II 117TH CONGRESS 1ST SESSION S. 560 To improve coverage of maternal oral health care, and for other purposes. IN THE SENATE OF THE UNITED STATES MARCH 3, 2021 Ms. STABENOW introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To improve coverage of maternal oral health care, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Oral Health for Moms 4 Act’’. 5 SEC. 2. REQUIRING COVERAGE OF ORAL HEALTH SERVICES 6 FOR PREGNANT AND POSTPARTUM INDIVID- 7 UALS. 8 (a) IN GENERAL.— 9 (1) MEDICAID.—Section 1905 of the Social Se- 10 curity Act (42 U.S.C. 1396d) is amended— 11 VerDate Sep 11 2014 19:14 Apr 06, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S560.IS S560 pamtmann on DSKBC07HB2PROD with BILLS 2 •S 560 IS (A) in subsection (a)(4)— 1 (i) by striking ‘‘; and (D)’’ and insert- 2 ing ‘‘; (D)’’; and 3 (ii) by inserting ‘‘; and (E) beginning 4 January 1, 2022, oral health services for 5 pregnant and postpartum individuals (as 6 defined in subsection (hh))’’ after ‘‘sub- 7 section (hh))’’; and 8 (B) by adding at the end the following new 9 subsection: 10 ‘‘(hh) ORAL HEALTH SERVICES FOR PREGNANT AND 11 POSTPARTUM INDIVIDUALS.— 12 ‘‘(1) IN GENERAL.—For purposes of this title, 13 the term ‘oral health services for pregnant and 14 postpartum individuals’ means dental services nec- 15 essary to prevent disease and promote oral health, 16 restore oral structures to health and function, and 17 treat emergency conditions that are furnished to an 18 individual during pregnancy (or during the 60-day 19 period beginning on the last day of the pregnancy or 20 such longer period beginning on the last day of the 21 pregnancy as the State shall elect). 22 ‘‘(2) COVERAGE REQUIREMENTS.—To satisfy 23 the requirement to provide oral health services for 24 pregnant and postpartum individuals, a State shall, 25 VerDate Sep 11 2014 19:14 Apr 06, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S560.IS S560 pamtmann on DSKBC07HB2PROD with BILLS 3 •S 560 IS at a minimum, provide coverage to prevent disease 1 and promote oral health, restore oral structures to 2 health and function, and treat emergency conditions, 3 consistent with recommendations for perinatal oral 4 health care and dental care during pregnancy from 5 the American Academy of Pediatric Dentistry and 6 the American College of Obstetricians and Gyne- 7 cologists. Such coverage shall include— 8 ‘‘(A) routine diagnostic and preventive care 9 such as dental cleanings, exams, and X-rays; 10 ‘‘(B) basic dental services such as fillings 11 and extractions; 12 ‘‘(C) major dental services such as root ca- 13 nals, crowns, and dentures; 14 ‘‘(D) emergency dental care; and 15 ‘‘(E) other necessary services related to 16 dental and oral health (as defined by the Sec- 17 retary).’’. 18 (2) COVERAGE OF ORAL HEALTH SERVICES FOR 19 PREGNANT AND POSTPARTUM INDIVIDUALS REGARD- 20 LESS OF ELIGIBILITY PATHWAY.—Section 21 1902(a)(10) of the Social Security Act (42 U.S.C. 22 1396a(a)(10)) is amended in the matter following 23 subparagraph (G)— 24 VerDate Sep 11 2014 19:14 Apr 06, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S560.IS S560 pamtmann on DSKBC07HB2PROD with BILLS 4 •S 560 IS (A) by striking ‘‘and (XVIII)’’ and insert- 1 ing ‘‘(XVIII)’’; and 2 (B) by striking the semicolon at the end 3 and inserting ‘‘, and (XIX) beginning January 4 1, 2022, medical assistance shall be made avail- 5 able for oral health services for pregnant and 6 postpartum individuals for any individual who 7 is eligible for and receiving medical assistance 8 under the State plan or under a waiver of such 9 plan during such individual’s pregnancy