S. 2740 (108th): Dental Health Provider Shortage Act

108th Congress, 2003–2004. Text as of Jul 22, 2004 (Introduced).

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S 2740 IS

108th CONGRESS

2d Session

S. 2740

To improve dental services in underserved areas by amending the Public Health Service Act, and for other purposes.

IN THE SENATE OF THE UNITED STATES

July 22, 2004

Mr. DASCHLE (for himself and Ms. COLLINS) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions


A BILL

To improve dental services in underserved areas by amending the Public Health Service Act, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) SHORT TITLE- This Act may be cited as the ‘Dental Health Provider Shortage Act’.

    (b) TABLE OF CONTENTS- The table of contents for this Act is as follows:

      Sec. 1. Short title; table of contents.

TITLE I--EXPANDED DELIVERY OF DENTAL SERVICES

      Sec. 101. Expansion of dental services offered in underserved areas.

      Sec. 102. Grants for capital expenditures for dental care practices in dental health professional shortage areas.

      Sec. 103. Grants for administrative simplification for medicaid providers.

TITLE II--EXPANSION OF DENTAL TRAINING PROGRAMS

      Sec. 201. Flexible use of training funds for general and pediatric dentistry.

      Sec. 202. Loan repayment for faculty of dental educational programs.

TITLE III--IMPROVING DELIVERY OF DENTAL SERVICES THROUGH THE INDIAN HEALTH SERVICE AND THE NATIONAL HEALTH SERVICE CORPS

      Sec. 301. Indian Health Service dental officer multiyear retention bonus.

      Sec. 302. Increase in National Health Service Corps dental training positions.

      Sec. 303. Availability of scholarship and loan repayment programs for National Health Service Corps dental hygienists.

TITLE I--EXPANDED DELIVERY OF DENTAL SERVICES

SEC. 101. EXPANSION OF DENTAL SERVICES OFFERED IN UNDERSERVED AREAS.

    Section 330 of the Public Health Service Act (42 U.S.C. 254b) is amended by adding at the end the following:

    ‘(s) HEALTH CENTER DENTAL ACCESS GRANTS-

      ‘(1) GRANT PROGRAM AUTHORIZED- The Secretary, acting through the Administrator of the Health Resources and Services Administration, is authorized to award grants and enter into cooperative agreements, for a period not to exceed 3 years, to health centers for the purpose of increasing the number of dental providers associated with the health centers.

      ‘(2) AUTHORIZED ACTIVITIES- A health center shall use amounts received under a grant under this subsection in any fiscal year--

        ‘(A) for recruitment or retention efforts targeting the dental health care staff of a health center;

        ‘(B) to contract for technical assistance for the purpose of recruiting or retaining dental health care staff; or

        ‘(C) to contract for technical assistance in preparing contracts with local providers of dental health care to provide dental services for medically underserved populations.

      ‘(3) APPLICATION- Each health center desiring a grant under this subsection shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may reasonably require.

    ‘(t) GRANTS FOR DENTAL CARE FACILITY CAPITAL EXPENDITURES-

      ‘(1) GRANT PROGRAM AUTHORIZED- The Secretary, acting through the Administrator of the Health Resources and Services Administration, is authorized to award 1-year grants to health centers for the purpose of increasing dental health care capabilities by constructing or renovating building space to provide for dental health care.

      ‘(2) AUTHORIZED ACTIVITIES- A health center shall use amounts received under a grant under this subsection in any fiscal year for the construction or expansion of dental care facilities, including--

        ‘(A) the costs of acquiring or leasing facilities;

        ‘(B) the costs of constructing new facilities;

        ‘(C) the costs of repairing or modernizing existing facilities; or

        ‘(D) the purchase or lease of equipment.

      ‘(3) APPLICATION- Each health center desiring a grant under this subsection shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may reasonably require.

    ‘(u) GRANTS FOR DENTAL RESIDENCY PROGRAMS-

      ‘(1) GRANTS AUTHORIZED- The Secretary is authorized to award grants to health centers for the purpose of establishing, at the health centers, new or alternative-campus accredited dental residency training programs affiliated with accredited dental programs.

      ‘(2) AUTHORIZED ACTIVITIES- A health center shall use amounts received under a grant under this subsection for the costs of establishing a new or alternative-campus accredited dental residency training program affiliated with an accredited dental program at the health center, including the costs of curriculum development, equipment, and recruitment, training, and retention of residents and faculty for such training program.

      ‘(3) PRIORITY- The Secretary shall give priority in awarding grants under this subsection to health centers in rural areas.

      ‘(4) APPLICATION- Each health center desiring a grant under this subsection shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may reasonably require.

      ‘(5) DEFINITION OF ACCREDITED-

        ‘(A) IN GENERAL- In this subsection, the term ‘accredited’, when applied to a dental training program or a new or alternative-campus dental residency training program, means a program that is accredited by a recognized body

or bodies approved for such purpose by the Secretary of Education.

