H. Rept. 115-328 - ACTION FOR DENTAL HEALTH ACT OF 2017115th Congress (2017-2018)
Committee Report
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115th Congress } { Report
HOUSE OF REPRESENTATIVES
1st Session } { 115-328
======================================================================
ACTION FOR DENTAL HEALTH ACT OF 2017
_______
September 25, 2017.--Committed to the Committee of the Whole House on
the State of the Union and ordered to be printed
_______
Mr. Walden, from the Committee on Energy and Commerce, submitted the
following
R E P O R T
[To accompany H.R. 2422]
[Including cost estimate of the Congressional Budget Office]
The Committee on Energy and Commerce, to whom was referred
the bill (H.R. 2422) to amend the Public Health Service Act to
improve essential oral health care for low-income and other
underserved individuals by breaking down barriers to care, and
for other purposes, having considered the same, report
favorably thereon with an amendment and recommend that the bill
as amended do pass.
CONTENTS
Page
Purpose and Summary.............................................. 2
Background and Need for Legislation.............................. 2
Committee Action................................................. 3
Committee Votes.................................................. 3
Oversight Findings and Recommendations........................... 3
New Budget Authority, Entitlement Authority, and Tax Expenditures 3
Congressional Budget Office Estimate............................. 4
Federal Mandates Statement....................................... 5
Statement of General Performance Goals and Objectives............ 6
Duplication of Federal Programs.................................. 6
Committee Cost Estimate.......................................... 6
Earmark, Limited Tax Benefits, and Limited Tariff Benefits....... 6
Disclosure of Directed Rule Makings.............................. 6
Advisory Committee Statement..................................... 6
Applicability to Legislative Branch.............................. 6
Section-by-Section Analysis of the Legislation................... 6
Changes in Existing Law Made by the Bill, as Reported............ 7
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Action for Dental Health Act of
2017''.
SEC. 2. VOLUNTEER DENTAL PROJECTS AND ACTION FOR DENTAL HEALTH PROGRAM.
Section 317M of the Public Health Service Act (42 U.S.C. 247b-14) is
amended--
(1) by redesignating subsections (e) and (f) as subsections
(f) and (g), respectively;
(2) by inserting after subsection (d) the following new
subsection:
``(e) Action for Dental Health Program.--
``(1) In general.--The Secretary, in consultation with the
Director of the Centers for Disease Control and Prevention and
the Administrator of the Health Resources and Service
Administration, may award grants to or enter into contracts
with eligible entities to collaborate with State, county, or
local public officials and other stakeholders to develop and
implement initiatives to accomplish any of the following goals:
``(A) To improve oral health education and dental
disease prevention, including through community-wide
prevention programs, through the use of dental sealants
and fluoride varnish, and by increasing oral health
literacy.
``(B) To reduce geographic barriers, language
barriers, cultural barriers, and other similar barriers
to the provision of dental services.
``(2) Eligible entity.--In this subsection, the term
`eligible entity' means an entity that is--
``(A) a State or local dental association;
``(B) a State oral health program;
``(C) a dental education, dental hygiene, or
postdoctoral dental education program accredited by the
Commission on Dental Accreditation; or
``(D) a community-based organization that--
``(i) partners with an academic institution;
``(ii) is exempt from tax under section
501(c) of the Internal Revenue Code of 1986;
and
``(iii) partners with public and private
stakeholders to facilitate the provision of
dental services for underserved populations.'';
and
(3) in subsection (g), as redesignated by paragraph (1), by
striking ``such sums as may be necessary for each of the fiscal
years 2001 through 2005'' and inserting ``$18,000,000 for each
of the fiscal years 2018 through 2022''.
SEC. 3. GRANTS FOR INNOVATIVE PROGRAMS.
Section 340G of the Public Health Service Act (42 U.S.C. 256g) is
amended--
(1) in subsection (b)(5)--
(A) in subparagraph (B), by striking ``and'' at the
end; and
(B) by adding at the end the following:
``(D) the establishment of dental homes for children
and adults, including for the aged, blind, and disabled
populations;
``(E) the establishment of initiatives to reduce the
use of emergency departments by individuals who seek
dental services more appropriately delivered in a
dental primary care setting; and
``(F) the provision of dental care to nursing home
residents;''; and
(2) in subsection (f), by striking ``$25,000,000 for the 5-
fiscal year period beginning with fiscal year 2008'' and
inserting ``$13,903,000 for each of fiscal years 2018 through
2022''.
