Improving Whole Health for Veterans with Chronic Conditions Act

II 118TH CONGRESS 1ST SESSION S. 1954 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. IN THE SENATE OF THE UNITED STATES JUNE 13, 2023 Mr. SANDERS (for himself, Mr. WHITEHOUSE, Mr. WELCH, Mr. MERKLEY, Mr. WYDEN, Mr. BLUMENTHAL, Mr. BOOKER, Mr. FETTERMAN, Mr. MENENDEZ, Mr. DURBIN, Ms. STABENOW, and Ms. HIRONO) introduced the following bill; which was read twice and 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. 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 ‘‘Improving Whole 4 Health for Veterans with Chronic Conditions Act’’. 5 SEC. 2. SENSE OF CONGRESS. 6 It is the sense of Congress that— 7 VerDate Sep 11 2014 23:27 Jul 07, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1954.IS S1954 kjohnson on DSK79L0C42PROD with BILLS 2 •S 1954 IS (1) the Department of Veterans Affairs has pio- 1 neered a whole health approach to health care that 2 provides access to alternative medicines, delivers a 3 holistic approach to health and well-being, and re- 4 peatedly demonstrates better health outcomes than 5 the private sector at a low cost to taxpayers in the 6 United States; 7 (2) the effects of poor dental care are shown to 8 worsen the symptoms of diabetes and heart disease; 9 (3) diabetes and heart disease are shown to in- 10 crease risk of periodontal disease; 11 (4) the combination of diabetes, heart disease, 12 and periodontal disease can be fatal; and 13 (5) to best achieve a whole health model for the 14 provision of health care to veterans with diabetes 15 and heart disease and reduce long-term costs, the 16 Department must furnish preventative and com- 17 prehensive dental care to veterans diagnosed with di- 18 abetes and heart disease. 19 SEC. 3. DEFINITIONS. 20 In this Act: 21 (1) COVERED CARE.—The term ‘‘covered care’’ 22 means dental care that is comprehensive in nature 23 and consistent with the dental services and treat- 24 ment furnished by the Secretary of Veterans Affairs 25 VerDate Sep 11 2014 23:27 Jul 07, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1954.IS S1954 kjohnson on DSK79L0C42PROD with BILLS 3 •S 1954 IS to veterans pursuant to section 1712(a)(1)(G) of 1 title 38, United States Code. 2 (2) COVERED VETERAN.—The term ‘‘covered 3 veteran’’ means a veteran who— 4 (A) is enrolled in the system of annual pa- 5 tient enrollment of the Department of Veterans 6 Affairs established and operated under sub- 7 section (a) of section 1705 of title 38, United 8 States Code, pursuant to paragraph (1) or (2) 9 of such subsection or is not enrolled in such 10 system but is otherwise entitled to hospital care 11 and medical services under subsection (c)(2) of 12 such section; 13 (B) is not eligible for dental services and 14 treatment and related dental appliances under 15 the laws administered by the Secretary of Vet- 16 erans Affairs as of the date of the enactment of 17 this Act; and 18 (C) has a diagnosis of— 19 (i) type 1 or type 2 diabetes; or 20 (ii) ischemic heart disease. 21 VerDate Sep 11 2014 23:27 Jul 07, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1954.IS S1954 kjohnson on DSK79L0C42PROD with BILLS 4 •S 1954 IS SEC. 4. PILOT PROGRAM TO FURNISH DENTAL CARE FROM 1 THE DEPARTMENT OF VETERANS AFFAIRS 2 TO CERTAIN VETERANS DIAGNOSED WITH DI- 3 ABETES OR ISCHEMIC HEART DISEASE. 4 (a) IN GENERAL.—Commencing not later than one 5 year after the date of the enactment of this Act, the Sec- 6 retary of Veterans Affairs shall carry out a pilot program 7 (in this section referred to as the ‘‘pilot program’’) under 8 which the Secretary shall furnish covered care to covered 9 veterans for the duration of the pilot program. 10 (b) DURATION.