        ‘(B) SPECIAL RULE- A new dental residency training program that, by reason of an insufficient period of operation, is not, at the time of application for a grant under this subsection, eligible for accreditation by such a recognized body or bodies, shall be deemed accredited for purposes of this subsection, if the Secretary of Education finds, after consultation with the appropriate accreditation body or bodies, that there is reasonable assurance that the new dental residency training program will meet the accreditation standards of such body or bodies prior to the graduation date of the first entering class in such program.

        ‘(C) RULE OF CONSTRUCTION- The special rule for accreditation described in subparagraph (B) shall not apply to an alternative-campus dental residency training program.’.

SEC. 102. GRANTS FOR CAPITAL EXPENDITURES FOR DENTAL CARE PRACTICES IN DENTAL HEALTH PROFESSIONAL SHORTAGE AREAS.

    Subpart V of part D of title III of the Public Health Service Act (20 U.S.C. 256 et seq.) is amended by adding at the end the following:

‘SEC. 340A. GRANTS FOR CAPITAL EXPENDITURES FOR DENTAL CARE PRACTICES IN DENTAL HEALTH PROFESSIONAL SHORTAGE AREAS.

    ‘(a) GRANT PROGRAM AUTHORIZED- The Secretary, acting through the Administrator of the Health Resources and Services Administration, is authorized to award 1-year grants to eligible individuals for the purpose of increasing dental health care capabilities in dental health professional shortage areas by constructing or renovating building space to provide for dental health care.

    ‘(b) AUTHORIZED ACTIVITIES- An eligible individual shall use amounts received under a grant under this section in any fiscal year for the construction or expansion of dental care facilities in dental health professional shortage areas, including--

      ‘(1) the costs of acquiring or leasing facilities;

      ‘(2) the costs of constructing new facilities;

      ‘(3) the costs of repairing or modernizing existing facilities; or

      ‘(4) the purchase or lease of equipment.

    ‘(c) APPLICATION- Each eligible individual 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.

    ‘(d) ELIGIBLE INDIVIDUAL- To be eligible to receive a grant under this section, an individual shall be a dental health professional who is licensed or certified in accordance with the laws of the State in which such individual provides dental services.

    ‘(e) ELIGIBLE INDIVIDUAL GRANT AGREEMENT- Each eligible individual who receives a grant under this section shall enter into an agreement with the Secretary under which the eligible individual agrees--

      ‘(1) to practice for 5 years in a dental health professional shortage area, as determined by the Secretary;

      ‘(2) that during the period under paragraph (1), not less than 25 percent of the patients of such individual receive assistance--

        ‘(A) under a State plan under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.); or

        ‘(B) under a State plan under title XXI of the Social Security Act (42 U.S.C. 1397aa et seq.);

      ‘(3) to provide services to patients regardless of such patients’ ability to pay;

      ‘(4) to use a sliding payment scale for patients who are unable to pay the total cost of services; and

      ‘(5) to repay a pro rata portion of the grant funds received if the eligible individual fails to practice in accordance with paragraphs (1) through (4).

    ‘(f) AUTHORIZATION OF APPROPRIATIONS- There is authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2005 through 2009.’.

SEC. 103. GRANTS FOR ADMINISTRATIVE SIMPLIFICATION FOR MEDICAID PROVIDERS.

    (a) AUTHORITY TO AWARD PROVIDER ADMINISTRATIVE SIMPLIFICATION GRANTS-

      (1) IN GENERAL- The Secretary of Health and Human Services shall award grants to State agencies responsible for the administration of the State medicaid program under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) for the purpose of simplifying and automating the procedures applicable to providers of medical assistance under the State medicaid program in order to encourage providers to participate in the dental component of such program.

      (2) USE OF FUNDS- A grant awarded under this subsection may be used to simplify--

        (A) provider enrollment contracts and processes through such means as providing for online provider enrollment forms;

        (B) preauthorization procedures;

        (C) claims remittance and processing; and

        (D) any other procedures or requirements that would reduce the time and expenses necessary for providers to participate in the medicaid program.

      (3) AUTHORIZATION OF APPROPRIATIONS- There is authorized to be appropriated to the Secretary of Health and Human Services to award grants under this subsection such sums as are necessary for fiscal year 2005.

    (b) MODEL CONTRACT FOR THE ENROLLMENT OF DENTISTS AS MEDICAID PARTICIPATING PROVIDERS-

      (1) IN GENERAL- The Secretary of Health and Human Services shall award grants to eligible entities to develop, disseminate, and assist with the implementation of a model contract for States to use

to enroll dentists as participating providers under the State medicaid program under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.).