Purpose and Summary
H.R. 2422 was introduced on May 15, 2017, by Rep. Robin
Kelly (D-IL). The bill reauthorizes the oral health promotion
and disease prevention activities at the Centers for Disease
Control and Prevention (CDC), expanding initiatives to enhance
oral health education and community-wide dental disease
prevention. The bill also reauthorizes the Health Resources and
Services Administration's (HRSA) Grants to States to Support
Oral Health Workforce Activities, increasing access to dental
care in underserved communities.
Background and Need for Legislation
Many oral conditions, such as tooth decay and gum disease,
can be avoided by straightforward preventive measures, such as
regular cleaning and water fluoridation. Yet good oral health
remains an unmet medical need for many Americans. According to
the CDC, on average, the nation spends more than $113 billion a
year on costs related to dental care.
Targeting resources to facilitate the provision of dental
services to those in need, in addition to improving oral health
education will help prevent dental diseases before they start.
This will ultimately reduce medical complications, emergency
room visits, and poor dental health outcomes in underserved
communities.
Committee Action
On May 17, 2017, the Subcommittee on Health held a hearing
on H.R. 2422. The hearing was entitled ``Examining Initiatives
to Advance Public Health.'' The Subcommittee received testimony
from:
Kevin O'Connor, Assistant to the General
President, International Association of Fire Fighters;
Cheryl D. Watson-Lowry, DDS; General
Dentist, American Dental Association;
Martin S. Levine, DO, MPH, FACOFP, dist;
Interim Clinical Dean, Professor of Family and
Community Medicine, Touro College of Osteopathic
Medicine; and
Jordan Greenbaum, MD; Medical Director,
Institute for Healthcare and Human Trafficking at
Children's Healthcare of Atlanta; Medical Director,
Global Initiative for Child Health and Well Being at
the International Centre for Missing and Exploited
Children.
On June 29, 2017, the Subcommittee on Health met in open
markup session and forwarded H.R. 2422, as amended, to the full
Committee by a voice vote. On July 27, 2017, the full Committee
on Energy and Commerce met in open markup session and ordered
H.R. 2422, as amended, favorably reported to the House by a
voice vote.
Committee Votes
Clause 3(b) of rule XIII requires the Committee to list the
record votes on the motion to report legislation and amendments
thereto. There were no record votes taken in connection with
ordering H.R. 2422 reported.
Oversight Findings and Recommendations
Pursuant to clause 2(b)(1) of rule X and clause 3(c)(1) of
rule XIII, the Committee held a hearing and made findings that
are reflected in this report.
New Budget Authority, Entitlement Authority, and Tax Expenditures
Pursuant to clause 3(c)(2) of rule XIII, the Committee
finds that H.R. 2422 would result in no new or increased budget
authority, entitlement authority, or tax expenditures or
revenues.
Congressional Budget Office Estimate
Pursuant to clause 3(c)(3) of rule XIII, the following is
the cost estimate provided by the Congressional Budget Office
pursuant to section 402 of the Congressional Budget Act of
1974.
U.S. Congress,
Congressional Budget Office,
Washington, DC, September 11, 2017.
Hon. Greg Walden,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 2422, the Action
for Dental Health Act of 2017.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Lisa Ramirez-
Branum.
Sincerely,
Keith Hall,
Director.
Enclosure.
H.R. 2422--Action for Dental Health Act of 2017
Summary: H.R. 2422 would amend the Public Health Service
Act to reauthorize and amend grant programs conducted by the
Health Resources and Services Administration (HRSA) and the
Centers for Disease Control and Prevention (CDC). Those
programs provide assistance to states and tribal governments to
increase access to oral health care services.
CBO estimates that implementing H.R. 2422 would cost $133
million over the 2018-2022 period, assuming appropriation of
the specified amounts.
Pay-as-you-go procedures do not apply to this legislation
because it would not affect direct spending or revenues.
CBO estimates that enacting H.R. 2422 would not increase
net direct spending or on-budget deficits in any of the four
consecutive 10-year periods beginning in 2028.
H.R. 2422 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA).
