[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4476 Introduced in House (IH)]







107th CONGRESS
  2d Session
                                H. R. 4476

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


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 17, 2002

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

_______________________________________________________________________

                                 A BILL


 
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.''.
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