in accordance with authorities on the collection of copayments for medical care of veterans under chapter 17 of title 38, United States Code. (8) Administration (A) Notice to covered veterans on phase one In carrying out phase one, the Secretary shall inform all covered veterans of the services and treatment available under phase one. (B) Contracts (i) In general Subject to clause (iii), in carrying out phase one, the Secretary may enter into contracts with appropriate entities for the provision of dental care under phase one. (ii) Performance standards and metrics Each contract entered into under clause (i) shall specify performance standards and metrics and processes for ensuring compliance of the contractor concerned with such performance standards. (iii) Limitation The Secretary may only enter into contracts under clause (i) if the Secretary determines that the Department does not employ, and cannot recruit and retain, qualified dentists, dental hygienists, and oral surgeons in the applicable location. (9) Definitions In this subsection: (A) Covered veteran The term covered veteran means a veteran enrolled in the system of annual patient enrollment of the Department of Veterans Affairs established and operated under section 1705(a) of title 38, United States Code, pursuant to paragraph (1) or (2) of such section. (B) Federally qualified health center The term Federally Qualified Health Center means a Federally-qualified health center as defined in section 1905(l)(2)(B) of the Social Security Act ( 42 U.S.C. 1396d(l)(2)(B) ). (c) Expansion (1) In general After the completion of phase one, the Secretary shall expand the provision of dental care under this section to all veterans, including through the use of the recommendations of the Secretary under subsection (d)(2)(F), as follows: (A) In phase two, which shall— (i) commence not later than 90 days after the completion of phase one; and (ii) consist of the provision of dental care to all veterans enrolled in the system of annual patient enrollment of the Department of Veterans Affairs established and operated under section 1705(a) of title 38, United States Code, pursuant to paragraph (1), (2), (3), or (4) of such section. (B) In phase three, which shall— (i) commence not later than 90 days after the completion of phase two; and (ii) consist of the provision of dental care to all veterans enrolled in such system pursuant to paragraph (1), (2), (3), (4), (5), or (6) of such section. (C) In phase four, which shall— (i) commence not later than 90 days after the completion of phase three; and (ii) consist of the provision of dental care to all veterans enrolled in such system. (2) Facility expansion Under each phase specified in paragraph (1), the Secretary shall expand the number of facilities described in subsection (b)(3) furnishing dental care under this section commensurate to the number of new veterans furnished care under such phase, including through the use of any other facilities to which veterans have access. (3) Duration Each phase specified in paragraph (1) shall be carried out during a period not to exceed two years and all such phases, including phase one, shall be carried out for a period not to exceed eight years. (4) Conclusion Upon the conclusion of phase four specified under paragraph (1)(C), all veterans enrolled in the system of annual patient enrollment of the Department of Veterans Affairs established and operated under section 1705(a) of title 38, United States Code, shall be eligible for dental care from the Department. (d) Reports (1) In general Not later than 90 days before the completion of phase one, and not later than 180 days after the completion of each subsequent phase under subsection (c)(1), the Secretary shall submit to the Committee on Veterans’ Affairs and the Committee on Armed Services of the Senate and the Committee on Veterans’ Affairs and the Committee on Armed Services of the House of Representatives a report on the phase about to be completed and the plans of the Secretary for implementation of expansion of the provision of dental care pursuant to subsection (c). (2) Contents Each report under paragraph (1) shall include the following: (A) A description of the implementation and operation of the phase covered by the report. (B) The number of veterans receiving dental care under such phase and a description of the dental care furnished to such veterans. (C) An analysis of the costs and benefits of such phase, including a comparison of costs and benefits by location type. (D) An assessment of the impact of such phase on appointments for care, prescriptions, hospitalizations, emergency room visits, well­ness, employability, and satisfaction of patients, and perceived quality of life of veterans. (E) An analysis and assessment of the efficacy of mobile clinics and home-based dental care to service the dental needs of veterans during such phase. (F) The findings and conclusions of the Secretary with respect to such phase. (G) A comparison of the costs for private sector dental care with cost of furnishing dental care from the Department, broken down by each locality included in such phase. (H) Such recommendations for the expansion of dental care pursuant to subsection (c) as the Secretary considers appropriate. 