      (2) ELIGIBLE ENTITIES DEFINED- In this subsection, the term ‘eligible entities’ means entities with expertise in the administration of State medicaid programs, which may include the National Association of State Medicaid Directors.

      (3) AUTHORIZATION OF APPROPRIATIONS- There is authorized to be appropriated to the Secretary of Health and Human Services to award grants under this subsection such sums as are necessary for fiscal year 2005.

TITLE II--EXPANSION OF DENTAL TRAINING PROGRAMS

SEC. 201. FLEXIBLE USE OF TRAINING FUNDS FOR GENERAL AND PEDIATRIC DENTISTRY.

    Section 747(a)(6) of the Public Health Service Act (42 U.S.C. 293k(a)(6)) is amended to read as follows:

      ‘(6) to plan, develop, or operate a program of general dentistry or pediatric dentistry, including the costs of faculty development, curriculum development, program administration, financial assistance to residents in such program, and other functions critical to building a competent dental workforce.’.

SEC. 202. LOAN REPAYMENT FOR FACULTY OF DENTAL EDUCATIONAL PROGRAMS.

    Part C of title VII of the Public Health Service Act (42 U.S.C. 293k et seq.) is amended by inserting after section 748 the following:

‘SEC. 749. LOAN REPAYMENT FOR FACULTY OF DENTAL EDUCATIONAL PROGRAMS.

    ‘(a) ESTABLISHMENT- The Secretary, acting through the Administrator of the Health Resources and Services Administration, shall carry out a program to repay (by direct payment on behalf of the individual) any outstanding student loan of an individual who is employed as a full-time faculty member of a school of dentistry or an accredited dental education program.

    ‘(b) LOAN REPAYMENT- The payments described in subsection (a) shall be made by the Secretary as follows:

      ‘(1) Upon completion by the individual for whom the payments are to be made of the first year of employment described under subsection (a), the Secretary shall pay 25 percent of the principal of, and the interest on, each outstanding student loan.

      ‘(2) Upon completion by such individual of the second consecutive year of such employment, the Secretary shall pay an additional 25 percent of the principal of, and the interest on, each such loan.

      ‘(3) Upon completion by such individual of the third consecutive year of such employment, the Secretary shall pay an additional 35 percent of the principal of, and the interest on, each such loan.

    ‘(c) PRIORITY- In entering into agreements to repay outstanding student loans under subsection (a), the Secretary shall give priority to qualified applicants--

      ‘(1) with the greatest financial need; or

      ‘(2) who are full-time faculty for an accredited program of general or pediatric dentistry.

    ‘(d) REGULATIONS- The Secretary shall promulgate such regulations as may be necessary to carry out the program under this section.

    ‘(e) REPORTS- Not later than 18 months after the date of enactment of this section, and annually thereafter, the Secretary shall prepare and submit to Congress a report describing the program carried out under this section, including--

      ‘(1) the number and amount of loan repayments made;

      ‘(2) the number of individuals who receive loan repayment under subsection (a) at each school of dentistry or accredited dental education program that employs individuals who receive such loan repayment;

      ‘(3) the demographics of the individuals participating in the loan repayment program; and

      ‘(4) an evaluation of the overall costs and benefits of the loan repayment program.

    ‘(f) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2005 through 2009.’.

TITLE III--IMPROVING DELIVERY OF DENTAL SERVICES THROUGH THE INDIAN HEALTH SERVICE AND THE NATIONAL HEALTH SERVICE CORPS

SEC. 301. INDIAN HEALTH SERVICE DENTAL OFFICER MULTIYEAR RETENTION BONUS.

    (a) TERMS AND DEFINITIONS- In this section:

      (1) CREDITABLE SERVICE- The term ‘creditable service’ includes all periods that a dental officer spent in graduate dental educational training programs while not on active duty in the Indian Health Service and all periods of active duty in the Indian Health Service as a dental officer.

      (2) DENTAL OFFICER- The term ‘dental officer’ means an individual in the dental health profession who is an officer of the Indian Health Service.

      (3) DIRECTOR- The term ‘Director’ means the Director of the Indian Health Service.

      (4) RESIDENCY- The term ‘residency’ means a graduate dental educational training program of at least 12 months leading to a specialty, including general practice residency or an advanced education general dentistry.

      (5) SPECIALTY- The term ‘specialty’ means a dental specialty for which there is an Indian Health Service specialty code number.

    (b) GENERAL AUTHORITY- The Director may authorize a multiyear retention bonus under this section for a dental officer of the Indian Health Service who meets the eligibility requirements of subsection (c) and who executes a written agreement to remain on active duty for 2, 3, or 4 years after the completion of any other active duty service commitment to the Indian Health Service.

