[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 2740 Introduced in Senate (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.''.
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