To expand the availability of oral health services by strengthening the dental workforce in designated underserved areas.

APRIL 17, 2002

Mr. SANDERS introduced the following bill; which was referred to the Committee on Energy and Commerce

To expand the availability of oral health services by strengthening the dental workforce in designated underserved areas.

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

SECTION 1. SHORT TITLE.

This Act may be cited as the `Dental Health Improvement Act'.

SEC. 2. FINDINGS.

Congress finds the following:

(1) Oral and general health are inseparable, and good dental care is critical to our overall physical health and well-being.

(2) Although oral health in America has improved dramatically over the last 50 years, these improvements have not occurred evenly across all sectors of our population, particularly among low-income individuals and families and people living in underserved areas.

(3) According to the United States Surgeon General, an estimated 25,000,000 Americans live in areas lacking adequate dental care services, and as many as 11 percent of our Nation's rural population has never been to a dentist.

(4) This access problem is exacerbated by the fact that our dental workforce is aging: more than 20 percent of dentists will retire in the next 10 years, and the number of dental graduates by 2015 may not be enough to replace these retirees. Although dentists have significantly increased their productivity, there are still distribution problems in specific geographic areas.

(5) Our Nation's dental school faculty is also aging. With retirement being the leading indicator, faculty shortage issues face United States dental schools with approximately 400 current vacancies for unfilled, budgeted positions. United States dental schools play an important role in improving access to care to underserved populations.

(6) While the National Health Service Corps has placed more than 20,000 health care providers in some of America's most difficult-to-place inner city, rural, and frontier communities, the current funding levels for this program do not begin to meet the need in these underserved communities for physical, oral, and mental and behavioral health care services and should be substantially increased.

(7) According to the United States Surgeon General, the number of dentists and dental hygienists with obligations to serve in the National Health Service Corps falls far short of meeting the total identified need: only about 6 percent of the dental need in designated underserved areas is currently being met by this program, and outreach and development are critical to future opportunities for strengthening the dental workforce in designated dental health professional shortage areas.

SEC. 3. EXPANDING AVAILABILITY OF DENTAL SERVICES.

Part D of title III of the Public Health Service Act (42 U.S.C. 254b et seq.) is amended by adding at the end the following:

`Subpart X--Primary Dental Programs

`SEC. 340F. DESIGNATED DENTAL HEALTH PROFESSIONAL SHORTAGE AREA.

`In this subpart, the term `designated dental health professional shortage area' means an area, population group, or facility that is designated by the Secretary as a dental health professional shortage area under section 332 or designated by the applicable State as having a dental health manpower shortage.

`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 State's 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) practice in designated dental health professional shortage areas; and

`(B) agree to--

`(i) provide services to patients regardless of such patients' ability to pay; and

`(ii) provide a sliding payment scale for patients who are unable to pay the total cost of services;

`(2) recruitment and retention efforts;

`(3) grants and low-interest or no-interest loans to help practitioners 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 operations;

`(4) the establishment or expansion of dental residency programs in coordination with accredited dental training facilities in States without dental schools;

`(5) programs developed in consultation with State and local dental societies to expand or establish oral health services in designated dental health professional shortage areas, 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;

`(6) placement and support of dental students, residents, and advanced dentistry trainees;

`(7) continuing dental education, including distance-based education;

`(8) practice support through teledentistry conducted in accordance with existing State laws;

`(9) community-based prevention services such as water fluoridation and dental sealant programs;

`(10) coordination with local education systems 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 current 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- Each application submitted under this subsection 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 by the grant and to evaluate and report on the outcomes resulting from such activities.

`(d) MATCHING REQUIREMENT- An entity that receives a grant under this section shall contribute non-Federal funds to activities carried out under the grant in a total amount equal to at least 40 percent of the amount of the grant. Such matching funds may be a combination of in-kind contributions, fairly valued, and any other funding from State or local sources or from community or other organizations.

`(e) REPORT- Not later than 5 years after the date of enactment of the Dental Health Improvement Act, 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, $50,000,000 for the 5-fiscal year period beginning with fiscal year 2003.'.

SEC. 4. NATIONAL HEALTH SERVICE CORPS.

(a) SCHOLARSHIP AND LOAN REPAYMENT PROGRAMS- The Secretary of Health and Human Services, in consultation with the American Dental Association, the American Dental Education Association, the American Dental Hygienists Association, the American Academy of Pediatric Dentistry, the Association of State and Territorial Dental Directors, and the National Association of Community Health Centers, shall develop and implement a plan for increasing the participation of dentists and dental hygienists in the National Health Service Corps' scholarship program under section 338A of the Public Health Service Act (42 U.S.C. 254l) and the loan repayment program under section 338B of such Act (42 U.S.C. 254l-1).

(b) LOAN REPAYMENT PLAN- Section 338C of the Public Health Service Act (42 U.S.C. 254m) is amended by adding at the end the following:

`(f) Notwithstanding any other provision of this title, periods of obligated service may be served and fulfilled on a part time basis if--

`(1) such part time service is agreed to by both the placement site or sites and the recipient of the scholarship or loan repayment; and

`(2) the recipient's total obligation is fulfilled.'.

(c) SCHOLARSHIP PROGRAMS- Any scholarship program for dental students administered through the National Health Service Corps shall meet the following requirements:

(1) AVAILABILITY- The scholarship program shall be open to students attending any accredited dental school or dental hygiene program in the United States.

(2) PLACEMENT- The placement of an oral health provider participating in the scholarship program shall be solely based upon community need for dental services.

(d) SITE DESIGNATION PROCESS-

(1) IMPROVEMENT OF DESIGNATION PROCESS- The Administrator of the Health Resources and Services Administration, in consultation with the Association of State and Territorial Dental Directors, dental societies, and other interested parties, shall--

(A) design and implement procedures to simplify the process of designating areas, population groups, and facilities as dental health professional shortage areas under section 332 of the Public Health Service Act (42 U.S.C. 254e); and

(B) revise the criteria upon which such designations are based so that such criteria provide a more accurate reflection of oral health care need, particularly in rural areas.

(2) PUBLIC HEALTH SERVICE ACT- Section 332 of the Public Health Service Act (42 U.S.C. 254e) is amended by adding at the end the following:

`(i) The Administrator of the Health Resources and Services Administration shall disseminate information concerning the designation criteria described in subsection (b) to--

`(1) the Governor of each State;

`(2) the representative of any area, population group, or facility selected by any such Governor to receive such information;

`(3) the representative of any area, population group, or facility that requests such information; and

`(4) the representative of any area, population group, or facility determined by the Administrator to be likely to meet the criteria described in subsection (b).

`(j) The Administrator of the Health Resources and Services Administration shall provide technical assistance to any area, population group, or facility that demonstrates an interest in applying for dental health professional shortage area designation.'.

END