I 118th CONGRESS 1st Session H. R. 4150 IN THE HOUSE OF REPRESENTATIVES June 15, 2023 Ms. Brownley introduced the following bill; which was referred to the Committee on Veterans' Affairs A BILL To improve the provision of health care furnished by the Department of Veterans Affairs for veterans diagnosed with diabetes and heart disease, and for other purposes.

1. Short title This Act may be cited as the Improving Whole Health for Veterans with Chronic Conditions 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 that 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 shown to worsen the symptoms of diabetes and heart disease; (3) diabetes and heart disease are shown to increase risk of periodontal disease; (4) the combination of diabetes, heart disease, and periodontal disease can be fatal; and (5) to best achieve a whole health model for the provision of health care to veterans with diabetes and heart disease and reduce long-term costs, the Department must furnish preventative and comprehensive dental care to veterans diagnosed with diabetes and heart disease. 3. Definitions In this Act: (1) Covered care The term covered care means dental care that is comprehensive in nature and consistent with the dental services and treatment furnished by the Secretary of Veterans Affairs to veterans pursuant to section 1712(a)(1)(G) of title 38, United States Code. (2) Covered veteran The term covered veteran means a veteran who— (A) is enrolled in the system of annual patient enrollment of the Department of Veterans Affairs established and operated under subsection (a) of section 1705 of title 38, United States Code, pursuant to paragraph (1) or (2) of such subsection or is not enrolled in such system but is otherwise entitled to hospital care and medical services under subsection (c)(2) of such section; (B) is not eligible for dental services and treatment and related dental appliances under the laws administered by the Secretary of Veterans Affairs as of the date of the enactment of this Act; and (C) has a diagnosis of— (i) type 1 or type 2 diabetes; or (ii) ischemic heart disease. 4. Pilot program to furnish dental care from the Department of Veterans Affairs to certain veterans diagnosed with diabetes or ischemic heart disease (a) In general Commencing not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall carry out a pilot program (in this section referred to as the pilot program ) under which the Secretary shall furnish covered care to covered veterans for the duration of the pilot program. (b) Duration The pilot program shall be carried out during the four-year period beginning on the date of the commencement of the pilot program. (c) Locations (1) In general The Secretary shall carry out the pilot program at the following locations: (A) Each medical center of the Department with an established dental clinic. (B) Each community-based outpatient clinic with an established dental clinic. (2) Mobile dental clinics In carrying out the pilot program, 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. (3) Home-based dental care In carrying out the pilot program, the Secretary shall test the efficacy of portable dental care units to service rural veteran in their homes, as the Secretary considers medically appropriate. (d) Dental therapists and tele-Dentistry (1) In general In carrying out the pilot program, The Secretary shall test the efficacy of the use of dental therapists and tele-dentistry to service the dental care needs of covered veterans. (2) Use of tele-dentistry When providing tele-dentistry under paragraph (1), the Secretary shall use Federal employees to the maximum extent possible. (e) Administration (1) Notice to covered veterans In carrying out the pilot program, the Secretary shall inform all covered veterans of the covered care available under the pilot program. (2) Copayments The Secretary may collect copayments for covered care furnished under the pilot program in accordance with authorities on the collection of copayments for medical care of veterans under chapter 17 of title 38, United States Code. (f) Reports (1) In general Not later than 90 days before the completion of the pilot program, and not later than 180 days after the completion of the pilot program, 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 pilot program. (2) Contents Each report under paragraph (1) shall include the following: (A) A description of the implementation and operation of the provision of covered care under the pilot program. (B) The number of covered veterans receiving covered care under the pilot program and a description of the covered care furnished to such veterans. (C) An analysis of the costs and benefits of covered care provided under the pilot program, including a comparison of costs and benefits by location type. (D) An assessment of the impact of the pilot program on appointments for care, prescriptions, hospitalizations, emergency room visits, wellness, employability, satisfaction, and perceived quality of life of covered veterans related to their diagnosis of diabetes or ischemic heart disease. (E) An analysis and assessment of the efficacy of mobile clinics and portable dental care units, to the extent such modalities are used, to service the needs of covered veterans under the pilot program. (F) An analysis and assessment of the efficacy of dental therapists and tele-dentistry to service the needs of covered veterans under the pilot program, to include a cost benefit analysis of such services. (G) The findings and conclusions of the Secretary with respect to the pilot program. (H) Such recommendations as the Secretary considers appropriate for the expansion of dental care to all veterans eligible for health care from the Department. (g) Impact on community care Nothing in this section limits a covered veteran from accessing care or services pursuant to section 1703 of title 38, United States Code. 5. 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 covered care to covered 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 selected under subsection (c) for a period that is not less than the duration of the pilot program under section 4. (b) Maximum amount (1) In general Except as provided in paragraph (2), the Secretary may reimburse not more than— (A) $100,000 for each dentist participating in the program under subsection (a); (B) $25,000 for each dental hygienist participating in such program; and (C) $40,000 for each credentialed doctor of medicine in dentistry serving as an oral surgeon and participating in such program. (2) Dual eligibility The Secretary may reimburse an individual serving in multiple positions described in subparagraphs (A) through (C) of paragraph (1) not more than $140,000. (c) Selection of locations The Secretary shall monitor demand among covered veterans for covered 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. 6. Authorization of appropriations (a) In general There is authorized to be appropriated for the Department of Veterans Affairs for fiscal year 2024 such sums as may be necessary to carry out 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.