Improving Whole Health for Veterans with Chronic Conditions Act

I 118TH CONGRESS 1ST SESSION H. R. 4150 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 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. 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 (1) the Department of Veterans Affairs has pio- 8 neered a whole health approach to health care that 9 VerDate Sep 11 2014 23:26 Jul 07, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H4150.IH H4150 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 4150 IH provides access to alternative medicines, delivers a 1 holistic approach to health and well-being, and re- 2 peatedly demonstrates better health outcomes than 3 the private sector at a low cost to taxpayers in the 4 United States; 5 (2) the effects of poor dental care are shown to 6 worsen the symptoms of diabetes and heart disease; 7 (3) diabetes and heart disease are shown to in- 8 crease risk of periodontal disease; 9 (4) the combination of diabetes, heart disease, 10 and periodontal disease can be fatal; and 11 (5) to best achieve a whole health model for the 12 provision of health care to veterans with diabetes 13 and heart disease and reduce long-term costs, the 14 Department must furnish preventative and com- 15 prehensive dental care to veterans diagnosed with di- 16 abetes and heart disease. 17 SEC. 3. DEFINITIONS. 18 In this Act: 19 (1) COVERED CARE.—The term ‘‘covered care’’ 20 means dental care that is comprehensive in nature 21 and consistent with the dental services and treat- 22 ment furnished by the Secretary of Veterans Affairs 23 to veterans pursuant to section 1712(a)(1)(G) of 24 title 38, United States Code. 25 VerDate Sep 11 2014 23:26 Jul 07, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H4150.IH H4150 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 4150 IH (2) COVERED VETERAN.—The term ‘‘covered 1 veteran’’ means a veteran who— 2 (A) is enrolled in the system of annual pa- 3 tient enrollment of the Department of Veterans 4 Affairs established and operated under sub- 5 section (a) of section 1705 of title 38, United 6 States Code, pursuant to paragraph (1) or (2) 7 of such subsection or is not enrolled in such 8 system but is otherwise entitled to hospital care 9 and medical services under subsection (c)(2) of 10 such section; 11 (B) is not eligible for dental services and 12 treatment and related dental appliances under 13 the laws administered by the Secretary of Vet- 14 erans Affairs as of the date of the enactment of 15 this Act; and 16 (C) has a diagnosis of— 17 (i) type 1 or type 2 diabetes; or 18 (ii) ischemic heart disease. 19 SEC. 4. PILOT PROGRAM TO FURNISH DENTAL CARE FROM 20 THE DEPARTMENT OF VETERANS AFFAIRS 21 TO CERTAIN VETERANS DIAGNOSED WITH DI- 22 ABETES OR ISCHEMIC HEART DISEASE. 23 (a) IN GENERAL.—Commencing not later than one 24 year after the date of the enactment of this Act, the Sec- 25 VerDate Sep 11 2014 23:26 Jul 07, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4150.IH H4150 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 4150 IH retary of Veterans Affairs shall carry out a pilot program 1 (in this section referred to as the ‘‘pilot program’’) under 2 which the Secretary shall furnish covered care to covered 3 veterans for the duration of the pilot program. 4 (b) DURATION.—The pilot program shall be carried 5 out during the four-year period beginning on the date of 6 the commencement of the pilot program. 7 (c) LOCATIONS.— 8 (1) IN GENERAL.—The Secretary shall carry 9 out the pilot program at the following locations: 10 (A) Each medical center of the Depart- 11 ment with an established dental clinic. 12 (B) Each community-based outpatient clin- 13 ic with an established dental clinic. 14 (2) MOBILE DENTAL CLINICS.—In carrying out 15 the pilot program, the Secretary shall test the effi- 16 cacy of mobile dental clinics to service rural areas 17 that do not have a population base to warrant a full- 18 time clinic but where there are covered veterans in 19 need of dental care. 20 (3) HOME-BASED DENTAL CARE.—In carrying 21 out the pilot program, the Secretary shall test the 22 efficacy of portable dental care units to service rural 23 veteran in their homes, as the Secretary considers 24 medically appropriate. 