S.Amdt. 5074

SA 5074. Mr. SANDERS submitted an amendment intended to be proposed
to amendment SA 5051 proposed by Mr. Tester (for himself and Mr. Moran)
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. REQUIREMENT THAT SECRETARY OF VETERANS AFFAIRS
FURNISH DENTAL CARE IN THE SAME MANNER AS ANY
OTHER MEDICAL SERVICE.

(a) In General.--Chapter 17 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)
is amended by striking ``medicines under section 1712(d)''
and inserting ``medicines under section 1712(b)''.
(B) Dental insurance plan.--Section 1712C(h) 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 is
amended to read as follows:

``Sec. 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 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.

SEC. 122. 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 therapists and tele-dentistry.--In carrying out
phase one, the Secretary shall test the efficacy of the use
of

[[Page S2871]]

dental therapists and tele-dentistry to service the dental
care needs of covered veterans.
(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) An analysis and assessment of the efficacy of dental
therapists and tele-dentistry to service the dental needs of
covered veterans during such phase, to include a cost benefit
analysis of such services.
(G) The findings and conclusions of the Secretary with
respect to such phase.
(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 such phase.
(I) Such recommendations for the expansion of dental care
pursuant to subsection (c) as the Secretary considers
appropriate.

SEC. 123. 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. 124. 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

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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 therapists, dental hygienists, or oral
surgeons, as the case may be, according to facility
enrollment and patient demand.

SEC. 125. 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. 126. 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 and the
amendments made by 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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