Estimated cost to the Federal Government: The estimated
budgetary effect of H.R. 2422 is shown in the following table.
The costs of this legislation fall within budget function 550
(health).
----------------------------------------------------------------------------------------------------------------
By Fiscal Year, in Millions of Dollars
----------------------------------------------------------------------
2017 2018 2019 2020 2021 2022 2017-2022
----------------------------------------------------------------------------------------------------------------
INCREASES IN SPENDING SUBJECT TO APPROPRIATION
HRSA:
Authorization Level.................. 0 14 14 14 14 14 70
Estimated Outlays.................... 0 7 11 13 14 14 59
CDC:
Authorization Level.................. 0 18 18 18 18 18 90
Estimated Outlays.................... 0 7 15 17 18 18 75
Total Changes:
Authorization Level.............. 0 32 32 32 32 32 160
Estimated Outlays................ 0 13 27 31 31 31 133
----------------------------------------------------------------------------------------------------------------
Notes: Components may not acid to totals because of rounding; HRSA = Health Resources and Services
Administration; CDC = Centers for Disease Control and Prevention.
Basis of estimate: For this estimate, CBO assumes that the
legislation will be enacted near the beginning of fiscal year
2018, that the authorized amounts will be appropriated in each
year, and that spending will follow historical patterns for the
authorized programs. CBO estimates that implementing H.R. 2422
would cost $133 million over the 2018-2022 period, assuming
appropriation of the specified amounts.
HRSA: The bill would authorize the appropriation of $13.9
million in each of the fiscal years 2018 through 2022 for HRSA
to provide grants to states for dentistry and dental hygiene
programs that support the needs of rural and other underserved
communities. About $37 million was appropriated for this
program in 2017. The bill also would expand activities that can
be carried out under the program such as providing dental care
to residents of nursing homes. CBO estimates implementing those
provisions would cost $59 million over the 2018-2022 period;
the remaining amount would be spent in years after 2022.
CDC: The bill would authorize the appropriation of $18
million in each of the fiscal years 2018 through 2022 for CDC
to provide grants to community based organizations and dental
education programs to improve oral health education, promote
disease prevention, and reduce disparities in oral healthcare.
About $18 million was appropriated for this program in 2017.
CBO estimates implementing those provisions would cost $75
million over the 2018-2022 period; the remaining amounts would
be spent in years after 2022.
Pay-as-You-Go considerations: None.
Increase in long-term direct spending and deficits: CBO
estimates that enacting H.R. 2422 would not increase net direct
spending or on-budget deficits in any of the four consecutive
10-year periods beginning in 2028.
Intergovernmental and private-sector impact: H.R. 2422
contains no intergovernmental or private-sector mandates as
defined in UMRA and would impose no costs on state, local, or
tribal governments.
Estimate prepared by: Federal Costs: Lisa Ramirez-Branum
and Rebecca Yip; Impact on State, Local, and Tribal
Governments: Zach Byrum; Impact on the Private Sector: Amy
Petz.
Estimate approved by: Holly Harvey, Deputy Assistant
Director for Budget Analysis.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates prepared by the Director of the Congressional Budget
Office pursuant to section 423 of the Unfunded Mandates Reform
Act.
Statement of General Performance Goals and Objectives
Pursuant to clause 3(c)(4) of rule XIII, the general
performance goal or objective of this legislation is to reduce
disparities in oral health in underserved communities by
fostering local preventive collaborative agreements, improving
the provision of dental care, and enhancing Federal grants to
States to support innovative dental health workforce
activities.
Duplication of Federal Programs
Pursuant to clause 3(c)(5) of rule XIII, no provision of
H.R. 2422 is known to be duplicative of another Federal
program, including any program that was included in a report to
Congress pursuant to section 21 of Public Law 111-139 or the
most recent Catalog of Federal Domestic Assistance.
Committee Cost Estimate
Pursuant to clause 3(d)(1) of rule XIII, the Committee
adopts as its own the cost estimate prepared by the Director of
the Congressional Budget Office pursuant to section 402 of the
Congressional Budget Act of 1974.
Earmark, Limited Tax Benefits, and Limited Tariff Benefits
Pursuant to clause 9(e), 9(f), and 9(g) of rule XXI, the
Committee finds that H.R. 2422 contains no earmarks, limited
tax benefits, or limited tariff benefits.