and 10 during the 60-day period beginning on the last 11 day of the pregnancy (or such longer period be- 12 ginning on the last day of the pregnancy as the 13 State shall elect), notwithstanding any other 14 provision of law (including another provision of 15 this paragraph) limiting such individual’s eligi- 16 bility for medical assistance under such plan or 17 waiver to coverage for a limited type of benefits 18 and services that would not otherwise include 19 coverage of oral health services for pregnant 20 and postpartum individuals;’’. 21 (3) CHIP.— 22 (A) IN GENERAL.—Section 2103(c)(6)(A) 23 of the Social Security Act (42 U.S.C. 24 1397cc(c)(6)(A)) is amended by inserting ‘‘and, 25 VerDate Sep 11 2014 19:14 Apr 06, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S560.IS S560 pamtmann on DSKBC07HB2PROD with BILLS 5 •S 560 IS in the case that the State elects to provide 1 pregnancy-related assistance pursuant to sec- 2 tion 2112, the pregnancy-related assistance pro- 3 vided to a targeted low-income pregnant 4 woman’’ after ‘‘targeted low-income child’’. 5 (B) EFFECTIVE DATE.—The amendment 6 made by this section shall take effect on Janu- 7 ary 1, 2022. 8 (b) ENHANCED FMAP; MAINTENANCE OF EF- 9 FORT.— 10 (1) MEDICAID.—Section 1905 of the Social Se- 11 curity Act (42 U.S.C. 1396d), as amended by sub- 12 section (a)(1), is further amended— 13 (A) in subsection (b), by striking ‘‘and 14 (ff)’’ and inserting ‘‘(ff), and (ii)’’; and 15 (B) by adding at the end the following: 16 ‘‘(ii) INCREASED FMAP FOR ADDITIONAL EXPENDI- 17 TURES FOR LOW-INCOME PREGNANT PEOPLE.— 18 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 19 for calendar quarters beginning on or after January 20 1, 2022, notwithstanding subsection (b), the Federal 21 medical assistance percentage for a State, with re- 22 spect to the additional amounts expended by such 23 State for medical assistance under the State plan 24 under this title or a waiver of such plan that are at- 25 VerDate Sep 11 2014 19:14 Apr 06, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S560.IS S560 pamtmann on DSKBC07HB2PROD with BILLS 6 •S 560 IS tributable to requirements imposed by the amend- 1 ments made by the Oral Health for Moms Act (as 2 determined by the Secretary), shall be equal to 100 3 percent. 4 ‘‘(2) MAINTENANCE OF EFFORT.—Paragraph 5 (1) shall not apply with respect to a State if, for any 6 calendar quarter during the period beginning with 7 the date of enactment of this subsection and ending 8 with January 1, 2025, the State— 9 ‘‘(A) has in effect under such plan eligi- 10 bility standards, methodologies, or procedures 11 (including any enrollment cap or other numer- 12 ical limitation on enrollment, any waiting list, 13 any procedures designed to delay the consider- 14 ation of applications for enrollment, or similar 15 limitation with respect to enrollment) for indi- 16 viduals described in subsection (l)(1) who are 17 eligible for medical assistance under the State 18 plan or waiver under subsection 19 (a)(10)(A)(ii)(IX) that are more restrictive than 20 the eligibility standards, methodologies, or pro- 21 cedures, respectively, for such individuals under 22 such plan or waiver that are in effect on the 23 date of the enactment of this subsection; or 24 VerDate Sep 11 2014 19:14 Apr 06, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S560.IS S560 pamtmann on DSKBC07HB2PROD with BILLS 7 •S 560 IS ‘‘(B) provides pregnancy-related assistance 1 to targeted low-income pregnant women under 2 the State plan under title XXI (or a waiver of 3 such a plan) at a level that is less than the level 4 at which the State provides such assistance to 5 such women under such plan on the date of the 6 enactment of this subsection.’’