S.Amdt. 5057

SA 5057. Mr. SANDERS submitted an amendment intended to be proposed
to amendment SA 5051 submitted by Mr. Tester (for himself and Mr.
Moran) and intended to be proposed to the bill H.R. 3967, to improve
health care and benefits for veterans exposed to toxic substances, and
for other purposes; which was ordered to lie on the table; as follows:

At the end of title I, add the following:

Subtitle C--Expansion of Dental Care for Veterans

SEC. 121. PILOT PROGRAM TO FURNISH DENTAL CARE FROM THE
DEPARTMENT OF VETERANS AFFAIRS IN THE SAME
MANNER AS ANY OTHER MEDICAL SERVICE.

(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 to assess
the feasibility and advisability of furnishing dental care in
the same manner as medical services furnished by the
Department, notwithstanding the limitations on the provision
of dental care under sections 1710(c) and 1712 of title 38,
United States Code.
(b) Medical Services Defined.--In this section, the term
``medical services'' has the meaning given that term in
section 1701(6) of title 38, United States Code

SEC. 122. PILOT PROGRAM ON EXPANSION OF FURNISHING BY
DEPARTMENT OF VETERANS AFFAIRS OF DENTAL CARE
TO CERTAIN ENROLLED VETERANS.

(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 under which
the Secretary 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) Duration.--The pilot program shall be carried out
during the two-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) 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.
(C) Not fewer than four community-based outpatient clinics
with space available for the furnishing of dental care under
the pilot program.
(D) Not fewer than four Federally Qualified Health Centers.
(E) 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.
(2) Considerations.--In selecting locations for the pilot
program, the Secretary shall consider the feasibility and
advisability of selecting locations in each of the following:
(A) Rural areas.
(B) Areas that are not in close proximity to an active duty
military installation.
(C) Areas representing different geographic locations, such
as census tracts established by the Bureau of the Census.
(3) 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.
(4) 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) Services.--
(1) Scope.--The dental care furnished to covered veterans
under the pilot program 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.
(2) Dental therapists and tele-dentistry.--
(A) 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.
(B) Use of tele-dentistry.--When providing tele-dentistry
under subparagraph (A), the Secretary shall use Federal
employees to the maximum extent possible.
(e) Voluntary Participation.--The participation of a
covered veteran in the pilot program shall be at the election
of the veteran.
(f) Administration.--
(1) Notice to covered veterans.--In carrying out the pilot
program, the Secretary shall inform all covered veterans of
the services and treatment available under the pilot program.
(2) Copayments.--The Secretary may collect copayments for
dental 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.
(3) Contracts.--
(A) In general.--Subject to subparagraph (C), in carrying
out the pilot program, the Secretary may enter into contracts
with appropriate entities for the provision of dental care
under the pilot program.
(B) Performance standards and metrics.--Each contract
entered into under subparagraph (A) shall specify performance
standards and metrics and processes for ensuring compliance
of the contractor concerned with such performance standards.
(C) Limitation.--The Secretary may only enter into
contracts under subparagraph (A) 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.
(g) 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 pilot program.
(B) The number of covered veterans receiving dental care
under the pilot program and a description of the dental care
furnished to such veterans.
(C) An analysis of the costs and benefits of 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, and
satisfaction of patients, and perceived quality of life of
covered veterans.
(E) An analysis and assessment of the efficacy of mobile
clinics and home based dental care to service the dental
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 dental 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) 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 the pilot program.
(I) Such recommendations as the Secretary considers
appropriate for the expansion of dental care to all veterans
eligible for health care from the Department.
(h) Definitions.--In this section:
(1) 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,

[[Page S2836]]

United States Code, pursuant to paragraph (1) or (2) of such
section.
(2) 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)).

SEC. 123. 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.

SEC. 124. 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.

SEC. 125. 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 therapists, dental hygienists, and oral
surgeons who agree--
(1) to be appointed by the Secretary as a dentist, dental
therapist, 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 therapist, 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.--
(1) In general.--Except as provided in paragraph (2), the
Secretary may reimburse not more than--
(A) $75,000 for each dentist participating in the program
under subsection (a);
(B) $20,000 for each dental therapist participating in such
program;
(C) $10,000 for each dental hygienist participating in such
program; and
(D) $20,000 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 (D) of paragraph (1) not more than
$95,000.
(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.

SEC. 126. EDUCATIONAL AND TRAINING PARTNERSHIPS FOR DENTISTS,
DENTAL THERAPISTS, 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 therapists, dental hygienists, and oral surgeons.

SEC. 127. AUTHORIZATION OF APPROPRIATIONS.

(a) In General.--There is authorized to be appropriated for
the Department of Veterans Affairs for fiscal year 2023 such
sums as may be necessary to carry out this subtitle.
(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.
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