5. Requirement of dental clinic of Department of Veterans Affairs in each State (a) In general The Secretary of Veterans Affairs shall ensure that each State has a dental clinic of the Department of Veterans Affairs to service the needs of the veterans within that State. (b) Effective date This section shall take effect on the date that is one year after the date of the enactment of this Act. 6. Program on education to promote dental health in veterans (a) Program required The Secretary of Veterans Affairs shall carry out a program of education to promote dental health for veterans who are enrolled in the system of annual patient enrollment of the Department of Veterans Affairs established and operated under section 1705(a) of title 38, United States Code. (b) Elements The program required by subsection (a) shall provide education for veterans on the following: (1) The association between dental health and overall health and well-being. (2) Proper techniques for dental care. (3) Signs and symptoms of commonly occurring dental conditions. (4) Treatment options for commonly occurring dental issues. (5) Options for obtaining access to dental care, including information on eligibility for dental care through the Department. (6) Available and accessible options for obtaining low or no-cost dental care, including through dental schools and Federally Qualified Health Centers. (7) Such other matters relating to dental health as the Secretary considers appropriate. (c) Delivery of educational materials (1) In general The Secretary shall provide educational materials to veterans under the program required by subsection (a) through a variety of mechanisms, including the following: (A) The availability and distribution of print materials at facilities of the Department (including at medical centers, clinics, Vet Centers, and readjustment counseling centers) and to providers (including members of Patient Aligned Care Teams). (B) The availability and distribution of materials over the internet, including through webinars, My HealtheVet, and VA.gov. (C) Presentations by the dental program office of the Department of information, including both small group and large group presentations, and distribution of such information to all locations in which the program is being carried out. (2) Selection of mechanisms In selecting mechanisms under paragraph (1), the Secretary shall select mechanisms designed to maximize the number of veterans who receive education under the program. (d) Construction Nothing in this section shall be construed to alter or revise the eligibility of any veteran for dental care under the laws administered by the Secretary. (e) Definitions In this section— (1) Federally qualified health center The term Federally Qualified Health Center means a Federally-qualified health center as defined in section 1905(l)(2)(B) of the Social Security Act ( 42 U.S.C. 1396d(l)(2)(B) ). (2) Vet Center The term Vet Center has the meaning given that term in section 1712A(h) of title 38, United States Code. (f) Effective date This section shall take effect on the date that is one year after the date of the enactment of this Act. 7. Student loan repayment program to incentivize dental training and ensure the dental workforce of the Department of Veterans Affairs (a) Program required The Secretary of Veterans Affairs, to ensure that the Department of Veterans Affairs has sufficient staff to provide dental service to veterans, shall implement a loan reimbursement program for qualified dentists, dental hygienists, and oral surgeons who agree— (1) to be appointed by the Secretary as a dentist, dental hygienist, or oral surgeon, as the case may be, under section 7401 of title 38, United States Code; and (2) to serve as a dentist, dental hygienist, or oral surgeon, as the case may be, of the Department pursuant to such appointment at a dental clinic of the Department for a period of not less than five years. (b) Maximum amount The Secretary may reimburse not more than— (1) $75,000 for each dentist participating in the program under subsection (a); (2) $10,000 for each dental hygienist participating in such program; and (3) $20,000 for each oral surgeon participating in such program. (c) Selection of locations The Secretary shall monitor demand among veterans for dental care and require participants in the program under subsection (a) to choose from dental clinics of the Department with the greatest need for dentists, dental hygienists, or oral surgeons, as the case may be, according to facility enrollment and patient demand. 8. Educational and training partnerships for dentists, dental hygienists, and oral surgeons The Secretary of Veterans Affairs shall enter into educational and training partnerships with dental schools to provide training and employment opportunities for dentists, dental hygienists, and oral surgeons. 9. Authorization of appropriations (a) In general There is authorized to be appropriated for the Department of Veterans Affairs for fiscal year 2021 such sums as may be necessary to carry out this Act and the amendments made by this Act. (b) Availability The amount authorized to be appropriated under subsection (a) shall be available for obligation for the eight-year period beginning on the date that is one year after the date of the enactment of this Act.