. 7 (2) CHIP.—Section 2105 of the Social Security 8 Act (42 U.S.C. 1397ee) is amended— 9 (A) in subsection (b), by adding at the end 10 the following: ‘‘For calendar quarters beginning 11 on or after January 1, 2022, the enhanced 12 FMAP for a State shall, subject to paragraph 13 (2) of subsection (h), be 100 percent with re- 14 spect to amounts described in paragraph (1) of 15 such subsection.’’; and 16 (B) by adding at the end the following new 17 subsection: 18 ‘‘(h) INCREASED eFMAP FOR ADDITIONAL EXPEND- 19 ITURES FOR TARGETED LOW-INCOME PREGNANT 20 WOMEN.— 21 ‘‘(1) AMOUNTS DESCRIBED.—For purposes of 22 subsection (b), the amounts described in this para- 23 graph are additional amounts expended by a State 24 for pregnancy-related assistance that is provided 25 VerDate Sep 11 2014 19:14 Apr 06, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S560.IS S560 pamtmann on DSKBC07HB2PROD with BILLS 8 •S 560 IS under the State plan under this title or a waiver of 1 such plan during a calendar quarter beginning on or 2 after January 1, 2022, that are attributable to the 3 provision of dental coverage to targeted low-income 4 pregnant women (as determined by the Secretary). 5 ‘‘(2) MAINTENANCE OF EFFORT.—The fourth 6 sentence of subsection (b) shall not apply with re- 7 spect to a State if, for any calendar quarter during 8 the period beginning with the date of enactment of 9 this subsection and ending with January 1, 2025, 10 the State— 11 ‘‘(A) has in effect under the State plan 12 under title XIX (or a waiver of such a plan) eli- 13 gibility standards, methodologies, or procedures 14 (including any enrollment cap or other numer- 15 ical limitation on enrollment, any waiting list, 16 any procedures designed to delay the consider- 17 ation of applications for enrollment, or similar 18 limitation with respect to enrollment) for indi- 19 viduals described in subsection (l)(1) of section 20 1902 who are eligible for medical assistance 21 under such State plan or waiver under sub- 22 section (a)(10)(A)(ii)(IX) of such section that 23 are more restrictive than the eligibility stand- 24 ards, methodologies, or procedures, respectively, 25 VerDate Sep 11 2014 19:14 Apr 06, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S560.IS S560 pamtmann on DSKBC07HB2PROD with BILLS 9 •S 560 IS for such individuals under such plan or waiver 1 that are in effect on the date of the enactment 2 of this subsection; or 3 ‘‘(B) provides pregnancy-related assistance 4 to targeted low-income pregnant women under 5 the State plan under this title (or a waiver of 6 such a plan) at a level that is less than the level 7 at which the State provides such assistance to 8 such women under such plan or waiver on the 9 date of the enactment of this subsection.’’. 10 (3) EXCLUSION OF AMOUNTS ATTRIBUTABLE 11 TO INCREASED FMAP FROM TERRITORIAL CAPS.— 12 Section 1108 of the Social Security Act (42 U.S.C. 13 1308) is amended— 14 (A) in subsection (f), in the matter pre- 15 ceding paragraph (1), by striking ‘‘subsections 16 (g) and (h)’’ and inserting ‘‘subsections (g), 17 (h), and (i)’’; and 18 (B) by adding at the end the following: 19 ‘‘(i) EXCLUSION FROM CAPS OF AMOUNTS ATTRIB- 20 UTABLE TO INCREASED FMAP FOR COVERAGE OF ORAL 21 HEALTH SERVICES FOR PREGNANT AND POSTPARTUM 22 INDIVIDUALS.