—The pilot program shall be carried 11 out during the four-year period beginning on the date of 12 the commencement of the pilot program. 13 (c) LOCATIONS.— 14 (1) IN GENERAL.—The Secretary shall carry 15 out the pilot program at the following locations: 16 (A) Each medical center of the Depart- 17 ment with an established dental clinic. 18 (B) Each community-based outpatient clin- 19 ic with an established dental clinic. 20 (2) MOBILE DENTAL CLINICS.—In carrying out 21 the pilot program, the Secretary shall test the effi- 22 cacy of mobile dental clinics to service rural areas 23 that do not have a population base to warrant a full- 24 time clinic but where there are covered veterans in 25 need of dental care. 26 VerDate Sep 11 2014 23:27 Jul 07, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1954.IS S1954 kjohnson on DSK79L0C42PROD with BILLS 5 •S 1954 IS (3) HOME-BASED DENTAL CARE.—In carrying 1 out the pilot program, the Secretary shall test the 2 efficacy of portable dental care units to service rural 3 veteran in their homes, as the Secretary considers 4 medically appropriate. 5 (d) DENTAL THERAPISTS AND TELE-DENTISTRY.— 6 (1) IN GENERAL.—In carrying out the pilot 7 program, The Secretary shall test the efficacy of the 8 use of dental therapists and tele-dentistry to service 9 the dental care needs of covered veterans. 10 (2) USE OF TELE-DENTISTRY.—When providing 11 tele-dentistry under paragraph (1), the Secretary 12 shall use Federal employees to the maximum extent 13 possible. 14 (e) ADMINISTRATION.— 15 (1) NOTICE TO COVERED VETERANS.—In car- 16 rying out the pilot program, the Secretary shall in- 17 form all covered veterans of the covered care avail- 18 able under the pilot program. 19 (2) COPAYMENTS.—The Secretary may collect 20 copayments for covered care furnished under the 21 pilot program in accordance with authorities on the 22 collection of copayments for medical care of veterans 23 under chapter 17 of title 38, United States Code. 24 (f) REPORTS.— 25 VerDate Sep 11 2014 23:27 Jul 07, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1954.IS S1954 kjohnson on DSK79L0C42PROD with BILLS 6 •S 1954 IS (1) IN GENERAL.—Not later than 90 days be- 1 fore the completion of the pilot program, and not 2 later than 180 days after the completion of the pilot 3 program, the Secretary shall submit to the Com- 4 mittee on Veterans’ Affairs and the Committee on 5 Armed Services of the Senate and the Committee on 6 Veterans’ Affairs and the Committee on Armed 7 Services of the House of Representatives a report on 8 the pilot program. 9 (2) CONTENTS.—Each report under paragraph 10 (1) shall include the following: 11 (A) A description of the implementation 12 and operation of the provision of covered care 13 under the pilot program. 14 (B) The number of covered veterans re- 15 ceiving covered care under the pilot program 16 and a description of the covered care furnished 17 to such veterans. 18 (C) An analysis of the costs and benefits 19 of covered care provided under the pilot pro- 20 gram, including a comparison of costs and ben- 21 efits by location type. 22 (D) An assessment of the impact of the 23 pilot program on appointments for care, pre- 24 scriptions, hospitalizations, emergency room vis- 25 VerDate Sep 11 2014 23:27 Jul 07, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1954.IS S1954 kjohnson on DSK79L0C42PROD with BILLS 7 •S 1954 IS its, wellness, employability, satisfaction, and 1 perceived quality of life of covered veterans re- 2 lated to their diagnosis of diabetes or ischemic 3 heart disease. 4 (E) An analysis and assessment of the effi- 5 cacy of mobile clinics and portable dental care 6 units, to the extent such modalities are used, to 7 service the needs of covered veterans under the 8 pilot program. 