Disclosure of Directed Rule Makings
Pursuant to section 3(i) of H. Res. 5, the Committee finds
that H.R. 2422 contains no directed rule makings.
Advisory Committee Statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act were created by this
legislation.
Applicability to Legislative Branch
The Committee finds that the legislation does not relate to
the terms and conditions of employment or access to public
services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act.
Section-by-Section Analysis of the Legislation
Section 1. Short title
Section 1 provides that the Act may be cited as the
``Action for Dental Health Act of 2017.''
Section 2. Volunteer dental projects and Action for Dental Health
Program
Section 2 authorizes the appropriation of $18 million for
each of fiscal years 2018 to 2022 for oral health promotion and
disease prevention programs at the CDC and establishes a grant
program for State and local organizations to develop
initiatives to improve oral health education, enhance dental
disease prevention, and reduce barriers to the provision of
dental services.
Section 3. Grants for innovative programs
Section 3 authorizes the appropriation of $13.309 million
for each of fiscal years 2018 to 2022 for HRSA's Grants to
States to Support Oral Health Workforce Activities and permits
States to establish dental homes, mobile or portable dental
clinics, initiatives to reduce emergency department visits, and
initiatives to provide dental care to nursing home residents.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italic, and existing law in which no
change is proposed is shown in roman):
PUBLIC HEALTH SERVICE ACT
* * * * * * *
TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE
* * * * * * *
Part B--Federal-State Cooperation
* * * * * * *
oral health promotion and disease prevention
Sec. 317M. (a) Grants to Increase Resources for Community
Water Fluoridation.--
(1) In general.--The Secretary, acting through the
Director of the Centers for Disease Control and
Prevention, may make grants to States and Indian tribes
for the purpose of increasing the resources available
for community water fluoridation.
(2) Use of funds.--A State shall use amounts provided
under a grant under paragraph (1)--
(A) to purchase fluoridation equipment;
(B) to train fluoridation engineers;
(C) to develop educational materials on the
benefits of fluoridation; or
(D) to support the infrastructure necessary
to monitor and maintain the quality of water
fluoridation.
(b) Community Water Fluoridation.--
(1) In general.--The Secretary, acting through the
Director of the Centers for Disease Control and
Prevention and in collaboration with the Director of
the Indian Health Service, shall establish a
demonstration project that is designed to assist rural
water systems in successfully implementing the water
fluoridation guidelines of the Centers for Disease
Control and Prevention that are entitled ``Engineering
and Administrative Recommendations for Water
Fluoridation, 1995'' (referred to in this subsection as
the ``EARWF'').
(2) Requirements.--
(A) Collaboration.--In collaborating under
paragraph (1), the Directors referred to in
such paragraph shall ensure that technical
assistance and training are provided to tribal
programs located in each of the 12 areas of the
Indian Health Service. The Director of the
Indian Health Service shall provide
coordination and administrative support to
tribes under this section.
(B) General use of funds.--Amounts made
available under paragraph (1) shall be used to
assist small water systems in improving the
effectiveness of water fluoridation and to meet
the recommendations of the EARWF.
(C) Fluoridation specialists.--
(i) In general.--In carrying out this
subsection, the Secretary shall provide
for the establishment of fluoridation
specialist engineering positions in
each of the Dental Clinical and
Preventive Support Centers through
which technical assistance and training
will be provided to tribal water
operators, tribal utility operators and
other Indian Health Service personnel
working directly with fluoridation
projects.
(ii) Liaison.--A fluoridation
specialist shall serve as the principal
technical liaison between the Indian
Health Service and the Centers for
Disease Control and Prevention with
respect to engineering and fluoridation
issues.
(iii) CDC.--The Director of the
Centers for Disease Control and
Prevention shall appoint individuals to
serve as the fluoridation specialists.
(D) Implementation.--The project established
under this subsection shall be planned,
implemented and evaluated over the 5-year
period beginning on the date on which funds are
appropriated under this section and shall be
designed to serve as a model for improving the
effectiveness of water fluoridation systems of
small rural communities.