    (c) ELIGIBILITY REQUIREMENTS- In addition to the requirements described under subsection (b), an eligible dental officer shall--

      (1) if trained as a dentist--

        (A) be at or below such grade as the Director shall determine;

        (B) hold the degree of doctor of dentistry or an equivalent degree;

        (C) have completed any active duty service commitment of the Indian Health Service incurred for dental education and training or have 8 years of creditable service; and

        (D) have completed initial residency training, or be scheduled to complete initial residency training before September 30 of the fiscal year in which the dental officer enters into a multiyear retention bonus service agreement under this section; or

      (2) if trained as a dental hygienist--

        (A) have graduated from a dental hygiene educational or training program accredited by the American Dental Association Commission on Dental Accreditation (ADA CDA);

        (B) hold a certification of successful completion of the National Board Dental Hygiene Examination; and

        (C) hold an active and current dental hygiene license.

    (d) MAXIMUM BONUS AMOUNTS-

      (1) MAXIMUM BONUS AMOUNTS FOR DENTISTS- A multiyear retention bonus authorized for a dental officer who meets the requirements of subsection (c)(1) shall not exceed--

        (A) $14,000 for a 4-year written agreement;

        (B) $8,000 for a 3-year written agreement; or

        (C) $4,000 for a 2-year written agreement.

      (2) MAXIMUM BONUS AMOUNTS FOR DENTAL HYGIENISTS- A multiyear retention bonus authorized for a dental officer who meets the requirements of subsection (c)(2) shall not exceed--

        (A) $4,000 for a 4-year written agreement;

        (B) $2,000 for a 3-year written agreement; or

        (C) $1,000 for a 2-year written agreement.

    (e) DISCRETION IN SELECTION PROCESS- The Director may, based on the requirements of the Indian Health Service, decline to offer a multi-year retention bonus to any specialty that is otherwise eligible, or to restrict the length of such a retention bonus contract for a specialty to less than 4 years.

    (f) TERMINATION OF ENTITLEMENT TO MULTIYEAR RETENTION BONUS-

      (1) IN GENERAL- The Director may terminate, with cause, a dental officer multiyear retention bonus agreement with a dental officer under this section at any time.

      (2) PRO RATA RECOUPMENT- If a dental officer multiyear retention bonus agreement is terminated under paragraph (1), the unserved portion of the retention bonus agreement shall be recouped on a pro rata basis.

      (3) REGULATIONS- The Director shall establish regulations that--

        (A) specify the conditions and procedures under which termination may take place; and

        (B) shall be included in the dental officer multiyear retention bonus agreement under subsection (b).

    (g) REFUNDS-

      (1) IN GENERAL- Prorated refunds shall be required for sums paid under a retention bonus contract under this section if a dental officer who has received the retention bonus fails to complete the total period of service specified in the dental officer multiyear retention bonus agreement, as conditions and circumstances warrant.

      (2) DEBT TO UNITED STATES- An obligation to reimburse the United States imposed under paragraph (1) is a debt owed to the United States.

      (3) NO DISCHARGE IN BANKRUPTCY- Notwithstanding any other provision of law, a discharge in bankruptcy under title 11, United States Code, that is entered less than 5 years after the termination of a dental officer multiyear retention bonus agreement under this section does not discharge the dental officer who signed such a contract from a debt arising under the contract or under paragraph (1).

    (h) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2005 through 2009.

SEC. 302. INCREASE IN NATIONAL HEALTH SERVICE CORPS DENTAL TRAINING POSITIONS.

    (a) IN GENERAL- The Secretary of Health and Human Services (referred to in this section as the ‘Secretary’) shall increase the number of dentists in the National Health Service Corps (referred to in this section as the ‘Corps’), as designated in subpart II of part D of title III of the Public Health Service Act (42 U.S.C. 254d et seq.), by not less than 100 in each of fiscal years 2005, 2006, and 2007.

    (b) AVAILABILITY OF LOAN REPAYMENT AND SCHOLARSHIP PROGRAMS FOR DENTISTS- The Secretary shall increase the number of Corps dentists selected for the loan repayment and scholarship programs under subpart III of part D of title III of the Public Health Service Act (42 U.S.C. 254l et seq.) in a sufficient number to address the demand for such programs by qualified individuals.

    (c) REPORT ON CORPS- The Secretary shall annually report to Congress concerning how the Corps is meeting the oral health needs in underserved areas, including rural, frontier, and border areas.

SEC. 303. AVAILABILITY OF SCHOLARSHIP AND LOAN REPAYMENT PROGRAMS FOR NATIONAL HEALTH SERVICE CORPS DENTAL HYGIENISTS.

    Section 338A of the Public Health Service Act (42 U.S.C. 254l) is amended--

      (1) by redesignating subsection (h) as subsection (i); and

      (2) by inserting after subsection (g) the following:

    ‘(h) Of the total number of contracts under this section and section 338B for each school year that are dedicated to dental hygienists, not less than 20 percent of such contracts for each such school year shall be entered into under this section.’.