9 (F) An analysis and assessment of the effi- 10 cacy of dental therapists and tele-dentistry to 11 service the needs of covered veterans under the 12 pilot program, to include a cost benefit analysis 13 of such services. 14 (G) The findings and conclusions of the 15 Secretary with respect to the pilot program. 16 (H) Such recommendations as the Sec- 17 retary considers appropriate for the expansion 18 of dental care to all veterans eligible for health 19 care from the Department. 20 (g) IMPACT ON COMMUNITY CARE.—Nothing in this 21 section limits a covered veteran from accessing care or 22 services pursuant to section 1703 of title 38, United 23 States Code. 24 VerDate Sep 11 2014 23:27 Jul 07, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1954.IS S1954 kjohnson on DSK79L0C42PROD with BILLS 8 •S 1954 IS SEC. 5. STUDENT LOAN REPAYMENT PROGRAM TO 1 INCENTIVIZE DENTAL TRAINING AND EN- 2 SURE THE DENTAL WORKFORCE OF THE DE- 3 PARTMENT OF VETERANS AFFAIRS. 4 (a) PROGRAM REQUIRED.—The Secretary of Vet- 5 erans Affairs, to ensure that the Department of Veterans 6 Affairs has sufficient staff to provide covered care to cov- 7 ered veterans, shall implement a loan reimbursement pro- 8 gram for qualified dentists, dental hygienists, and oral 9 surgeons who agree— 10 (1) to be appointed by the Secretary as a den- 11 tist, dental hygienist, or oral surgeon, as the case 12 may be, under section 7401 of title 38, United 13 States Code; and 14 (2) to serve as a dentist, dental hygienist, or 15 oral surgeon, as the case may be, of the Department 16 pursuant to such appointment at a dental clinic of 17 the Department selected under subsection (c) for a 18 period that is not less than the duration of the pilot 19 program under section 4. 20 (b) MAXIMUM AMOUNT.— 21 (1) IN GENERAL.—Except as provided in para- 22 graph (2), the Secretary may reimburse not more 23 than— 24 (A) $100,000 for each dentist participating 25 in the program under subsection (a); 26 VerDate Sep 11 2014 23:27 Jul 07, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1954.IS S1954 kjohnson on DSK79L0C42PROD with BILLS 9 •S 1954 IS (B) $25,000 for each dental hygienist par- 1 ticipating in such program; and 2 (C) $40,000 for each credentialed doctor of 3 medicine in dentistry serving as an oral surgeon 4 and participating in such program. 5 (2) DUAL ELIGIBILITY.—The Secretary may re- 6 imburse an individual serving in multiple positions 7 described in subparagraphs (A) through (C) of para- 8 graph (1) not more than $140,000. 9 (c) SELECTION OF LOCATIONS.—The Secretary shall 10 monitor demand among covered veterans for covered care 11 and require participants in the program under subsection 12 (a) to choose from dental clinics of the Department with 13 the greatest need for dentists, dental hygienists, or oral 14 surgeons, as the case may be, according to facility enroll- 15 ment and patient demand. 16 SEC. 6. AUTHORIZATION OF APPROPRIATIONS. 17 (a) IN GENERAL.—There is authorized to be appro- 18 priated for the Department of Veterans Affairs for fiscal 19 year 2024 such sums as may be necessary to carry out 20 this Act. 21 (b) AVAILABILITY.—The amount authorized to be ap- 22 propriated under subsection (a) shall be available for obli- 23 VerDate Sep 11 2014 23:27 Jul 07, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1954.IS S1954 kjohnson on DSK79L0C42PROD with BILLS 10 •S 1954 IS gation for the eight-year period beginning on the date that 1 is one year after the date of the enactment of this Act. 2 Æ VerDate Sep 11 2014 23:27 Jul 07, 2023 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6301 E:\BILLS\S1954.IS S1954 kjohnson on DSK79L0C42PROD with BILLS