[Congressional Record Volume 150, Number 103 (Thursday, July 22, 2004)]
[Senate]
[Pages S8720-S8723]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DASCHLE (for himself and Ms. Collins):
  S. 2740. A bill to improve dental services in underserved areas by 
amending the Public Health Service Act, and for other purposes; to the 
Committee on Health, Education, Labor, and Pensions.
  Mr. DASCHLE. Mr. President, every year, I spend time driving across 
the State of South Dakota, and every year, I hear unbelievable stories 
from my constituents about the growing health care crisis in South 
Dakota and across America. One issue that comes up repeatedly in my 
travels is South Dakota's dental shortage.
  The statistics speak for themselves. Almost one-third of my State's 
66 counties have been designated Dental Health Professional Shortage 
Areas. In total, over 97,000 South Dakotans live in a county that does 
not have enough dentists to meet the needs of the population. 
Nationally, 25 million Americans reside in such shortage areas.
  South Dakota has only one dentist for every 250 square miles, which 
means that many South Dakotans must travel more than 100 miles to visit 
a dentist. To see a pediatric dentist, parents often have to travel up 
to 400 miles. I've heard stories of families driving clear across the 
State so that their children can receive urgent dental care. 
Comparatively, Minnesota's rate is 28 square miles per dentist. 
Massachusetts's rate is less than 2 square miles per dentist, and here 
in Washington, DC, the rate is 0.1 square miles per dentist.
  In addition, the dentists my State does have are getting older. A 
study conducted in South Dakota found that roughly half of the dentists 
currently practicing there are over 50 years old, and that 30 percent 
plan to retire within 10 years. Nationally, 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 them.
  The problem in Indian country is even worse. Indian pre-school 
children have 5 times the rate of dental decay experienced by other 
children in their age group. Despite this great need, the Indian Health 
Services estimates that one-third of its dental positions are vacant.
  A report by the Government Accounting Office in 2000 found that, 
while several factors contribute to the low use of dental services 
among low-income individuals, the most important factor was the 
inability to find a

[[Page S8721]]

dentist to treat them. That is simply unacceptable.
  Another report by Oral Health America in 2003 found that the United 
States does poorly in several areas that measure access to dental care. 
In fact, in the report's assessment of dentist availability, the 
majority of States received a grade of C or lower. The report card also 
found that those with the greatest need have the hardest time finding 
care; 18 states received a failing grade for the availability of 
dentists who provide significant services under Medicaid, contributing 
to an alarming D grade for the entire nation.
  In an effort to address this urgent problem, I have been working with 
representatives from the South Dakota Oral Health Coalition to develop 
a legislative remedy at the Federal level. The culmination of that 
effort is the bill I am introducing today, the Dental Health Provider 
Shortage Act. Together with Senator Collins--herself a longtime 
supporter of expanding access to dental care--I am proud to introduce 
this bill, which would help to expand the number of dentists and dental 
hygienists, both nationwide and in rural and underserved areas.
  Specifically, the Dental Heath Provider Shortage Act would work to 
increase the overall number of dentists and dental hygienists by 
providing faculty loan repayment programs for dentists who agree to 
teach, especially in general and pediatric training programs. It would 
also provide incentives for dentists and dental hygienists to work in 
rural and underserved areas by expanding both the National Health 
Service Corps and the Indian Health Service; providing support to 
Community Health Centers, which play a critical role in the delivery of 
dental care; and helping these centers and other providers that work in 
underserved areas to expand their practices. Finally, to encourage 
participation in State Medicaid programs, the bill would provide 
funding for states to simplify the Medicaid enrollment and payment 
process.
  In this day and age, people should not be forced to travel great 
distances--let alone more than 100 miles--just to see a dentist. We can 
and must do better. The Surgeon General's report, ``Oral Health in 
America,'' reinforced that oral health is essential to the general 
health and well-being of all Americans. In its ``Call to Action,'' the 
report challenged the Nation to build a health infrastructure that can 
effectively meet the oral health needs of all Americans. By passing the 
bipartisan Dental Health Provider Shortage Act, we can begin to do just 
that.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2740

       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

[[Page S8722]]

     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);

[[Page S8723]]

       (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.''.
                                 ______