(3) Evaluation.--In conducting the ongoing evaluation
as provided for in paragraph (2)(D), the Secretary
shall ensure that such evaluation includes--
(A) the measurement of changes in water
fluoridation compliance levels resulting from
assistance provided under this section;
(B) the identification of the administrative,
technical and operational challenges that are
unique to the fluoridation of small water
systems;
(C) the development of a practical model that
may be easily utilized by other tribal, State,
county or local governments in improving the
quality of water fluoridation with emphasis on
small water systems; and
(D) the measurement of any increased
percentage of Native Americans or Alaskan
Natives who receive the benefits of optimally
fluoridated water.
(c) School-Based Dental Sealant Program.--
(1) In general.--The Secretary, acting through the
Director of the Centers for Disease Control and
Prevention and in collaboration with the Administrator
of the Health Resources and Services Administration,
shall award a grant to each of the 50 States and
territories and to Indians, Indian tribes, tribal
organizations and urban Indian organizations (as such
terms are defined in section 4 of the Indian Health
Care Improvement Act) to provide for the development of
school-based dental sealant programs to improve the
access of children to sealants.
(2) Use of funds.--A State shall use amounts received
under a grant under paragraph (1) to provide funds to
eligible school-based entities or to public elementary
or secondary schools to enable such entities or schools
to provide children with access to dental care and
dental sealant services. Such services shall be
provided by licensed dental health professionals in
accordance with State practice licensing laws.
(3) Eligibility.--To be eligible to receive funds
under paragraph (1), an entity shall--
(A) prepare and submit to the State an
application at such time, in such manner and
containing such information as the State may
require; and
(B) be a public elementary or secondary
school--
(i) that is located in an urban area
in which and more than 50 percent of
the student population is participating
in Federal or State free or reduced
meal programs; or
(ii) that is located in a rural area
and, with respect to the school
district in which the school is
located, the district involved has a
median income that is at or below 235
percent of the poverty line, as defined
in section 673(2) of the Community
Services Block Grant Act (42 U.S.C.
9902(2)).
(d) Oral Health Infrastructure.--
(1) Cooperative agreements.--The Secretary, acting
through the Director of the Centers for Disease Control
and Prevention, shall enter into cooperative agreements
with State, territorial, and Indian tribes or tribal
organizations (as those terms are defined in section 4
of the Indian Health Care Improvement Act) to establish
oral health leadership and program guidance, oral
health data collection and interpretation, (including
determinants of poor oral health among vulnerable
populations), a multi-dimensional delivery system for
oral health, and to implement science-based programs
(including dental sealants and community water
fluoridation) to improve oral health.
(2) Authorization of appropriations.--There is
authorized to be appropriated such sums as necessary to
carry out this subsection for fiscal years 2010 through
2014.
(e) Action for Dental Health Program.--
(1) In general.--The Secretary, in consultation with
the Director of the Centers for Disease Control and
Prevention and the Administrator of the Health
Resources and Service Administration, may award grants
to or enter into contracts with eligible entities to
collaborate with State, county, or local public
officials and other stakeholders to develop and
implement initiatives to accomplish any of the
following goals:
(A) To improve oral health education and
dental disease prevention, including through
community-wide prevention programs, through the
use of dental sealants and fluoride varnish,
and by increasing oral health literacy.
(B) To reduce geographic barriers, language
barriers, cultural barriers, and other similar
barriers to the provision of dental services.
(2) Eligible entity.--In this subsection, the term
``eligible entity'' means an entity that is--
(A) a State or local dental association;
(B) a State oral health program;
(C) a dental education, dental hygiene, or
postdoctoral dental education program
accredited by the Commission on Dental
Accreditation; or
(D) a community-based organization that--
(i) partners with an academic
institution;
(ii) is exempt from tax under section
501(c) of the Internal Revenue Code of
1986; and
(iii) partners with public and
private stakeholders to facilitate the
provision of dental services for
underserved populations.
[(e)] (f) Definitions.--For purposes of this section, the
term ``Indian tribe'' means an Indian tribe or tribal
organization as defined in section 4(b) and section 4(c) of the
Indian Self-Determination and Education Assistance Act.
[(f)] (g) Authorization of Appropriations.--For the purpose
of carrying out this section, there are authorized to be
appropriated [such sums as may be necessary for each of the
fiscal years 2001 through 2005] $18,000,000 for each of the
fiscal years 2018 through 2022.