25 VerDate Sep 11 2014 23:26 Jul 07, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H4150.IH H4150 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 4150 IH (d) DENTAL THERAPISTS AND TELE-DENTISTRY.— 1 (1) IN GENERAL.—In carrying out the pilot 2 program, The Secretary shall test the efficacy of the 3 use of dental therapists and tele-dentistry to service 4 the dental care needs of covered veterans. 5 (2) USE OF TELE-DENTISTRY.—When providing 6 tele-dentistry under paragraph (1), the Secretary 7 shall use Federal employees to the maximum extent 8 possible. 9 (e) ADMINISTRATION.— 10 (1) NOTICE TO COVERED VETERANS.—In car- 11 rying out the pilot program, the Secretary shall in- 12 form all covered veterans of the covered care avail- 13 able under the pilot program. 14 (2) COPAYMENTS.—The Secretary may collect 15 copayments for covered care furnished under the 16 pilot program in accordance with authorities on the 17 collection of copayments for medical care of veterans 18 under chapter 17 of title 38, United States Code. 19 (f) REPORTS.— 20 (1) IN GENERAL.—Not later than 90 days be- 21 fore the completion of the pilot program, and not 22 later than 180 days after the completion of the pilot 23 program, the Secretary shall submit to the Com- 24 mittee on Veterans’ Affairs and the Committee on 25 VerDate Sep 11 2014 23:26 Jul 07, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H4150.IH H4150 kjohnson on DSK79L0C42PROD with BILLS 6 •HR 4150 IH Armed Services of the Senate and the Committee on 1 Veterans’ Affairs and the Committee on Armed 2 Services of the House of Representatives a report on 3 the pilot program. 4 (2) CONTENTS.—Each report under paragraph 5 (1) shall include the following: 6 (A) A description of the implementation 7 and operation of the provision of covered care 8 under the pilot program. 9 (B) The number of covered veterans re- 10 ceiving covered care under the pilot program 11 and a description of the covered care furnished 12 to such veterans. 13 (C) An analysis of the costs and benefits 14 of covered care provided under the pilot pro- 15 gram, including a comparison of costs and ben- 16 efits by location type. 17 (D) An assessment of the impact of the 18 pilot program on appointments for care, pre- 19 scriptions, hospitalizations, emergency room vis- 20 its, wellness, employability, satisfaction, and 21 perceived quality of life of covered veterans re- 22 lated to their diagnosis of diabetes or ischemic 23 heart disease. 24 VerDate Sep 11 2014 23:26 Jul 07, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H4150.IH H4150 kjohnson on DSK79L0C42PROD with BILLS 7 •HR 4150 IH (E) An analysis and assessment of the effi- 1 cacy of mobile clinics and portable dental care 2 units, to the extent such modalities are used, to 3 service the needs of covered veterans under the 4 pilot program. 5 (F) An analysis and assessment of the effi- 6 cacy of dental therapists and tele-dentistry to 7 service the needs of covered veterans under the 8 pilot program, to include a cost benefit analysis 9 of such services. 10 (G) The findings and conclusions of the 11 Secretary with respect to the pilot program. 12 (H) Such recommendations as the Sec- 13 retary considers appropriate for the expansion 14 of dental care to all veterans eligible for health 15 care from the Department. 16 (g) IMPACT ON COMMUNITY CARE.—Nothing in this 17 section limits a covered veteran from accessing care or 18 services pursuant to section 1703 of title 38, United 19 States Code. 20 VerDate Sep 11 2014 23:26 Jul 07, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H4150.IH H4150 kjohnson on DSK79L0C42PROD with BILLS 8 •HR 4150 IH 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 23:26 Jul 07, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H4150.IH H4150 kjohnson on DSK79L0C42PROD with BILLS 9 •HR 4150 IH (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 23:26 Jul 07, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H4150.IH H4150 kjohnson on DSK79L0C42PROD with BILLS 10 •HR 4150 IH 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 23:26 Jul 07, 2023 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6301 E:\BILLS\H4150.IH H4150 kjohnson on DSK79L0C42PROD with BILLS