—Any payment made to a territory for ex- 23 penditures on medical assistance that are subject to the 24 Federal medical assistance percentage specified under sec- 25 VerDate Sep 11 2014 19:14 Apr 06, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S560.IS S560 pamtmann on DSKBC07HB2PROD with BILLS 10 •S 560 IS tion 1905(ii) shall not be taken into account for purposes 1 of applying payment limits under subsections (f) and (g) 2 to the extent that such payment exceeds the amount of 3 the payment that would have been made to the territory 4 for such expenditures without regard to such section.’’. 5 (4) ADJUSTMENT OF CHIP ALLOTMENTS TO AC- 6 COUNT FOR INCREASED EFMAP.—Section 2104 of 7 the Social Security Act (42 U.S.C. 1397dd) is 8 amended— 9 (A) in subsection (c)— 10 (i) in paragraph (1), by inserting 11 ‘‘paragraph (5) and’’ before ‘‘subsections 12 (d) and (m)(5)’’; and 13 (ii) by adding at the end the following 14 new paragraph: 15 ‘‘(5) ADJUSTING ALLOTMENTS TO ACCOUNT 16 FOR INCREASED FEDERAL PAYMENTS FOR COV- 17 ERAGE OF DENTAL SERVICES FOR PREGNANT PEO- 18 PLE.—If a commonwealth or territory described in 19 paragraph (3) receives payment for a fiscal year 20 under subsection (a) of section 2105 for expendi- 21 tures that are subject to the enhanced FMAP speci- 22 fied under subsection (h) of such section, the 23 amount of the allotment determined for such com- 24 VerDate Sep 11 2014 19:14 Apr 06, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S560.IS S560 pamtmann on DSKBC07HB2PROD with BILLS 11 •S 560 IS monwealth or territory under this subsection shall be 1 increased by the amount by which— 2 ‘‘(A) the amount of the payment received 3 by the commonwealth or territory for such ex- 4 penditures for the fiscal year; exceeds 5 ‘‘(B) the amount of the payment that the 6 commonwealth or territory would have received 7 for such expenditures for the fiscal year without 8 regard to such subsection (h).’’; and 9 (B) in subsection (m)— 10 (i) in paragraph (2)(B), in the matter 11 preceding clause (i), by striking ‘‘para- 12 graphs (5) and (7)’’ and inserting ‘‘para- 13 graphs (5), (7), and (12)’’; and 14 (ii) by adding at the end the following 15 new paragraph: 16 ‘‘(12) ADJUSTING ALLOTMENTS TO ACCOUNT 17 FOR INCREASED FEDERAL PAYMENTS FOR COV- 18 ERAGE OF DENTAL SERVICES FOR PREGNANT PEO- 19 PLE.—If a State receives payment for a fiscal year 20 under subsection (a) of section 2105 for expendi- 21 tures that are subject to the enhanced FMAP speci- 22 fied under subsection (h) of such section, the 23 amount of the allotment determined for the State 24 VerDate Sep 11 2014 19:14 Apr 06, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S560.IS S560 pamtmann on DSKBC07HB2PROD with BILLS 12 •S 560 IS and fiscal year under this subsection shall be in- 1 creased by the amount by which— 2 ‘‘(A) the amount of the payment received 3 by the State for such expenditures for the fiscal 4 year; exceeds 5 ‘‘(B) the amount of the payment that the 6 State would have received for such expenditures 7 for the fiscal year without regard to such sub- 8 section (h).’’. 9 SEC. 3. MATERNAL ORAL HEALTH QUALITY MEASURES. 10 Title XI of the Social Security Act (42 U.S.C. 1301 11 et seq.) is amended by inserting after section 1139B the 12 following new section: 13 ‘‘SEC. 1139C. MATERNAL ORAL HEALTH QUALITY MEAS- 14 URES. 15 ‘‘(a) DEVELOPMENT OF CORE SET OF MATERNAL 16 ORAL HEALTH CARE QUALITY MEASURES.— 17 ‘‘(1) IN GENERAL.—The Secretary shall iden- 18 tify and publish a recommended core set of health 19 quality measures for enrolled pregnant individuals in 20 the same manner as the Secretary identifies and 21 publishes a core set of child health quality measures 22 under section 1139A, including with res [Text truncated for display. Full text available on Congress.gov.]