* * * * * * *
Part D--Primary Health Care
* * * * * * *
Subpart X--Primary Dental Programs
* * * * * * *
SEC. 340G. GRANTS FOR INNOVATIVE PROGRAMS.
(a) Grant Program Authorized.--The Secretary, acting through
the Administrator of the Health Resources and Services
Administration, is authorized to award grants to States for the
purpose of helping States develop and implement innovative
programs to address the dental workforce needs of designated
dental health professional shortage areas in a manner that is
appropriate to the States' individual needs.
(b) State Activities.--A State receiving a grant under
subsection (a) may use funds received under the grant for--
(1) loan forgiveness and repayment programs for
dentists who--
(A) agree to practice in designated dental
health professional shortage areas;
(B) are dental school graduates who agree to
serve as public health dentists for the
Federal, State, or local government; and
(C) agree to--
(i) provide services to patients
regardless of such patients' ability to
pay; and
(ii) use a sliding payment scale for
patients who are unable to pay the
total cost of services;
(2) dental recruitment and retention efforts;
(3) grants and low-interest or no-interest loans to
help dentists who participate in the medicaid program
under title XIX of the Social Security Act (42 U.S.C.
1396 et seq.) to establish or expand practices in
designated dental health professional shortage areas by
equipping dental offices or sharing in the overhead
costs of such practices;
(4) the establishment or expansion of dental
residency programs in coordination with accredited
dental training institutions in States without dental
schools;
(5) programs developed in consultation with State and
local dental societies to expand or establish oral
health services and facilities in designated dental
health professional shortage areas, including services
and facilities for children with special needs, such
as--
(A) the expansion or establishment of a
community-based dental facility, free-standing
dental clinic, consolidated health center
dental facility, school-linked dental facility,
or United States dental school-based facility;
(B) the establishment of a mobile or portable
dental clinic; [and]
(C) the establishment or expansion of private
dental services to enhance capacity through
additional equipment or additional hours of
operation;
(D) the establishment of dental homes for
children and adults, including for the aged,
blind, and disabled populations;
(E) the establishment of initiatives to
reduce the use of emergency departments by
individuals who seek dental services more
appropriately delivered in a dental primary
care setting; and
(F) the provision of dental care to nursing
home residents;
(6) placement and support of dental students, dental
residents, and advanced dentistry trainees;
(7) continuing dental education, including distance-
based education;
(8) practice support through teledentistry conducted
in accordance with State laws;
(9) community-based prevention services such as water
fluoridation and dental sealant programs;
(10) coordination with local educational agencies
within the State to foster programs that promote
children going into oral health or science professions;
(11) the establishment of faculty recruitment
programs at accredited dental training institutions
whose mission includes community outreach and service
and that have a demonstrated record of serving
underserved States;
(12) the development of a State dental officer
position or the augmentation of a State dental office
to coordinate oral health and access issues in the
State; and
(13) any other activities determined to be
appropriate by the Secretary.
(c) Application.--
(1) In general.--Each State desiring a grant under
this section shall submit an application to the
Secretary at such time, in such manner, and containing
such information as the Secretary may reasonably
require.
(2) Assurances.--The application shall include
assurances that the State will meet the requirements of
subsection (d) and that the State possesses sufficient
infrastructure to manage the activities to be funded
through the grant and to evaluate and report on the
outcomes resulting from such activities.
(d) Matching Requirement.--The Secretary may not make a grant
to a State under this section unless that State agrees that,
with respect to the costs to be incurred by the State in
carrying out the activities for which the grant was awarded,
the State will provide non-Federal contributions in an amount
equal to not less than 40 percent of Federal funds provided
under the grant. The State may provide the contributions in
cash or in kind, fairly evaluated, including plant, equipment,
and services and may provide the contributions from State,
local, or private sources.
(e) Report.--Not later than 5 years after the date of
enactment of the Health Care Safety Net Amendments of 2002, the
Secretary shall prepare and submit to the appropriate
committees of Congress a report containing data relating to
whether grants provided under this section have increased
access to dental services in designated dental health
professional shortage areas.
(f) Authorization of Appropriations.--There is authorized to
be appropriated to carry out this section, [$25,000,000 for the
5-fiscal year period beginning with fiscal year 2008]
$13,903,000 for each of fiscal years 2018 through 2022.
* * * * * * *
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